Association of Health Literacy With Chronic Pain and Pain-Related Distress

Research suggests health literacy should be considered when treating chronic pain. The purpose of this secondary analysis was to examine the relationship of health literacy with pain and psychological functioning and to determine whether health literacy status was associated with outcomes after a brief psychological intervention for chronic pain. Participants with chronic musculoskeletal pain (N = 60) were randomized to a five-session psychological intervention or control group between September 2018 and February 2020. Participants completed a baseline and postassessment, which included measures of health literacy status (i.e., adequate vs. lower level), pain severity, pain interference, pain catastrophizing, depression, anxiety, and pain acceptance. Participants were mostly female (78.3%) and Black (88.3%) with a mean age of 62.2 years. At baseline, lower levels of health literacy were associated with greater pain severity (p = .003), pain catastrophizing (p = .03), and depressive symptoms (p = .02). Among those randomized to the intervention group, health literacy status was not related to engagement in the intervention. However, those with adequate levels of health literacy were more likely to have lower depressive symptoms (p = .045) and higher acceptance of pain (p = .01) at postintervention compared to those with lower levels. Among individuals with chronic pain, those with lower levels of health literacy may have worse pain and psychological functioning. Those with lower levels may also not benefit as much from standardized psychological interventions for pain management. Clinicians delivering psychological interventions for chronic pain may want to consider screening for health literacy status and adapt the intervention to ensure understanding.