Why is low educational attainment linked to worse pain and function in fibromyalgia?

Abstract

Lower educational attainment has been linked to worse pain in individuals with chronic pain, but the mechanisms of this relationship are not fully elucidated. This observational study analyzed the relationship between educational attainment and pain in patients with fibromyalgia (FM) and the potential psychological mechanisms driving this relationship. We hypothesized that (1) lower educational attainment would be associated with greater pain intensity and interference, and that (2) concerns about pain (CAP), anxiety, and depression would mediate the relationship between educational attainment and pain. A total of 119 adults (93.3% female, 79.7% White, Mage=50.4) with FM completed questionnaires including demographics, Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scales (HADS). Pearson correlations and bootstrapped mediation analyses were conducted to examine the relationships among education, psychological variables, and pain variables. Education was inversely correlated with pain intensity and interference, CAP, anxiety, and depression (p<.05). CAP significantly mediated the relationship between education and pain intensity (95% CI [0.151, 0.026]), while both CAP and depression mediated the effects of education on pain interference (95% CI [0.195, −0.025]; 95% CI [−0.163, −0.004]). However, anxiety did not mediate either relationship. These findings suggest that greater CAP, and in part depression, may be possible mechanisms in the relationships between lower educational attainment and worse pain intensity and interference. This work has important implications in reducing pain disparities and provides direction for psychological treatment, suggesting that both depression and CAP may be critical targets especially for people with lower education attainment.

Perspectives

This study examined the relationship between educational attainment, psychological variables, and pain. Results have implications for psychological intervention aimed at concerns about pain and depression, especially among individuals with low educational attainment.