Background Chronic pain inequities follow a social power-driven gradient of health, whereby those with less social advantage experience chronic pain more often. Feeling socially supported may reduce the burden of chronic pain.Purpose To take an intersectional approach to understand inequities in chronic pain in the United States, by testing whether living at different intersections of sexual orientation and gender shape chronic pain through differences in experiences of social and emotional support.Methods We compared chronic pain frequency and availability of social support at intersections of sexual orientation and gender in the 2021 National Health Interview Study using an analytic intercategorical intersectional approach using a 3-way decomposition approach to mediation.Results Pairwise comparisons highlighted inequities in chronic pain among sexual minority women (i.e., women who identified as "something else," gay/lesbian, or bisexual) and bisexual men compared to all other identities (i.e., straight and questioning men and women, and men who identified as "something else"). Inequities were most salient for bisexual men and women, especially bisexual women. A theoretical intervention to increase available social support to that of straight women, who reported the greatest availability of social support, would decrease chronic pain frequency for all sexual minority people except for gay/lesbian women. Inequities, while attenuated, would persist among bisexual men and women after a theoretical intervention.Conclusions Social position shapes chronic pain inequities in sexual minority people in the United States through differences in available social and emotional support. Results highlight bisexual men as an understudied group in chronic pain research. Women identifying as gay or lesbian, bisexual, or with a sexual orientation other than straight, gay or lesbian, and men identifying as bisexual experienced inequities in how often they experienced chronic pain. The availability of social support explains some, but not all, of these inequities. Research suggests that social support plays a role in chronic pain, such that people who have more support tend to have less chronic pain. In this article, we aimed to understand how social support is related to chronic pain inequities in the United States through an intersectional perspective focused on the intersections of gender and sexual orientation. Using data from the 2021 National Health Interview Study, we found that bisexual men and women who identified as gay/lesbian, bisexual, or "something else" experienced more chronic pain compared to straight men and women, questioning men and women, and men identified as gay or "something else." Inequities were greatest among bisexual men and women, especially bisexual women. Social support levels were highest among straight women. Gay men and women and men who identified as bisexual, "something else," or questioning all experienced less social support compared to straight women. Our results suggest that the reduced levels of social support may increase how often all sexual minority people except gay/lesbian women experience chronic pain and likely play a role in creating chronic pain inequities. An intervention to improve how much social support is available to sexual minority people would likely reduce chronic pain inequities.
