Author ORCID Identifier
Matthew B. Jennings: 0009-0009-3798-6022
Benita Jackson: 0000-0001-6313-0812
Kristine M. Molina: 0000-0001-9127-993X
Mark A. Lumley: 0000-0001-7095-8378
Document Type
Article
Publication Date
4-2025
Publication Title
The Journal of Pain
Abstract
Black Americans report more intense and disabling pain than White Americans, but differences in pain behavior have rarely been studied. The Structured Pain Behavior Test (SPBT), a standardized, video-recorded series of pain-inducing movements, assesses the behavioral expression of pain. We conducted the first test of whether Black Americans with chronic low back pain (CLBP) have greater pain behavior and increased self-reported pain intensity during the SPBT, compared to White Americans. Adults (N = 267) with CLBP (174 Black, 93 White; 57% female) rated their clinical pain severity and interference (Multidimensional Pain Inventory; MPI) and their current pain intensity (Numerical Rating Scale; NRS) both before and after engaging in the SPBT, which was coded for observed pain behavior. Consistent with prior research, Black participants reported greater MPI clinical pain severity and interference (large effect). More importantly, during the SPBT, Black participants had greater pain behavior (medium effect) and reported a greater increase in pain intensity (NRS; small-medium effect) than did Whites. Racialized differences in all pain measures remained significant after controlling for multiple variables (including depressive symptoms and pain catastrophizing), and differences in observed pain behavior remained after also controlling for self-reported pain intensity (NRS) or MPI clinical pain severity. We conclude that greater self-reported pain severity and interference among Black Americans is accompanied by greater pain behavior and increased pain intensity in response to pain-inducing movements. Research should examine possible mechanisms of this racialized difference, including differential access and care, racism as pain exacerbator, and the social communication of pain.
Keywords
Racialized differences, Pain severity, Pain behavior, Observed pain, African American
Volume
29
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Rights
Licensed to Smith College and distributed CC-BY 4.0 under the Smith College Faculty Open Access Policy.
Version
Author's Accepted Manuscript
Recommended Citation
Jennings, Matthew B.; Burns, John W.; Jackson, Benita; Molina, Kristine M.; and Lumley, Mark A., "Self-rated pain and Observed Pain Behavior in Black and White Americans with Chronic Low Back Pain" (2025). Psychology: Faculty Publications, Smith College, Northampton, MA.
https://scholarworks.smith.edu/psy_facpubs/235