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Hsu PS, Liu CH, Yang CJ, Lee LC, Li WC, Chao HT, Lin MW, Chen LF, Hsieh JC. Reward system neurodynamics during menstrual pain modulated by COMT Val158Met polymorphisms. Front Mol Neurosci 2024; 17:1457602. [PMID: 39290829 PMCID: PMC11405383 DOI: 10.3389/fnmol.2024.1457602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Primary dysmenorrhea (PDM), characterized by cyclic pain, may involve pain modulation within the reward system (RS). The Catechol-O-methyltransferase (COMT) Val158Met polymorphism, which significantly influences dopamine activity, is linked to the regulation of both acute and chronic pain. This study examines the differential neurodynamic modulation in the RS associated with COMT Val158Met polymorphisms during menstrual pain among PDM subjects. Method Ninety-one PDM subjects underwent resting-state fMRI during menstruation and were genotyped for COMT Val158Met polymorphisms. The amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) analyses were used to assess the RS response. Psychological evaluations included the McGill Pain Questionnaire, Pain Catastrophizing Scale, Beck Anxiety Inventory, and Beck Depression Inventory. Result Val/Val homozygotes (n = 50) and Met carriers (n = 41) showed no significant differences in McGill Pain Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory. However, Met carriers exhibited lower scores on the Pain Catastrophizing Scale. Distinct FC patterns was observed between Val/Val homozygotes and Met carriers, specifically between the nucleus accumbens (NAc) and prefrontal cortex, NAc and inferior parietal lobe, ventral tegmental area (VTA) and prefrontal cortex, VTA and precentral gyrus, and VTA and superior parietal lobe. Only Met carriers showed significant correlations between ALFF and FC values of the NAc and VTA with pain-related metrics (McGill Pain Questionnaire and Pain Catastrophizing Scale scores). NAc ALFF and NAc-prefrontal cortex FC values positively correlated with pain-related metrics, while VTA ALFF and VTA-prefrontal cortex and VTA-superior parietal lobe FC values negatively correlated with pain-related metrics. Discussion This study reveals that the COMT Val158Met polymorphism results in genotype-specific functional changes in the brain's RS during menstrual pain. In Met carriers, engagement of these regions is potentially linked to motivational reward-seeking and top-down modulation. This polymorphism likely influences the RS's responses, significantly contributing to individual differences in pain regulation.
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Affiliation(s)
- Pei-Shan Hsu
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ching-Hsiung Liu
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ching-Ju Yang
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biological Science and Technology, College of Engineering Bioscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Lin-Chien Lee
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wei-Chi Li
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biological Science and Technology, College of Engineering Bioscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiang-Tai Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Wei Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Fen Chen
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Chuen Hsieh
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biological Science and Technology, College of Engineering Bioscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Liu Y, Huang C, Xiong Y, Wang X, Shen Z, Zhang M, Gao N, Wang N, Du G, Zhan H. The causal relationship between human brain morphometry and knee osteoarthritis: a two-sample Mendelian randomization study. Front Genet 2024; 15:1420134. [PMID: 39040992 PMCID: PMC11260717 DOI: 10.3389/fgene.2024.1420134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background Knee Osteoarthritis (KOA) is a prevalent and debilitating condition affecting millions worldwide, yet its underlying etiology remains poorly understood. Recent advances in neuroimaging and genetic methodologies offer new avenues to explore the potential neuropsychological contributions to KOA. This study aims to investigate the causal relationships between brain-wide morphometric variations and KOA using a genetic epidemiology approach. Method Leveraging data from 36,778 UK Biobank participants for human brain morphometry and 487,411 UK Biobank participants for KOA, this research employed a two-sample Mendelian Randomization (TSMR) approach to explore the causal effects of 83 brain-wide volumes on KOA. The primary method of analysis was the Inverse Variance Weighted (IVW) and Wald Ratio (WR) method, complemented by MR Egger and IVW methods for heterogeneity and pleiotropy assessments. A significance threshold of p < 0.05 was set to determine causality. The analysis results were assessed for heterogeneity using the MR Egger and IVW methods. Brain-wide volumes with Q_pval < 0.05 were considered indicative of heterogeneity. The MR Egger method was employed to evaluate the pleiotropy of the analysis results, with brain-wide volumes having a p-value < 0.05 considered suggestive of pleiotropy. Results Our findings revealed significant causal associations between KOA and eight brain-wide volumes: Left parahippocampal volume, Right posterior cingulate volume, Left transverse temporal volume, Left caudal anterior cingulate volume, Right paracentral volume, Left paracentral volume, Right lateral orbitofrontal volume, and Left superior temporal volume. These associations remained robust after tests for heterogeneity and pleiotropy, underscoring their potential role in the pathogenesis of KOA. Conclusion This study provides novel evidence of the causal relationships between specific brain morphometries and KOA, suggesting that neuroanatomical variations might contribute to the risk and development of KOA. These findings pave the way for further research into the neurobiological mechanisms underlying KOA and may eventually lead to the development of new intervention strategies targeting these neuropsychological pathways.
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Affiliation(s)
- Yongming Liu
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chao Huang
- Yunyang County People’s Hospital Rehabilitation Medicine Department, Chongqing, China
| | - Yizhe Xiong
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Wang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhibi Shen
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Mingcai Zhang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ningyang Gao
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Nan Wang
- Department of Traditional Chinese Medicine, Shanghai Yangzhi Rehabilitation Hospital (Yangzhi Affiliated Rehabilitation Hospital), School of Medicine, Tongji University, Shanghai, China
| | - Guoqing Du
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Hongsheng Zhan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Apriliyasari RW, Chou CW, Tsai PS. Pain Catastrophizing as a Mediator Between Pain Self-Efficacy and Disease Severity in Patients with Fibromyalgia. Pain Manag Nurs 2023; 24:622-626. [PMID: 37321890 DOI: 10.1016/j.pmn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, sleep disturbances, cognitive impairment, and mood disturbance. Both pain catastrophizing and pain self-efficacy have been found to be mediators of pain treatment effectiveness. However, whether pain catastrophizing mediates the association between pain self-efficacy and FM severity remains unclear. AIM To examine whether pain catastrophizing mediates the association between pain self-efficacy and disease severity in patients with FM. METHODS This cross-sectional study included the baseline data of 105 people with FM from a randomized controlled trial. Hierarchical linear regression analysis was performed to examine the predictive ability of pain catastrophizing for FM severity. Furthermore, we examined the mediating effect of pain catastrophizing on the association between pain self-efficacy and FM severity. RESULTS Pain self-efficacy was negatively associated with pain catastrophizing (β = -.4043, p < .001). FM severity was positively associated with pain catastrophizing (β = .8290, p < .001) and negatively associated with pain self-efficacy (β = -.3486, p = .014). Pain self-efficacy had a direct effect on FM severity (β = -.6837, p < .001) and an indirect effect on FM severity through the effect of pain catastrophizing (β = -.3352, 95% CI bootstrapping -.5008 to -.1858). CONCLUSION Pain catastrophizing independently predicts FM severity and mediates the association between pain self-efficacy and FM severity. Pain catastrophizing should be monitored through interventions aimed at improving pain self-efficacy to reduce symptom burden in patients with FM.
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Affiliation(s)
- Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Institut Teknologi Kesehatan (ITEKES) Cendekia Utama Kudus, Kudus, Indonesia
| | - Chia-Wen Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Ionescu D, Iacob CI, Brehar FM, Avram E. The role of catastrophizing and basic psychological needs satisfaction on health-related quality of life and pain in patients with lumbar disc herniation. Front Psychol 2023; 14:1147254. [PMID: 37425150 PMCID: PMC10323192 DOI: 10.3389/fpsyg.2023.1147254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Lumbar disc herniation (LDH) is one of the most common conditions associated with functional disability, affecting patients' quality of life (QOL). Disability can be affected by cognitive factors, such as pain catastrophizing. Similarly, unfulfilled basic psychological needs (i.e., autonomy, competence, relatedness) are associated with biases in pain perception and QOL. Using the fear-avoidance model and the self-determination theory, this study investigates: (1) the separate contribution of pain-related variables and basic psychological needs satisfaction in predicting QOL in patients proposed for LDH surgery; (2) pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction. Methods First, we used hierarchical regression on 193 patients (Mage = 46.10, SDage = 11.40) to identify predictors of QOL. Second, we performed paired t-tests on 55 patients to investigate pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction. Results Hierarchical regression showed that the model predicts 27% of the variance in QOL; medium pain level, age, pain catastrophizing, and basic psychological needs satisfaction were significant predictors. Also, pain catastrophizing significantly decreased after surgery [t (54) = 6.07, p < 0.001, Cohen's d = 0.81], but basic psychological needs satisfaction did not modify significantly. Discussion This research confirms the importance of pain perception and pain catastrophizing for LDH patients' QOL and broadens the applicability of the self-determination theory for spinal patients.
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Affiliation(s)
- Daniela Ionescu
- Department of Sociology, National School of Political and Administrative Studies, Bucharest, Romania
| | - Claudia Iuliana Iacob
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Felix Mircea Brehar
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eugen Avram
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
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Wilk M, Pripp AH, Korkosz M, Haugeberg G. Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders. Rheumatol Int 2023; 43:687-694. [PMID: 36624289 DOI: 10.1007/s00296-023-05271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient's personality traits and coping abilities, plays a less important role for the patient than general pain perception.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland.
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Lannon EW, Hellman N, Huber FA, Kuhn BL, Sturycz CA, Palit S, Payne MF, Guereca YM, Toledo T, Shadlow JO, Rhudy JL. Exploration of the trait-activation model of pain catastrophizing in Native Americans: results from the Oklahoma Study of Native American pain risk (OK-SNAP). Scand J Pain 2022; 22:587-596. [PMID: 35289511 PMCID: PMC10165978 DOI: 10.1515/sjpain-2021-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Native Americans (NAs) have the highest prevalence of chronic pain of any racial/ethnic group. This issue has received little attention from the scientific community. One factor that may contribute to racial pain disparities is pain catastrophizing. Pain catastrophizing is a construct related to negative pain outcomes in persons with/without chronic pain. It has been suggested that the relationship between trait catastrophizing and pain is mediated by situation-specific (state) catastrophizing. The present study has 2 aims: (1) to investigate whether state pain catastrophizing mediates the relationship between trait catastrophizing and experimental pain (e.g., cold, ischemic, heat and electric tolerance), and (2) to investigate whether this relationship is stronger for NAs. METHODS 145 non-Hispanic Whites (NHWs) and 137 NAs completed the study. Bootstrapped indirect effects were calculated for 4 unmoderated and 8 moderated mediation models (4 models with path a moderated and 4 with path b). RESULTS Consistent with trait-activation theory, significant indirect effects indicated a tendency for trait catastrophizing to be associated with greater state catastrophizing which in turn is associated with reduced pain tolerance during tonic cold (a × b=-0.158) and ischemia stimuli (a × b=-0.126), but not during phasic electric and heat stimuli. Moderation was only noted for the prediction of cold tolerance (path a). Contrary to expectations, the indirect path was stronger for NHWs (a × b for NHW=-.142). CONCLUSIONS Together, these findings suggest that state catastrophizing mediates the relationship between trait catastrophizing and some measures of pain tolerance but this indirect effect was non-significant for NAs.
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Affiliation(s)
- Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Stanford University, 450 Serra Mall, Stanford, Stanford, CA94305, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Shreela Palit
- University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH, USA
| | - Yvette M Guereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Tyler Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Kell PA, Huber FA, Street EN, Shadlow JO, Rhudy JL. Sleep Problems Mediate the Relationship Between Psychosocial Stress and Pain Facilitation in Native Americans: A Structural Equation Modeling Analysis from the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2022; 56:1116-1130. [PMID: 35775809 PMCID: PMC9924047 DOI: 10.1093/abm/kaac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset. PURPOSE This study examined the effects of psychological stress and sleep problems on subjective and physiological measures of pain processing in NAs and NHWs. METHODS Structural equation modeling was used to determine whether ethnicity (NA or NHW) was associated with psychological stress or sleep problems and whether these variables were related to conditioned pain modulation of pain perception (CPM-pain) and the nociceptive flexion reflex (CPM-NFR), temporal summation of pain (TS-pain) and NFR (TS-NFR), and pain tolerance in a sample of 302 (153 NAs) pain-free participants. RESULTS NAs experienced more psychological stress (Estimate = 0.027, p = .009) and sleep problems (Estimate = 1.375, p = .015) than NHWs. When controlling for age, sex, physical activity, BMI, and general health, NA ethnicity was no longer related to greater sleep problems. Psychological stress was also related to sleep problems (Estimate = 30.173, p = <.001) and psychological stress promoted sleep problems in NAs (indirect effect = 0.802, p = .014). In turn, sleep problems were associated with greater TS-pain (Estimate = 0.714, p = .004), but not other pain measures. CONCLUSIONS Sleep problems may contribute to chronic pain risk by facilitating pain perception without affecting facilitation of spinal neurons or endogenous inhibition of nociceptive processes. Since psychological stress promoted pain facilitation via enhanced sleep problems, efforts to reduce psychological stress and sleep problems among NAs may improve health outcomes.
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Affiliation(s)
- Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Rhudy JL, Huber FA, Toledo TA, Kell PA, Street EN, Shadlow JO. Psychosocial and cardiometabolic predictors of chronic pain onset in Native Americans: serial mediation analyses of 2-year prospective data from the Oklahoma Study of Native American Pain Risk. Pain 2022; 163:e654-e674. [PMID: 34433767 PMCID: PMC8866534 DOI: 10.1097/j.pain.0000000000002458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain results in considerable suffering, as well as significant economic and societal costs. Previous evidence suggests that Native Americans (NAs) have higher rates of chronic pain than other U.S. racial or ethnic groups, but the mechanisms contributing to this pain disparity are poorly understood. The Oklahoma Study of Native American Pain Risk was developed to address this issue and recruited healthy, pain-free NAs and non-Hispanic Whites. Cross-sectional analyses identified several measures of adversity (eg, trauma and discrimination), cognitive-affective factors (perceived stress and pain-related anxiety/catastrophizing), and cardiometabolic factors (eg, body mass index, blood pressure, and heart rate variability) that were associated with pronociceptive processes (eg, central sensitization, descending inhibition, and hyperalgesia). Every 6-months after enrollment, eligible participants (N = 277) were recontacted and assessed for the onset of chronic pain. This study examines predictors of chronic pain onset in the 222 participants (80%) who responded over the first 2 years. The results show that NAs developed chronic pain at a higher rate than non-Hispanic Whites (OR = 2.902, P < 0.05), even after controlling for age, sex, income, and education. Moreover, serial mediation models identified several potential pathways to chronic pain onset within the NA group. These paths included perceived discrimination, psychological stress, pain-related anxiety, a composite measure of cardiometabolic risk, and impaired descending inhibition of spinal nociception (assessed from conditioned pain modulation of the nociceptive flexion reflex). These results provide the first prospective evidence for a pain disparity in NAs that seems to be promoted by psychosocial, cardiometabolic, and pronociceptive mechanisms.
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Affiliation(s)
- Jamie L. Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Tyler A. Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Parker A. Kell
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Erin N. Street
- The University of Tulsa, Department of Psychology, Tulsa, OK
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Huber FA, Kell PA, Kuhn BL, Lannon EW, Palit S, Payne MF, Hellman N, Sturycz CA, Güereca YM, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. The Association Between Adverse Life Events, Psychological Stress, and Pain-Promoting Affect and Cognitions in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J Racial Ethn Health Disparities 2022; 9:215-226. [PMID: 33428157 PMCID: PMC8272727 DOI: 10.1007/s40615-020-00945-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
Native Americans (NAs) experience higher rates of chronic pain. To examine the mechanisms for this pain inequity, we have previously shown that NAs report higher levels of pain-related anxiety and pain catastrophizing, which are in turn related to pronociceptive (pain-promoting) processes. But, it is currently unclear why NAs would report greater pain-related anxiety and catastrophizing. Given that NAs are also more likely to experience adverse life events (ALEs) and associated psychological distress, it was hypothesized that higher anxiety/catastrophizing in NAs would be partially explained by higher rates of ALEs and psychological distress. Structural equation modeling was used to analyze these pathways (NA ethnicity ➔ ALEs ➔ psychological distress ➔ pain anxiety/catastrophizing) in 305 healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Pain-related anxiety and situational pain catastrophizing were assessed in response to a variety of painful tasks. The Life Events Checklist was used to assess cumulative exposure to ALEs that directly happened to each participant. A latent psychological distress variable was modeled from self-reported perceived stress and psychological symptoms. Results found that NAs experienced more ALEs and greater psychological distress which was associated with higher rates of pain-related anxiety and pain catastrophizing. Notably, NAs did not report greater psychological distress when controlling for ALE exposure. This suggests that a higher risk of chronic pain in NAs may be due, in part, to psychological distress, pain-related anxiety, and pain catastrophizing that are promoted by exposure to ALEs. These results highlight several targets for intervention to decrease NA pain risk.
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Affiliation(s)
- Felicitas A Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
- Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Cassandra A Sturycz
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Burkhart J Hahn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
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10
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Rhudy JL, Kuhn BL, Demuth MJ, Huber FA, Hellman N, Toledo TA, Lannon EW, Palit S, Payne MF, Sturycz CA, Kell PA, Guereca YM, Street EN, Shadlow JO. Are Cardiometabolic Markers of Allostatic Load Associated With Pronociceptive Processes in Native Americans?: A Structural Equation Modeling Analysis From the Oklahoma Study of Native American Pain Risk. THE JOURNAL OF PAIN 2021; 22:1429-1451. [PMID: 34033965 PMCID: PMC8578174 DOI: 10.1016/j.jpain.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Native Americans (NAs) experience higher rates of chronic pain than the general U.S. population, but the risk factors for this pain disparity are unknown. NAs also experience high rates of stressors and cardiovascular and metabolic health disparities (eg, diabetes, cardiovascular disease) consistent with allostatic load (stress-related wear-and-tear on homeostatic systems). Given that allostatic load is associated with chronic pain, then allostatic load may contribute to their pain disparity. Data from 302 healthy, pain-free men and women (153 NAs, 149 non-Hispanic Whites [NHW]) were analyzed using structural equation modeling to determine whether cardiometabolic allostatic load (body mass index, blood pressure, heart rate variability) mediated the relationship between NA ethnicity and experimental measures of pronociceptive processes: temporal summation of pain (TS-pain) and the nociceptive flexion reflex (TS-NFR), conditioned pain modulation of pain (CPM-pain) and NFR (CPM-NFR), and pain tolerance. Results indicated that NAs experienced greater cardiometabolic allostatic load that was related to enhanced TS-NFR and impaired CPM-NFR. Cardiometabolic allostatic load was unrelated to measures of pain perception (CPM-pain, TS-pain, pain sensitivity). This suggests cardiometabolic allostatic load may promote spinal sensitization in healthy NAs, that is not concomitant with pain sensitization, perhaps representing a unique pain risk phenotype in NAs. PERSPECTIVE: Healthy, pain-free Native Americans experienced greater cardiometabolic allostatic load that was associated with a pronociceptive pain phenotype indicative of latent spinal sensitization (ie, spinal sensitization not associated with hyperalgesia). This latent spinal sensitization could represent a pain risk phenotype for this population.
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Affiliation(s)
- Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma.
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio
| | | | - Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Yvette M Guereca
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
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11
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Ross EN, Toledo TA, Huber F, Kell PA, Hellman N, Shadlow JO, Rhudy JL. The role of self-evaluated pain sensitivity as a mediator of objectively measured pain tolerance in Native Americans: findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP). J Behav Med 2021; 45:272-284. [PMID: 34545536 DOI: 10.1007/s10865-021-00257-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/06/2021] [Indexed: 11/24/2022]
Abstract
Native Americans (NAs) are at increased risk for chronic pain. One mechanism contributing to this pain disparity could be personal pain beliefs, which may influence actual pain sensitivity. Thus, we examined whether self-evaluated pain sensitivity (SEPS) mediates the relationship between ethnicity [NAs vs. non-Hispanic Whites (NHWs)] and objectively-measured pain tolerance, and whether catastrophic thinking and pain-related anxiety influence these pain beliefs. 232 healthy, pain-free NAs and NHWs completed questionnaires measuring SEPS, catastrophizing, and anxiety. Objective pain tolerance was also assessed. Results suggested: (1) NAs reported higher levels of SEPS, catastrophizing, and anxiety, (2) catastrophizing may have enhanced anxiety and both catastrophizing and anxiety were associated with higher SEPS, and (3) anxiety and SEPS were associated with lower pain tolerance. A significant bootstrapped mediation analysis suggested NAs experienced higher pain-related anxiety, which may have promoted higher SEPS, that in turn reduced pain tolerance. Longitudinal research is needed to confirm this.
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Affiliation(s)
- Erin N Ross
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
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12
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Kell PA, Hellman N, Huber FA, Lannon EW, Kuhn BL, Sturycz CA, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. The Relationship Between Adverse Life Events and Endogenous Inhibition of Pain and Spinal Nociception: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP). THE JOURNAL OF PAIN 2021; 22:1097-1110. [PMID: 33819573 PMCID: PMC8419014 DOI: 10.1016/j.jpain.2021.03.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Adverse life events (ALEs) are a risk factor for chronic pain; however, mechanisms underlying this association are not understood. This study examined whether cumulative ALE exposure impairs endogenous inhibition of pain (assessed from pain report) and spinal nociception (assessed from nociceptive flexion reflex; NFR) in healthy, pain-free Native Americans (n = 124) and non-Hispanic Whites (n = 129) during a conditioned pain modulation (CPM) task. Cumulative ALE exposure was assessed prior to testing by summing the number of potentially traumatic events experienced by each participant across their lifespan. Multilevel modeling found that ALEs were associated with NFR modulation during the CPM task even after controlling for general health, body mass index, sex, age, blood pressure, sleep quality, stimulation intensity, stimulus number, perceived stress, and psychological distress. Low exposure to ALEs was associated with NFR inhibition, whereas high exposure to ALEs was associated with NFR facilitation. By contrast, pain perception was inhibited during the CPM task regardless of the level of ALE exposure. Race/ethnicity did not moderate these results. Thus, ALEs may be pronociceptive for both Native Americans and non-Hispanic Whites by impairing descending inhibition of spinal nociception. This could contribute to a chronic pain risk phenotype involving latent spinal sensitization. PERSPECTIVE: This study found that adverse life events were associated with impaired descending inhibition of spinal nociception in a sample of Native Americans and non-Hispanic Whites. These findings expand on previous research linking adversity to chronic pain risk by identifying a proximate physiological mechanism for this association.
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Affiliation(s)
- Parker A Kell
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Natalie Hellman
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Edward W Lannon
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Bethany L Kuhn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Tyler A Toledo
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Burkhart J Hahn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma.
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13
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Identification of preoperative predictors for acute postsurgical pain and for pain at three months after surgery: a prospective observational study. Sci Rep 2021; 11:16459. [PMID: 34385556 PMCID: PMC8361098 DOI: 10.1038/s41598-021-95963-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Identifying patients at risk is the start of adequate perioperative pain management. We aimed to identify preoperative predictors for acute postsurgical pain (APSP) and for pain at 3 months after surgery to develop prediction models. In a prospective observational study, we collected preoperative predictors and the movement-evoked numerical rating scale (NRS-MEP) of postoperative pain at day 1, 2, 3, 7, week 1, 6 and 3 months after surgery from patients with a range of surgical procedures. Regression analyses of data of 2258 surgical in- and outpatients showed that independent predictors for APSP using the mean NRS-MEP over the first three days after surgery were hospital admittance, female sex, higher preoperative pain, younger age, pain catastrophizing, anxiety, higher score on functional disability, highest categories of expected pain, medical specialty, unknown wound size, and wound size > 10 cm compared to wound size ≤ 10 cm (RMSE = 2.11). For pain at three months, the only predictors were preoperative pain and a higher score on functional disability (RMSE = 1.69). Adding pain trajectories improved the prediction of pain at three months (RMSE = 1.37). Our clinically applicable prediction models can be used preoperatively to identify patients at risk, as well as in the direct postoperative period.
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