Racial Differences in Movement-Related Appraisals and Pain Behaviors Among Adults With Chronic Low Back Pain

Self-rated pain and observed pain behavior in Black and White Americans with chronic low back pain

Black Americans report more intense and disabling pain than White Americans, but differences in pain behavior have rarely been studied. The Structured Pain Behavior Test (SPBT), a standardized, video-recorded series of pain-inducing movements, assesses the behavioral expression of pain. We conducted the first test of whether Black Americans with chronic low back pain (CLBP) have greater pain behavior and increased self-reported pain intensity during the SPBT, compared to White Americans. Adults (N = 267) with CLBP (174 Black, 93 White; 57% female) rated their clinical pain severity and interference (Multidimensional Pain Inventory; MPI) and their current pain intensity (Numerical Rating Scale; NRS) both before and after engaging in the SPBT, which was coded for observed pain behavior. Consistent with prior research, Black participants reported greater MPI clinical pain severity and interference (large effect). More importantly, during the SPBT, Black participants had greater pain behavior (medium effect) and reported a greater increase in pain intensity (NRS; small-medium effect) than did Whites. Racialized differences in all pain measures remained significant after controlling for multiple variables (including depressive symptoms and pain catastrophizing), and differences in observed pain behavior remained after also controlling for self-reported pain intensity (NRS) or MPI clinical pain severity. We conclude that greater self-reported pain severity and interference among Black Americans is accompanied by greater pain behavior and increased pain intensity in response to pain-inducing movements. Research should examine possible mechanisms of this racialized difference, including differential access and care, racism as pain exacerbator, and the social communication of pain. PERSPECTIVE: Black Americans with chronic back pain have greater self-reported pain severity than White Americans and greater pain behavior during the Structured Pain Behavior Test, even after controlling for self-reported pain and other variables. Black Americans' elevated pain may reflect poorer health care, racism-induced pain exacerbation, and/or social communication of need.

Psychologically Informed Physical Therapy Management of Chronic Musculoskeletal Pain in Culturally Diverse Populations: An Intervention Logic Model

Culturally and linguistically diverse (CALD) individuals are underrepresented in pain research, including studies of psychologically informed physical therapy (PIPT) for musculoskeletal pain. This perspective describes a conceptual framework for PIPT management of chronic musculoskeletal pain that identifies essential elements that can be culturally tailored to meet the needs of different CALD populations. Essential interventions, determinants of behavior change, and clinical outcomes were identified from studies of existing PIPT interventions for chronic pain. PIPT approaches shared the following essential interventions: 1) cognitive skill training, 2) general aerobic activity, 3) impairment-based therapeutic exercises, and 4) graded functional movement training. An intervention logic model was developed to conceptualize how these interventions might promote active coping behaviors and greater engagement in physical activity, therapeutic exercise, and functional mobility. The model included physical and cognitive-emotional processes that may contribute to behavioral changes that ultimately reduce pain-related disability. To illustrate the cultural tailoring of model constructs, we describe how intervention delivery and assessments were customized for Latino persons with chronic spine pain at a health center located near the United States-Mexico border. A literature review of sociocultural influences on the pain experience of Latino persons was conducted, and essential elements of the model were operationalized to ensure that therapeutic goals, language, content, and processes were compatible with Latino cultural beliefs, values, and behaviors. Future research using the proposed model to adapt and test PIPT interventions for other CALD populations may help identify shared and divergent mechanisms of treatment response for culturally tailored pain management programs. PERSPECTIVE: A novel conceptual framework may help inform the cultural tailoring of PIPT management approaches for chronic musculoskeletal pain by maintaining fidelity to essential treatment elements while also leveraging the unique sociocultural context of different CALD communities to improve health outcomes.

The interplay of fear of pain, emotional states, and pain perception in medical and nursing students: A cross-sectional study

BACKGROUND

Fear of pain is known to influence pain perception and worsen pain outcomes. However, its relationship with pain threshold remains unclear. Negative emotional states, namely depression, anxiety, and stress, have been found to increase fear of pain. Previous pain experiences, both undergone and observed, can also influence fear of pain. Furthermore, healthcare students' interactions with pain patients may be influenced by fear of pain and pain perception. This study aimed to assess fear of pain among Portuguese medical and nursing students, analyse its association with sex, negative emotional states, previous pain experiences, and curricular year, and evaluate the influence of fear of pain on heat pain threshold.

METHODS

A survey based on validated Portuguese questionnaires was carried out. Participants were then invited for quantitative sensory tests to assess heat pain threshold.

RESULTS

Fear of pain was similar for medical and nursing students. Female students presented a higher fear of medical pain. Stress was associated with an increased fear of severe pain. Previous painful experiences, particularly those involving medical procedures, have been found to be variably associated with fear of pain, depending on the type and characteristics of these experiences. No associations were found between fear of pain and curricular year, nor between heat pain threshold and sex or fear of pain.

CONCLUSIONS

This study highlights relevant aspects of the emotional and cognitive modulation of fear of pain and pain perception in medical and nursing students. The influence of previous pain experiences on fear of pain is also essential because healthcare students are frequently exposed to painful medical situations during their courses. As altered pain perception can influence their role as future healthcare professionals, the study of fear of pain and its modulators in healthcare students represents an important research field.