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Guekos A, Saxer J, Salinas Gallegos D, Schweinhardt P. Healthy women show more experimentally induced central sensitization compared with men. Pain 2024; 165:1413-1424. [PMID: 38231588 PMCID: PMC11090033 DOI: 10.1097/j.pain.0000000000003144] [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: 06/29/2023] [Revised: 09/14/2023] [Accepted: 10/13/2023] [Indexed: 01/18/2024]
Abstract
ABSTRACT Women more often experience chronic pain conditions than men. Central sensitization (CS) is one key mechanism in chronic pain that can differ between the sexes. It is unknown whether CS processes are already more pronounced in healthy women than in men. In 66 subjects (33 women), a thermal CS induction protocol was applied to the dorsum of one foot and a sham protocol to the other. Spatial extent [cm 2 ] of secondary mechanical hyperalgesia (SMH) and dynamic mechanical allodynia were assessed as subjective CS proxy measures, relying on verbal feedback. Changes in nociceptive withdrawal reflex magnitude (NWR-M) and response rate (NWR-RR) recorded through surface electromyography at the biceps and rectus femoris muscles were used as objective CS proxies. The effect of the CS induction protocol on SMH was higher in women than in men (effect size 2.11 vs 1.68). Nociceptive withdrawal reflex magnitude results were statistically meaningful for women (effect size 0.31-0.36) but not for men (effect size 0.12-0.29). Differences between men and women were not meaningful. Nociceptive withdrawal reflex response rate at the rectus femoris increased in women after CS induction and was statistically different from NWR-RR in men (median differences of 13.7 and 8.4% for 120 and 140% reflex threshold current). The objective CS proxy differences indicate that dorsal horn CS processes are more pronounced in healthy women. The even larger sex differences in subjective CS proxies potentially reflect greater supraspinal influence in women. This study shows that sex differences are present in experimentally induced CS in healthy subjects, which might contribute to women's vulnerability for chronic pain.
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Affiliation(s)
- Alexandros Guekos
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Decision Neuroscience Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Janis Saxer
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Biology, ETH Zurich, Zurich, Switzerland
| | - Diego Salinas Gallegos
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- IQVIA AG, Rotkreuz, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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2
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Kell PA, Vore CN, Hahn BJ, Payne MF, Rhudy JL. Optimizing Temporal Summation of Heat Pain Using a Constant Contact Heat Stimulator. J Pain Res 2024; 17:583-598. [PMID: 38347852 PMCID: PMC10860393 DOI: 10.2147/jpr.s439862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose Temporal summation (TS) of pain occurs when pain increases over repeated presentations of identical noxious stimuli. TS paradigms can model central sensitization, a state of hyperexcitability in nociceptive pathways that promotes chronic pain onset and maintenance. Many experimenters use painful heat stimuli to measure TS (TS-heat); yet, TS-heat research faces unresolved challenges, including difficulty evoking summation in up to 30-50% of participants. Moreover, substantial variability exists between laboratories regarding the methods for evoking and calculating TS-heat. Patients and Methods To address these limitations, this study sought to identify optimal parameters for evoking TS-heat in healthy participants with a commercially available constant contact heat stimulator, the Medoc TSA-II. Working within constraints of the TSA-II, stimulus trains with varying parameters (eg, stimulus frequency, baseline temp, peak temp, peak duration, testing site) were tested in a sample of 32 healthy, chronic pain-free participants to determine which combination best evoked TS-heat. To determine whether TS scoring method altered results, TS-heat was scored using three common methods. Results Across all methods, only two trains successfully evoked group-level TS-heat. These trains shared the following parameters: site (palmar hand), baseline and peak temperatures (44°C and 50°C, respectively), and peak duration (0.5 s). Both produced summation that peaked at moderate pain (~50 out of 100 rating). Conclusion Future TS-heat investigations using constant contact thermodes and fixed protocols may benefit from adopting stimulus parameters that include testing on the palmar hand, using 44°C baseline and 50°C peak temperatures, at ≥0.33 Hz stimulus frequency, and peak pulse durations of at least 0.5 seconds.
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Affiliation(s)
- Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Claudia N Vore
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Burkhart J Hahn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Child & Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Morris MC, Goodin BR, Bruehl S, Myers H, Rao U, Karlson C, Huber FA, Nag S, Carter C, Kinney K, Dickens H. Adversity type and timing predict temporal summation of pain in African-American adults. J Behav Med 2023; 46:996-1009. [PMID: 37563499 PMCID: PMC10592130 DOI: 10.1007/s10865-023-00440-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
African Americans are disproportionately exposed to adversity across the lifespan, which includes both stressful and traumatic events. Adversity, in turn, is associated with alterations in pain responsiveness. Racial differences in pain responsiveness among healthy adults are well established. However, the extent to which adversity type and timing are associated with alterations in pain responsiveness among healthy African-American adults is not well understood. The present study included 160 healthy African-American adults (98 women), ages 18 to 45. Outcome measures included pain tolerance and temporal summation of pain to evoked thermal pain. Composite scores were created for early-life adversity (childhood trauma, family adversity) and recent adversity (perceived stress, chronic stress burden). A measure of lifetime racial discrimination was also included. Higher levels of recent adversity were associated with higher temporal summation of pain, controlling for gender, age, and education. Neither early-life adversity nor lifetime racial discrimination were associated with temporal summation of pain. The present findings suggest that heightened temporal summation of pain among healthy African-American adults is associated with exposure to recent adversity events. Improved understanding of how recent adversity contributes to heightened temporal summation of pain in African Americans could help to mitigate racial disparities in pain experiences by identifying at-risk individuals who could benefit from early interventions.
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Affiliation(s)
- Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
- , 2525 West End Ave, Nashville, TN, 37206, USA.
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, England
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hector Myers
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Uma Rao
- Department of Psychiatry & Human Behavior and Center for the Neurobiology of Learning and Memory, University of California - Irvine, California, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
| | - Cynthia Karlson
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Pediatrics, Hematology and Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Felicitas A Huber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Subodh Nag
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Chelsea Carter
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Kerry Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Harrison Dickens
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
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Booker SQ, Baker TA, Esiaka D, Minahan JA, Engel IJ, Banerjee K, Poitevien M. A historical review of pain disparities research: Advancing toward health equity and empowerment. Nurs Outlook 2023; 71:101965. [PMID: 37023670 PMCID: PMC11198876 DOI: 10.1016/j.outlook.2023.101965] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND PURPOSE This theory-guided review draws on 30 years of published data to examine and interrogate the current and future state of pain disparities research. METHODS Using the Hierarchy of Health Disparity Research framework, we synthesize and present an overview of "three generations" of pain disparities scholarship, while proposing directions for adopting a "fourth generation" that redefines, explains, and theorizes future pain disparities research in a diverse society. DISCUSSION Prior research has focused on describing the scope of disparities, and throughout the historical context of human existence, racialized groups have been subjected to inadequate pain care. It is imperative that research not only illuminates existing problems but also provides solutions that can be implemented and sustained across varying social milieus. CONCLUSION We must invest in new theoretical models that expand on current perspectives and ideals that position all individuals at the forefront of justice and equity in their health.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, The University of Florida, Gainesville, FL.
| | - Tamara A Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darlingtina Esiaka
- Department of Family Medicine and Community Health, Rutgers University, Newark, NJ
| | | | - Ilana J Engel
- Department of Psychology, The University of Kansas, Lawrence, KS
| | - Kasturi Banerjee
- Department of Psychology, The University of Kansas, Lawrence, KS
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Guekos A, Grata AC, Hubli M, Schubert M, Schweinhardt P. Are changes in nociceptive withdrawal reflex magnitude a viable central sensitization proxy? Implications of a replication attempt. Clin Neurophysiol 2023; 145:139-150. [PMID: 36272950 DOI: 10.1016/j.clinph.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The nociceptive withdrawal reflex (NWR) has been proposed to read-out central sensitization (CS). Replicating a published study, it was assessed if the NWR magnitude reflects sensitization by painful heat. Additionally, NWR response rates were compared for two stimulation, the sural nerve at the lateral malleolus (SU) and the medial plantar nerve on the foot sole (MP), and three recording sites, biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA) muscles. METHODS 16 subjects underwent one experiment with six blocks of eight transcutaneous electrical stimulations to elicit the NWR while surface electromyography was collected. Tonic heat was concurrently applied in the same dermatome. Temperatures rose from 32 °C in the first to 46 °C in the last block following the previously published protocol. RESULTS Tonic heat did not influence NWR magnitude. The highest NWR response rate was obtained for MP-TA combination (79%). Regarding elicitation in all three muscles, SU stimulation outperformed MP (59% vs 57%). CONCLUSIONS The replication failed. NWR magnitude as a CS proxy in healthy subjects needs continued investigation. With respect to response rates, MP-TA proved efficient, whereas SU stimulation seemed preferable for multiple muscle recordings. SIGNIFICANCE Unclear methodological descriptions in the original study affected CS and NWR replication. The NWR magnitude changes induced by CS may closely depend on the different stimulation methods used.
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Affiliation(s)
- A Guekos
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Decision Neuroscience Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - A C Grata
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago IL, United States
| | - M Hubli
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Schubert
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - P Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Overstreet DS, Pester BD, Wilson JM, Flowers KM, Kline NK, Meints SM. The Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment. Curr Pain Headache Rep 2023; 27:1-10. [PMID: 36527589 PMCID: PMC10683048 DOI: 10.1007/s11916-022-01098-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. RECENT FINDINGS Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.
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Affiliation(s)
- Demario S Overstreet
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Bethany D Pester
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Nora K Kline
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA.
- Harvard Medical School, Boston, MA, USA.
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7
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Zajacova A, Grol-Prokopczyk H, Fillingim R. Beyond Black vs White: racial/ethnic disparities in chronic pain including Hispanic, Asian, Native American, and multiracial US adults. Pain 2022; 163:1688-1699. [PMID: 35250011 PMCID: PMC9294074 DOI: 10.1097/j.pain.0000000000002574] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023]
Abstract
ABSTRACT Previous literature on race/ethnicity and pain has rarely included all major US racial groups or examined the sensitivity of findings to different pain operationalizations. Using data from the 2010 to 2018 National Health Interview Surveys on adults 18 years or older (N = 273,972), we calculated the weighted prevalence of 6 definitions of pain to provide a detailed description of chronic pain in White, Black, Hispanic, Asian, Native American, and multiracial groups. We also estimated modified Poisson models to obtain relative disparities, net of demographic and socioeconomic (SES) factors including educational attainment, family income, and home ownership; finally, we calculated average predicted probabilities to show prevalence disparities in absolute terms. We found that Asian Americans showed the lowest pain prevalence across all pain definitions and model specifications. By contrast, Native American and multiracial adults had the highest pain prevalence. This excess pain was due to the lower SES among Native Americans but remained significant and unexplained among multiracial adults. The pain prevalence in White, Black, and Hispanic adults fell in between the 2 extremes. In this trio, Hispanics showed the lowest prevalence, an advantage not attributable to immigrant status or SES. Although most previous research focuses on Black-White comparisons, these 2 groups differ relatively little. Blacks report lower prevalence of less severe pain definitions than Whites but slightly higher prevalence of severe pain. Net of SES, however, Blacks experienced significantly lower pain across all definitions. Overall, racial disparities are larger than previously recognized once all major racial groups are included, and these disparities are largely consistent across different operationalizations of pain.
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Lannon EW, Hellman N, Huber FA, Kuhn BL, Sturycz CA, Palit S, Payne MF, Guereca YM, Toledo T, Shadlow JO, Rhudy JL. Exploration of the trait-activation model of pain catastrophizing in Native Americans: results from the Oklahoma Study of Native American pain risk (OK-SNAP). Scand J Pain 2022; 22:587-596. [PMID: 35289511 PMCID: PMC10165978 DOI: 10.1515/sjpain-2021-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Native Americans (NAs) have the highest prevalence of chronic pain of any racial/ethnic group. This issue has received little attention from the scientific community. One factor that may contribute to racial pain disparities is pain catastrophizing. Pain catastrophizing is a construct related to negative pain outcomes in persons with/without chronic pain. It has been suggested that the relationship between trait catastrophizing and pain is mediated by situation-specific (state) catastrophizing. The present study has 2 aims: (1) to investigate whether state pain catastrophizing mediates the relationship between trait catastrophizing and experimental pain (e.g., cold, ischemic, heat and electric tolerance), and (2) to investigate whether this relationship is stronger for NAs. METHODS 145 non-Hispanic Whites (NHWs) and 137 NAs completed the study. Bootstrapped indirect effects were calculated for 4 unmoderated and 8 moderated mediation models (4 models with path a moderated and 4 with path b). RESULTS Consistent with trait-activation theory, significant indirect effects indicated a tendency for trait catastrophizing to be associated with greater state catastrophizing which in turn is associated with reduced pain tolerance during tonic cold (a × b=-0.158) and ischemia stimuli (a × b=-0.126), but not during phasic electric and heat stimuli. Moderation was only noted for the prediction of cold tolerance (path a). Contrary to expectations, the indirect path was stronger for NHWs (a × b for NHW=-.142). CONCLUSIONS Together, these findings suggest that state catastrophizing mediates the relationship between trait catastrophizing and some measures of pain tolerance but this indirect effect was non-significant for NAs.
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Affiliation(s)
- Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Stanford University, 450 Serra Mall, Stanford, Stanford, CA94305, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Shreela Palit
- University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH, USA
| | - Yvette M Guereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Tyler Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Atthakomol P, Kaensuk S, Manosroi W, Sangsin A, Buntragulpoontawee M, Tongprasert S. Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities. BMC Musculoskelet Disord 2022; 23:708. [PMID: 35879713 PMCID: PMC9316708 DOI: 10.1186/s12891-022-05663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
Trial design The prospective randomized controlled trial. Background This study compares outcomes in terms of early postoperative anterior wrist pain and time to return to work or activities of daily living of patients who underwent carpal tunnel syndrome (CTS) release with short incision and those who had minimally invasive surgery (MIS) with CTS kits. Methods A total of 24 patients diagnosed with primary CTS confirmed with electrodiagnosis at an academic university hospital were randomly assigned into one of two groups of 12 patients each: a short incision group and an MIS with tool-kit group using computer-generated block randomization (block of four). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. In the short incision group, skin was incised longitudinally from Kaplan’s line to the area distal to transverse wrist crease (2.5–4.0 cm) while in the tool-kit group, an incision of less than 2.5 cm. was made using special MIS-CTS kits. Primary outcomes evaluated include visual analogue scale (VAS) measurement of pain intensity in the anterior carpal area both while at rest and while conducting daily activities at the 2nd week postoperatively as well as the time to return to activities of daily living and work. Improvement in the Michigan hand questionnaire (MHQ) score, a secondary outcome, was also measured at the 2nd week postoperatively. Patients, allocator and outcome assessor were blinded. Results Demographic data, including preoperative electrodiagnostic severity and occupation, were similar in the two groups. There were no significant differences in terms of VAS of the early postoperative anterior carpal area at rest (p > 0.99), while conducting daily activities (p = 0.89) and time to return to activities of daily living (p = 0.46) and work (p = 0.24). The MHQ score improvement at the 2nd week postoperatively showed no significant difference between the groups (p = 0.95). The MIS wound length in the tool-kit group was significantly shorter than in the short incision group (1.95 vs 2.92 cm, p < 0.01). Conclusions There is no difference in early postoperative anterior wrist pain, time to return to work or to activities of daily living between the surgical techniques. Short incision is recommended for benefit in term of cost-effectiveness, while MIS with tool-kit could be preferred in patients who concerned in cosmetic appearance between the surgical techniques. Trial registration www.clinicaltrials.in.th (TCTR20200530003). Registered 30 May 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05663-5.
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Affiliation(s)
- Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sitthikorn Kaensuk
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worapaka Manosroi
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apiruk Sangsin
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Siam Tongprasert
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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10
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Kell PA, Huber FA, Street EN, Shadlow JO, Rhudy JL. Sleep Problems Mediate the Relationship Between Psychosocial Stress and Pain Facilitation in Native Americans: A Structural Equation Modeling Analysis from the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2022; 56:1116-1130. [PMID: 35775809 PMCID: PMC9924047 DOI: 10.1093/abm/kaac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset. PURPOSE This study examined the effects of psychological stress and sleep problems on subjective and physiological measures of pain processing in NAs and NHWs. METHODS Structural equation modeling was used to determine whether ethnicity (NA or NHW) was associated with psychological stress or sleep problems and whether these variables were related to conditioned pain modulation of pain perception (CPM-pain) and the nociceptive flexion reflex (CPM-NFR), temporal summation of pain (TS-pain) and NFR (TS-NFR), and pain tolerance in a sample of 302 (153 NAs) pain-free participants. RESULTS NAs experienced more psychological stress (Estimate = 0.027, p = .009) and sleep problems (Estimate = 1.375, p = .015) than NHWs. When controlling for age, sex, physical activity, BMI, and general health, NA ethnicity was no longer related to greater sleep problems. Psychological stress was also related to sleep problems (Estimate = 30.173, p = <.001) and psychological stress promoted sleep problems in NAs (indirect effect = 0.802, p = .014). In turn, sleep problems were associated with greater TS-pain (Estimate = 0.714, p = .004), but not other pain measures. CONCLUSIONS Sleep problems may contribute to chronic pain risk by facilitating pain perception without affecting facilitation of spinal neurons or endogenous inhibition of nociceptive processes. Since psychological stress promoted pain facilitation via enhanced sleep problems, efforts to reduce psychological stress and sleep problems among NAs may improve health outcomes.
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Affiliation(s)
- Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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11
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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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12
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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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13
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Huber FA, Kell PA, Kuhn BL, Lannon EW, Palit S, Payne MF, Hellman N, Sturycz CA, Güereca YM, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. The Association Between Adverse Life Events, Psychological Stress, and Pain-Promoting Affect and Cognitions in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J Racial Ethn Health Disparities 2022; 9:215-226. [PMID: 33428157 PMCID: PMC8272727 DOI: 10.1007/s40615-020-00945-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
Native Americans (NAs) experience higher rates of chronic pain. To examine the mechanisms for this pain inequity, we have previously shown that NAs report higher levels of pain-related anxiety and pain catastrophizing, which are in turn related to pronociceptive (pain-promoting) processes. But, it is currently unclear why NAs would report greater pain-related anxiety and catastrophizing. Given that NAs are also more likely to experience adverse life events (ALEs) and associated psychological distress, it was hypothesized that higher anxiety/catastrophizing in NAs would be partially explained by higher rates of ALEs and psychological distress. Structural equation modeling was used to analyze these pathways (NA ethnicity ➔ ALEs ➔ psychological distress ➔ pain anxiety/catastrophizing) in 305 healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Pain-related anxiety and situational pain catastrophizing were assessed in response to a variety of painful tasks. The Life Events Checklist was used to assess cumulative exposure to ALEs that directly happened to each participant. A latent psychological distress variable was modeled from self-reported perceived stress and psychological symptoms. Results found that NAs experienced more ALEs and greater psychological distress which was associated with higher rates of pain-related anxiety and pain catastrophizing. Notably, NAs did not report greater psychological distress when controlling for ALE exposure. This suggests that a higher risk of chronic pain in NAs may be due, in part, to psychological distress, pain-related anxiety, and pain catastrophizing that are promoted by exposure to ALEs. These results highlight several targets for intervention to decrease NA pain risk.
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Affiliation(s)
- Felicitas A Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
- Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Cassandra A Sturycz
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Burkhart J Hahn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
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14
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Ibancos-Losada MDR, Osuna-Pérez MC, Cortés-Pérez I, Montoro-Cárdenas D, Díaz-Fernández Á. Validation and Cross-Cultural Adaptation of the Spanish Version of the Pain Sensitivity Questionnaire (PSQ-S). J Clin Med 2021; 11:jcm11010151. [PMID: 35011891 PMCID: PMC8745301 DOI: 10.3390/jcm11010151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Experimental pain testing requires specific equipment and may be uncomfortable for patients. The Pain Sensitivity Questionnaire (PSQ) was developed to assess pain sensitivity, based on the pain intensity ratings (range: 0–10) of painful situations that occur in daily life. The main objective of this study was to carry out a cross-cultural adaptation and validation of the Spanish version of the PSQ (PSQ-S). A total of 354 subjects (296 healthy and 58 chronic pain patients) filled in the PSQ-S. A subgroup of 116 subjects performed experimental pain testing, including two modalities (cold and pressure), with different measures: pain intensity rating, pressure pain threshold, and tolerance. The validation results showed two factors: PSQ-S-moderate and PSQ-S-minor and, for the total scale and the two factors, an excellent internal consistency (Cronbach’s alpha coefficient > 0.9) and a substantial reliability (Intraclass Correlation Coefficient > 0.8). We obtained strong correlations with all the experimental pain rating parameters, catastrophizing, and depression variables, as well as moderate correlations with anxiety, central sensibilization, and impact on the quality of life. Chronic pain patients received elevated PSQ-S scores compared to healthy controls, and three cut-off values (PSQ-S-total = 7.00, PSQ-S-moderate = 7.57, and PSQ-S-minor = 6.29) based on ROC curve analyses were shown to be able to discriminate between healthy adults and adults with chronic pain. Therefore, PSQ-S may be a simple alternative to experimental pain procedures for clinical and experimental pain research.
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Affiliation(s)
| | | | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain
- Granada Northeast Health District, Andalusian Health Service, Street San Miguel 2, 18500 Guadix, Spain
| | | | - Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain
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15
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Rhudy JL, Kuhn BL, Demuth MJ, Huber FA, Hellman N, Toledo TA, Lannon EW, Palit S, Payne MF, Sturycz CA, Kell PA, Guereca YM, Street EN, Shadlow JO. Are Cardiometabolic Markers of Allostatic Load Associated With Pronociceptive Processes in Native Americans?: A Structural Equation Modeling Analysis From the Oklahoma Study of Native American Pain Risk. THE JOURNAL OF PAIN 2021; 22:1429-1451. [PMID: 34033965 PMCID: PMC8578174 DOI: 10.1016/j.jpain.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Native Americans (NAs) experience higher rates of chronic pain than the general U.S. population, but the risk factors for this pain disparity are unknown. NAs also experience high rates of stressors and cardiovascular and metabolic health disparities (eg, diabetes, cardiovascular disease) consistent with allostatic load (stress-related wear-and-tear on homeostatic systems). Given that allostatic load is associated with chronic pain, then allostatic load may contribute to their pain disparity. Data from 302 healthy, pain-free men and women (153 NAs, 149 non-Hispanic Whites [NHW]) were analyzed using structural equation modeling to determine whether cardiometabolic allostatic load (body mass index, blood pressure, heart rate variability) mediated the relationship between NA ethnicity and experimental measures of pronociceptive processes: temporal summation of pain (TS-pain) and the nociceptive flexion reflex (TS-NFR), conditioned pain modulation of pain (CPM-pain) and NFR (CPM-NFR), and pain tolerance. Results indicated that NAs experienced greater cardiometabolic allostatic load that was related to enhanced TS-NFR and impaired CPM-NFR. Cardiometabolic allostatic load was unrelated to measures of pain perception (CPM-pain, TS-pain, pain sensitivity). This suggests cardiometabolic allostatic load may promote spinal sensitization in healthy NAs, that is not concomitant with pain sensitization, perhaps representing a unique pain risk phenotype in NAs. PERSPECTIVE: Healthy, pain-free Native Americans experienced greater cardiometabolic allostatic load that was associated with a pronociceptive pain phenotype indicative of latent spinal sensitization (ie, spinal sensitization not associated with hyperalgesia). This latent spinal sensitization could represent a pain risk phenotype for this population.
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Affiliation(s)
- Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma.
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio
| | | | - Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Yvette M Guereca
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
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16
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Ross EN, Toledo TA, Huber F, Kell PA, Hellman N, Shadlow JO, Rhudy JL. The role of self-evaluated pain sensitivity as a mediator of objectively measured pain tolerance in Native Americans: findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP). J Behav Med 2021; 45:272-284. [PMID: 34545536 DOI: 10.1007/s10865-021-00257-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/06/2021] [Indexed: 11/24/2022]
Abstract
Native Americans (NAs) are at increased risk for chronic pain. One mechanism contributing to this pain disparity could be personal pain beliefs, which may influence actual pain sensitivity. Thus, we examined whether self-evaluated pain sensitivity (SEPS) mediates the relationship between ethnicity [NAs vs. non-Hispanic Whites (NHWs)] and objectively-measured pain tolerance, and whether catastrophic thinking and pain-related anxiety influence these pain beliefs. 232 healthy, pain-free NAs and NHWs completed questionnaires measuring SEPS, catastrophizing, and anxiety. Objective pain tolerance was also assessed. Results suggested: (1) NAs reported higher levels of SEPS, catastrophizing, and anxiety, (2) catastrophizing may have enhanced anxiety and both catastrophizing and anxiety were associated with higher SEPS, and (3) anxiety and SEPS were associated with lower pain tolerance. A significant bootstrapped mediation analysis suggested NAs experienced higher pain-related anxiety, which may have promoted higher SEPS, that in turn reduced pain tolerance. Longitudinal research is needed to confirm this.
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Affiliation(s)
- Erin N Ross
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
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17
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Kell PA, Hellman N, Huber FA, Lannon EW, Kuhn BL, Sturycz CA, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. The Relationship Between Adverse Life Events and Endogenous Inhibition of Pain and Spinal Nociception: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP). THE JOURNAL OF PAIN 2021; 22:1097-1110. [PMID: 33819573 PMCID: PMC8419014 DOI: 10.1016/j.jpain.2021.03.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Adverse life events (ALEs) are a risk factor for chronic pain; however, mechanisms underlying this association are not understood. This study examined whether cumulative ALE exposure impairs endogenous inhibition of pain (assessed from pain report) and spinal nociception (assessed from nociceptive flexion reflex; NFR) in healthy, pain-free Native Americans (n = 124) and non-Hispanic Whites (n = 129) during a conditioned pain modulation (CPM) task. Cumulative ALE exposure was assessed prior to testing by summing the number of potentially traumatic events experienced by each participant across their lifespan. Multilevel modeling found that ALEs were associated with NFR modulation during the CPM task even after controlling for general health, body mass index, sex, age, blood pressure, sleep quality, stimulation intensity, stimulus number, perceived stress, and psychological distress. Low exposure to ALEs was associated with NFR inhibition, whereas high exposure to ALEs was associated with NFR facilitation. By contrast, pain perception was inhibited during the CPM task regardless of the level of ALE exposure. Race/ethnicity did not moderate these results. Thus, ALEs may be pronociceptive for both Native Americans and non-Hispanic Whites by impairing descending inhibition of spinal nociception. This could contribute to a chronic pain risk phenotype involving latent spinal sensitization. PERSPECTIVE: This study found that adverse life events were associated with impaired descending inhibition of spinal nociception in a sample of Native Americans and non-Hispanic Whites. These findings expand on previous research linking adversity to chronic pain risk by identifying a proximate physiological mechanism for this association.
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Affiliation(s)
- Parker A Kell
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Natalie Hellman
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Edward W Lannon
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Bethany L Kuhn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Tyler A Toledo
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Burkhart J Hahn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma.
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18
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Shadlow JO, Kell PA, Toledo TA, Huber FA, Kuhn BL, Lannon EW, Hellman N, Sturycz CA, Ross EN, Rhudy JL. Sleep Buffers the Effect of Discrimination on Cardiometabolic Allostatic Load in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J Racial Ethn Health Disparities 2021; 9:1632-1647. [PMID: 34319571 DOI: 10.1007/s40615-021-01103-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Compared to other racial/ethnic groups, Native Americans (NAs) are more likely to develop health conditions associated with allostatic load (stress-related wear-and-tear). Psychosocial factors (i.e., adverse life events, discrimination, psychological distress) often promote stress and may help explain greater allostatic load in NAs. Moreover, previous research suggests sleep may either mediate or moderate the effects of some psychosocial stressors, like discrimination, on allostatic load. The current study investigated the relationship between adverse life events, discrimination, psychological stress, sleep, and cardiometabolic load. METHODS Using a sample of 302 healthy, chronic pain-free NAs and non-Hispanic White (NHW) participants, bootstrapped mediation analyses were conducted to determine whether the relationship between NA race/ethnicity and cardiometabolic allostatic load (composite score of body mass index, mean arterial pressure, and heart rate variability) was mediated by psychosocial stressors. Models also assessed whether sleep disturbance served as an additional mediator or a moderator to the effects. RESULTS Consistent with prior research, we found that NAs experienced greater discrimination, adverse life events (potentially traumatic events), and cardiometabolic allostatic load than NHWs. Further, discrimination was associated with increased psychological stress for NAs, but this did not explain why NAs experience higher cardiometabolic allostatic load. A moderating effect of sleep on discrimination was found, such that discrimination partially contributed to the relationship between NA race/ethnicity and cardiometabolic allostatic load, but only for participants reporting greater sleep disturbance. Implications These findings highlight that good sleep can buffer the effect of psychosocial stress on cardiometabolic allostatic load in Native Americans.
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Affiliation(s)
- Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Felicitas A Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Cassandra A Sturycz
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Erin N Ross
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
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19
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Wu S, Zhang W, Yan J, Noma N, Young A, Yan Z. Worldwide prevalence estimates of burning mouth syndrome: A systematic review and meta-analysis. Oral Dis 2021; 28:1431-1440. [PMID: 33818878 DOI: 10.1111/odi.13868] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the worldwide prevalence and epidemiology profile of burning mouth syndrome. MATERIAL AND METHODS A systematic review and meta-analysis was conducted. Search strategies were performed in PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database for studies published before January 31, 2021, for the prevalence of burning mouth syndrome. RESULTS Eighteen articles were included. The overall pooled prevalence of burning mouth syndrome was 1.73% (95% CI = 0.176-0.351, n = 26,632) in general population, and 7.72% (95% CI = 0.434-0.691, n = 86,591) in clinical patients. The subgroup analysis by continent showed that among the population-based studies the prevalence in Asia (1.05%) lower than in Europe (5.58%) and North America (1.10%). The subgroup analysis by gender showed the prevalence of female (1.15%) was higher than male (0.38%) in general population. The subgroup analysis by age showed the prevalence was higher for people over 50 (3.31%) than under 50 (1.92%). CONCLUSIONS The pooled prevalence of burning mouth syndrome was relatively high in both general population and clinical patients, varies in different regions with the highest prevalence in Europe, and females over 50 years were the most susceptible group. More epidemiological surveys on the prevalence of burning mouth syndrome are needed.
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Affiliation(s)
- Shuangshuang Wu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wenqing Zhang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jingxian Yan
- Chinese Medical College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Noboru Noma
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan
| | - Andrew Young
- Department of Diagnostic Sciences, Arthur Dugoni School of Dentistry, University of the Pacific, Stockton, CA, USA
| | - Zhimin Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
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20
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Huang SS, Cao S, Lu CE, Qin YB, Yang JP. Effects of nicorandil on p120 expression in the spinal cord and dorsal root ganglion of rats with chronic postsurgical pain. Mol Med Rep 2020; 22:4821-4827. [PMID: 33173987 PMCID: PMC7646919 DOI: 10.3892/mmr.2020.11546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/21/2020] [Indexed: 01/25/2023] Open
Abstract
Chronic postsurgical pain (CPSP) has a high incidence, but the underlying mechanism is not well understood. Accumulating evidence has suggested that central sensitization is the main mechanism of pain. To study the role of p120 in CPSP, a skin/muscle incision and retraction (SMIR) model was established, and immunofluorescence staining and western blotting were performed to analyze the expression of p120 in the spinal cord and dorsal root ganglion (DRG). The results demonstrated that SMIR increased the expression of p120 in the DRG and the spinal cord compared with the naive group. Furthermore, it was demonstrated that p120 was mainly distributed in the glial fibrillary acidic protein-positive astrocytes in the spinal cord, and in the neurofilament 200-positive medium and large neurons in the DRG. Our previous studies have shown that adenosine triphosphate-sensitive potassium channel (KATP) agonists can reduce postoperative pain in rats. Therefore, the changes in p120 were observed in the DRG and spinal cord of rats following the intraperitoneal injection of nicorandil, a KATP agonist. It was demonstrated that nicorandil administration could relieve mechanical pain experienced following SMIR in rats, and decrease the expression of p120 in the DRG and spinal cord. The results revealed that p120 may contribute to the prophylactic analgesic effect of nicorandil, thus providing a novel insight into the mechanism of CPSP prevention.
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Affiliation(s)
- Sai-Sai Huang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Su Cao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Cui E Lu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Yi-Bin Qin
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Jian-Ping Yang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
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21
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Ibancos-Losada MDR, Osuna-Pérez MC, Castellote-Caballero MY, Díaz-Fernández Á. Conditioned Pain Modulation Effectiveness: An Experimental Study Comparing Test Paradigms and Analyzing Potential Predictors in a Healthy Population. Brain Sci 2020; 10:brainsci10090599. [PMID: 32872642 PMCID: PMC7565989 DOI: 10.3390/brainsci10090599] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022] Open
Abstract
Conditioned pain modulation (CPM) is an endogenous pain inhibition phenomenon that can be summarized simply as one type of pain being able to inhibit another, which must be in a remote area in relation to the first pain. We aimed to compare the effectiveness of four CPM test paradigms as well as the association of the CPM effect with potential predictors in 72 healthy volunteers. Pressure pain from an algometer was used as the test stimulus, and pain provoked by cold water or ischemic pressure was used as the conditioning stimulus, applied either sequentially or in parallel. No significant differences were found between the test paradigms, although the cold-parallel test showed the most significant effect size (ηP2 = 0.614). No association was found between the CPM effect and sociodemographic variables (age or sex), nor anxiety, depression, catastrophizing, previous history of pain or self-perceived pain tolerance. Nevertheless, a strong association was found between the CPM effect and individual affinity for the stimulus in participants who underwent the cold water test paradigm; this explained around 45% of the total CPM effect when the paradigm (cold water) coincided with personal affinity for the stimulus (“I prefer cold to heat”, “cold is not unpleasant”).
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Affiliation(s)
| | - María C. Osuna-Pérez
- Department of Health Sciences, University of Jaén, Jaén-23071, Spain; (M.Y.C.-C.); (Á.D.-F.)
- Correspondence: ; Tel.: +34-953213020
| | | | - Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaén, Jaén-23071, Spain; (M.Y.C.-C.); (Á.D.-F.)
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22
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Toledo TA, Kuhn BL, Payne MF, Lannon EW, Palit S, Sturycz CA, Hellman N, Güereca YM, Demuth MJ, Huber F, Shadlow JO, Rhudy JL. The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2020; 54:575-594. [PMID: 32073117 PMCID: PMC7414293 DOI: 10.1093/abm/kaaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Conditioned pain modulation (CPM) is a task that involves measuring pain in response to a test stimulus before and during a painful conditioning stimulus (CS). The CS pain typically inhibits pain elicited by the test stimulus; thus, this task is used to assess endogenous pain inhibition. Moreover, less efficient CPM-related inhibition is associated with chronic pain risk. Pain catastrophizing is a cognitive-emotional process associated with negative pain sequelae, and some studies have found that catastrophizing reduces CPM efficiency. PURPOSE The current study examined the relationship between catastrophizing (dispositional and situation specific) and CPM-related inhibition of pain and the nociceptive flexion reflex (NFR; a marker of spinal nociception) to determine whether the catastrophizing-CPM relationship might contribute to the higher risk of chronic pain in Native Americans (NAs). METHODS CPM of pain and NFR was assessed in 124 NAs and 129 non-Hispanic Whites. Dispositional catastrophizing was assessed at the beginning of the test day, whereas situation-specific catastrophizing was assessed in response to the CS, as well as painful electric stimuli. RESULTS Situation-specific, but not dispositional, catastrophizing led to less NFR inhibition but more pain inhibition. These effects were not moderated by race, but mediation analyses found that: (a) the NA race was associated with greater situation-specific catastrophizing, which led to less NFR inhibition and more pain inhibition, and (b) situation-specific catastrophizing was associated with greater CS pain, which led to more pain inhibition. CONCLUSIONS Catastrophizing may contribute to NA pain risk by disrupting descending inhibition.
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Affiliation(s)
- Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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23
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Rhudy JL, Huber F, Kuhn BL, Lannon EW, Palit S, Payne MF, Hellman N, Sturycz CA, Güereca YM, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO. Pain-related anxiety promotes pronociceptive processes in Native Americans: bootstrapped mediation analyses from the Oklahoma Study of Native American Pain Risk. Pain Rep 2020; 5:e808. [PMID: 32072102 PMCID: PMC7004502 DOI: 10.1097/pr9.0000000000000808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Evidence suggests Native Americans (NAs) experience higher rates of chronic pain than the general US population, but the mechanisms contributing to this disparity are poorly understood. Recently, we conducted a study of healthy, pain-free NAs (n = 155), and non-Hispanic whites (NHWs, n = 150) to address this issue and found little evidence that NAs and NHWs differ in pain processing (assessed from multiple quantitative sensory tests). However, NAs reported higher levels of pain-related anxiety during many of the tasks. OBJECTIVE The current study is a secondary analysis of those data to examine whether pain-related anxiety could promote pronociceptive processes in NAs to put them at chronic pain risk. METHODS Bootstrapped indirect effect tests were conducted to examine whether pain-related anxiety mediated the relationships between race (NHW vs NA) and measures of pain tolerance (electric, heat, ischemia, and cold pressor), temporal summation of pain and the nociceptive flexion reflex (NFR), and conditioned pain modulation of pain/NFR. RESULTS Pain-related anxiety mediated the relationships between NA race and pain tolerance and conditioned pain modulation of NFR. Exploratory analyses failed to show that race moderated relationships between pain-related anxiety and pain outcomes. CONCLUSION These findings imply that pain-related anxiety is not a unique mechanism of pain risk for NAs, but that the greater tendency to experience pain-related anxiety by NAs impairs their ability to engage descending inhibition of spinal nociception and decreases their pain tolerance (more so than NHWs). Thus, pain-related anxiety may promote pronociceptive processes in NAs to place them at risk for future chronic pain.
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Affiliation(s)
- Jamie L. Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Bethany L. Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Edward W. Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Community Dentistry & Behavioral Science, University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL, USA
| | - Michael F. Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | | | - Tyler A. Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Mara J. Demuth
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Burkhart J. Hahn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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