Current understanding of how and why race influences the transition from acute to chronic pain following traumatic injury remains limited. Traumatic injuries result in over 30 million emergency department visits and 2.5 million hospitalizations each year in the U.S. Risk for developing post-injury chronic pain is significantly greater for non-Hispanic Black (NHB) patients compared to non-Hispanic White (NHW) patients with similar injuries. Although NHB patients experience higher levels of acute post-injury pain and are more likely to transition to chronic pain than NHW patients, the biobehavioral and social factors that influence this transition are not well understood. The overall aim of this proposal is to improve understanding of the factors that influence racial disparities in the transition to post-injury pain. In order to address our aims, will recruit 150 NHB and 150 NHW adult traumatic injury patients from a level 1 trauma center and assess pain outcomes during hospitalization (acute pain intensity) and across monthly follow-ups (pain intensity, pain-related interference, chronic pain status). First, we will evaluate the extent to which NHBs exhibit worse post-injury pain outcomes as compared to NHWs. We hypothesize that NHBs will exhibit higher in-hospital pain intensity, higher rates of chronic pain conditions over 6-month follow-up, and greater pain intensity/interference across monthly assessments. Next, we will determine the extent to which biobehavioral factors explain racial differences in post-injury pain. We hypothesize that higher odds of chronic pain and greater pain intensity/interference over time in NHB relative to NHW patients will be accounted for by the indirect effects of greater pain sensitivity (assessed in hospital via quantitative sensory testing), higher inflammatory biomarkers (hsCRP, TNFα, IL1β, IL-6), more negative cognitions (pain catastrophizing, expectations regarding pain/treatment), and higher depressive/posttraumatic stress symptoms in NHB patients. Finally, we will determine the extent to which racial differences in post-injury pain depend on social factors. We hypothesize that greater life and neighborhood stress and lower socioeconomic status and social support will be associated with higher odds of chronic pain and greater pain intensity/interference over time in NHB relative to NHW patients. Together, these aims will test key elements of an innovative integration of the diathesis-stress model of chronic pain and minority stress theory. The investigators assembled for this multidisciplinary team possess complementary skill sets in traumatic injury, chronic pain, quantitative sensory testing, inflammation, pain-relevant biobehavioral and social factors, and racial disparities in chronic pain. The comprehensive assessment of mediators and moderators across multiple levels of the biopsychosocial model will advance our understanding of the pathways that contribute to racial differences in post-injury pain. ...