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The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.




This work was supported by the Football Players Health Study at Harvard University, which is funded by the National Football League Players Association (NFLPA). In addition, support for RRE was provided by the National Institute of Neurological Disorders and Stroke under award K24NS126570. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Medical School, Harvard University, and its affiliated academic healthcare centers. The NFLPA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Ethical committee approvals: All research activities were approved by the ethical review committees at the Harvard T. H. Chan School of Public Health, the Beth Israel Deaconess Medical Center, and Harvard Medical School. Informed consent from all participants was obtained as required prior to participation.

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