Abstract
This study evaluated the contributions of psychological status and cardiovascular responsiveness to racial/ethnic differences in experimental pain sensitivity. The baseline measures of 3,159 healthy individuals—non-Hispanic white (NHW): 1,637, African-American (AA): 1,012, Asian: 299, and Hispanic: 211—from the OPPERA prospective cohort study were used. Cardiovascular responsiveness measures and psychological status were included in structural equation modeling based mediation analyses. Pain catastrophizing was a significant mediator for the associations between race/ethnicity and heat pain tolerance, heat pain ratings, heat pain aftersensations, mechanical cutaneous pain ratings and aftersensations, and mechanical cutaneous pain temporal summation for both Asians and AAs compared to NHWs. HR/MAP index showed a significant inconsistent (mitigating) mediating effect on the association between race/ethnicity (AAs vs. NHWs) and heat pain tolerance. Similarly, coping inconsistently mediated the association between race/ethnicity and mechanical cutaneous pain temporal summation in both AAs and Asians, compared to NHWs. The factor encompassing depression, anxiety, and stress was a significant mediator for the associations between race/ethnicity (Asians vs. NHWs) and heat pain aftersensations. Thus, while pain catastrophizing mediated racial/ethnic differences in many of the QST measures, the psychological and cardiovascular mediators were distinctly restrictive, signifying multiple independent mechanisms in racial/ethnic differences in pain.
Highlights
Pain is a major health problem in the US, with an estimated 120 million (55.7%) adults reporting some level of pain in the previous three months, including chronic pain [1]
The problem is compounded by lower quality of care provided to patients who are racial/ethnic minorities, including African Americans (AAs) and Hispanics compared to NHWs, whether the treatment is for acute pain, chronic pain, cancer pain, and or palliative pain care [5], [6]
Greater pain sensitivity to noxious stimuli is reported in AAs and Asians compared to NHWs [2], [15], [16], suggesting that experimental pain sensitivity may account for the differences in severity of clinical pain conditions among racial/ethnic groups [2]
Summary
Pain is a major health problem in the US, with an estimated 120 million (55.7%) adults reporting some level of pain in the previous three months, including chronic pain [1]. Racial/ethnic disparities related to pain in the US have been studied widely, with racial/ethnic minorities reporting greater severity of chronic pain than non-Hispanic white (NHWs) [2,3,4]. The problem is compounded by lower quality of care provided to patients who are racial/ethnic minorities, including African Americans (AAs) and Hispanics compared to NHWs, whether the treatment is for acute pain, chronic pain, cancer pain, and or palliative pain care [5], [6]. Greater pain sensitivity to noxious stimuli is reported in AAs and Asians compared to NHWs [2], [15], [16], suggesting that experimental pain sensitivity may account for the differences in severity of clinical pain conditions among racial/ethnic groups [2]
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