Racial Health Disparities in Pain Levels Exist in Elite Athletes

Even among patients with endless resources at their fingertips, racial health disparities loom large. In a study of professional football players, researchers found that Black players report worse and more intense pain than their White counterparts, potentially the aftereffects of discrimination.

The study, completed by researchers at Mass General Brigham and Harvard Medical School and published in the journal Pain, looked at nearly 4,000 former professional football players who identified as either Black or White. As part of Harvard’s Football Players Health Study, the researchers surveyed former NFL players about their pain levels, how that pain interferes with their daily life, and different demographic and health history factors.

Overall, the researchers found that Black players were more likely to report intense pain and that pain gets in the way of their daily lives compared to White players. This was true even after controlling for certain factors like age, football history, comorbidities, and psychosocial factors.

There were also different compounding factors depending upon respondent race. For Black players, reports of fatigue and psychosocial factors were more strongly linked to pain compared to their White teammates. Meanwhile, White respondents displayed a stronger link between higher body mass index than their Black teammates did.

These findings come as healthcare researchers observed racial health disparities across numerous disease states. There are differences in outcomes based on race when looking at COVID-19 patients, overdose deaths, and even overall hospital and patient safety events.

Some researchers have indicated that health inequity and unequal access to quality healthcare could be driving some of those disparities.

“We've known for quite a while that there are large racial and ethnic differences in pain outcomes around the world, just like there are for most other medical outcomes,” Robert R. Edwards, PhD, the study’s corresponding author and a clinical psychologist in the Pain Management Center at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, stated publicly. “It's only recently we've been studying some of the contributors to these sorts of effects in the U.S.”

This latest study of the NFL players adds another layer. Although the researchers stressed that there were too many conflicting variables to draw informed conclusions about the disparities in pain between Black and White NFL players, it is hard to ignore the differences when NFL players tend to have many resources for their health and well-being.

“Collectively, in this sample, the potential social and economic advantages of working as a professional athlete (which are not universal and which do not necessarily accrue equally to White and Black former players) did not seem to erase race-related disparities in pain,” the researchers wrote in the study’s discussion section.

Part of this could be the lifetime of racial inequity faced by Black players, the researchers said, potentially indicating the weathering hypothesis.

“Indeed, in the present sample, pain was more strongly associated with other disabling symptoms such as depression, anxiety, and fatigue among Black players, which may be partially driven by such long-standing disparities,” the team added.

Moreover, discrimination is a pressing issue in healthcare, the researchers noted.

“There are many factors that likely drive the racial disparities in chronic pain that we found in elite athletes, such as discrimination in medical settings, early life socioeconomic disadvantages, and more,” Rachel Grashow, PhD, study senior author and director of epidemiological research initiatives for the Football Players Health Study at Harvard University and a research scientist at the Harvard T. H. Chan School of Public Health, said in a statement.

The researchers also suggested that social differences, such as how patients perceive, report, and treat pain, could be driving the differences in results.

Future study should look at the causes behind some of the racial health disparities in pain.

“This study is a microcosm of the racial and ethnic disparities in pain that we’ve observed over the years, and reminds us that elite athletic status is not sufficient to eliminate these differences,” Ross Zafonte, DO, principle investigator of the Football Players Health Study, said in a press release.

“By exploring other factors that are closely associated with differences in pain outcomes, we can help identify therapeutic interventions to improve disparities and facilitate a personalized pain medicine approach that maximizes treatment benefits for populations most acutely impacted by pain,” added Zafonte, who is also president of Spaulding Rehabilitation Network and the Earle P. and Ida S. Charlton Professor and Chair of the Harvard Medical School Department of Physical Medicine and Rehabilitation.