I’ve recently discovered a researcher I’d not heard of before but thanks to Michael Ray, a colleague in the US, I’ve come across Hanna Grol-Prokopczyk from University at Buffalo, New York. Hanna is a medical sociologist who has been researching the NIH-funded “Demography of Chronic Pain: A Population Approach to Pain Trends, Pain Disparities, and Pain-Related Disability and Death” (R01 AG065351; 2020-2025), and co-authored the study that sparked this blog (see below).
When people discuss ‘the social’ in a biopsychosocial model of health, I’m never quite sure what ‘the social’ actually refers to: sometimes it’s about interactions with family and friends, other times it refers to gender and sex, but it can include age, ethnicity, socio-economic status and geographical location. It can also refer to legislation, socio-political systems, healthcare models and frameworks, funding models and even the physical features of where people live.
Over the past 50 years research into health disparities has expanded, with the main conclusion being that modifiable social factors drive unequal outcomes (eg Khalatbari-Soltani, & Blyth, 2022). As Grol-Prokopczyk points out in a major scoping review of reviews – if pain is seen as a major public health problem with high societal costs these social inequities in pain ‘represent avoidable suffering at large scale’ (Grol-Prokopczyk et al., in press).
From this study, it seems much of the research looks at sex/gender, ethnicity and age, while socioeconomic status and geographical location were less commonly studied. Biological, psychological and sociocultural mechanisms were more frequently considered than sociostructural or macro-level ones. Recommendations arising from such studies targeted individual-level behaviour change for either clinicians or patients.
Does this surprise anyone?
This kind of research is really difficult to do, especially with increasing ‘commercial sensitivity’ about releasing information, at least in New Zealand. Good data can be difficult to access because these studies tend to be large and population-level, meaning data consistency and integrity is variable. It’s not sexy research because there’s no quick fix or product that can be marketed at the end of it. And it’s much, much easier to suggest that individuals change their behaviour than to call for systemic change in public health policy or reducing poverty or eliminating racism, sexism and stigma.
In the Grol-Prokopczyk et al (in press) study, almost all the research looking at social disparities found increasing pain incidence in mid-life, women/girls to have more pain and more incidence and prevalence of pain problems, ethnic minorities receiving worse treatment and people with lower socioeconomic having higher pain prevalence and worse pain-related outcomes.
Recommendations suggested things currently unpopular with the New Zealand government: vary treatment based on group membership (that’s right, Māori might need different treatments, and different treatment delivery), address sociocultural factors in treatment, collect additional research/data, increase representation in trials, workforce and policy development (yes, more diversity) and make policy changes such as reducing poverty and enhancing access to healthcare.
Most of the recommendations were to clinicians to improve their assessment, treatment and communication with people with pain, while ‘lifestyle’ recommendations were given to people. This, regardless of how people are expected to do these things given socioeconomic disparities, stigma and even practical things like limited safety, access to healthy food, places to exercise or relax in the neighbourhood.
What does this mean?
I promised to include more about how clinicians and people with pain can do the things I discuss in this blog. Today is no exception. Three things: vote thoughtfully, consider practicalities, and be authentic.
My first take-home action from this study is this: I can vote. You can vote. What we vote for influences what gets done – these are the macrolevel or sociostructural influences on health and pain. A focus on ‘individual responsibility’ without taking into account the contextual, structural and social influences on what an individual can do (or is willing to do, encouraged to do, can afford to do) fails to recognise the direct impact of these factors on the choices available. Targeting ‘individual responsibility’ also fails to recognise the biases held by those creating policies based on this individualistic view of people. After all, if you’ve never had to consider your personal safety while exercising, you will likely blame the individual for ‘not taking responsibility’ for their health when they feel unsafe exercising in the local neighbourhood – especially if you never think to ask.
Note: I’m not suggesting that we can’t make choices. I am saying that the range of choices available to us varies enormously depending on these social factors.
Another take-home for clinicians: there are some things you can consider when suggesting pain self-management approaches. You can think about the sex and gender of the person in front of you, and their lived experiences. The responsibilities they have outside of their health. The values they hold. The reaction from other people around them if they have to, say, prioritise doing that exercise programme over caring for the family. Their location – is it safe for them to exercise? Will exercise cost them time and money? If you’re suggesting that they pace activities, what impact might changing how they go about their life have on them and the people around them? Can pacing be done at work, at home, when caring for kids, when they commute 90 minutes each way to and from work? Is prioritising their health top of the list, or are there other things they value more?
And finally, for today, I’m suggesting more self-disclosure. Yes, you read that right. Done in the service of the person we see in front of us. Disclosing our own life contexts, our own health challenges, our own limitations and vulnerabilities helps to create greater awareness that ‘we’re all in this soup together.’ This reduces stigma. It reduces the ‘othering’ that can divide clinicians and people with pain (see Walton & Lazaro-Salazar, 2016; Akbulut & Razum, 2022; Macgregor et al., 2023). It normalises what is such a common experience (1 in 5 New Zealanders with pain lasting for more than 3 months). It can invite curiosity – in what ways are we similar? different? It’s inherent in the Māori tikanga of whakawhanaungatanga, or building relationships through sharing the ways we connect. Self-disclosure is subversive, sidestepping the boundaries we’ve put on being fully present and gives us the freedom to to put ourselves in the shoes of the person we’re communicating with. We can’t do this without sharing who we are. I can’t think of a greater way to show respect than to be willing to be vulnerable.
Akbulut, N., & Razum, O. (2022). Why Othering should be considered in research on health inequalities: Theoretical perspectives and research needs. SSM Popul Health, 20, 101286. https://doi.org/10.1016/j.ssmph.2022.101286
Grol-Prokopczyk, H., Huang, R., Yu, C., Chen, Y. A., Kaur, S., Limani, M., Lin, T. H., Zajacova, A., Zimmer, Z., Cowan, P., Fillingim, R. B., Gewandter, J. S., Gilron, I., Hirsh, A. T., Macfarlane, G. J., Meghani, S. H., Patel, K. V., Poleshuck, E. L., Strain, E. C.,…Turk, D. C. (2025). Over 50 years of research on social disparities in pain and pain treatment: a scoping review of reviews. Pain. https://doi.org/10.1097/j.pain.0000000000003676
Khalatbari-Soltani S, Blyth FM. (2022). Socioeconomic position and pain: a topical review. Pain, 163, p1855–61.
Macgregor, C., Walumbe, J., Tulle, E., History, C., & Blane, Dn (2023). Intersationality as a theoretical framework for researching health inequities in chronic pain. British Journal of Pain, 17(5), 479-4 https://doi.org/10.1177/204949494637231188583
Tubeuf, S., Valdivia, A., Tavoschi, L., Empana, J. P., & Engebretsen, E. (2025). The responsibility of health: shifting the focus from individuals to systems. Lancet Public Health, 10(3), e170. https://doi.org/10.1016/S2468-2667(25)00013-1
Walton, J. A., & Lazzaro-Salazar, M. (2016). Othering the Chronically Ill: A Discourse Analysis of New Zealand Health Policy Documents. Health Communication, 31(4), 460-467. https://doi.org/10.1080/10410236.2014.966289