The Association of Loneliness and Chronic Pain Among African-American, Latino and White Older Adults

Background:

 Loneliness and chronic pain are significant public health problems in later life. Studies have found that loneliness is  associated with poor physical health, poor mental well-being and morbidity. Pain also contributes to decreases in functioning and quality of life and comes at a significant costs to healthcare systems.  Yet, limited research has examined the relationship of loneliness and chronic pain among racially diverse older adults.  Guided by the Biopsychosocial Model of Pain, we posit that cultural factors may significantly impact the experiences of loneliness and chronic pain. We examined the main and interactive effects of race and loneliness on clinically significant chronic pain among African-American, Latino and White community dwelling older adults in the US.

Methods:

We used data from Waves 2 (2010) and 3 (2015) of the National Social Life, Health, and Aging Project (NSHAP) to investigate the relationship between loneliness and chronic pain among 1,113 African-American, Latino and White adults aged 50 and over. We conceptualized clinically significant pain chronic pain as self-reported pain with at least moderate intensity in the same body location during the previous month at both waves.We used logistic regression to explore the main and interactive effects of race and loneliness on chronic pain. Our final model, considers relevant demographic controls, physical and mental health, functioning, medication, health behaviors and social factors.

Results:

At wave 2, the mean age of the sample was 72 years (SD= 8), 57% were female, 19% were widowed, and 20% had less than a high school education. Loneliness, but not pain, differed by race in bivariate analyses.  More African-Americans (36%) than Latinos (19%) and Whites (19%) report loneliness. Approximately 20% of the sample met  criteria for chronic pain. Adjusted analyses revealed no significant main or interactive effects of race or loneliness on pain between Latinos and Whites. However, African-Americans were more than 2.5 times (OR: 2.68, CI: 1.225, 5.878) more likely to experience chronic pain than whites. The interaction of African-American and loneliness was associated with decreased odds of chronic pain (OR: .805, CI: .648, .998).

Conclusions and Implications:

The National Pain Strategy (2016) calls for elucidation of the experiences of chronic pain among diverse elders in the US. Previous studies have suggested that Latinos experience higher rates of pain, but our analyses did not replicate this finding. Future work should examine these conflicting findings and should aim to obtain a clearer understanding of the potential role of cultural perceptions of pain in later life. Further research is also needed to better understand older African Americans’ experiences of loneliness and chronic pain and how cultural dynamics may help explain our counterintuitive findings (e.g., “Superwoman Schema”). Finally, given high rates of loneliness and chronic pain across diverse populations of older adults, social workers and other health professionals should engage in the development and implementation of interventions that prevent and address these experiences.