Patients with sickle cell disease (SCD) who experience racial discrimination in the healthcare setting are more likely to have a greater level of pain, according to research published in the Journal of Pain. This level of pain, the authors argued, may be linked with depression and insomnia.

Previous research has suggested that patients with SCD face inferior health care, such as longer wait-times, potentially because of adverse provider bias. In the United States, SCD is primarily diagnosed among Black patients and is considered by many — incorrectly — to be a race-related disease. Consequently, many patients with SCD in the US face racial discrimination and often, an insufficient access to high-quality care.

Previous research has also suggested that discrimination may be linked with greater pain among patients with SCD, although how this manifests was previously unestablished. For this study, researchers evaluated factors that may link racial discrimination with an increased level of pain among patients with SCD.

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Overall, data from 68 patients with SCD were included. In the cohort, 48 patients were female sex, the mean age was 38.69 years, and 53 patients had attended some college. All patients provided baseline levels of pain and completed a pain diary over the subsequent 3-month period.

Analysis showed that baseline depression and insomnia mediated a significant link between racial discrimination and baseline pain interference, average daily diary pain severity, and average daily diary pain interference. The authors suggested, furthermore, that discrimination is likely to contribute to depression, which leads to insomnia and a consequent increase in pain.

“Findings support the need for systemic and structural changes to eliminate discrimination in healthcare settings and behavioral mood and sleep interventions to reduce the impact of discrimination on clinical pain,” they wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


McGill LS, Hamilton KR, Letzen JE, et al. Depressive and insomnia symptoms sequentially mediate the association between racism-based discrimination in healthcare settings and clinical pain among adults with sickle cell disease. J Pain. Published online November 19, 2022. doi:10.1016/j.jpain.2022.11.004