Vulnerable populations more likely to develop chronic pain

Pain-medicine providers need to acknowledge patients’ histories of trauma, UW Medicine specialists say.

If there was a superhero who relieved pain, millions would be overjoyed.

More than 100 million Americans suffer from chronic pain, costing in excess of $650 billion a year in medical treatments and lost productivity, according to a report from the Institute of Medicine.

Vulnerable populations are far more likely to develop chronic pain because of higher rates of historical trauma – personal, racial, ethnic, and indigenous – and poverty, according to David Tauben, clinical professor emeritus in anesthesiology and pain medicine at the University of Washington School of Medicine.

“Threatening life circumstances contribute to the severity and progress of pain,” Tauben said. “We need to recognize it and then we will be much better at treating it.”

Reaching vulnerable populations is now a mission of the Department of Anesthesiology and Pain Medicine. The department founded the Equity Diversity & Inclusion Council in September 2020 and appointed Dr. Nathalia Jimenez as the inaugural vice chair.

At an online pain medicine conference in November, Jimenez presented on the topic of pain identification and prevention in vulnerable populations. She cited literature in JAMA showing how Black children received less pain medication for appendicitis than white children. She also showed how poverty (defined as annual income of less than $12,784 for the year 2018) affects people of color at much higher rates: In Native Americans, the poverty rate was 25.4.%; for Blacks, 20.8%; for Hispanics, 17.6%; and for white and Asian groups, 10.1%, according to the U.S. Census.

With the U.S. population getting more diverse, the healthcare community must be mindful and respectful of the effects of race and ethnicity on a person’s well-being.

Dr. Kim Kardonsky, a family medicine specialist who sees patients at Harborview Medical Center, is from the Jamestown S’Klallam tribe. She worked at the Tulalip Health Clinic north of Seattle and urban Indian clinics in Minneapolis before coming to UW Medicine.

She explains is like this. She had a patient with fibromyalgia and depression who told her she wanted to get in her community’s canoe. Among Native Americans, health is the connection of the physical, mental, and spiritual worlds, and a canoe means all those things. Out in nature, paddling, she can be connected to land and water, and the exercise improves her physical and mental health.

Kardonsky said it’s important that providers be open to treatment modalities that celebrate culture.

“The key is being seen and heard as a Native person,” she said. “Historically, erasure has been a theme.”

Evidence has shown how social pain and chronic pain activates the same parts of the brain, helping pain experts understand more about the role of trauma in pain relief.

“We need to focus on the social-psychological economic trauma that patients experience and activates the pain system,” Tauben said. “The bottom line is that biography matters.”

Specialists at the UW School of Medicine have long taken a multidisciplinary approach toward relieving pain, realizing that it is a complex problem that pills often cannot solve, especially when it comes to chronic pain.

Bobbi Nodell, 206.543.7129,

For details about UW Medicine, please visit

Tags:painAmerican Indian / Native AmericanBlack communitypopulations at risk

UW Medicine