Understanding risk and protective factors for pain and healthy aging: an intersectional and resilience-based perspective.

Chronic pain (CP) is a major public health concern in the United States, with healthcare costs exceeding $700 billion. Beyond its' economic burden, CP imposes significant physical, emotional, and functional strain, particularly among populations that are disproportionately affected by pain (i.e., older adults, people with HIV, racial and gender minorities). Despite growing trends in pain research, there remains no consensus on optimal pain management or the mechanisms underlying pain exacerbation. Therefore, this review highlights key risk (e.g., sociodemographic determinants of health, clinical co-morbidities) and protective (e.g., resilience, spirituality, complementary approaches, lifestyle) factors that shape pain experiences and influence trajectories of healthy aging. This manuscript will integrate both risk and resilience promoting factors to inform intervention development, clinical practice, and policy. We discuss intersectionality, defined as the interaction of multiple social identities, as well as its influence on pain and aging trajectories over time. Lastly, we propose a framework that integrates intersectionality and resilience to improve pain outcomes among aging adults.