Abstract
Persistent stressors associated with sociodemographic disadvantage exert a physiologic
toll, labeled “allostatic load,” that contributes to disparities in some health conditions.
We investigated the contribution of allostatic load to pain prevalence in U.S. adults.
Interviews with 14,184 adults in the 1999–2004 National Health and Nutrition Examination
Survey asked about severe headache, pain that lasted >24 hours, and widespread pain.
Ten biomarkers of allostatic load were quantified from blood (glycated hemoglobin),
serum (C-reactive protein, homocysteine, cholesterol, triglycerides), urine (creatinine,
albumin), and physical measurements (body mass index, systolic and diastolic blood
pressure). Log-binomial regression models estimated prevalence ratios (PRs) and 95%
confidence intervals (95% CIs). Prevalence ranged from 3.4% for widespread pain to
26.9% for pain >24 hours. After adjustment for demographic characteristics, low income
was associated with greater prevalence of pain >24 hours (PR = 1.65, 95% CI = 1.49,
1.83), severe headache (PR = 2.05, 95% CI = 1.68, 2.50), and widespread pain (PR =
3.67, 95% CI = 2.56, 5.27). Racial/ethnic minorities had lower prevalence of all 3
pain conditions than non-Hispanic whites. While greater allostatic load was associated
with elevated prevalence of pain, allostatic load did not meaningfully attenuate PRs
associated with income or race/ethnicity. We conclude that greater pain prevalence
among low-income groups is not explained by greater allostatic load.
Perspective
In U.S. adults, pain occurs more frequently in lower-income groups, although the relationship
is not attributable to their experience of greater allostatic load. While allostatic
load contributes to population variation in pain, other etiologic mechanisms contributing
to pain are needed to account for income disparities in pain.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cytokine patterns in fibromyalgia and their correlation with clinical manifestations.Clin Exp Rheumatol. 2007; 25: 225-230
- On the variances of asymptotically normal estimators from complex surveys.Int Stat Rev. 1983; 51: 279-292
- Racial/ethnic disparities in all-cause mortality in U.S. adults: The effect of allostatic load.Public Health Rep. 2010; 125: 810-816
- Centers for Disease Control and Prevention (CDC): Any tobacco use in 13 states–behavioral risk factor surveillance system, 2008.MMWR Morb Mortal Wkly Rep. 2010; 59: 946-950
Centers for Disease Control and Prevention (CDC): National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey Data. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed August 11, 2011
Centers for Disease Control and Prevention (CDC): National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey Examination Protocol. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed August 11, 2011
Centers for Disease Control and Prevention (CDC): National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey Laboratory Protocol. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed August 11, 2011
Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey Questionnaire. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed August 11, 2011
- Socioeconomic status is associated with stress hormones.Psychosom Med. 2006; 68: 414-420
- Age differences in allostatic load: An index of physiological dysregulation.Exp Gerontol. 2003; 38: 731-734
- Basal circadian and pulsatile ACTH and cortisol secretion in patients with fibromyalgia and/or chronic fatigue syndrome.Brain Behav Immun. 2004; 18: 314-325
- The prevalence of chronic widespread pain in the general population.J Rheumatol. 1993; 20: 710-713
- Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome.Ann N Y Acad Sci. 1998; 840: 684-697
- Idiopathic pain disorders–pathways of vulnerability.Pain. 2006; 123: 226-230
- Race, ethnicity and pain.Pain. 2001; 94: 133-137
- Prevalence of neck and low back pain in community-dwelling adults in Spain: A population-based national study. Spine.(Phila Pa 1976). 2011; 36: E213-E219
- “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States.Am J Public Health. 2006; 96: 826-833
- Allostatic load is associated with symptoms in chronic fatigue syndrome patients.Pharmacogenomics. 2006; 7: 485-494
- Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies.Am J Epidemiol. 2004; 160: 301-315
- Prevalence of chronic pain in a representative sample in the United States.Pain Med. 2008; 9: 803-812
- Elevated insular glutamate in fibromyalgia is associated with experimental pain.Arthritis Rheum. 2009; 60: 3146-3152
- Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS).Psychophysiology. 2011; 48: 1134-1145
Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(Suppl 1):9-160, 2004
- The prevalence and associated features of chronic widespread pain in the community using the ‘Manchester’ definition of chronic widespread pain.Rheumatology (Oxford). 1999; 38: 275-279
- IOM (Institute of Medicine): Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press, Washington, DC2011
- Temporomandibular joint and muscle disorder-type pain in U.S. adults: The National Health Interview Survey.J Orofac Pain. 2008; 22: 317-322
- The prevalence of chronic pain in United States adults: Results of an Internet-based survey.J Pain. 2010; 11: 1230-1239
- The biological response to stress and chronic pain.in: Croft P. Blyth F.M. Windt d v D. Chronic Pain Epidemiology: From Aetiology to Public Health. Oxford University Press, New York, NY2010: 101-118
- C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: An individual participant meta-analysis.Lancet. 2010; 375: 132-140
- Socioeconomic status, hostility, and risk factor clustering in the Normative Aging Study: Any help from the concept of allostatic load?.Ann Behav Med. 1999; 21: 330-338
- Sampling: Design and Analysis.Duxbury Press, Pacific Grove, CA1999
- Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study.Soc Sci Med. 2010; 70: 1988-1996
- Physiology and neurobiology of stress and adaptation: Central role of the brain.Physiol Rev. 2007; 87: 873-904
- The role of corticosteroids and stress in chronic pain conditions.Metabolism. 2010; 59: S9-S15
- Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load.Ann N Y Acad Sci. 1999; 896: 30-47
- Association of smoking and chronic pain syndromes in kentucky women.J Pain. 2011; 12: 892-899
- Variance estimation in complex survey sampling for generalized linear models.J R Stat Soc Ser C Appl Stat. 2008; 57: 75-87
- Number of pain sites–a simple measure of population risk?.in: Croft P. Blyth F.M. Windt D v d D. Chronic Pain Epidemiology: From Aetiology to Public Health. Oxford University Press, New York, NY2010: 71-79
- Racial/Ethnic and gender prevalences in reported common pains in a national sample.J Orofac Pain. 2011; 25: 25-31
- Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects.J Pain. 2004; 5: 317-328
- The analysis of categorical-data from complex sample-surveys - chi-squared tests for goodness of fit and independence in 2-way tables.J Am Stat Assoc. 1981; 76: 221-230
- Factors associated with chronic noncancer pain in the Canadian population.Pain Res Manag. 2009; 14: 454-460
- Effects of allostatic load on the social gradient in ischaemic heart disease and periodontal disease: Evidence from the Third National Health and Nutrition Examination Survey.J Epidemiol Community Health. 2008; 62: 415-420
- Excess risk of temporomandibular disorder associated with cigarette smoking in young adults.J Pain. 2012; 13: 21-31
- Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging.Soc Sci Med. 2004; 58: 1985-1997
- Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging.Proc Natl Acad Sci U S A. 2001; 98: 4770-4775
- Gender differences in age-related changes in HPA axis reactivity.Psychoneuroendocrinology. 2001; 26: 225-240
- Price of adaptation–allostatic load and its health consequences. MacArthur studies of successful aging.Arch Intern Med. 1997; 157: 2259-2268
- The association between smoking and low back pain: A meta-analysis.Am J Med. 2010; 123: 87.e7-87.e35
- Hierarchies of life histories and associated health risks.Ann N Y Acad Sci. 1999; 896: 96-115
- Easy SAS calculations for risk or prevalence ratios and differences.Am J Epidemiol. 2005; 162: 199-200
- Stress responsivity and socioeconomic status: A mechanism for increased cardiovascular disease risk?.Eur Heart J. 2002; 23: 1757-1763
- The role of psychobiological pathways in socio-economic inequalities in cardiovascular disease risk.Eur Heart J. 2002; 23: 13-25
- Allostasis: A New paradigm to explain arousal pathology.in: Fisher S. Reason J. Handbook of Life Stress, Cognition and Health. John Wiley & Sons Ltd, New York, NY1988: 629-649
- Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors.JAMA. 1992; 267: 64-69
- The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome.Stress. 2007; 10: 13-25
- The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis care Res (Hoboken). 2010; 62: 600-610
- Pain prevalence in Singapore.Ann Acad Med Singapore. 2009; 38: 937-942
- High plasma levels of MCP-1 and eotaxin provide evidence for an immunological basis of fibromyalgia.Exp Biol Med (Maywood). 2008; 233: 1171-1180
Article info
Publication history
Published online: June 07, 2012
Accepted:
April 3,
2012
Received in revised form:
March 21,
2012
Received:
September 29,
2011
Footnotes
Supported by NIH/National Institute of Neurological Disorders and Stroke (2 P01 NS045685).
The authors declare no financial or other relationships that might lead to a conflict of interest in their conduct of this research.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
