Pain Resilience and Chronic Low Back Pain Outcomes: The Mediating Role of Pace of Biological Aging.

In this study, we aimed to investigate if the pace of biological aging serves as a critical mediator in the relationship between chronic pain resilience and chronic low back pain intensity and disability. Two hundred seven community-dwelling non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults completed the Pain Resilience Scale (PRS) and Graded Chronic Pain Scale (GCPS). Blood genomic DNA was sequenced using Illumina's MethylationEPIC, and the pace of biological aging estimated using the DunedinPACE (the Dunedin Pace of Aging Calculated from the Epigenome) algorithm. In bivariate correlations, DunedinPACE significantly correlated with pain intensity (r = 0.40), and disability (r = 0.39), at p < .05. Pain resilience negatively correlated with pain intensity (rs = -0.22), pain disability (rs = -0.30), and DunedinPACE (r = -0.11). After controlling for chronological age, sex, race, and BMI, mediation analyses revealed a significant indirect association of pain resilience on pain intensity through the pace of biological aging (β = -0.66 (SE); Boot 95% CI [-1.06, -0.25]). Similarly, DunedinPACE partially mediated the relationship between resilience and pain disability (β = -0.82; 95% CI, [-1.20 to -0.44]). We found that higher levels of resilience correlate with a slower pace of biological aging, which in turn correlates with better pain outcomes. The pace of biological aging emerged as an important potential target for future interventions studies for pain management.