Unequal burden: chronic pain disparities in sexual and gender minority adolescents

Sexual and gender minoritized youth (SGMY) face unique psychosocial stressors that may contribute to mental and physical health disparities. A recent socioecological-biopsychosocial model suggests that minority stress disrupts psychological and physiological processes, increasing vulnerability to chronic pain in these youth. However, little is known about how chronic pain manifests in SGMY. This study utilized secondary analysis of cross-sectional data and examined sexual orientation and gender identity (SOGI) in youth with chronic pain, comparing pain-related outcomes (psychological and physical functioning) between SGMY and cisgender, heterosexual youth (CHY). In addition, we evaluated the indirect effects of psychological distress on pain-related outcomes. Participants included 382 youth (Mage = 15.41). Sexual and gender minoritized youth (25.4%) were identified using the current best-practice assessment of SOGI. Sexual and gender minoritized youth reported significantly greater pain interference, mobility impairment, fatigue, and sleep impairment compared with CHY (all P < 0.01), despite no differences in pain severity or duration. Analyses of indirect effects revealed that psychological distress (ie, symptoms of depression and anxiety) may partially account for group differences, with the strongest contribution observed for pain interference. However, differences in physical functioning remained even after accounting for distress, suggesting additional factors (eg, minority stress) may contribute to disparities. These findings underscore the importance of routine, inclusive assessment of SOGI and highlight the disproportionate functional burden of pain in SGMY. Understanding the physiological and psychological impact of minority stress is needed to inform inclusive, affirming pain care and advocate for systemic change to reduce disparities in pediatric chronic pain.