Abstract
Despite mounting evidence of a robust relation between discrimination and poor pain outcomes in people of color (POC) with chronic pain, little is known about everyday discrimination's role in increasing the risk of opioid misuse and its potential interactive effects. This study aimed to evaluate the potential moderating effect of everyday discrimination on the relationship between chronic pain severity and the risk of opioid misuse among POC with chronic pain. Everyday discrimination was assessed using the 9-item Everyday Discrimination Scale (EDS), while the risk of opioid misuse was measured with the 14-item Screener and Opioid Assessment for Patients with Pain (SOAPP). Using a racially diverse sample of 348 individuals with chronic pain, ranging in age from 20 to 75 years old (M = 28.56), this study investigated these relationships through path analysis conducted in Mplus, controlling for age, sex, and social class. The results showed that high levels of everyday discrimination placed POC patients at a higher risk of opioid misuse when they experienced more severe pain. When chronic physical pain was accompanied by chronic social pain stemming from discrimination, POC patients reported a significantly higher risk of opioid misuse. Discrimination may intensify pain severity, potentially necessitating a higher dose and/or longer-term opioid treatment and, thus, increasing the risk of opioid misuse among POC. The integration of routine assessments of patients' experiences of discrimination could strengthen the ecological validity of pain assessment and treatment. Where feasible, clinicians might consider exploring the experiences of discrimination among POC patients as part of a holistic approach to pain management, and when indicated, facilitate referrals to psychosocial services to address both social and physical aspects of pain.