1. Introduction and Aim Research indicates that socioeconomic status (SES) is an important predictor of mortality and morbidity. Low SES increases susceptibility to most illnesses, including diabetes, arthritis, and cardiovascular disease. However, SES is measured objectively (via income, occupation, and education), which can have limitations. An alternative to objective socioeconomic status (OSS) is subjective economic status (SSS), where the participant considers their personal income, occupational status, and educational attainment in relation to the rest of society, and then places a cross on a diagram of a ladder with ten rungs in order to indicate their personal status. SSS seems to be a more nuanced measure than OSS, as it involves assessment of past events, current circumstances, and future prospects. Strong SSS-health associations have been reported, and these remain even once OSS has been accounted for. Researchers have established links between low SSS and indicators of poor subjective and poor objective health. Moreover, there is now research that links SSS to an array of specific illnesses, including angina, diabetes, respiratory illness, heart disease, mental dysfunction, and obesity. However, there is little research on the link between SSS and pain, even though the link between OSS and pain is well-established. Our aim in this study was to investigate the SSS-pain relationship in a large representative sample, using number of analgesic (painkiller) prescriptions as an objective measure of pain. Considering previous research, we predicted a negative SSS-prescriptions relationship, even after controlling for OSS and potentially- important demographic variables. Method This study is based on the Scottish portion of the data obtained for Wave 1 of the two- wave Health in Groups project. Five General Practitioner (GP) surgeries situated throughout Scotland posted participation invitations to all their adult patients for whom the study was deemed suitable. Interest in participating was expressed by returning a reply slip included with the invitation, and 2508 patients did so. These patients were sent a Wave 1 questionnaire, which was completed and returned by 1824 patients (henceforth participants; 771 males, 1053 females). Questionnaire Measures -We measured SSS by presenting participants with an image of a ten-rung ladder and asking them to “Place a large “X” on the rung where you think you stand at this point in your life, relative to other people in the UK.” Participants were given a value from 1-10 (top rung = 10; higher values = higher SSS). A categorical variable was created (henceforth called subjective socioeconomic status or SSS), where scores from one to three were categorized as 1 (low SSS), scores from four to six were categorized as 2 (medium SSS), and scores from seven to ten were categorized as 3 (high SSS). -We also recorded a variety of demographic variables: age, gender, whether or not the participant had education above high school, whether or not the participant was employed, and whether the participant went to a GP surgery (and thus lived) in a low, medium, or high status area. -We also recorded whether or not each participant had been prescribed analgesics in the last six months. Discussion The results confirm our predictions: higher SSS significantly predicted lower odds of being prescribed analgesics, even after controlling for OSS-related variables (education, occupational status, and location) and demographic variables (age and gender). This suggests that SSS has effects on pain that transcend OSS’s influence. Numerous researchers have proposed explanations for the SSS-general health relationship. Much of this work is inspired by studies showing that subordinate animals often suffer from ill-health, which may be due to their relatively low rank. The closest human equivalent to animal rank is socioeconomic status, so stress might be central to the SSS-health relationship. It is well-established that prolonged stress response activation can promote body tissue breakdown, producing chronic pain. This might explain why SSS still significantly predicted the odds of being prescribed analgesics even after accounting for OSS. There are various limitations to our study. Our analgesics measure is objective, but we cannot assume there is a direct relationship between analgesic prescriptions and pain. Moreover, we cannot establish that low SSS actually causes pain without conducting a longitudinal study. Our results offer the first evidence to suggest that SSS has important effects on pain that go beyond the influence of OSS. Further research is required in order to untangle the potential reasons for this finding, and to consider how it might help to improve wellbeing. The pain of low status: the relationship between subjective socio-economic status and analgesic prescriptions in a Scottish community sample Results We investigated analgesics frequencies as a function of SSS and the other variables. As predicted, we found that as SSS increased, the number of participants prescribed analgesics decreased. The chi- square value was significant. Participants with education above high school were less likely to have been prescribed than those with education up to high school, while employees were less likely to have been prescribed analgesics than non- employees. Participants from the lowest- status and highest-status areas were the most and least likely to have been prescribed respectively. There were no gender effects. We performed a binary logistic regression to investigate the effects of SSS and the other variables on the odds that participants have been prescribed at least one analgesic in the last six months. SSS contributed significantly to predicting lower odds of participants having been prescribed. Odds increased with age, and participants possessing education above high school had smaller odds than those with up to high school education. Employees also had smaller odds than non-employees. Participants in higher- status locations had lower odds than those in lower-status locations. There was no effect of gender. Juliet R. H. Wakefield a, Fabio Sani a, Vishnu Madhok a, Michael Norbury b, & Pat Dugard a a University of Dundee, Dundee, UK. b Craigmillar Medical Group, Edinburgh, UKPublished in: Psychology, Health & Medicine, 2015. For More Information: Dr. Juliet Wakefield: j.r.h.wakefield@dundee.ac.uk