At a glance:
- Research shows that among former football players, Black athletes experienced more disruptive and more intense chronic pain.
- Researchers say both biologic and psychosocial factors may drive the chronic pain differences between Black and white former players.
- The findings underscore the complex nature of racial disparities in chronic pain, raise important questions about mechanisms that underlie these differences.
Former Black National Football League players experience disproportionate levels of chronic pain, compared with their white peers, according to a new study led by researchers from Harvard Medical School, Brigham and Women’s Hospital, Massachusetts General Hospital, and Spaulding Rehabilitation Hospital.
The analysis, done as part of the Football Players Health Study at Harvard University, showed that Black former players experienced more intense and higher levels of pain that interfered with daily activities than white former players.
The findings, published in the journal Pain, represent one of the largest studies on pain in racial and ethnic minority groups and align with similar findings of race-related disparities in chronic pain in general populations.
“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,” said senior author Robert Edwards, HMS associate professor of anaesthesia and a clinical psychologist in the Center for Pain Medicine at Brigham and Women’s. “It’s only recently we’ve been studying some of the contributors to these sorts of effects in the U.S.”
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Chronic pain is estimated to affect over 100 million American adults and is among the leading global causes of reduced quality of life. The annual cost of chronic pain approaches $1 trillion in the United States, but its burden is not distributed equally.
“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,” said senior author Rachel Grashow, director of epidemiological research initiatives for the Football Players Health Study and a research scientist at the Harvard T. H. Chan School of Public Health.
Edwards worked with colleagues from Brigham and Women’s, Mass General, Spaulding, and the Football Players Health Study to conduct the study. The team analyzed extensive data, which surveyed 3,995 former NFL players on their playing positions, demographics, exposure to injury during their football careers, pain outcomes, and various other health and psychosocial factors.
The analysis showed that Black players, though significantly younger than white players, reported greater pain intensity. Moreover, Black former athletes reported that their pain impacted their day-to-day life to a far greater degree.
The disparities were consistent across several statistical models that accounted for confounding factors such as age, body mass index, and other health conditions including hypertension, diabetes, and sleep apnea and football-related factors, such as the frequency of concussion symptoms. The researchers also found that Black players experienced more severe fatigue, were more likely to smoke, and exercised less. Psychosocial factors, such as depression, anxiety, and lack of social support were more strongly associated with pain among Black players than they were in white players.
The study findings underscore the complex nature of racial disparities in chronic pain and raise important questions about mechanisms that underlie these differences.
“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,” said Ross Zafonte, principal investigator of the Football Players Health Study and the HMS Earle P. and Ida S. Charlton Professor of Physical Medicine and Rehabilitation at Spaulding.
Untangling this complexity will be critical in correcting these disparities, the research team said.
“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,” Zafonte said.
Authorship, funding, disclosures
Study co-authors included Can Ozan Tan, Inana Dairi, Alicia J. Whittington, Julius Dewayne Thomas, Claudia M. Campbell, Edgar Ross, Herman A. Taylor, Marc Weisskopf, and Aaron L. Baggish.
This work was supported by the Football Players Health Study (FPHS) at Harvard University, which is funded by the National Football League Players Association (NFLPA). In addition, National Institutes of Health grant K24NS126570 provided support for Robert R. Edwards. This funding body had no direct role in study design, data analysis, or the writing of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Medical School, Harvard University, and its affiliated academic health care centers. The NFLPA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Zafonte reported receiving royalties from Springer/Demos publishing for serving as co-editor of the text Brain Injury Medicine; serving on the scientific advisory board of Myomo Inc., and onecare.ai Inc.; evaluating patients in the Massachusetts General Hospital Brain and Body-TRUST Program, which is funded by the NFLPA; and receiving grants from the NIH and NIDILRR.
Taylor reported receiving grants from the NFLPA outside the submitted work and grants from the NIH. Weisskopf reported receiving grants from the NFLPA and the NIH during the conduct of the study. Grashow, Whittington, and Speizer received grant funding from the NFLPA. Thomas is a member of the Society for Neurosports and serves on the FPHS Player Advisory Board.
