iIt’s to be expected, says two-time Pro Bowler Julius Thomas, that “colliding with other people for a living” can lead to 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 from Harvard and Brigham & Women’s Hospital. The paper was published in the journal Pain this week.
The study, part of Harvard’s Football Players Health Study, used survey data from nearly 4,000 former U.S.-style professional 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 pain medication use. Yet data showed that race-related health disparities existed even among these elite professional athletes who had access to top-notch health care and other resources during their careers.
“It’s important for people to understand that there is no status, income level, or amount of money in your savings that erases the racial disparities in chronic pain,” says 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 likely to have been quarterbacks or offensive linemen). And while black players were much younger than white players, they reported more 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 more “pain interference,” the extent to which their pain interfered with normal 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 poorer health outcomes for many black Americans. Research also suggests that black people are more likely to be disbelieved by medical providers, or believe they have higher pain thresholds, and may even underestimate their own pain to cope.
Older age, concussion symptoms, fatigue, sleep apnea, anxiety, and depression were all found to be predictors of greater pain interference in all groups. More social support was associated with less pain in the study, indicating it could be a crucial protective force.
While pain is notoriously difficult to measure and surveys are an imperfect source of data, Thomas says the findings raise important questions about what causes racial differences in pain more broadly.
He came into contact 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 from a career — including a Super Bowl appearance — in 2018 as a tight end for the Denver Broncos, the Jacksonville Jaguars, and the Miami Dolphins, to study psychology.
“A lot of attention goes directly to the cognitive decline or cognitive dysfunction, CTE [chronic traumatic encephalopathy]but there are so many other health issues that affect players’ quality of life and life satisfaction,” he told STAT.
STAT spoke with Thomas about his latest research, big health questions to be answered, and his decision to pursue health care after the NFL. This interview has been edited for clarity and brevity.
What is the most striking finding from this study for you?
We understand that there are racial disparities in health for Americans. But you would assume that in a population of people like NFL players who would probably have had similar medical treatment and care, similar education, high levels of health, especially while playing, you probably wouldn’t expect to see a racial disparity in chronic pain similar to what we seen in the general population. But to see it there really shows that there are other factors that influence racial disparities in health problems, especially chronic pain. Even if you’re making a good salary and have probably been doing the healthiest things you can under the supervision of some of the best physical and health professionals in the world, it doesn’t erase the differences in chronic pain.
The study found that higher levels of social support were associated with reduced pain intensity. How does that reflect to you the role that psychosocial factors play in these outcomes?
During our training as psychologists and thinking about this deep power of social support, it is one of the most overlooked protective factors we have as humans. Whether it’s our mood, pain, stress, having a strong social support network will be very protective. And when you see that, you start to wonder: What are some of the reasons black players didn’t report the same level of social support? And what are the things we might be able to do to help intervene in those areas where we know that social support can reduce pain intensity or pain interference? How do we increase their social support?
For me, from a neuroscientific perspective, I like to think about inflammation. And you start looking at some of the social and demographic experiences black players have throughout their lives and outside of the game. Are some of those stressors or different things that create different inflammatory variables that increase pain in that group that the white players don’t suffer from?
Do you think these findings have broad application, or are former football players in a health class of their own, something of a veteran, in terms of what they’re exposed to at work?
What’s interesting is that these findings are similar to what’s commonly understood: There are racial disparities in health. It’s important first of all to understand what those modifiable things are – like myself, being a former black player, knowing I have a chance of experiencing high levels of chronic pain – what can I do? Well, I can make progress, improve my mental health, how I deal with maybe anxiety or depression. Or if I can try to create more social support and less fatigue. And these are all things that will help reduce pain.
And I think those will always be our next steps. The data shows what the picture is, and the next step is to figure out, “How can we step in to make positive changes that lead to more positive health outcomes?”
Do you hope to serve pro athletes in your second career?
Yes absolutely. You know, I want to continue to grow in some of the behavioral health research that I’m doing right now, like the Football Players Health Study and the NFL Players Association’s behavioral health committee. In my next career, I really want to do everything I can to make an impact on player health and well-being. That’s why I walked away from the game, because I wanted to understand it better for myself and for the men I shared the field with. But it is also something that gives me a lot of meaning and value.
How did it feel as a former player to see this data and read through the findings of your research?
I think the first and hardest step for players is to really look at what the data says because it can be daunting. It can be daunting and you may feel like, “Okay, what can I do?” So as players, sometimes it feels more comfortable for us to ignore the research or not so actively seek to understand it. But I think as we grow into getting this information out to players, we can help them understand, ‘Hey, this is the case, what it looks like today, but it doesn’t determine what it’s going to be like in the future. ‘
What really encourages me when I do research is the research outcomes that create interventions. And then the interventions can be broadly applied by many different populations.
STAT’s coverage of chronic health conditions is supported by a grant from Bloomberg philanthropies. Us financial supporters are not involved in decisions about our journalism.