Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

A syncing feeling: reductions in physiological arousal in response to observed social synchrony

Synchronized movements are often key elements in activities where social bonding and emotional connection are a shared goal, such as religious gatherings, sporting events, parties and weddings. Previous studies have shown that synchronous movements enhance prosocial attitudes and affiliative behaviors. Similarly, observers attribute more social closeness to people moving synchronously together than people moving asynchronously. The mechanisms by which synchrony modulates these attributions are not well understood. In the present study, we ask whether viewing synchronous activities influences physiological arousal as measured by skin conductance and whether group size impacts this effect. Undergraduates viewed a series of short videos depicting people moving either (1) in or out of synchrony with each other and (2) in a large or small group. Participants’ skin conductance was measured. Change in skin conductance levels and response counts were attenuated while watching synchronous movement, but only in the large-group condition. Post-hoc analyses suggest that viewer enjoyment/interest in the large-group synchronous videos mediated this association for phasic skin conductance responses, but no evidence of mediation was found for tonic skin conductance levels. Results extend previous research on affiliative effects of first-person interpersonal synchrony and demonstrate that watching others moving synchronously has an attenuating effect on observers’ physiological state.

Blocking mu-opioid receptors inhibits social bonding in rituals

Religious rituals are universal human practices that play a seminal role in community bonding. In two experiments, we tested the role of mu-opioids as the active factor fostering social bonding. We used a mu-opioid blocker (naltrexone) in two double-blind studies of rituals from different religious traditions. We found the same effect across both studies, with naltrexone leading to significantly lower social bonding compared with placebo. These studies suggest that mu-opioids play a significant role in experiences of social bonding within ritual contexts.

Group structure and entitativity in group fitness: considering groupness at within- and between-group levels

OBJECTIVE

How can we distinguish between a collection of individuals exercising alongside one another from group that is exercising 'together'? This question is central to research on the extent that individuals perceive their fitness settings to entail core features of groups. To advance understanding of the nature of groupness and its implications in exercise, the current study (a) evaluated a brief measure of groupness and (b) examined the extent that groupness predicted perceptions of exertion and affect.

DESIGN

Participants included 633 exercisers (M_age = 33.92, SD = 11.05, 74% female) who completed surveys after group fitness classes (k = 34).

MAIN OUTCOME MEASURES

Groupness, affect, exertion, and group cohesion.

RESULTS

Exploratory structural equation modelling provided support for a two-factor solution reflecting entitativity and group structure as subdimensions of groupness. The groupness factors were differentially associated with theoretically relevant aspects of classes (e.g. synchronised movement), the individual (e.g. number of members interacted with), as well as group cohesion. Groupness also predicted perceived exertion and affect.

CONCLUSION

Our research provides support for a brief measure of groupness, advances theory related to how individuals perceive exercise groups, and provides evidence regarding how broader experiences during exercise may relate to exercisers' perceptions of groupness.