• Posted June 19, 2023

Study of Former NFL Players Shows Race Differences in Chronic Pain

A pro football career can mean chronic pain after retirement, but Black players are especially hard-hit, a new study finds.

The study, of nearly 4,000 former National Football League (NFL) players, found that Black men reported more intense, more debilitating pain than their white counterparts. They were also more likely to suffer from depression, anxiety or fatigue -- and those problems were often related to their pain levels.

Researchers said the findings speak to a larger, well-documented issue: Black Americans are more affected by chronic pain, and less likely to have it effectively treated, than white people.

And it appears those disparities are not erased by the status and resources that can come with being a professional athlete.

"I do think it's striking that this disparity is still seen in a group of people that has relatively more advantage than the average American," said lead researcher Robert Edwards, a clinical psychologist at Brigham and Women's Hospital's Pain Management Center in Boston.

It all suggests that racial disparities in chronic pain are not explained by health insurance and access to health care alone.

"It's more complicated than that," Edwards said. "We have known about some of the risk factors for adverse pain-related outcomes, and they include low social support, depression and anxiety."

Those risk factors, he added, are both more common among Black Americans, and -- based on the new findings -- have a greater impact on their experience of chronic pain, compared with white people.

For the study -- published recently in the journal Pain -- Edwards and his colleagues at Mass General Brigham pulled data from an ongoing health survey of former NFL players. It included 3,995 retirees who identified as either Black or white.

When asked about any pain they'd suffered in the past week, Black respondents typically reported more intense pain (on average, about 5 on a scale of 1 to 10). They also reported more problems with daily functioning because of it.

That was despite the fact that Black players were younger -- 48 years old, on average, versus 54 among white players. And even when the researchers accounted for various other factors, like playing position, concussion history and other health conditions, Black players were still at greater risk of more-intense pain than their white counterparts.

What did stand out where certain "psychosocial" factors.

Black players were more likely to report depression and anxiety: 28% said they'd suffered symptoms of one or both in the past two weeks, compared to 19% of white players. They also reported worse fatigue and were less likely to be satisfied with their social relationships.

All of those factors, in turn, were more strongly linked to physical pain among Black players than they were among white players.

The findings paint a complex picture, and it's hard to say exactly what's going on, according to Edwards.

Take depression, for one: Chronic pain can lead to depression, and depression can also contribute to physical pain. It's not clear why the two were more strongly linked among Black players. Was their depression more severe, for example, or were they less likely to be receiving treatment for it?

Antoinette Schoenthaler is a professor at NYU Grossman School of Medicine who studies racial disparities in health. She was not involved with the study.

Schoenthaler said there is plenty of evidence that Black Americans generally do not receive the same level of care for pain that white people do. One reason, she said, is the longstanding myth, still present today, that Black people have "thick skin" and can tolerate more pain.

Some providers, Schoenthaler added, also think that Black patients are more likely to abuse pain medications.

On top of that, treatment disparities go beyond pain, with Black people being less likely to receive help for depression and other mental health conditions, Schoenthaler said.

The experience of chronic pain is complex, both researchers said, and has to be seen within the wider context of people's lives -- including, for Black Americans, lifetime experiences of racism.

"Repeated exposure to stress over time increases allostatic load," Schoenthaler said, referring to the cumulative burden of stress that exacts a physical toll on the body.

Elite athletes, she said, are not immune to that.

Edwards said that while access to high-quality health care is only part of the story, it's an important one. There are many effective treatments for depression and anxiety, he said -- including medications and non-drug options like cognitive behavioral therapy ("talk therapy") and approaches based on meditation and yoga.

"We absolutely have to make these treatments more accessible," Edwards said.

That, he added, might help many people better manage chronic pain, but could have a particularly strong benefit for Black patients.

More information

The U.S. Pain Foundation has more on managing chronic pain.

SOURCES: Robert Edwards, PhD, clinical psychologist, Pain Management Center, Brigham and Women's Hospital, Boston; Antoinette Schoenthaler, EdD, professor, population health, medicine, NYU Grossman School of Medicine, New York City; Pain, June 9, 2023, online