Social determinants of health, the conditions in which people are born, grow, live, work, and age, play an important role in pain and disability. They are associated with increased risk of developing chronic pain and are predictors of therapeutic outcomes.

A new systematic review and narrative synthesis by Yap et al. reaffirms this correlation for lumbar spine surgery. Lower education and lower socioeconomic status were found to be clear independent contributors to poorer outcomes following lumbar spine surgery. No conclusion concerning race/ethnicity could be drawn because these determinants were infrequently investigated.

This gap in knowledge needs to be addressed since minority populations have different sets of attitudes, beliefs, and expectations that need to be considered in the management of patients to optimize health care delivery. Furthermore, the experience, assessment, and treatment of pain are influenced by racial and ethnic differences.

Understanding social determinants of health and cultural mechanisms at play in the clinical presentation of patients is central to optimal patient care.

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