Using an epigenomic approach to advance pain equity

Abstract Chronic pain is a global epidemic that disproportionately affects Black, Indigenous, and other people of color as well as individuals of lower socioeconomic status. Unfortunately, the mechanisms that cause and sustain disparities in pain outcomes remain underexamined. This review highlights recent insights into epigenetics as a uniquely suited biological mechanism linking environmental stressors and pain disparities. Emerging evidence suggests that epigenetic modification of genes in pathways involved in stress dysregulation and neuroinflammation may play a central role in racial pain disparities and internalized stigma. These findings indicate that differential environmental exposure (ie, chronic stress) induces epigenetic changes (mediators) that explain pain disparities. Another putative mechanism by which differential epigenetic modifications contribute to pain disparities is epigenetic age acceleration. Emerging evidence suggests that epigenetic age acceleration mediates the relationship between lower socioeconomic status (household income, food insecurity, and neighborhood deprivation) and worse pain outcomes. Epigenetic modifications are dynamic and reversible, leaning toward pharmacological and nonpharmacological interventions. Logically, these will contribute to tailored interventions for pain management and equity in pain management. Finally, we cannot ignore that social and structural forces are the root causes of pain disparities. Thus, there is a need for policy changes addressing these forces.