Ethnic Differences In Pain Research Articles

Neural and sociocultural mediators of ethnic differences in pain.

Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity/gender-balanced sample of African Americans, Hispanics, and non-Hispanic Whites using fMRI during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased fronto-striatal circuit activations associated with pain rating, discrimination, experimenter trust, and extra-nociceptive aspects of pain elsewhere. In contrast, the Neurologic Pain Signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extra-nociceptive central pain mechanisms, and suggest that nociceptive pain processing may be similar across ethnicities.

Persistent pain associated with socioeconomic and personal factors in a Sami and Non-Sami population in Norway: an analysis of SAMINOR 2 survey data

ABSTRACT In international studies, higher prevalence of persistent pain has been reported in indigenous populations compared to majority populations. The present study aimed to determine the prevalence of persistent pain within a Sami and a non-Sami population in northern Norway, with adjustment for the confounding factors of age, sex, marital status, education, income, mental health, smoking status and ethnic background. Using SAMINOR 2 survey data including Sami and non-Sami populations, we analysed 5,546 responses, from individuals aged 40–79 years, to questions concerning persistent pain (≥ 3 months). In total, 2,426 (43.7%) participants reported persistent pain with differences between Sami women and non-Sami women (44.1% versus 51.1%, respectively), but none between Sami men and non-Sami men (38.7% versus 38.2%, respectively). Elderly Sami women were less likely to report persistent pain than were elderly non-Sami women. In men, no ethnic differences in pain were observed according to age-group. Marital status, education levels, household income, psychological distress, and smoking status did not influence the association between ethnicity and pain. Pain severity and location did not differ between Sami and non-Sami participants. In this study, we found only minor ethnic differences in persistent pain. Similar living conditions and cultural features may explain these findings.

Racial and ethnic differences in the experience and treatment of noncancer pain.

The burden of pain is unequal across racial and ethnic groups. In addition to racial and ethnic differences in the experience of pain, there are racial and ethnic disparities in the assessment and treatment of pain. In this article, we provide a nonexhaustive review of the biopsychosocial mechanistic factors contributing to racial and ethnic differences in both the experience and treatment of pain. Using a modified version of the Socioecological Model, we focus on patient-, provider- and system-level factors including coping, perceived bias and discrimination, patient preferences, expectations, patient/provider communication, treatment outcomes and healthcare access. In conclusion, we provide psychosocial factors influencing racial and ethnic differences in pain and highlight future research targets and possible solutions to reduce these disparities.

Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation.

A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = -5.84; P < 0.002 for Japanese; beta = -6.17; P < 0.001 for African American; beta = -8.74; P < 0.001 for Chinese; beta = -10.54; P < 0.001 for Caucasians; beta = -12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = -4.50; P < 0.001), Chinese (beta = -6.62; P < 0.001), and Caucasian (beta = -7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.

Ethnicity, Cortisol, and Experimental Pain Responses Among Persons With Symptomatic Knee Osteoarthritis.

Although several factors are known to contribute to ethnic differences in pain, relatively little attention has been devoted to physiological factors. Our first aim was to examine the relationship between cortisol and pain responses during a cold-pressor task (CPT) among African American (AA) and non-Hispanic White (NHW) adults with knee osteoarthritis (OA). Our second aim was to assess the relationship between perceived racial discrimination and cortisol among AA participants. Participants were 91 (56 AA; 35 NHW) community-dwelling adults between the ages of 45 to 85 with knee OA based upon the American College of Rheumatology clinical criteria. Plasma cortisol was measured at 3 timepoints: (1) baseline, (2) before the CPT, and (3) 20 minutes following the CPT. Perceived racial discrimination was measured by the Experiences of Discrimination scale. Using linear regression, we found a significant interaction between ethnicity and cortisol before the CPT with pain intensity ratings (β=-0.26; P=0.02). Analysis of simple slopes revealed that cortisol concentrations were negatively associated with pain intensity ratings in NHW participants (β=-0.54; P=0.001), but not in AA participants (β=-0.15; P=0.26). Perceived racial discrimination was not related to cortisol concentrations or pain ratings. Consistent with previous findings in young healthy adults, cold-pressor pain responses are related to pre-CPT cortisol concentrations in NHW persons with knee OA but not in their AA counterparts. Additional studies are required to better understand this finding.

Bernard Tursky (1918-2012).

Psychophysiology, 51 (2014), 1059–1060. Wiley Periodicals, Inc. Printed in the USA. Copyright © 2014 Society for Psychophysiological Research DOI: 10.1111/psyp.12338 In Memoriam Bernard Tursky (1918–2012) LARRY D. JAMNER, Ph.D. Department of Psychology and Social Behavior University of California Irvine bs_bs_banner Psychophysiology and our Society lost one of its original greats when Bernard Tursky passed away on September 13, 2012 at the age of 93. Bernard Tursky was an academic trail blazer and pioneer extraordinaire. Raised in New York City, Bernard immigrated to the U.S. with his grandparents and brothers at the age of three. Circumstances demanded that he cease his formal education after the eighth grade in order to support his family. Bernie or “Profes- sor” as I affectionately referred to him represented as close an embodiment of the self-taught “Renaissance Man” I have ever met or will likely ever come across again. To enter Bernie’s office was to enter a veritable library of classic and contemporary texts, and reference manuals on topics such as electrical engineering, classic psychology, political science, medical sciences, physiology, psy- chiatry, systems theory, and mathematics. His academic career began as a technical engineer at MIT, and as his reputation grew as an ingenious developer of laboratory equipment and programming, he was recruited by the Massachusetts Mental Health Center. Remarkably, Bernie was to become the only faculty member in the State University of New York system to hold the title of Full Professor in three separate departments; Political Science, Psychol- ogy, and Psychiatry and Behavioral Science at Stony Brook Uni- versity. Bernie’s academic career was characterized by the use of elegant procedures, meticulous methods, and clever experimental designs to address fundamental scientific questions in areas ranging from human pain perception and clinical psychophysi- ology to political psychology. His work showed a fastidiousness not often seen today, and Bernie was, at the same time, a visionary. In 1965 David Shapiro convinced David McClelland to offer Bernie an appointment in the Department of Social Relations at Harvard where Bernie and David Shapiro built a state-of-the-art psychophysiology laboratory and together with Andrew Crider, and Gary Schwartz developed and taught what perhaps was the first seminar/lab courses devoted entirely to psychophysiological concepts, methods, and applications. Among the notable students who took the course or were involved in the course’s laboratory were Nancy Adler, Iris Bell, Richard Davidson, John Kabat-Zinn, and Alan Sirota. This training effort eventually spawned a NIH- sponsored summer training institute in Psychophysiology at Harvard Medical School that offered formal training to young scientists. It was at this 1972 summer institute that Bernie became acquainted with Milton Lodge a political scientist from SUNY Stony Brook who soon after convinced him to head a comprehen- sive behavioral research laboratory as a Professor of Political Science. Eventually, Bernie was to become Chair of the SUNY Stony Brook’s Department of Political Science, a position he held until his retirement in 1985. Bernie, like several of our Society’s founding members, designed his own experimental apparatus and created the equip- ment necessary to study human pain perception in a standardized fashion. This pioneering program of research conducted in collabo- ration with Peter Watson and Donald O’Connell focused on the development of a reliable laboratory pain stimulus delivery system in the form of a constant-current stimulator and the Tursky con- centric electrode capable of quantifying and precisely specifying the parameters of painful stimuli used in experimental pain studies. With his meticulous and elegant techniques Bernie systematically studied the electrical parameters necessary for stable repeated delivery of painful stimuli as well as the local and more general physiological responses associated with these stimuli. The devel- opment of the constant-current stimulator along with the Tursky concentric electrode represented, at the time, major methodological advances in the area of human pain perception. Parenthetically, one of the original constant-current stimulator units and concentric electrodes Bernie built remain in active use in my laboratory today and is affectionately known by my students as the “Dragon Lady.” With these tools in his armamentarium, Bernie went on to study psychophysiological aspects of pain including the role of attention and control, as well as culture, in pain perception. In what were to become seminal papers, Bernie and Richard Sternbach demon- strated substantial ethnic differences in pain thresholds/tolerance levels and psychophysiological pain responses. Another signifi- cant contribution of Bernie’s to the field of human pain research

Racial and Ethnic Variation in Pain Following Inpatient Palliative Care Consultations

Studies have documented high levels of pain in hospitalized individuals at the end of life, with minorities reporting higher levels of pain than whites. In response, inpatient palliative care (IPC) teams have grown rapidly to improve care of seriously ill individuals. Although research indicates that IPC teams effectively reduce and maintain control of pain, racial and ethnic differences in pain following IPC consultation remain unclear. This study investigated racial and ethnic pain differences after an IPC intervention in 385 seriously ill white, black, and Latino individuals aged 65 and older. Using the 11-point Numeric Rating Scale for pain, individuals were asked to rate their pain intensity at four points during hospitalization (before IPC consultation, 2 and 24 hours after the consultation, and at hospital discharge). Results indicate that whites (F1.657, 173.998 = 16.528, P < .001), blacks (F1.800, 95.410 = 7.103, P = .002), and Latinos (F1.388, 73.584 = 10.902, P < .001) all experienced significant reductions in pain after the intervention. Adjusted multivariate models testing between-group racial and ethnic differences revealed that Latinos were 62% more likely than whites to report experiencing pain at hospital discharge (relative risk = 0.38, 95% confidence interval = 0.15-0.97). Regardless of race or ethnicity, IPC effectively reduces and controls pain after consultation. Despite pain decreases, Latinos remain more likely than whites to report pain at follow-up. Further research is needed to determine the mechanisms in operation and to better understand and address the needs of this population.

Multiethnic differences in responses to laboratory pain stimuli among children.

A growing body of literature suggests ethnic differences in experimental pain. However, these studies largely focus on adults and the comparison between Caucasians and African Americans. The primary aim of this study is to determine ethnic differences in laboratory-induced pain in a multiethnic child sample. Participants were 214 healthy children (mean age = 12.7, SD = 3.0 years). Ninety-eight Caucasian, 58 Hispanic, 34 African American, and 24 Asian children were exposed to four trials of pressure and radiant heat pain stimuli. Pain responses were assessed with self-report measures (i.e., pain intensity and unpleasantness) and behavioral observation (i.e., pain tolerance). Asians demonstrated more pain sensitivity than Caucasians, who evidenced more pain sensitivity than African Americans and Hispanics. The results hold even after controlling for age, sex, SES, and experimenter's ethnicity. Asians also showed higher anticipatory anxiety compared with other ethnic groups. Anticipatory anxiety accounted for some ethnic differences in pain between Asians, Hispanics, and African Americans. By examining response to laboratory pain stimuli in children representing multiple ethnicities, an understudied sample, the study reveals unique findings compared to the existing literature. These findings have implications for clinicians who manage acute pain in children from diverse ethnic backgrounds. Future investigations should examine mechanisms that account for ethnic differences in pain during various developmental stages.

Ethnic Differences in Pain and Pain Management

Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers' treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes.

The burden of chronic lower back pain with neuropathic components: a healthcare resource perspective

The burden of chronic lower back pain with neuropathic components: a healthcare resource perspective

Ethnic differences in pain, itch and thermal detection in response to topical capsaicin: African Americans display a notably limited hyperalgesia and neurogenic inflammation

Topical application of capsaicin commonly produces burning, stinging and itching as well as hyperalgesia to heat stimuli via activation of transient receptor potential vanilloid subtype 1. To investigate whether there are differences in sensory response and neurogenic inflammation to topical capsaicin in four different ethnic populations with different skin types. The study was performed in 40 healthy subjects consisting of 10 African Americans, 10 East Asians, 10 Hispanics and 10 Caucasians. Warmth sensation and heat pain detection thresholds, as well as pain intensity, were measured before and after application of capsaicin or placebo on forearms along with skin blood flow and the extent of the flare reaction. In African Americans the heat pain detection threshold, pain intensity and skin blood flow did not change significantly after capsaicin application, while in the other three ethnic groups a significant change occurred characterized by hyperalgesia and vasodilatation. The postcapsaicin warmth sensation threshold increased in African Americans and decreased in Hispanics, the latter also uniquely experiencing postcapsaicin itch. Our observations indicate that African Americans display a limited hypersensitivity following topical capsaicin, compared with the three other ethnic groups.

Ethnic differences in pain, itch and thermal detection in response to topical capsaicin: African Americans display a notably limited hyperalgesia and neurogenic inflammation

Ethnic differences in pain, itch and thermal detection in response to topical capsaicin: African Americans display a notably limited hyperalgesia and neurogenic inflammation

(932): Ethnic differences in pain, acculturation, and pain coping in young adults

(932): Ethnic differences in pain, acculturation, and pain coping in young adults

(837): Health disparities among race-ethnic and gender differences in self-care

Ethnic disparities in pain have recently gained increasing attention; however, very little is known about how differences in self-initiated care contribute to pain-related race-ethnic and gender disparities. The purpose of this study was to investigate ethnic differences in pain reducing self-initiated behaviors across race-ethnicity for males and females. Another aim was to evaluate both between group and within group differences in the use of pain medication and commonly practiced pain self-care as they relate to culture using both level of acculturation and linguistic factors among healthy Hispanic, non-Hispanic Whites, and non-Hispanic Black adults reporting oral or arthritic pain.

Ethnic Differences in Pain Among Outpatients with Terminal and End-Stage Chronic Illness

To explore ethnic and country of origin differences in pain among outpatients with terminal and end-stage chronic illness. Cohort study within a year-long trial of a palliative care consultation. Outpatient general medicine practice in an academic medical center. Ninety patients with advanced congestive heart failure, chronic obstructive pulmonary disease, or cancer, and with a prognosis between 1 and 5 years. Patients' report of pain using the Brief Pain Inventory and analgesic medications prescribed by primary care physicians. Differences in pain report and treatment were assessed at study entry, at 6 and 12 months. The overall burden of pain was high. Patients of color reported more pain than white patients, including measures of least pain (P = 0.02), average pain (P = 0.05), and current pain (P = 0.03). No significant ethnic group differences in pain were found comparing Asian, black, and Latino patients. Although nearly all patients who were offered opioid analgesics reported using them, opioids were rarely prescribed to any patient. There were no differences in pain between patients born in the U.S. and immigrants. Pain is common among outpatients with both terminal and end-stage chronic illness. There do not appear to be any differences in pain with regard to country of origin, but patients of color report more pain than white patients. Patients of all ethnicities are inadequately treated for their pain, and further study is warranted to explore the relative patient and physician contributions to the finding of unequal symptom burden and inadequate treatment effort.

Ethnic Similarities and Differences in the Chronic Pain Experience: A Comparison of African American, Hispanic, and White Patients

Ethnic differences in the perception, experience, and impact of pain have received growing attention in recent years. Although studies comparing pain among African Americans, Hispanics, and whites have yielded mixed findings, increasing evidence suggests an enhancement of the pain experience for African American and Hispanic patients. Mechanisms proposed to account for this effect include systematic differences in psychological distress and in pain-coping strategies, or differential relationships between these factors and pain. However, few studies have evaluated all of these variables, or matched ethnic groups precisely on potential confounds. The present study compares African American, Hispanic, and white chronic pain patients across multiple dimensions of pain, emotional distress, pain-related disability, and pain coping after matching patients on a variety of potentially confounding variables. Results indicated no significant ethnic differences on measures of pain, depression, psychopathology, or pain-related disability. While most coping variables did not differ by ethnicity, substantive group differences were evident on the praying and hoping subscale of the Coping Strategies Questionnaire, with African Americans and Hispanics reporting higher scores relative to whites on items relating to prayer. Inter-relationships among pain, coping, and distress were generally quite similar across ethnic groups, although active coping showed some variation in its relationship with pain-related outcomes. Catastrophizing was generally associated with greater pain and distress, and use of prayer/hope as a coping strategy was associated with greater disability across ethnic groups. These results suggest that ethnic differences in pain, pain-related sequelae, and affective factors may be small when ethnic groups are closely matched on confounding variables. Moreover, interventions designed to facilitate adaptive coping are likely to be effective across ethnic groups.

Ethnic differences in pain coping: Factor structure of the coping strategies questionnaire and coping strategies questionnaire-revised

Coping has been examined extensively in the pain literature, although coping instruments have been typically validated in clinical populations with little ethnic diversity. This study examined the factor structure of the Coping Strategies Questionnaire (CSQ) and the CSQ-Revised (CSQ-R) in 650 healthy male and female African American (44%) and white (56%) subjects and explored associations of coping to health and pain-related measures. Factor analyses revealed 6 components for each ethnic group, accounting for comparable amounts of variance and resembling previously reported CSQ subscales. Internal consistency for both ethnic groups was acceptable (0.72-0.91). There were significant main effects for ethnicity on 4 of the CSQ-R scales ( P < .05). No ethnic differences in pain or health variables emerged, although when split into high-pain versus minimal-pain groups, differences were revealed on catastrophizing. Results indicate that the factor structure of the CSQ-R in healthy adults is similar to clinical populations and is comparable across African American and white subjects. Group differences on CSQ-R scales suggest potentially important ethnic influences on pain coping. These findings support the use of the CSQ-R to assess coping in African Americans and in healthy young adults. Additional clinical research is needed to determine the practical importance of group differences in pain coping. Perspective Coping has been examined extensively in the pain literature, although coping instruments typically have been validated in clinical populations with little ethnic diversity. This study examines the factor structure of the CSQ-Revised in an ethnically diverse population and supports the use of the CSQ-R to assess coping in African Americans and in healthy young adults.

Social and cultural variables: Ethnic differences in pain and other symptoms associated with blood or marrow transplantations

BMT (Blood and marrow transplantation) is widely used and leads to a variety of severe symptoms. As with other cancer treatments, patients' survival and treatment effectiveness are linked with effective symptom management. Virtually no literature has examined African American or Hispanic experiences or symptoms with BMT, and little BMT research has been longitudinal. A recently completed study included the aim of evaluating the relationship of symptoms, functional status, and quality of life at multiple time points over the course of the BMT experience in these ethnic groups. The goals of this longitudinal study are to examine ethnic differences in pain and symptom report and to determine the relationships between symptoms, functional status and quality of life of patients during the first 100 days post-transplantation. Sixty-two patients (24 African-Americans and 38 Hispanics) completed the BMT module of the M.D. Anderson Symptom Inventory (MDASI) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) at baseline and seven more times during the first 100 days post-transplantation. The patients' performance status was also recorded. There were no significant differences in symptom severity, symptom interference, quality of life and ECOG performance status between Hispanics and African-Americans over time. Pain was reported to be severe in 10 to 23% of patients over time. There were significant differences in symptom severity, symptom interference and ECOG performance status across time in both groups. These measures gradually increased starting from baseline, reached their maximum at T4 (when white blood cell counts were at nadir) and then started to decline. There were no significant differences in quality of life between ethnic groups. Changes in symptom interference are significantly correlated with changes in quality of life. Symptom interference for patients undergoing BMT was more closely related to quality of life than was symptom severity.