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Kwagala C, Munube D, Abbo C, Muhwezi WW, Mwesiga EK. Prevalence and factors associated with opioid use disorder among adolescents with sickle cell disease in Mulago hospital, Uganda. Child Adolesc Psychiatry Ment Health 2024; 18:94. [PMID: 39090740 PMCID: PMC11295896 DOI: 10.1186/s13034-024-00790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Opioid use disorder (OUD) among adolescents with sickle cell disease (SCD) patients increases their risk of complications from sickle cell disease, such as infections, stroke, acute chest syndrome, sudden death, and organ failure. This negatively impacts families, communities, the national health system, and the economy. This study aimed to determine the prevalence and factors associated with opioid use disorder among adolescents with SCD at Mulago Hospital Uganda. METHODS This study was carried out at the Sickle Cell Clinic of Mulago Hospital, the national referral hospital in Uganda. The study participants were adolescents aged 10 to 19 years. Following informed consent/ assent, a sociodemographic questionnaire, the WHO Alcohol, Smoking and Substance Involvement Screening Test - Young (ASSIST-Y), the Beck Depression Inventory-II (BDI II), and Generalized Anxiety Disorder - 7 (GAD-7) questionnaires were used to collect data. Data was entered in EpiInfo and analyzed in STATA 15. RESULTS The prevalence of opioid use disorder was 5.3%. The significant risk factor was increasing depressive score AOR: 1.11(95% CI: 1.01-1.22, p = 0.035), while living with a family was protective against opioid use disorders AOR: 0.01; (95% CI: 0.0004, 0.27, p = 0.007). CONCLUSION There was a significant problem of OUD among adolescents with SCD. There is, therefore, needed to integrate screening of OUD and mental illnesses like depression among adolescents with SCD and to emphasize the importance of family support in their care.
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Affiliation(s)
- Claire Kwagala
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
| | - Deogratias Munube
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Wilson Winstons Muhwezi
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Emmanuel Kiiza Mwesiga
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
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Garcia-Hernandez A, de la Coba P, Martinez-Triana RJ, Reyes Del Paso GA. Pain sensitisation in patients with sickle cell disease: A preliminary study. J Eval Clin Pract 2024. [PMID: 39023328 DOI: 10.1111/jep.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/12/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Responses to experimental pain have suggested central and peripheral sensitisation in adult patients with sickle cell disease (SCD). Recent studies have proposed an algometry-derived dynamic measure of pain sensitisation, slowly repeated evoked pain (SREP), which is useful in the discrimination of painful conditions related to central sensitisation. Pain and fatigue are two symptoms that affect the general functioning of patients with SCD most significantly, however, research about experimental dynamic pain measures and their relation to the main symptoms of SCD (pain and fatigue) is still scarce. OBJECTIVE This preliminary study aimed to test the utility of the SREP protocol for detecting pain sensitisation in patients with SCD, and to evaluate the associations of pain sensitisation, pain threshold, and pain tolerance with the main clinical symptoms of SCD, pain and fatigue. METHODS Twenty-two female outpatients with SCD and 20 healthy women participated. Pain threshold, pain tolerance, and pain sensitisation were assessed by algometry in the fingernail. Clinical pain, fatigue, anxiety, depression and pain catastrophizing were evaluated. RESULTS No group differences were found in pain threshold and tolerance. However, using the SREP protocol, pain sensitisation was greater in patients than in healthy participants, even after controlling for psychological variables and body mass index. Pain threshold and tolerance were inversely associated with fatigue levels in the SCD group, with pain tolerance being the main predictor. CONCLUSIONS Pain threshold and tolerance did not discriminate between patients and healthy individuals, but were useful for predicting fatigue severity in SCD. The SREP protocol provides a useful dynamic measure of pain for the discrimination and detection of enhanced pain sensitisation in patients with SCD, which could contribute to more personalised pain evaluations and treatment for these patients.
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Affiliation(s)
| | - Pablo de la Coba
- Department of Psychology and Anthropology, University of Extremadura, Avenida de la Universidad, Cáceres, Spain
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AuBuchon KE, Stock ML, Mathur VA, Attey B, Bowleg L. Bystander Acknowledgment Mitigates the Psychological and Physiological Pain of Racial Discrimination for Black Young Adults: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2024:104560. [PMID: 38735424 DOI: 10.1016/j.jpain.2024.104560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024]
Abstract
Racism increases pain sensitization and contributes to racialized pain inequities; however, research has not tested interventions targeting racism to reduce pain. In this study, we examined whether White bystanders can act to mitigate racism's pain-sensitizing effects. To simulate racial exclusion in the laboratory, Black young adults (age 18-30; N = 92) were randomly assigned to be included or excluded by White players in a ball-tossing game (Cyberball). For half of the excluded participants, White bystanders acknowledged and apologized for the racial exclusion. Participants completed a cold pressor task to assess pain threshold, tolerance, and unpleasantness, and completed a survey assessing psychological needs (ie, belongingness, self-esteem, meaningful existence, and self-control). Participants who experienced racial exclusion reported significantly more threatened psychological needs and increased laboratory pain sensitization (ie, lower pain threshold and tolerance) than those who were included. However, when a White bystander acknowledged the racism, excluded participants reported higher levels of self-control, self-esteem, and decreased pain sensitization (pain threshold and tolerance) relative to excluded participants whose experience was not acknowledged. Our findings support that racism increased Black people's pain sensitivity and provide initial evidence for White bystander acknowledgment as a health intervention. PERSPECTIVE: Continual exposure to racism likely contributes to inequities in pain sensitization. We demonstrate that acute exposure to mild racism increases acute pain sensitization. Results suggest that a bystander acknowledging witnessed racism can buffer the acute sensitizing effects of racism on pain, pointing to the potential of interpersonal interventions targeting racism. TRIAL REGISTRATION: Clinicaltrials.gov NCT06113926.
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Affiliation(s)
- Katarina E AuBuchon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Michelle L Stock
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Brianna Attey
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia
| | - Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia
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Volpe SG, Ahmad J, Patel RA, Rosendale N. Neurological care for LGBT+ people. Nat Rev Neurol 2024; 20:288-297. [PMID: 38499761 DOI: 10.1038/s41582-024-00944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
Sexual and gender minority (LGBT+) people face unique health disparities that must be considered by health-care providers to ensure equitable and inclusive care. Although traditionally LGBT+ health has not been integrated into neurology training, sexual orientation and gender identity have direct relevance to neurological health, driven by both systemic and interpersonal factors. In this Review, we summarize the evidence for associations between sexual orientation and gender identity with the prevalence and outcomes of various neurological conditions, including neurodegenerative diseases, epilepsy, stroke and neurodevelopmental disorders, among others. We describe important clinical considerations pertaining to LGBT+ people and recommend language and practices to promote inclusive care, as well as highlight gaps in need of further research and possible strategies to minimize these, including systematic collection of sexual orientation and gender identity and use of inclusive language.
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Affiliation(s)
| | - Joya Ahmad
- College of Medicine, SUNY Downstate Health Sciences University, New York City, NY, USA
| | - Roshni Abee Patel
- Neurology Service, Jesse Brown VA Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Nicole Rosendale
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
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5
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Herrero Babiloni A, Brazeau D, Jodoin M, Theis-Mahon N, Martel MO, Lavigne GJ, Moana-Filho EJ. The Impact of Sleep Disturbances on Endogenous Pain Modulation: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:875-901. [PMID: 37914093 DOI: 10.1016/j.jpain.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
The bidirectional relationship between sleep and pain problems has been extensively demonstrated but despite all the accumulating evidence, their shared mechanisms are currently not fully understood. This review examined the association between sleep disturbances, defined as a broad array of sleep-related outcomes (eg, poor quality, short duration, insomnia), and endogenous pain modulation (EPM) in healthy and clinical populations. Our search yielded 6,151 references, and 37 studies met the eligibility criteria. Qualitative results showed mixed findings regarding the association between sleep disturbances and temporal summation of pain (TSP) and conditioned pain modulation (CPM), with poor sleep more commonly associated with decreased pain inhibition in both populations. Quantitative results indicated that such associations were not statistically significant, neither in healthy populations when EPM outcomes were assessed for changes pre-/post-sleep intervention (TSP: .31 [95%CI: -.30 to .92]; P = .321; CPM: .40 [95%CI: -.06 to .85] P = .088) nor in clinical populations when such association was assessed via correlation (TSP: -.00 [95%CI: -.22 to .21] P = .970; CPM: .12 [95%CI: -.05 to .29]; P = .181). For studies that reported results by sex, meta-analysis showed that experimental sleep disturbances impaired pain inhibition in females (1.43 [95%CI: .98-1.88]; P < .001) but not in males (-.30 [95%CI: -2.69 to 1.60]; P = .760). Only one study investigating the association between sleep disturbances and offset analgesia was identified, while no studies assessing spatial summation of pain were found. Overall, this review provides a comprehensive overview of the association between sleep disturbances and EPM function, emphasizing the need for further investigation to clarify specific mechanisms and phenotypic subtypes. PERSPECTIVE: This review shines a light on the association between sleep disturbances and endogenous pain modulation function. Qualitatively, we found a frequent association between reduced sleep quality and impaired pain inhibition. However, quantitatively such an association was not corroborated. Sex-specific effects were observed, with females presenting sleep-related impaired pain inhibition but not males.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Quebec, Canada
| | - Daphnée Brazeau
- Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Nicole Theis-Mahon
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Faculty of Dentistry, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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Weaver SB, Nonyel NP, Rungkitwattanakul D. Roles of Pharmacists in the Management of Sickle Cell Disease in Adults: A Narrative Review. J Pharm Technol 2024; 40:92-99. [PMID: 38525091 PMCID: PMC10959085 DOI: 10.1177/87551225231222437] [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: 03/26/2024] Open
Abstract
Background: Sickle cell disease (SCD) is an autosomal, recessive, genetic condition of the sickle cell genes. It affects about 100 000 people in the United States where an estimated 1 out of every 365 black children and 1 out of every 13 black children will be born with SCD and sickle cell trait, respectively. Severe and unpredictable pain crisis are the leading cause of emergency department visit for adult patients with SCD and account for 90% of inpatient hospitalizations and 85% of all acute medical care, as well as high usage of medical resources. The care of patients with SCD is complex and requires a multidisciplinary approach. With a few pharmacotherapeutic options to reduce SCD complications and pain episodes, the role of pharmacists in the medication management is unclear. This article aims to outline the potential role of pharmacists in SCD management. Data sources: The authors searched Medline, PubMed, EMBASE, and Scopus from January 1, 1990 to August 31, 2022, for primary literature that assessed the role of pharmacists in managing patients with SCD. Results: The authors identified relevant studies and summarized the role of pharmacists in SCD management. Conclusions: Access to comprehensive health care is essential to ensure that patients with SCD have decreased hospitalizations and good health-related quality of life. Pharmacists are an integral part of the multidisciplinary health-care team and can help patients with SCD navigate the complexities of health care. Pharmacists are medication experts who are positioned to ensure comprehensive care in the acute and chronic SCD management.
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Affiliation(s)
- Salome Bwayo Weaver
- Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, USA
| | - Nkem P. Nonyel
- Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, USA
| | - Dhakrit Rungkitwattanakul
- Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, USA
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Jonassaint CR, Parchuri E, O'Brien JA, Lalama CM, Lin J, Badawy SM, Hamm ME, Stinson J, Lalloo C, Carroll CP, Saraf SL, Gordeuk VR, Cronin R, Shah N, Lanzkron SM, Liles D, Trimnell C, Bailey L, Lawrence RH, Abebe KZ. Mental health, pain and likelihood of opioid misuse among adults with sickle cell disease. Br J Haematol 2024; 204:1029-1038. [PMID: 38171495 PMCID: PMC10939903 DOI: 10.1111/bjh.19243] [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: 07/19/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Depressive symptoms are prevalent in individuals living with sickle cell disease (SCD) and may exacerbate pain. This study examines whether higher depressive symptoms are associated with pain outcomes, pain catastrophizing, interference and potential opioid misuse in a large cohort of adults with SCD. The study utilized baseline data from the 'CaRISMA' trial, which involved 357 SCD adults with chronic pain. Baseline assessments included pain intensity, daily mood, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorders scale, PROMIS Pain Interference, Pain Catastrophizing Scale, the Adult Sickle Cell Quality of Life Measurement Information System and the Current Opioid Misuse Measure. Participants were categorized into 'high' or 'low' depression groups based on PHQ scores. Higher depressive symptoms were significantly associated with increased daily pain intensity, negative daily mood, higher pain interference and catastrophizing, poorer quality of life and a higher likelihood of opioid misuse (all p < 0.01). SCD patients with more severe depressive symptoms experienced poorer pain outcomes, lower quality of life and increased risk of opioid misuse. Longitudinal data from this trial will determine whether addressing depressive symptoms may potentially reduce pain frequency and severity in SCD.
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Affiliation(s)
| | - Ektha Parchuri
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia A O'Brien
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christina M Lalama
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan Lin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Hamm
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Stinson
- Child Health Evaluative Sciences in Research Institute, Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Chitra Lalloo
- Child Health Evaluation Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Santosh L Saraf
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Cronin
- Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Nirmish Shah
- Division of Hematology, Division of Pediatric Hematology/Oncology, Sickle Cell Transition Program, Duke University, Durham, North Carolina, USA
| | - Sophie M Lanzkron
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darla Liles
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Lakiea Bailey
- Sickle Cell Community Consortium, Atlanta, Georgia, USA
| | - Raymona H Lawrence
- The Jiann-Ping Hsu College of Public Health, Georgia Southern University in Statesboro, Statesboro, Georgia, USA
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kenney MO, Knisely MR, McGill LS, Campbell C. Altered pain processing and sensitization in sickle cell disease: a scoping review of quantitative sensory testing findings. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:144-156. [PMID: 37815822 DOI: 10.1093/pm/pnad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Over 50% of adults living with sickle cell disease (SCD) have chronic pain, but the underlying mechanisms of chronic pain in this population remain unclear. Quantitative sensory testing is an important measurement tool for understanding pain and sensory processing. This scoping review summarizes quantitative sensory testing methodologies used in sickle cell studies and the evidence for central sensitization in this population. METHODS We conducted a systematic search of PubMed, Embase, and CINAHL to identify studies using quantitative sensory testing in individuals living with sickle cell disease. Search strategies were based on variations of the terms "sickle cell disease," and "quantitative sensory testing." Eligible studies were observational or experimental studies in human participants living with SCD that reported findings and detailed methodology for at least 1 quantitative sensory testing modality. RESULTS Our search yielded a total of 274 records; 27 of which are included in this scoping review. Of the 27 studies, 17 were original studies (with combined total of 516 adult and 298 pediatric participants), and 10 were secondary or subgroup analyses of these prior studies. Significant variation existed in quantitative sensory testing methodologies across studies, including testing locations, type and intensity of stimuli, and interpretation of findings. Of the identified studies, 22% (2/9 studies) reported sensory abnormalities in mechanical sensitivity and thresholds, 22% (2/9 studies) reported abnormal pressure pain thresholds, 46% (6/13 studies) reported sensory abnormalities in thermal pain thresholds and tolerance (cold and warm), and 50% (2/4 studies) reported abnormalities in temporal summation. CONCLUSION Future studies should use standardized quantitative sensory testing protocols with consistent and operationalized definitions of sensitization to provide clear insight about pain processing and central sensitization in sickle cell disease.
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Affiliation(s)
- Martha O Kenney
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Duke University, Durham, NC 27710, United States
| | | | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Claudia Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
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Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. Am J Obstet Gynecol 2024; 230:B17-B40. [PMID: 37866731 PMCID: PMC10961101 DOI: 10.1016/j.ajog.2023.10.031] [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] [Indexed: 10/24/2023]
Abstract
Pregnant individuals with sickle cell disease have an increased risk of maternal and perinatal morbidity and mortality. However, prepregnancy counseling and multidisciplinary care can lead to favorable maternal and neonatal outcomes. In this consult series, we summarize what is known about sickle cell disease and provide guidance for sickle cell disease management during pregnancy. The following are Society for Maternal-Fetal Medicine recommendations.
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Bhat D, Babu BV, Surti SB, Ranjit M, Sarmah J, Sridevi P, Sharma Y. Stigma of sickle cell disease among Indian tribal population: A multi-centric qualitative study. J Natl Med Assoc 2023; 115:556-565. [PMID: 37845145 DOI: 10.1016/j.jnma.2023.09.006] [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: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Sickle Cell Disease (SCD) is the most prevalent hemoglobinopathy, impacting around 5% of the global population. The Indian tribal population, which has been a key focus of the Indian SCD program, can experience health-related stigma due to the multidimensional impact of the disease. This preliminary qualitative inquiry delves into the lived experiences of individuals and synthesizes domains to identify the sources of stigma. METHODOLOGY The study's framework for developing the stigma tool was rooted in Bronfenbrenner's Ecology of Human Development. The study was implemented in five tribal-dominated districts of India and involved in-depth interviews with sickle cell disease (SCD) patients and their caregivers to explore their stigmatizing experiences. RESULTS The analysis revealed four overarching themes and several subthemes explaining the type of stigma, its source, and factors contributing to stigmatization. First, the study focused on elements associated with perceived stigma, such as disclosure, self-isolation/refusal to participate, and self-judgment. The second theme pertained to the internalization of stigma. The third theme addressed experienced stigma concerning the disease's impact on day-to-day events, and the fourth theme explored the support system patients needed. The framework highlighted the varying degrees of stigmatizing components within different aspects of patients' ecology. CONCLUSION Our study highlights the importance of addressing stigma at various levels. Policies, programs, and healthcare interventions must target stigma across these levels. Culturally adaptive tools for identifying stigma, implementing appropriate interventions, and improving healthcare participation are essential for enhancing the quality of life and reducing the disease burden.
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Affiliation(s)
- Deepa Bhat
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Bontha V Babu
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India.
| | - Shaily B Surti
- Department of Community Medicine, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
| | - Manoranjan Ranjit
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Jatin Sarmah
- Department of Biotechnology, Bodoland University, Kokrajhar, India
| | - Parikipandla Sridevi
- Department of Biotechnology, Central Tribal University of Andhra Pradesh, Vizianagaram, India
| | - Yogita Sharma
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India
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11
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Blakey AO, Lavarin C, Brochier A, Amaro CM, Eilenberg JS, Kavanagh PL, Garg A, Drainoni ML, Long KA. Effects of Experienced Discrimination in Pediatric Sickle Cell Disease: Caregiver and Provider Perspectives. J Racial Ethn Health Disparities 2023; 10:3095-3106. [PMID: 36536165 PMCID: PMC10645630 DOI: 10.1007/s40615-022-01483-4] [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: 08/10/2022] [Revised: 11/19/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
For Black children with sickle cell disease (SCD) and their families, high disease stigmatization and pervasive racism increase susceptibility to discrimination in healthcare settings. Childhood experiences of discrimination can result in medical nonadherence, mistrust of healthcare providers, and poorer health outcomes across the lifespan. Caregivers and medical providers are essential to childhood SCD management and are therefore well-positioned to provide insight into discrimination in the context of pediatric SCD. This mixed-methods study sought caregivers' and providers' perspectives on processes underlying discrimination and potential solutions to mitigate the negative effects of perceived discrimination among children with SCD. Caregivers (N = 27) of children with SCD (≤ 12 years old) and providers from their hematology clinics (N = 11) participated in individual semi-structured interviews exploring experiences of discrimination and daily SCD management and completed a quantitative measure of discrimination. Qualitative data were collected until themes reached saturation and subsequently transcribed verbatim, coded, and analyzed using applied thematic analysis. Quantitative and qualitative data converged to suggest the pervasiveness of discrimination in healthcare settings. Three qualitative themes emerged: (1) healthcare system factors underlie discrimination, (2) families' challenging interactions with providers lead to perceptions of discrimination, and (3) experiences of discrimination impact caregiver-provider interactions. Both caregivers and providers highlighted building trusting patient-provider relationships and encouraging patients' self-advocacy as means to reduce experiences and impacts of discrimination. These findings offer potential approaches to tangibly mitigate occurrences of discrimination in pediatric healthcare settings by trust building, accountability keeping, and fostering rapport to improve quality of care and pediatric SCD health outcomes.
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Affiliation(s)
- Ariel O Blakey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Claudine Lavarin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | | | - Christina M Amaro
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Behavioral Health and the Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | | | - Patricia L Kavanagh
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Memorial Health, Worcester, MA, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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12
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Mathur VA, Payano Sosa JS, Keaser ML, Meiller TF, Seminowicz DA. The social context of burning mouth syndrome: an exploratory pilot study of stigma, discrimination, and pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1213-1218. [PMID: 37314981 PMCID: PMC10628978 DOI: 10.1093/pm/pnad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The social context of burning mouth syndrome (BMS) has received little attention in the scientific literature. However, social psychological theory and insights from those with lived experiences suggest that people living with BMS experience compounding effects of stigma related to their pain, diagnosis (or lack thereof), and intersectional identities. OBJECTIVE Our aim is to provide initial evidence and to motivate new directions for research on BMS. Here, we present the results of an exploratory pilot study (n = 16) of women living with BMS in the United States. METHODS Participants completed self-report measures of stigma, discrimination, and pain, as well as laboratory assessments of pain through quantitative sensory testing. RESULTS Results indicate a high prevalence of internalized BMS stigma, experience of BMS-related discrimination from clinicians, and gender stigma consciousness in this population. Moreover, results provide initial evidence that these experiences are related to pain outcomes. The most robust pattern of findings is that internalized BMS stigma was related to greater clinical pain severity, interference, intensity, and unpleasantness. CONCLUSION Given the prevalence and pain-relevance of intersectional stigma and discrimination identified in this pilot study, lived experience and social context should be incorporated into future research on BMS.
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Affiliation(s)
- Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 77843, United States
| | - Janell S Payano Sosa
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - Timothy F Meiller
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
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13
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Simmons A, Vasquez A, Green K, Christopher M, Colgan DD. The impact of ethnic discrimination on chronic pain: the role of sex and depression. ETHNICITY & HEALTH 2023; 28:1053-1068. [PMID: 37137819 PMCID: PMC10524930 DOI: 10.1080/13557858.2023.2208315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
ABSTRACTPerceived ethnic discrimination (PED) is predictive of chronic pain-related outcomes. Less is known about pathways through which these constructs interact. The goal of this study was to test whether PED was predictive of chronic pain-related outcomes (pain interference, pain intensity, and symptoms related to central sensitization), whether depression mediated the relationship between PED and pain outcomes, and if these relationships were maintained across sex in a sample of racially and ethnically minoritized adults (n = 77). PED significantly predicted pain interference, pain intensity, and symptoms related to central sensitization. Sex accounted for a significant proportion of the variance in pain interference only. Depression explained the relationship between PED and pain interference and pain intensity. Sex moderated the indirect pathway, such that for men, the relationship between PED and pain interference and pain intensity was explained via depression. Depression partially explained the relationship between PED and symptoms related to central sensitization. Sex did not moderate this mediational effect. This study provided a unique contribution to the pain literature by providing a contextual analysis of PED and pain. Addressing and validating experiences of lifetime discrimination may be a clinically relevant tool in the management of chronic pain for of racially and ethnically minoritized adults.
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Affiliation(s)
- Akeesha Simmons
- Pacific University, School of Graduate Psychology, 190 SE 8 Ave, Hillsboro, OR 97123 USA
| | - Alicia Vasquez
- Pacific University, School of Graduate Psychology, 190 SE 8 Ave, Hillsboro, OR 97123 USA
| | - Kaylie Green
- Pacific University, School of Graduate Psychology, 190 SE 8 Ave, Hillsboro, OR 97123 USA
| | - Michael Christopher
- Pacific University, School of Graduate Psychology, 190 SE 8 Ave, Hillsboro, OR 97123 USA
| | - Dana Dharmakaya Colgan
- Oregon Health and Science University, Oregon Center for Complementary and Alternative Medicine in Neurological Disorders, 3181 SW Sam Jackson Park Road, Portland, OR 97239 US
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14
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Nanavaty N, Walsh KT, Boring BL, Ganesan A, Carter-Sowell AR, Mathur VA. Acute Ostracism-Related Pain Sensitization in the Context of Accumulated Lifetime Experiences of Ostracism. THE JOURNAL OF PAIN 2023; 24:1229-1239. [PMID: 36842734 DOI: 10.1016/j.jpain.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023]
Abstract
Ostracism (ie, being ignored/excluded) is a form of social adversity that powerfully impacts health and well-being. While laboratory research indicates that experimentally manipulated experiences of ostracism impact pain, findings have been mixed. Prior investigations have not considered moderating or main effects of individual histories of ostracism, and have been limited in the scope of their pain testing. In this study, participants without current pain reported lifetime experiences of ostracism prior to a laboratory visit where they were randomized to experience either a single episode of ostracism (ie, acute ostracism) or control condition that was immediately followed by quantitative sensory testing. Results indicate that the experimental effect of a single episode of ostracism on pain ratings, after-sensations, and temporal summation of pain is moderated by lifetime ostracism; no main effects were found. For individuals with histories of more lifetime ostracism, encountering a single episode of ostracism led to greater pain sensitization relative to the control condition, whereas no experimental effect was observed for individuals with little lifetime exposure to ostracism. These findings indicate that acute experiences of ostracism may be accompanied by periods of hyperalgesia for people who are chronically ostracized, implicating ostracism as a potential social moderator of pain sensitization. People who are stigmatized may therefore experience enhanced pain burden with repeated and accumulating experiences of ostracism. PERSPECTIVE: Results suggest that in the context of accumulated lifetime experiences of ostracism, single experiences of ostracism evoke central sensitization. In this way, ostracism may function to trigger central sensitization and shape socially- and societally-determined patterns of pain burden and disparity.
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Affiliation(s)
- N Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - K T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - B L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - A Ganesan
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - A R Carter-Sowell
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Diversity Science Research Cluster, College Station, Texas
| | - V A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Diversity Science Research Cluster, College Station, Texas; Texas A&M Institute for Neuroscience, College Station, Texas.
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15
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O’Brien JA, Hickman RL, Burant C, Dolansky M, Padrino S. Health Literacy, Perceived Stigma, Self-Efficacy, and HRQOL in Sickle Cell Disease. West J Nurs Res 2023; 45:335-343. [PMID: 36377080 PMCID: PMC10035374 DOI: 10.1177/01939459221135331] [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] [Indexed: 11/17/2022]
Abstract
Little is known about the relationships among self-efficacy, social determinants of health, and health outcomes in adults living with sickle cell disease (SCD). We conducted mediation analyses examining the relationships among health literacy, perceived stigma, self-efficacy, and health outcomes in an online cohort of adults living with SCD. The health outcomes explored were physical and mental health-related quality of life (HRQOL) and pain interference; covariates included gender, disease severity, and depressive symptoms. Data came from a cross-sectional, descriptive study of 60 adults with SCD. Perceived stigma and self-efficacy had significant relationships with the study outcomes, while health literacy did not. Self-efficacy partially mediated the relationship between perceived stigma and physical HRQOL, when controlling for depressive symptoms. Future research should investigate the influence of stigma and self-efficacy on health outcomes in patients with SCD and consider stigma when creating interventions to modify self-efficacy.
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Affiliation(s)
- Julia A. O’Brien
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mary Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan Padrino
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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16
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McGill LS, Hamilton KR, Letzen JE, Finan PH, Lanzkron SM, Smith MT, Haythornthwaite JA, Campbell CM. Depressive and Insomnia Symptoms Sequentially Mediate the Association Between Racism-Based Discrimination in Healthcare Settings and Clinical Pain Among Adults With Sickle Cell Disease. THE JOURNAL OF PAIN 2023; 24:643-654. [PMID: 36414154 PMCID: PMC10079566 DOI: 10.1016/j.jpain.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
Racism-based discrimination in healthcare settings has been associated with clinical pain in adults living with sickle cell disease; however, no studies have examined depressive and insomnia symptoms as mechanisms that may drive this relationship. This secondary data analysis examined associations between depressive and insomnia symptoms, racism-based discrimination, and clinical pain. Seventy-one adults with sickle cell disease (70% female, Mage = 38.79) provided baseline reports of racism-based discrimination, depressive symptoms, insomnia symptoms, and pain (severity, interference, catastrophizing), and they completed daily diaries of pain severity and interference over 3 months. In a sequential mediation model, baseline depressive (1st) and insomnia symptoms (2nd) significantly mediated the association between racism-based discrimination and baseline pain interference, average daily diary pain severity, and average daily diary pain interference. Although the mediation model with baseline pain severity as the outcome was significant, the total and direct effects were not. Results indicate that discrimination in healthcare settings contributes to depression, which may act on pain through sleep disturbance. Findings support the need for systemic and structural changes to eliminate discrimination in healthcare settings and behavioral mood and sleep interventions to reduce the impact of discrimination on clinical pain. PERSPECTIVE: The relationship between discrimination in healthcare settings and pain in adults with sickle cell disease may be driven by depression and sleep disturbance, modifiable risk factors and potential treatment targets. Results suggest that systemic, structural, and institutional changes must be implemented to promote better patient care and health outcomes.
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Affiliation(s)
- Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Katrina R Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sophie M Lanzkron
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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17
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Disparities in Chronic Pain Experience and Treatment History Among Persons With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2023; 38:125-136. [PMID: 36883895 DOI: 10.1097/htr.0000000000000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To determine disparities in pain severity, pain interference, and history of pain treatment for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics with traumatic brain injury (TBI) and chronic pain. SETTING Community following discharge from inpatient rehabilitation. PARTICIPANTS A total of 621 individuals with medically documented moderate to severe TBI who had received acute trauma care and inpatient rehabilitation (440 non-Hispanic Whites, 111 non-Hispanic Blacks, and 70 Hispanics). DESIGN A multicenter, cross-sectional, survey study. MAIN MEASURES Brief Pain Inventory; receipt of opioid prescription; receipt of nonpharmacologic pain treatments; and receipt of comprehensive interdisciplinary pain rehabilitation. RESULTS After controlling for relevant sociodemographic variables, non-Hispanic Blacks reported greater pain severity and greater pain interference relative to non-Hispanic Whites. Race/ethnicity interacted with age, such that the differences between Whites and Blacks were greater for older participants (for severity and interference) and for those with less than a high school education (for interference). There were no differences found between the racial/ethnic groups in the odds of having ever received pain treatment. CONCLUSIONS Among individuals with TBI who report chronic pain, non-Hispanic Blacks may be more vulnerable to difficulties managing pain severity and to interference of pain in activities and mood. Systemic biases experienced by many Black individuals with regard to social determinants of health must be considered in a holistic approach to assessing and treating chronic pain in individuals with TBI.
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18
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Letzen JE, Hunt C, Kuwabara H, McGill LS, Reid MJ, Hamilton KR, Buenaver LF, Burton E, Sheinberg R, Wong DF, Smith MT, Campbell CM. Preliminary Evidence for the Sequentially Mediated Effect of Racism-Related Stress on Pain Sensitivity Through Sleep Disturbance and Corticolimbic Opioid Receptor Function. THE JOURNAL OF PAIN 2023; 24:1-18. [PMID: 36167231 PMCID: PMC10863672 DOI: 10.1016/j.jpain.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Sleep disturbance predicts worse pain outcomes. Because sleep disturbance inequitably impacts Black adults - with racism as the upstream cause - understanding how racism-related stress impacts pain through sleep might help minimize racialized pain inequities. This preliminary study examined sequential mediation of the effect of racism-related stress on experimental pain through sleep disturbance and corticolimbic μOR function in pain-free non-Hispanic Black (NHB) and White (NHW) adults. Participants completed questionnaires, actigraphy, positron emission tomography, and sensory testing. We reproduced findings showing greater sleep disturbance and pain sensitivity among NHB participants; greater sleep disturbance (r = .35) and lower pain tolerance (r=-.37) were significantly associated with greater racism-related stress. In a sequential mediation model, the total effect of racism-related stress on pain tolerance (β=-.38, P = .005) weakened after adding sleep disturbance and ventromedial prefrontal cortex (vmPFC) μOR binding potential (BPND) as mediators (β = -.18, P = .16). The indirect effect was statistically significant [point estimate = -.003, (-.007, -.0003). Findings showed a potential sequentially mediated effect of racism-related stress on pain sensitivity through sleep disturbance and vmPFC μOR BPND. As policy efforts are enacted to eliminate the upstream cause of systemic racism, these results cautiously suggest that sleep interventions within racism-based trauma informed therapy might help prevent downstream effects on pain. PERSPECTIVE: This preliminary study identified the effect of racism-related stress on pain through sleep disturbance and mu-opioid receptor binding potential in the ventromedial prefrontal cortex. Findings cautiously support the application of sleep interventions within racism-based trauma-informed therapy to prevent pain inequities as policy changes function to eliminate all levels of racism.
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Affiliation(s)
- Janelle E Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland..
| | - Carly Hunt
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Hiroto Kuwabara
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Matthew J Reid
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Katrina R Hamilton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Luis F Buenaver
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Emily Burton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Rosanne Sheinberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dean F Wong
- Departments of Radiology, Psychiatry, Neurology, Neurosciences, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St, Louis Missouri
| | - Michael T Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
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19
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Walsh KT, Boring BL, Nanavaty N, Carter-Sowell AR, Mathur VA. Lifetime ostracism experiences and mechanisms of pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1037472. [PMID: 36590646 PMCID: PMC9800841 DOI: 10.3389/fpain.2022.1037472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
One social mechanism by which marginalization is enacted is via ostracism. Recent research has demonstrated ostracism's impact on physical health, but little is known about the relationship between accumulated lifetime experiences of ostracism and pain. Despite recent calls for added attention to social modulation of pain and social indicators of pain disparities, the impact of specific social factors on pain-including those of ostracism-are not well understood. Results of laboratory studies on the effects of acute ostracism experiences on pain sensitivity have been mixed. However, these studies have not considered lived and repeated experiences of ostracism, and primarily included single static measures of pain sensitivity. Additionally, inclusion and representation of the relationship between ostracism experiences and pain among people with minoritized identities are lacking in the current literature. In this study, we explored accumulated lifetime experiences of ostracism as a potential contributing factor to enhanced pain and one social mechanism by which societal inequity may create and maintain inequity in pain. We extracted measures of lifetime experiences of ostracism from six studies focused on social factors and (non-chronic) pain conducted between 2016 and 2020 (n = 505 adults). To retain and examine diversity within the sample, we used moderation and within-group analyses. Results indicate that greater experiences of lifetime ostracism are associated with lower cold pain tolerance, but not other pain measures, in the whole sample. Moderation and within-group analyses reveal opposing patterns of results between populations included in the extant literature (White participants, convenience samples) and those under-represented in the scientific literature (racialized groups, community samples). This study provides an example of a diversity science approach to examining social indicators of pain, illustrates the limited generalizability of previous studies on ostracism and pain, and highlights the need for increased representation and inclusion to understand mechanisms of pain and inequity.
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Affiliation(s)
- Kaitlyn T. Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Brandon L. Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, United States
| | | | - Vani A. Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States,Diversity Science Research Cluster, Texas A&M University, College Station, TX, United States,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, United States,Correspondence: Vani A. Mathur
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20
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Jenerette C, O’Brien J, Jaja C, Carvalho ESDS, Brewer C, Hickman RL. Psychometrics of the Sickle Cell Disease Health-Related Stigma Scale-Short Form. West J Nurs Res 2022; 45:425-431. [PMID: 36495228 PMCID: PMC10115242 DOI: 10.1177/01939459221142164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Health-related stigma, a form of devaluation related to a health condition, is common in individuals with sickle cell disease (SCD). Pain is the hallmark symptom of SCD, and health-related stigma is often described during care-seeking for pain management. Few published instruments measure health-related stigma in individuals with SCD. This study builds on the psychometrics of the 30- and 40-item Sickle Cell Disease Health-Related Stigma Scale (SCD-HRSS). In a sample of 197 adults with SCD, the results support the reliability and validity of a 21-item scale, the SCD-HRSS-Short Form, with an overall Cronbach’s alpha reliability of 0.91 and discriminant validity with the PROMIS-29 subscales (anxiety, depressive symptoms, pain interference, physical fatigue, sleep, and role satisfaction). A shorter yet reliable and valid scale may decrease the burden for this underrepresented, minoritized population while still providing important information regarding their experiences of stigmatization.
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Affiliation(s)
| | - Julia O’Brien
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheedy Jaja
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | | | - Cheryl Brewer
- Private Diagnostic Clinics, Duke Health, Durham, NC, USA
| | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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21
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Understanding Racism in Anesthesia Care. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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22
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Walsh KT, Boring BL, Nanavaty N, Guzman H, Mathur VA. Sociocultural context and pre-clinical pain facilitation: Multiple dimensions of racialized discrimination experienced by Latinx Americans are associated with enhanced temporal summation of pain. THE JOURNAL OF PAIN 2022; 23:1885-1893. [PMID: 35753661 DOI: 10.1016/j.jpain.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022]
Abstract
The experiences of injustice and their impacts on pain among Latinx Americans are overlooked and understudied. Multidimensional and consequential experiences of racialized discrimination are common for Latinx Americans but have not been considered as factors relevant for enhanced pain experience or risk. In this study, we focused on the experiences of Latinx Americans living in Texas by assessing multiple dimensions of racialized discrimination (total lifetime discrimination, racialized exclusion, stigmatization, discrimination in the workplace or school, and racism-related threat and aggression) and a laboratory marker of central sensitization of pain (temporal summation of mechanical pain, MTS). Among 120 adults who did not have chronic pain, nearly all (94.2%) experienced racialized discrimination. Accumulated lifetime experience of racialized discrimination, as well as the frequency of each dimension of discrimination assessed, was associated with greater MTS. Results suggest that a process of discrimination-related central sensitization may start early, and may reflect enhanced pain experiences and pre-clinical chronic pain risk. Though replication is needed, results also indicate the discrimination and pain burden among Latinx Texans, and Latinx Americans broadly, are likely under-represented in the scientific literature. PERSPECTIVE: : Racialized discrimination is multidimensional. Latinx Texans experience frequent discrimination that is associated with enhanced temporal summation of pain in the laboratory. Results indicate the importance of societal factors in pain processing and may reflect a mechanism of racism-related pre-clinical central sensitization observable before chronic pain onset.
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Affiliation(s)
- Kaitlyn T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Hanan Guzman
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Diversity Science Research Cluster, College Station, Texas
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Texas A&M Institute for Neuroscience, College Station, Texas; Diversity Science Research Cluster, College Station, Texas.
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23
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Confronting Racism in All Forms of Pain Research: Reframing Study Designs. THE JOURNAL OF PAIN 2022; 23:893-912. [PMID: 35296390 PMCID: PMC9472383 DOI: 10.1016/j.jpain.2022.01.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/27/2022]
Abstract
This second paper in a 3-part series on antiracism in pain research across the translational spectrum focuses on study design factors. Although objectivity is a cornerstone value of science, subjectivity is embedded in every step of the research process as investigators make choices about who they collaborate with, which research questions they ask, how they recruit participants, which research tools they use, and how they analyze and interpret data. We present theory and evidence from disciplines such as sociology, medical anthropology, statistics, and public health to discuss 4 common study design factors, including 1) the dominant biomedical narrative of pain that restricts funding and exploration of social indicators of pain, 2) low diversity and inclusion in pain research enrollment that restricts generalizability to racialized groups, 3) the use of "race" or "ethnicity" as a statistical variable and proxy for lived experiences (eg, racism, resilience), and 4) limited modeling in preclinical research for the impact of social factors on pain physiology. The information presented in this article is intended to start conversations across stakeholders in the pain field to explore how we can come together to adopt antiracism practices in our work at large to achieve equity for racialized groups. PERSPECTIVE: This is the second paper in a 3-part series on antiracism in pain research. This part identifies common study design factors that risk hindering progress toward pain care equity. We suggest reframes using an antiracism framework for these factors to encourage all pain investigators to collectively make strides toward equity.
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Do racial and ethnic disparities lead to the undertreatment of pain? Are there solutions? Curr Opin Anaesthesiol 2022; 35:273-277. [PMID: 35671012 DOI: 10.1097/aco.0000000000001139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review aims to empower anesthesiologists, specifically pain medicine specialists, to become leaders in ensuring equitable care. RECENT FINDINGS Disparities in both acute and chronic pain medicine lead to increased morbidity for patients of color. Gaps in care include misdiagnosis or under diagnosis of chronic pain disease states, undertreatment of sickle cell disease and other conditions that are common in minorities, under prescription of opioids, and lack of access to novel opioid sparing treatments. While the causes of these disparities are multifactorial, care team implicit bias and lack of representation are two of the major factors. Solutions are challenging, but the authors suggest an inside out solution. We believe that this practice will have far-reaching downstream effects, including improving diversity in our field and quality of care for our patients. SUMMARY The current article reviews disparities in both acute and chronic pain treatment for underrepresented racial and ethnic minorities in the United States. The authors examine whether implicit bias and lack of representation are a contributing factor for these disparities. Lastly, we will discuss potential solutions.
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25
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Mathur VA, Trost Z, Ezenwa MO, Sturgeon JA, Hood AM. Mechanisms of injustice: what we (do not) know about racialized disparities in pain. Pain 2022; 163:999-1005. [PMID: 34724680 PMCID: PMC9056583 DOI: 10.1097/j.pain.0000000000002528] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/29/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Vani A. Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Miriam O. Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - John A. Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Anna M. Hood
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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Confronting Racism in Pain Research: A Call to Action. THE JOURNAL OF PAIN 2022; 23:878-892. [PMID: 35292201 PMCID: PMC9472374 DOI: 10.1016/j.jpain.2022.01.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Racism is an established health determinant across the world. In this 3-part series, we argue that a disregard of how racism manifests in pain research practices perpetuates pain inequities and slows the progression of the field. Our goal in part-1 is to provide a historical and theoretical background of racism as a foundation for understanding how an antiracism pain research framework - which focuses on the impact of racism, rather than "race," on pain outcomes - can be incorporated across the continuum of pain research. We also describe cultural humility as a lifelong self-awareness process critical to ending generalizations and successfully applying antiracism research practices through the pain research continuum. In part-2 of the series, we describe research designs that perpetuate racism and provide reframes. Finally, in part-3, we emphasize the implications of an antiracism framework for research dissemination, community-engagement practices and diversity in research teams. Through this series, we invite the pain research community to share our commitment to the active process of antiracism, which involves both self-examination and re-evaluation of research practices shifting our collective work towards eliminating racialized injustices in our approach to pain research. PERSPECTIVE: We call on the pain community to dismantle racism in our research practices. As the first paper of the 3-part series, we introduce dimensions of racism and its effect on pain inequities. We also describe the imperative role of cultural humility in adopting antiracism pain research practices.
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Güereca YM, Kell PA, Kuhn BL, Hellman N, Sturycz CA, Toledo TA, Huber FA, Demuth M, Lannon EW, Palit S, Shadlow JO, Rhudy JL. The Relationship Between Experienced Discrimination and Pronociceptive Processes in Native Americans: Results From the Oklahoma Study of Native American Pain Risk. THE JOURNAL OF PAIN 2022; 23:1006-1024. [PMID: 35021117 DOI: 10.1016/j.jpain.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 12/24/2022]
Abstract
Native Americans (NAs) have higher pain rates than the general U.S. population. It has been found that increased central sensitization and reduced pain inhibition are pronociceptive processes that increase pain risk; yet, little attention has focused on the influence of psychosocial factors. Discrimination is a psychosocial factor associated with increased pain in other minoritized groups; however, it is unclear whether it also promotes pain in NAs. This study analyzed data from 269 healthy, pain-free participants (N = 134 non-Hispanic whites [NHWs], N = 135 NAs) from the Oklahoma Study of Native American Pain Risk. Experienced discrimination was measured using the Everyday Discrimination Scale (EDS). Nociceptive processes were measured via static measures of spinal sensitivity (nociceptive flexion reflex [NFR] threshold, 3-stimulation NFR threshold), temporal summation of pain (TS-Pain) and nociceptive flexion reflex (TS-NFR), and conditioned pain modulation of pain (CPM-Pain) and NFR (CPM-NFR). Results demonstrated that greater discrimination was associated with enhanced TS-NFR and impaired CPM-NFR but not static measures of spinal sensitivity or measures of pain modulation (TS-Pain, CPM-Pain). Although the effects of discrimination on outcomes were similar in both groups (not moderated by ethnicity), NAs experienced higher levels of discrimination and therefore discrimination mediated a relationship between ethnicity and impaired CPM-NFR. This indicates experienced discrimination may promote a pain risk phenotype in NAs that involves spinal sensitization resulting from impaired inhibition of spinal nociception without sensitization of pain experience. PERSPECTIVE: This study found that discrimination was associated with spinal sensitization and impaired descending inhibition of spinal nociception. These findings bolster our understanding of how social stressors experienced disproportionately by minoritized groups can contribute to pain outcomes.
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Affiliation(s)
- Yvette M Güereca
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Bethany L Kuhn
- 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
| | | | - Mara Demuth
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Shreela Palit
- University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, Florida
| | - 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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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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Terry EL, Tanner JJ, Cardoso JS, Sibille KT, Lai S, Deshpande H, Deutsch G, Price CC, Staud R, Goodin BR, Redden DT, Fillingim RB. Associations between pain catastrophizing and resting-state functional brain connectivity: Ethnic/race group differences in persons with chronic knee pain. J Neurosci Res 2022; 100:1047-1062. [PMID: 35187703 PMCID: PMC8940639 DOI: 10.1002/jnr.25018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/01/2023]
Abstract
Chronic pain is a significant public health problem, and the prevalence and societal impact continues to worsen annually. Multiple cognitive and emotional factors are known to modulate pain, including pain catastrophizing, which contributes to pain facilitation and is associated with altered resting-state functional connectivity in pain-related cortical and subcortical circuitry. Pain and catastrophizing levels are reported to be higher in non-Hispanic black (NHB) compared with non-Hispanic White (NHW) individuals. The current study, a substudy of a larger ongoing observational cohort investigation, investigated the pathways by which ethnicity/race influences the relationship between pain catastrophizing, clinical pain, and resting-state functional connectivity between anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), insula, and primary somatosensory cortex (S1). Participants included 136 (66 NHBs and 70 NHWs) community-dwelling adults with knee osteoarthritis. Participants completed the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale and Western Ontario and McMaster Universities Osteoarthritis Index. Magnetic resonance imaging data were obtained, and resting-state functional connectivity was analyzed. Relative to NHW, the NHB participants were younger, reported lower income, were less likely to be married, and self-reported greater clinical pain and pain catastrophizing (ps < 0.05). Ethnicity/race moderated the mediation effects of catastrophizing on the relationship between clinical pain and resting-state functional connectivity between the ACC, dlPFC, insula, and S1. These results indicate the NHB and NHW groups demonstrated different relationships between pain, catastrophizing, and functional connectivity. These results provide evidence for a potentially important role of ethnicity/race in the interrelationships among pain, catastrophizing, and resting-state functional connectivity.
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Affiliation(s)
- Ellen L. Terry
- College of Nursing, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA,Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
| | - Jared J. Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Josue S. Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
| | - Kimberly T. Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA,CTSI Human Imaging Core, University of Florida, Gainesville, Florida, USA
| | - Hrishikesh Deshpande
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, USA,Division of Advanced Medical Imaging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Georg Deutsch
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, USA,Division of Advanced Medical Imaging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
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The Negative Effect of Social Discrimination on Pain Tolerance and the Moderating Role of Pain Catastrophizing. J Clin Psychol Med Settings 2022; 30:169-181. [PMID: 35244822 DOI: 10.1007/s10880-022-09860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
This study examined the negative impact of social discrimination on the time to pain tolerance during experimentally induced cold pressor pain among healthy individuals. It was hypothesized that the degree to which one catastrophized about pain would exacerbate the negative impact of a history discriminatory experiences on pain tolerance, and that this interaction would be different between individuals of a racial and ethnic minority and non-Hispanic white individuals (thus testing catastrophizing as a moderated moderator). Higher levels of discrimination were positively related to catastrophic thinking about pain, and there was a significant negative relationship between the level of experienced discrimination and time to pain tolerance. Pain catastrophizing emerged as a significant moderator in that when pain catastrophizing levels were high, there was no association between social discrimination and pain tolerance. A history of social discrimination was significantly associated with reduced pain tolerance at low and moderate levels of pain catastrophizing. Racial minority status did not significantly alter this moderating relationship. Implications for the importance of assessing sociocultural variables, such as experiencing social discrimination in the clinical assessment of the individual with pain are outlined.
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31
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Eze B, Kumar S, Yang Y, Kilcoyne J, Starkweather A, Perry MA. Bias in Musculoskeletal Pain Management and Bias-Targeted Interventions to Improve Pain Outcomes: A Scoping Review. Orthop Nurs 2022; 41:137-145. [PMID: 35358134 PMCID: PMC9154307 DOI: 10.1097/nor.0000000000000833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Bias in healthcare negatively impacts disparities in care, treatment, and outcomes, especially among minority populations. A scoping review of the literature was performed to provide a deeper understanding of how bias influences musculoskeletal pain and potential effects of bias-targeted interventions on reducing pain disparities, as well as identify gaps and make suggestions for further research in this area. Publications from peer-reviewed journals were searched using the databases PubMed/MEDLINE, PsycINFO, CINAHL, and Scopus, with 18 studies identified. The literature review revealed that clinician-based bias and discrimination worsen pain and disability by reducing access to treatment and increasing patient pain-related injustice, catastrophizing, depression, and perceived stress. In contrast, clinician education and perspective-taking, patient decision tools, and community outreach interventions can help reduce bias and disparities in musculoskeletal pain outcomes. Increasing the diversity of the healthcare workforce should also be a priority. Models of care focused on health equity may provide an ideal framework to reduce bias and provide sustainable improvement in musculoskeletal pain management.
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Affiliation(s)
- Bright Eze
- Bright Eze, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Sumanya Kumar, BS, Research Assistant, University of Connecticut School of Medicine, Storrs, CT
- Yuxuan Yang, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Jason Kilcoyne, BS, Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Angela Starkweather, PhD, ACNP-BC, CCRN, FAANP, FAAN, Professor, Associate Dean for Academic Affairs, University of Connecticut School of Nursing, Storrs, CT
- Mallory A. Perry, PhD, RN, CCRN, Postdoctoral Fellow, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Sumanya Kumar
- Bright Eze, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Sumanya Kumar, BS, Research Assistant, University of Connecticut School of Medicine, Storrs, CT
- Yuxuan Yang, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Jason Kilcoyne, BS, Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Angela Starkweather, PhD, ACNP-BC, CCRN, FAANP, FAAN, Professor, Associate Dean for Academic Affairs, University of Connecticut School of Nursing, Storrs, CT
- Mallory A. Perry, PhD, RN, CCRN, Postdoctoral Fellow, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Yuxuan Yang
- Bright Eze, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Sumanya Kumar, BS, Research Assistant, University of Connecticut School of Medicine, Storrs, CT
- Yuxuan Yang, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Jason Kilcoyne, BS, Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Angela Starkweather, PhD, ACNP-BC, CCRN, FAANP, FAAN, Professor, Associate Dean for Academic Affairs, University of Connecticut School of Nursing, Storrs, CT
- Mallory A. Perry, PhD, RN, CCRN, Postdoctoral Fellow, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Jason Kilcoyne
- Bright Eze, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Sumanya Kumar, BS, Research Assistant, University of Connecticut School of Medicine, Storrs, CT
- Yuxuan Yang, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Jason Kilcoyne, BS, Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Angela Starkweather, PhD, ACNP-BC, CCRN, FAANP, FAAN, Professor, Associate Dean for Academic Affairs, University of Connecticut School of Nursing, Storrs, CT
- Mallory A. Perry, PhD, RN, CCRN, Postdoctoral Fellow, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Angela Starkweather
- Bright Eze, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Sumanya Kumar, BS, Research Assistant, University of Connecticut School of Medicine, Storrs, CT
- Yuxuan Yang, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Jason Kilcoyne, BS, Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Angela Starkweather, PhD, ACNP-BC, CCRN, FAANP, FAAN, Professor, Associate Dean for Academic Affairs, University of Connecticut School of Nursing, Storrs, CT
- Mallory A. Perry, PhD, RN, CCRN, Postdoctoral Fellow, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Mallory A Perry
- Bright Eze, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Sumanya Kumar, BS, Research Assistant, University of Connecticut School of Medicine, Storrs, CT
- Yuxuan Yang, BS, RN, Graduate Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Jason Kilcoyne, BS, Research Assistant, University of Connecticut School of Nursing, Storrs, CT
- Angela Starkweather, PhD, ACNP-BC, CCRN, FAANP, FAAN, Professor, Associate Dean for Academic Affairs, University of Connecticut School of Nursing, Storrs, CT
- Mallory A. Perry, PhD, RN, CCRN, Postdoctoral Fellow, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
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Ong AD, Goktas S, Reid MC. More than Hurt Feelings: The Wear and Tear of Day-to-Day Discrimination in Adults with Chronic Pain. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2925-2930. [PMID: 33830245 PMCID: PMC8665997 DOI: 10.1093/pm/pnab135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the extent to which self-reported experiences of discrimination are associated with pain interference among men and women with chronic non-cancer pain. METHODS Data are from the Study of Midlife in the United States (MIDUS) Refresher Cohort. The analytic sample consisted of 207 adults with chronic pain (54.2 ± 12.8 years; 53.6% female) who completed the Major Experiences of Discrimination and Everyday Discrimination scales. Regression analyses examined cross-sectional relations between discrimination and pain interference. RESULTS On average, the level of pain interference was moderate in the sample (mean = 3.46, standard deviation = 2.66; observed range 0-10). Approximately a third of respondents reported at least one major discriminatory event in their lifetime, while 22% reported three or more discriminatory lifetime events. Everyday discrimination scores averaged 14.19 ± 5.46 (observed range 0-33). With adjustment for sociodemographics, physical health, cognitive and psychological factors, social isolation, and loneliness, everyday discrimination was associated with increased pain interference (B = 0.099; 95% confidence interval [CI]: 0.02 to 0.17). CONCLUSION These findings add weight to the importance of day-to-day experiences of interpersonal discrimination by documenting independent associations with functional interference in adults with chronic pain.
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Affiliation(s)
- Anthony D Ong
- Department of Human Development, Cornell University, Ithaca, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Selin Goktas
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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Harvey AR. Integrated neuroimmune processing of threat, injury, and illness: An ecological framework mapping social alienation onto lifetime health vulnerability. Brain Behav Immun Health 2021; 18:100349. [PMID: 34723222 PMCID: PMC8531850 DOI: 10.1016/j.bbih.2021.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Social alienation is a pre-eminent ecological threat for humans. In clinical and social care settings its impact is acknowledged in conditions as diverse as severe mood disturbance, chronic pain, and metabolic non-communicable diseases. An integrated psychoneuroimmune perspective shows how threat, injury, healing, and recovery follow through as a continuous process, but accepted cultural and clinical paradigms separating mental from physical illness provide little common ground on which to analyse and apply this continuum in practice. By reviewing the ecological relationships between emotional threat, tissue dyshomeostasis and injury, infection, pain, and mood this article explores not only how primeval somatic responses underpin the evolutionary foundations of depression and somatisation, but also links them to escalating physical non-communicable disease through archived socioeconomic adversity (allostatic load). Social alienation (in the absence of trauma) may prime and activate this ancient repertoire in which sensitised responses lay the foundation for persistent maladaptive states of aversive sensory misinterpretation, behavioural avoidance, anhedonia, and neuroinflammation presenting as widespread non-nociceptive pain, non-pain somatisation, and severe depression. The ecological perspective illuminates perverse clinical presentations, shows how some approaches to care may facilitate self-reinforcement in maladaptive syndromes, and offers pointers for inclusive rehabilitative clinical and social care.
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Affiliation(s)
- Andrew R. Harvey
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LS2 9JT, UK
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Al Raqaishi H, Al Qadire M, Alzaabi O, Al Omari O. Health-Related Stigma, Social Support, Self-Efficacy, and Self-Care Actions Among Adults With Sickle Cell Disease in Oman. Clin Nurs Res 2021; 31:803-811. [PMID: 34555941 DOI: 10.1177/10547738211046731] [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: 11/16/2022]
Abstract
Stigma contributes to the burden of individuals and families affected by Sickle cell disease (SCD) and causes delay in appropriate care seeking. The aim of this study is to examine the levels and associations between stigma, social support, self-efficacy, and self-care actions among adult patients with SCD in Oman using a cross-sectional, correlational design. Of the 264 participants, 56.1% (n = 148) were males, with mean age of 30.1 years (SD 7.7). Half of the participants were married, and 88.3% had no other associated diseases. The results demonstrate that patients in Oman suffer from health-related stigma. However, social support, self-efficacy, and self-care actions were reported to be high and correlated with several clinical and demographic variables. Based on the results, effective, low-cost interventions such as psycho-educational groups, individual counseling, or group therapies might be developed. They can promote belief in enhanced efficacy and improved SCD adaptation, thereby increasing patient, and provider satisfaction.
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Affiliation(s)
| | - Mohammad Al Qadire
- Sultan Qaboos University, Muscat, Sultanate of Oman.,Al al-Bayt University, Mafraq, Jordan
| | - Omar Alzaabi
- Sultan Qaboos University, Muscat, Sultanate of Oman
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Ethnic disparities in pain processing among healthy adults: μ-opioid receptor binding potential as a putative mechanism. Pain 2021; 161:810-820. [PMID: 31764386 DOI: 10.1097/j.pain.0000000000001759] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although ethnic differences in pain perception are well documented, the underlying mechanism for these outcomes has not been established. µ-opioid receptor (MOR) function might contribute to this disparity, given that MORs play a key role in pain sensitivity and modulation. However, no study has characterized ethnic differences in MOR physiology. This study sought to address this knowledge gap by examining differences in µ-selective agonist binding potential (BPND; [C]-Carfentanil) between 27 non-Hispanic black (NHB) and 27 demographically similar, non-Hispanic white participants. Participants completed questionnaires and two 90-minute high-resolution research tomograph positron emission tomography (PET) imaging sessions. During PET imaging, a capsaicin or control cream was applied to individuals' arms, and pain ratings were collected. Bonferroni-corrected PET volumes of interest analyses revealed significantly greater [C]-Carfentanil BPND among NHB participants in bilateral ventral striatum ([left]: F1,52 = 16.38, P < 0.001; [right]: F1,52 = 21.76, P < 0.001), bilateral dorsolateral prefrontal cortex ([left] F1,52 = 17.3, P < 0.001; [right]: F1,52 = 14.17, P < 0.001), bilateral subgenual anterior cingulate cortex ([left]: F1,52 = 10.4, P = 0.002; [right]: F1,52 = 12.91, P = 0.001), and right insula (F1,52 = 11.0, P = 0.002). However, there were no significant main effects of condition or ethnicity × condition interaction effects across models, likely attributable to individual variability in the direction of change within groups. BPND values were significantly correlated with pain ratings collected during the capsaicin condition (r range = 0.34-0.46, P range = 0.01-0.001). Results suggest that NHB individuals might have generally greater unoccupied MOR density than non-Hispanic white peers. Findings have implications for physiological differences underlying ethnicity-related pain disparities. If replicated, these results further emphasize the need for tailored treatments in historically underserved populations.
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Oudin Doglioni D, Chabasseur V, Barbot F, Galactéros F, Gay MC. Depression in adults with sickle cell disease: a systematic review of the methodological issues in assessing prevalence of depression. BMC Psychol 2021; 9:54. [PMID: 33823930 PMCID: PMC8025551 DOI: 10.1186/s40359-021-00543-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Sickle cell disease (SCD) as other chronic medical conditions is commonly complicated by depression or other psychiatric symptoms. Results reported in studies present a large variation. Thus, synthetic data are needed to understand impact of depression in adults with SCD. The aim of this literature review is to analyse the methodology used in the studies assessing depression and discuss the different prevalence levels reported.
Methods Studies involving adults with SCD from 1999 to 2018 were included when providing data on prevalence of depression. It was defined by a psychometric assessment, a structured interview, or a medical record review. PRISMA recommendations were followed. Results 36 studies are included accordingly to our methodology. Prevalence variation is large, from 0% to more than 85%. We find that the type of assessment tool used plays a major role in this between studies variation. Also, methodological issues arise with respect to psychometric assessment. Moreover, differences emerge between continents, setting of recruitment or time of assessment. Conclusion All these issues are discussed to provide insight on depression in adults with sickle cell disease.
Trial Registration PROSPERO Registration CRD42018100684.
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Affiliation(s)
- Damien Oudin Doglioni
- EA4430 EvaCliPsy/ED139, Paris Nanterre University, Nanterre, France. .,Red Blood Cell Genetic Diseases Unit (UMGGR), Teaching Hospital Henri Mondor, Créteil, France.
| | | | - Frédéric Barbot
- INSERM Clinical Investigation Center 1429, Teaching Hospital Raymond Poincaré AP-HP, Garches, France
| | - Frédéric Galactéros
- Red Blood Cell Genetic Diseases Unit (UMGGR), Teaching Hospital Henri Mondor, Créteil, France.,French National Referral Centre for Sickle Cell Disease (MCGRE), Créteil, France
| | - Marie-Claire Gay
- EA4430 EvaCliPsy/ED139, Paris Nanterre University, Nanterre, France
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Royal CDM, Babyak M, Shah N, Srivatsa S, Stewart KA, Tanabe P, Wonkam A, Asnani M. Sickle cell disease is a global prototype for integrative research and healthcare. ADVANCED GENETICS (HOBOKEN, N.J.) 2021; 2:e10037. [PMID: 36618444 PMCID: PMC9744540 DOI: 10.1002/ggn2.10037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
Differences in health outcomes and treatment responses within and between global populations have been well documented. There is growing recognition of the need to move beyond simple inventories and descriptions of these differences and our linear explanations for them, and gain a better understanding of the multifaceted systems and networks underlying them in order to develop more precise and effective remedies. Typical targets for such integrative research have been common multifactorial diseases. We propose sickle cell disease, one of the most common monogenic diseases, as an ideal candidate for elucidating the complexity of the influences of endogenous and exogenous factors on disease pathophysiology, phenotypic diversity, and variations in responses to treatments at both the individual and population levels. We provide data-informed representations of diverse contributors to sickle cell disease complications that could guide innovative efforts to advance scientific knowledge, clinical practice, and policy formulation related to the disease; help improve outcomes for people worldwide with sickle cell disease; and inform approaches to studying and addressing other diseases.
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Affiliation(s)
- Charmaine D. M. Royal
- Department of African & African American StudiesDuke UniversityDurhamNorth CarolinaUSA,Duke Global Health InstituteDuke UniversityDurhamNorth CarolinaUSA,Center on Genomics, Race, Identity, DifferenceDuke UniversityDurhamNorth CarolinaUSA
| | - Michael Babyak
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Nirmish Shah
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Shantanu Srivatsa
- Center on Genomics, Race, Identity, DifferenceDuke UniversityDurhamNorth CarolinaUSA
| | | | - Paula Tanabe
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA,Duke University School of NursingDurhamNorth CarolinaUSA
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa,Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé 1YaoundéCameroon
| | - Monika Asnani
- Caribbean Institute for Health Research ‐ Sickle Cell UnitThe University of the West IndiesKingstonJamaica
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Greater mechanical temporal summation of pain in Latinx-Americans and the role of adverse life experiences. Pain Rep 2020; 5:e842. [PMID: 33134748 PMCID: PMC7467457 DOI: 10.1097/pr9.0000000000000842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Latinx-Americans showed greater temporal summation, adversity, and adversity correlates relative to non-Hispanic Whites. Discrimination and lifespan social status change inversely related to summation for Latinx-Americans. Introduction: Adverse life experiences disproportionately impact Latinx-Americans and are related to greater chronic pain rates. However, little is known about how adversities interact with central pain mechanisms for the development of later pain among Latinx-Americans. Objectives: The current study examined the relationship between adverse life experiences (eg, trauma and ethnic discrimination) and correlates (eg, social status) with mechanical temporal summation of pain (a proxy measure of central sensitization) between pain-free U.S. native Latinx (n = 65) and non-Hispanic White (NHW) (n = 51) adults. Methods: Participants completed self-report adverse life experience and correlational measures regarding childhood and adulthood and a mechanical temporal summation protocol. Results: Relative to NHWs, Latinx-Americans reported experiencing significantly greater trauma, discrimination, and lower social status during childhood and adulthood, along with greater temporal summation. Contrary to hypotheses, recent and lifetime experiences of ethnic discrimination significantly correlated with less temporal summation among Latinx-Americans. Decreases in objective and subjective social status across the lifespan (childhood to present day) correlated with greater temporal summation for Latinx-Americans. However, r-to-z transformation analyses confirmed that significant adversity and social status correlations observed among the Latinx group did not significantly differ from NHW participants. Conclusions: The present findings highlight the complex association between adverse experiences, adverse experience risk factors, and pain for Latinx-Americans. Given the disproportion of experienced pain and adversity among Latinx-Americans, the current findings suggest that a better understanding of the unique adversities for this sample may help elucidate the mechanisms underlying the relationship between adversities, adversity correlates, and pain risk for Latinx-Americans.
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Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey. PLoS One 2020; 15:e0237650. [PMID: 32881940 PMCID: PMC7470400 DOI: 10.1371/journal.pone.0237650] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/30/2020] [Indexed: 12/01/2022] Open
Abstract
Background Healthcare experiences associated with perceived racial/ethnic discrimination among patients are poorly understood. Objective Identify domains of patient dissatisfaction associated with perceived racial/ethnic discrimination among patients with pain. Design Semi-structured telephone surveys completed in 2013–2015. Participants White, African American, and Latino participants who reported receiving pain management from 25 Veterans Affairs (VA) Medical Centers. Main measures Surveys included open-ended questions about healthcare satisfaction/dissatisfaction and a measure of perceived racial/ethnic-based discrimination while seeking VA healthcare. Binary indicators for ten qualitative domains of dissatisfaction were derived from open-ended questions. We used multilevel models to identify dissatisfaction domains associated with perceived discrimination, adjusting for patient characteristics and site. Within domains associated with discrimination, we identified the most frequent codes and examined whether patients primarily referenced clinical or non-clinical staff in their experiences. Key results Overall, 622 participants (30.4% White, 37.8% African American, 31.8% Latino; 57.4% female; mean age = 53.4) reported a median discrimination score of 1.0 (IQR: 1.0–1.3) on a scale of 1 to 5; 233 (37.5%) perceived any racial/ethnic discrimination in healthcare. Individually, 7 of 10 qualitative domains were significantly associated with perceived discrimination: dissatisfaction with care quality, facilities, continuity of care, interactions with staff, staff demeanor, unresolved pain, and pharmacy services (ps<0.005). In combined models stratified by racial/ethnic group, 3 domains remained statistically significant: poor interactions for Latinos (adjOR = 5.24, 95% CI = 2.28–12.06), negative demeanor for African Americans (adjOR = 2.82, 95% CI = 1.45–5.50), and unresolved pain for Whites (adjOR = 6.23, 95% CI = 2.39–16.28). Clinical staff were referenced more often than non-clinical staff for all domains (interactions: 51% vs. 30%; demeanor: 46% vs. 15%; unresolved pain: 18% vs. 1%, respectively). Conclusion Negative interpersonal experiences and unresolved pain are strong correlates of perceived racial/ethnic discrimination among patients with pain. Future studies should test whether interventions targeting these domains reduce patient perceptions of racial/ethnic discrimination in healthcare.
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Varty M, Popejoy LL. Young Adults With Sickle Cell Disease: Challenges With Transition to Adult Health Care. Clin J Oncol Nurs 2020; 24:451-454. [PMID: 32678361 DOI: 10.1188/20.cjon.451-454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because life expectancy has increased greatly in the past few decades for individuals living with sickle cell disease (SCD), transition to the adult healthcare setting has become a necessity to continue disease management. Transition for young adults with SCD is associated with declining health outcomes, including increased acute care use and mortality. Nurses can assist young adults with SCD who are at risk after transition by assessing the young adult's ability to carry out disease self-management, facilitating the supportive role of the family, and recognizing young adults who may have difficulty accessing healthcare resources and providers.
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Do chronic pain and comorbidities affect brain function in sickle cell patients? A systematic review of neuroimaging and treatment approaches. Pain 2020; 160:1933-1945. [PMID: 31045749 DOI: 10.1097/j.pain.0000000000001591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) is a medical condition in which chronic pain is common and negatively impacts psychosocial function and quality of life. Although the brain mechanisms underlying chronic pain are well studied in other painful conditions, the brain mechanisms underlying chronic pain and the associated psychosocial comorbidities are not well established in SCD. A growing literature demonstrates the effect of treatment of chronic pain, including pharmacological and nonpharmacological treatments, on brain function. The present systematic review aimed to (1) determine the effects of chronic pain and psychosocial comorbidities on brain function of patients with SCD; (2) summarize pharmacological and nonpharmacological approaches to treat these symptoms; and (3) identify areas for further investigation of potential beneficial effects of treatments on brain function. Titles were screened using predefined criteria, including SCD, and abstracts and full texts were reviewed by 2 independent reviewers. A total of 1167 SCD articles were identified, and 86 full articles were included covering 3 sections: chronic pain (4 studies), psychosocial comorbidities (11 studies), and pharmacological and nonpharmacological treatments (71 studies). Neuroimaging evidence demonstrates aberrant neural processing related to chronic pain and psychosocial comorbidities in SCD beyond ischemic stroke and cerebral hemorrhage. Although neuroimaging studies show an important role for psychological factors, pain management is nearly exclusively based on opioids. Behavior therapy seems useful to improve psychological symptoms as well as chronic pain and quality of life. Further investigation is required with larger cohorts, matched controls, and examination of treatment-related neural mechanisms.
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Ziadni MS, Sturgeon JA, Bissell D, Guck A, Martin KJ, Scott W, Trost Z. Injustice Appraisal, but not Pain Catastrophizing, Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain. THE JOURNAL OF PAIN 2019; 21:582-592. [PMID: 31562992 DOI: 10.1016/j.jpain.2019.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/04/2019] [Accepted: 09/11/2019] [Indexed: 01/03/2023]
Abstract
Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California
| | - John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington.
| | - Daniel Bissell
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas
| | - Kelly J Martin
- Department of Psychology, University of North Texas, Denton, Texas
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Zina Trost
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
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Pecker LH, Darbari DS. Psychosocial and affective comorbidities in sickle cell disease. Neurosci Lett 2019; 705:1-6. [DOI: 10.1016/j.neulet.2019.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/11/2019] [Accepted: 04/05/2019] [Indexed: 12/31/2022]
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Bakhshaie J, Rogers AH, Mayorga NA, Ditre J, Rodríguez-Cano R, Ruiz AC, Viana AG, Garza M, Lemaire C, Ochoa-Perez M, Bogiaizian D, Zvolensky MJ. Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity. J Immigr Minor Health 2019; 21:21-29. [PMID: 29460134 DOI: 10.1007/s10903-018-0715-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study examined the role of anxiety sensitivity (AS; fear of the negative consequences of anxiety) in the relation between perceived racial discrimination and pain-related problems among Latinos seeking health services at a Federally Qualified Health Center. Participants included 145 adult Latinos (87.80% female, Mage = 38.07 years, SD = 11.98, and 96.2% reported Spanish as their first language). Results indicated that perceived racial discrimination was indirectly related to the pain intensity and pain disability through AS. These effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and number of axis I diagnoses. Overall, the present findings highlight the merit in focusing further scientific attention on the interplay between perceived racial discrimination and AS to better understand and inform interventions to reduce pain problems among Latinos in primary care.
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Affiliation(s)
- Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Rubén Rodríguez-Cano
- Department of Psychology and Psychobiology, University of Santiago de Compostela, Galicia, Santiago de Compostela, Spain
| | - Ana C Ruiz
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | | | - Daniel Bogiaizian
- Psychotherapeutic Area of "Asociación Ayuda", Anxiety Disorders Clinic, Buenos Aires, Argentina
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
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Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag 2019; 9:317-334. [PMID: 31140916 PMCID: PMC6587104 DOI: 10.2217/pmt-2018-0030] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alejandro Cortes
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Calia A Morais
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
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Field JJ, Ballas SK, Campbell CM, Crosby LE, Dampier C, Darbari DS, McClish DK, Smith WR, Zempsky WT. AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain. THE JOURNAL OF PAIN 2018; 20:746-759. [PMID: 30578848 DOI: 10.1016/j.jpain.2018.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/14/2022]
Abstract
Acute pain episodes are the most common complication in patients with sickle cell disease (SCD). Classically attributed to vaso-occlusion, recent insights suggest that chronic pain may also contribute to the pathogenesis of acute pain episodes, which adds complexity to their diagnosis and management. A taxonomy, or classification system, for acute pain in patients with SCD would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including SCD. To accomplish this, a working group of experts in SCD and pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific to SCD. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of chronic pain, are proposed to define the types of acute pain observed in patients with SCD. PERSPECTIVE: This article presents a taxonomy for acute pain in patients with SCD. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients with SCD.
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Affiliation(s)
- Joshua J Field
- JJF Medical Sciences Institute, BloodCenter of Wisconsin, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Samir K Ballas
- SKB Department of Medicine,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claudia M Campbell
- CCM Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lori E Crosby
- LEC Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlton Dampier
- CD Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Deepika S Darbari
- DSD Division of Hematology, Children's National Medical Center, Washington, DC
| | - Donna K McClish
- DKM Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Wally R Smith
- WRS Department of Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - William T Zempsky
- WTZ Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
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Abstract
The aim of this systematic review was to synthesize the literature regarding health-related stigma in adolescents and adults living with sickle cell disease (SCD). Four domains were identified from 27 studies: (1) social consequences of stigma; (2) the effect of stigma on psychological well-being; (3) the effect of stigma on physiological well-being; and (4) the impact of stigma on patient-provider relationships and care-seeking behaviors. Current literature revealed that SCD stigma has detrimental consequences. Methodological issues as well as research and practice implications were identified. Future research should further examine the impact of health-related stigma on self-management of SCD.
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Affiliation(s)
- Dominique Bulgin
- a Duke University School of Nursing, Durham, North Carolina, USA
| | - Paula Tanabe
- a Duke University School of Nursing, Durham, North Carolina, USA
| | - Coretta Jenerette
- b University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
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48
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Stigma and Pain in Adolescents Hospitalized for Sickle Cell Vasoocclusive Pain Episodes. Clin J Pain 2018; 34:438-444. [DOI: 10.1097/ajp.0000000000000553] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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49
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Discrimination hurts: The effect of discrimination on the development of chronic pain. Soc Sci Med 2018; 204:1-8. [DOI: 10.1016/j.socscimed.2018.03.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 12/19/2022]
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50
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Walker Taylor JL, Campbell CM, Thorpe RJ, Whitfield KE, Nkimbeng M, Szanton SL. Pain, Racial Discrimination, and Depressive Symptoms among African American Women. Pain Manag Nurs 2018; 19:79-87. [PMID: 29422125 PMCID: PMC6053541 DOI: 10.1016/j.pmn.2017.11.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
African American women with osteoarthritis (OA) are at high risk of experiencing pain. They report more pain than non-Hispanic White women and men of other racial/ethnic groups. This pain can limit independence and diminish their quality of life. Despite the detrimental effects that pain can have on older African American women with OA, there is a dearth of literature examining factors beyond the OA pathology that are associated with pain outcomes within this population. The purpose of this study was to examine the relationships between racial discrimination and depressive symptoms with pain intensity in African American women with OA. The sample comprised of 120 African American women, aged 50-80 years, with OA, from Texas and New Mexico. The women completed survey booklets to answer study questionnaires. We used multiple linear regression to test associations between racial discrimination, depressive symptoms, and pain intensity. We tested whether depressive symptoms mediated the relationship between racial discrimination and pain intensity by using bootstrapping. Results indicated that racial discrimination was significantly associated with pain intensity and that this relationship was mediated by depressive symptoms, even after controlling for body mass index, years of education, and length of time with OA. Both depressive symptoms and racial discrimination may be modifiable. If these modifiable factors are addressed in this population, there may be decreased pain in middle-aged and older African American women.
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Affiliation(s)
| | - Claudia M Campbell
- School of Medicine, Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wayne State University, Detroit, Michigan
| | | | - Manka Nkimbeng
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L Szanton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wayne State University, Detroit, Michigan
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