BUFFALO, N.Y. — Pain is usually a personal matter, but researchers from the University of Buffalo suggest that there may be a geographical component to all those nagging aches and pains as well — at least when it comes to arthritis joint pain. Study authors found the prevalence of moderate or severe joint pain due to arthritis varies widely across states. For example, while just 6.9 percent of the population in Minnesota deals with such pain, a whopping 23.1 percent of West Virginia residents deal with the same issues.
All in all, this research provides valuable new insights regarding the connection between geography and pain, established using a novel combination of individual and macro-level measures.
“The risk of joint pain is over three times higher in some states compared to others, with states in the South, especially the lower Mississippi Valley and southern Appalachia, having particularly high prevalence of joint pain,” says Rui Huang, a sociology PhD student in the UB College of Arts and Sciences and the paper’s first author, in a university release. “We also observed educational disparities in joint pain in all states that vary substantially in magnitude, even after adjusting for demographic characteristics.”
Notably, the percentage point difference in pain prevalence between those who did not finish high school compared to others who obtained at least a bachelor’s degree in college was much larger in states like West Virginia (31.1), Arkansas (29.7), and Alabama (28.3) than in California (8.8), Nevada (9.8), and Utah (10.1).
“Education can function as a ‘personal firewall’ that protects more highly educated people from undesirable state-level contexts, while increasing the vulnerability of less educated individuals,” Huang notes.
Close to 59 million Americans live with arthritis, and at least 15 million deal with severe joint pain because of their condition. Severe joint pain, meanwhile, has a link to diminished range of motion, disability, and mortality.
Researchers explain that while the majority of existing research concerning the social determinants of pain relies on individual-level data, individuals themselves are embedded in social contexts, such as specific U.S. states. Different states often have dramatically different policies that can potentially affect numerous aspects of a person’s life. Just a few examples include opportunities, resources, and social relationships. These factors can in turn influence a person’s pain.
“Very little research has examined the geography of chronic pain, and virtually none has examined the role of state-level policies in shaping pain prevalence,” adds Hanna Grol-Prokopczyk, PhD, UB associate professor of sociology, and a co-author of the study. “We were excited to identify state characteristics that reduce residents’ risk of pain.”
This latest project encompassed data on close to 408,000 adults (ages 25-80) provided by the 2017 Behavioral Risk Factor Surveillance System featuring state-level data pertaining to SNAP programs (formerly known as food stamps), Earned Income Tax Credits, income inequality, social cohesion (relationship strength among community members), Medicaid Generosity Scores, and taxation of tobacco.
While SNAP programs exist in all 50 states, some states offer qualifying residents more expansive benefits than others. Generally, states with more generous SNAP benefits displayed a lower pain prevalence. The same held true regarding states with greater social cohesion. This suggests, according to the study, that both material resources and social functioning play critical roles in determining pain risk.
“The increase in the generosity of SNAP benefits could potentially alleviate pain by promoting healthier eating habits and alleviating the life stress associated with food insecurity,” Huang comments. “Social factors such as conflict, isolation and devaluation are also among the ‘social threats’ that can lead to physical reactions such as inflammation and immune system changes.”
Besides just providing valuable new information on pain disparities across states, this study may also spark a reorientation of pain research efforts in general, with scientists putting more of an emphasis on macro- and individual-level factors.
“Chronic pain can – and should – be addressed through macro-level policies, as well as through individual-level interventions,” Huang concludes. “This study also implies that pain research in general should move towards a greater understanding of the macro contextual factors that shape pain and pain inequalities.”
The study is published in the journal Pain.
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