Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives

Flavia Kapos, Kenneth Craig, Steven Anderson, Sonia Bernardes, Adam Hirsh, Kai Karos, Edmund Keogh, Elizabeth Losin, Joanna McParland, David Moore, Claire Ashton-James

Research output: Contribution to journalReview articlepeer-review

Abstract

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Original languageEnglish
Article number104608
JournalJournal of Pain
Early online date17 Jun 2024
DOIs
Publication statusE-pub ahead of print - 17 Jun 2024

Acknowledgements

The authors thank the International Association for the Study of Pain and the Social Aspects of Pain Special Interest Group (SocSIG) for serving as catalysts for interdisciplinary collaboration which enabled this project. The authors thank Kaylee Murphy, BA, and Aneri Shah, BA, for assistance preparing the manuscript reference library, and Drs. Anjum Hajat, Kushang Patel, Jeffrey Mogil, Jessica Jones-Smith, and Michael Von Korff for feedback on an earlier version of this work.

Keywords

  • Social structure
  • health equity
  • intersectional framework
  • life course perspective
  • social determinants of health

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine

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