Racism Exposure and Trauma Accumulation Perpetuate Pain Inequities-Advocating for Change (RESTORATIVE): A Conceptual Model

Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as two halves of the same coin, in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model.

Automated summary

Experiences of racism can have a significant impact on individuals, leading to psychological injury known as racism-based traumatic stress (RBTS). RBTS has similar symptoms to posttraumatic stress disorder (PTSD) but is characterized by constant threats. The relationship between RBTS and chronic pain, exacerbated by racism and health inequities, has not been explored. To address this, a conceptual model called RESTORATIVE is proposed, highlighting the interconnection between racism, trauma, and pain for racialized groups in the US.