When People ‘Don’t Want Us to Exist’: Chronic Pain and LGBTQ+ Patients

By Grayson Schultz

The 2022 annual Transgender Day of Remembrance and Resilience was also the day of one of the worst hate crimes against LGBTQ+ people in recent memory: the mass shooting at Club Q in Colorado Springs. Sara Gehrig, who leads U.S. Pain Foundation’s LGBTQ+ support group, knew that the members of her group would be reeling from the news.

“I sent out an email blast, letting people know that I was here for them if they needed to talk,” she recalls. The next day, during the support group, “that was all that we talked about,” with members sharing their current pain and past trauma.

“That’s where LGBTQ+ folks go” to find community, says Gehrig, who is a lesbian, about bars like Q. “It’s hard when many in the current climate don’t want us to exist.”

Most members of the group understand the harm that often faces LGBTQ+ individuals who live with chronic pain.

Studies have found that “the same part of the brain becomes activated in both physical pain and social rejection pain,” says clinical health psychologist Kimeron Hardin, PhD, ABPP, FACHP.

“When the emotional pain is strong,” Gehrig adds, “what does that do to your physical pain?”

Hardin, a pain psychologist who specializes in working with LGBTQ+ individuals, stresses that this isn’t to say pain is all in someone’s head. “Your brain is so complexly organized that it responds to threats in a specific way,” he says. “That includes eliciting a stress response, but it also includes increasing your pain levels.”

The hidden harm of stress

There has been a recent spike in legislation that is blatantly discriminatory against LGBTQ+ Americans, particularly minors, and a corresponding rise in discrimination and hate crimes. Beyond the specifics of each law, as a whole they already are having a chilling effect not just on speech but also on research: “It’s going to be dangerous for people to submit grants that support their career around topics that are somewhat becoming taboo again,” explains Hardin.

The stress this causes can be surprisingly harmful physically, especially for those with chronic pain. “You can’t stay in that state [of fear and anxiety] constantly, or it will exhaust you,” shares Hardin. “There’s clear, clear evidence that high levels of sustained stress are precursors to serious depression and anxiety issues”—and depression is a risk factor for developing chronic pain.

If your body is always on high alert, any injuries you obtain can be harder to heal. And, Hardin notes, “your stress response is going to absolutely impact the pain, and the pain is now perceived as an additional threat or stressor.”

Self-care and finding those who understand

For those healing from trauma especially, Hardin sees his role as helping patients “learn self-care that they didn’t have time to do because they were surviving or they didn’t have role models for it or support systems in place.”

One important component of building a support system is finding a doctor who is experienced with LGBTQ+ issues, which can be difficult in some areas. While some providers are overtly prejudiced, there are many others who simply lack the appropriate training to effectively treat LGBTQ+ patients.

The Pain Connection group also serves as a crucial support system, providing knowledge, understanding, and community to its members. The group regularly talks about topics like pronouns, gender identity, medical gatekeeping, and issues with sexual function. Although the group initially met monthly when Gehrig began facilitating it in April 2022, the frequency increased as members expressed a need for additional support. Members have told her the meetings are “the only place I can be my true self.”

“Love wins in this group,” Gehrig adds. “Love finally wins.”

The LGBTQ+ pain group meets on the first Sunday, second Tuesday, and third Monday of each month. Learn more by visiting painconnection.org.


If you’re looking for a way to find inclusive providers, check out:

—The LGBTQ+ Healthcare Directory: lgbtqhealthcaredirectory.org

—Open Path Collective: openpathcollective.org

—Inclusive Therapists: inclusivetherapists.com

—OutCare Health: outcarehealth.org

—Trans in the South: bit.ly/transinsouth

—Psychology Today: psychologytoday.com

These websites allow you to search for LGBTQ+ friendly providers. Some also allow you to put in your insurance information to help find a match. Note that some listings may be out of date; always call to double-check any information.

If you can’t find a provider from one of these lists who is in your area or takes your insurance, Hardin recommends searching for providers who have general experience in working with chronic illness, trauma, cognitive behavioral therapy (CBT), or with health psychology training.

For providers looking to learn more about providing competent care to the LGBTQ+ community, visit:

—The National LGBTQIA+ Health Education Center from The Fenway Institute: lgbtqiahealtheducation.org 

—QueerCME, mostly focused on primary care: queercme.com

—The American Association of Pain Psychology (AAPP) offers a search function for patients (unfortunately without the option to search by LGBTQ+ friendly) and a number of seminars and continuing education resources for providers: bit.ly/providersaapp