The impact of interpersonal stressors and residential stressors on chronic pain in older adults: neurobiological and psychological mechanisms

In the United States, older adults are more likely to experience chronic pain and related decline in physical functioning. Evidence suggests that exposure to both interpersonal and residential stressors may contribute to the development and progression of chronic pain. The psychological and neurobiological mechanisms through which these stressors influence pain outcomes—and to what extent they overlap-- remain insufficiently understood. Clarifying these mechanisms is critical to identifying modifiable factors that could improve pain management strategies for older adults. We hypothesize that residential stressors (e.g., limited neighborhood resources) and interpersonal stressors (e.g., negative social interactions) affect chronic pain outcomes through at least partially distinct psychosocial and neurobiological pathways. Our rationale is that such stressors influence interconnected biological and psychological systems, potentially accelerating the progression of musculoskeletal pain and related decreased physical function. We will test this central hypothesis through three specific aims: (1) Evaluate the independent and combined effects of residential and interpersonal stressors on chronic pain outcomes; (2) Identify psychosocial and biological mediators linking these stressors to pain outcomes; and (3) Examine individual-level protective factors that may buffer the psychological and biological effects of these stressors. Residential stress will be assessed using objective measures of neighborhood resource availability (e.g., Area Deprivation Index). Interpersonal stress will include perceived and observed experiences of negative social interactions. This research is innovative in its integration of multiple stress domains, mechanistic pathways, and protective factors. It is expected to improve our understanding of how different forms of stress contribute to chronic pain in older adults, ultimately informing strategies to improve outcomes in aging populations.