Pain disparities among Medicaid beneficiaries with chronic low back pain: The differential role of psychological distress

This study examined associations between Medicaid status and pain-related experiences in adults with chronic low back pain (cLBP), and examined whether the association attenuated after adding psychological distress. This cross-sectional analysis used baseline data from 751 adults with cLBP (112 Medicaid, 639 non-Medicaid) from a multi-site clinical trial across three healthcare systems. Linear regressions were used to assess associations between Medicaid status and pain outcomes (intensity, physical function, interference), controlling for demographic and clinical covariates including race, followed by sequential regression to examine the role of psychological distress (anxiety/depression composite). In adjusted models, Medicaid beneficiaries reported significantly higher pain intensity (B = 0.906, 95% CI [0.555, 1.257]), lower physical function (B = −1.556, 95% CI [-2.642, −0.470]), and greater pain interference (B = 1.243, 95% CI [0.034, 2.452]). Independently, Black participants reported higher pain intensity than White participants. Sequential regression analyses revealed that psychological distress differentially accounted for these associations. It was associated with substantial attenuation of pain interference, such that the association with Medicaid status was no longer significant, but only partially explained the associations for pain intensity and physical function, which remained significant after accounting for distress. Pain disparities for Medicaid beneficiaries appear to reflect the dual burdens of heightened psychological distress and persistent systemic factors not fully explained by mental health. These findings underscore the need for a two-pronged approach that integrates clinical care to address psychosocial needs while advancing equitable health policy to address systemic barriers that may contribute to worse pain outcomes. Perspective: Among adults with chronic low back pain, psychological distress largely accounted for the Medicaid-related disparity in pain interference, but not in pain intensity or physical function. This highlights that addressing these disparities may require both integrated mental health care for the individual and equitable health policies that target systemic barriers.