“Ooh, You Got to Holler Sometime” Pain Meaning and Experiences of Black Older Adults

Abstract

Throughout the history of the United States, the Black pain experience has been widely ignored and diminished, by media, medicine, and science. Convergent evidence demonstrates that Black adults shoulder a disproportionate burden of chronic pain and related disability. A structural racism lens shows how conditions such as residential segregation, economic deprivation, experiences of discrimination, and inferior access to high-quality medical care contribute to persistent pain in Black adults, worsen its impact, and impede its effective management. In addition to the negative physical consequences of daily pain, the emotional, social, and spiritual distress caused by unmet pain needs can significantly diminish quality of life. These factors collectively contribute to complex pain meanings that center around dependence and defeat and are countered through social engagement, spiritual coping, and meaningful activity. Consequently, despite reporting moderate to severe daily pain and an increased frequency of catastrophizing—that is, negative emotional responses to pain and perceived exaggeration—Black older adults often report high levels of adaptive coping as evidenced by continued engagement in activities. The following chapter examines the meaning of pain for Black older adults both within and outside of the medical establishment, and in the context of implicit racial bias. The authors examine challenges of effective assessment and treatment, and identify strategies Black older adults engage in to effectively cope with pain and prevent what many fear—becoming dependent on others. Finally, we highlight the need for culturally responsive pain management interventions to effectively address the complex meanings ascribed to pain by Black older adults, including the need for accessible care that is developed in close collaboration with community members to build on existing strengths and resources.