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It’s to be expected, says two-time Pro Bowler Julius Thomas, that “colliding into other people for a living” might result in some long-term injuries. But among former NFL players, Black athletes report worse and more disruptive chronic pain than white players, according to a new study Thomas co-authored with researchers at Harvard and Brigham & Women’s Hospital. The paper was published in the journal Pain this week.
The research, part of Harvard’s Football Players Health Study, used survey data from nearly 4,000 former pro American-style football players to examine their rates of chronic pain and what might be contributing to it. The analysis controlled for seasons of play, field position, self-reported concussion symptoms during active play, body mass index, and current use of pain medications. Still, data showed race-related health disparities existed even among these elite professional athletes who had access to top-of-the-line health care and other resources during their careers.
“It’s important for people to understand that there’s not a status, income level, or amount of money in your savings that removes the racial disparities in chronic pain,” said Thomas, who is pursuing his doctorate in psychology at Nova Southeastern University in Florida.
About 41% of people surveyed identified themselves as Black, and 59% as white. Both groups had similar numbers of seasons played and surgeries during their playing careers. Black players were twice as likely as white players to have been defensive backs or running backs (white players were more often quarterbacks or offensive linemen). And although Black players were much younger than white players, they reported higher rates of chronic conditions such as high blood pressure, diabetes, or sleep apnea, as well as more concussion symptoms, severe fatigue, anxiety, and depression. Black players also noted more intense pain and greater “pain interference,” the degree to which their pain got in the way of regular life, as measured by the PROMIS Pain Interference scale.
Other studies support the idea that social factors including discrimination, trauma, socioeconomic disparities, reduced access to timely health care, and adverse childhood experiences lead to worse health outcomes for many Black Americans. Research also suggests Black people are more likely to be disbelieved by medical providers, or thought to have higher pain thresholds, and might even under-acknowledge their own pain in order to cope.
Older age, concussion symptoms, fatigue, sleep apnea, anxiety, and depression were all found to be predictors of greater pain interference across all groups. More social support was linked with lesser pain in the study, indicating it could be a crucial, protective force.
While pain is notoriously tricky to measure, and surveys are an imperfect source of data, Thomas says the findings open up important questions about what is driving racial disparities in pain more broadly.
He got connected with the Boston researchers through his role on the advisory board of the Football Players Health Study (which is funded by the NFL Players Association). Thomas retired in 2018 from a career — including a Super Bowl appearance — as a tight end for the Denver Broncos, the Jacksonville Jaguars and the Miami Dolphins, in order to study psychology.
“A lot of the attention goes immediately to the cognitive decline or cognitive dysfunction, CTE [chronic traumatic encephalopathy], but there’s so many other health conditions that are affecting the quality of life and life satisfaction of players,” he told STAT.
STAT spoke to Thomas about his latest research, big health questions that need answers, and his decision to pursue health care after the NFL. This interview has been edited for clarity and brevity.
What, to you, is the most striking finding from this research?
We understand that there’s race disparities in health for Americans. But you would assume that in a population of people like NFL players that have probably had similar medical treatment and care, similar education, high levels of health, especially while playing, that you would probably not expect to see a racial disparity in chronic pain similar to what we see in the general population. But to see it there really shows that there’s other factors affecting racial disparities in health conditions, especially chronic pain. Even if you earn a good salary and have done probably the healthiest things that you can do under the supervision of some of the best physical and health professionals in the world, it doesn’t eliminate the disparities in chronic pain.
The study found that a higher degree of social support was associated with reduced pain intensity. How does that reflect to you the role that psychosocial factors play in these outcomes?
In training to be a psychologist and thinking about this profound power of social support, it’s one of the most overlooked protective factors that we have as humans. Whether it’s our mood, pain, stress, having a strong social support network is going to be very protective. And when you see that, it starts to make you wonder: What are some of the reasons why Black players didn’t report the same level of social support? And what are the things that we can do possibly to help intervene in those areas that we know that social support can decrease pain intensity or pain interference? How do we increase their social support?
For me, from a neuroscience perspective, I really like to think about inflammation. And you start to look at some of the social and demographic experiences that Black players have throughout their life and outside of the game. Are some of those stressors or different things creating different inflammatory variables that are increasing pain in that group that the white players aren’t suffering from?
Do you think these findings can be broadly applied, or are former football players in a health class of their own, sort of like veterans, in terms of what they’re exposed to on the job?
What’s interesting is these findings are similar to what is broadly understood: there’s racial disparities in health. It’s, first, important to understand what are those modifiable things — like myself, being a Black former player, knowing that I have a chance of experiencing high levels of chronic pain — what can I do? Well, I can make inroads, improve my mental health, how I’m dealing with maybe anxiety or depression. Or if I can try to create greater social support and less fatigue. And these are all things that are going to help create a reduction in pain.
And I think that those will always be our next steps. The data shows what the picture is, and then the next step is to figure out, ‘How do we intervene to make positive changes that lead to more positive health outcomes?’
Are you hoping to be able to cater to pro athletes with your second career?
Yeah, absolutely. You know, I want to continue to grow in some of the research in behavioral health things that I’m doing right now, like the Football Players Health Study and the behavioral health committee with the NFL Players Association. In my next career, I really want to do everything I can to have an impact on player health and well-being. It’s why I walked away from the game, because I wanted to better understand it for myself and for the men that I shared the field with. But it also is something that brings me a lot of meaning and value.
As a former player, how did it feel to see this data and read through the findings from your research?
I think the first and hardest step for players is to actually look at what the data says, because it can be disheartening. It can be discouraging and you can feel like, ‘O.K., well, what can I do?’ So as players, it sometimes feels more comfortable for us to ignore the research or not be so actively seeking it out to understand it. But I think that as we start to grow in disseminating this information to players, we can help them understand, ‘Hey, this is the case, what it looks like today, but this doesn’t determine what it’s going to be like in the future.’
What I really get encouraged about when I do research is the study results create interventions. And then the interventions can be broadly applied through lots of different populations.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
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