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Mergler BD, Toles AO, Alexander A, Mosquera DC, Lane-Fall MB, Ejiogu NI. Racial and Ethnic Patient Care Disparities in Anesthesiology: History, Current State, and a Way Forward. Anesth Analg 2024; 139:420-431. [PMID: 38153872 DOI: 10.1213/ane.0000000000006716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Disparities in patient care and outcomes are well-documented in medicine but have received comparatively less attention in anesthesiology. Those disparities linked to racial and ethnic identity are pervasive, with compelling evidence in operative anesthesiology, obstetric anesthesiology, pain medicine, and critical care. This narrative review presents an overview of disparities in perioperative patient care that is grounded in historical context followed by potential solutions for mitigating disparities and inequities.
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Affiliation(s)
- Blake D Mergler
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allyn O Toles
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony Alexander
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diana C Mosquera
- Department of Anesthesiology, Albany Medical Center, Albany, New York
| | - Meghan B Lane-Fall
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nwadiogo I Ejiogu
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Zhang L, Wager TD, Koban L. Social cues influence perception of others' pain. Eur J Pain 2024; 28:845-854. [PMID: 38146898 DOI: 10.1002/ejp.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Accurately perceiving other people's pain is important in both daily life and healthcare settings. However, judging other's pain is inherently difficult and can be biased by various social and cultural factors. Here, we examined whether perception of others' pain and pain management recommendations are socially influenced by seeing the opinions of other raters. METHODS In Experiment 1 (N = 50), participants rated pictures depicting injured hands or feet of pre-selected high, medium and low intensities. Each picture was preceded by cues indicating ratings of 10 previous participants. Cues were randomized to indicate low (SocialLOW) or high (SocialHIGH) pain judgements and were not predictive of actual normative pain intensity. In Experiment 2 (N = 209), participants viewed facial video clips of patients with chronic shoulder pain making painful movements. They estimated patients' pain intensity and provided pain management recommendations. RESULTS Experiment 1 revealed that perceivers' pain estimates were significantly and substantially higher for stimuli following SocialHIGH than SocialLOW cues (Cohen's d = 1.26, p < 0.001) and paralleled by increased skin conductance responses. Experiment 2 replicated the effect of social cues on pain judgements (d = 0.58, p < 0.001). However, social cues did not influence post-study pain management recommendations, potentially due to memory limitations. CONCLUSIONS Together, these studies reveal that judgements of others' pain are robustly modulated by information about others' opinions. Future research could test the prevalence and strength of such effects in clinical settings. SIGNIFICANCE The present study shows that even arbitrary opinions of other raters influence the perception of others' pain. This finding adds new insight into the growing evidence of social and cultural biases in pain estimation.
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Affiliation(s)
- Lanlan Zhang
- Department of Public Teaching, Guangzhou Sport University, Guangzhou, China
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Leonie Koban
- Lyon Neuroscience Research Center, CNRS, Inserm, Université Claude Bernard Lyon 1, Bron, France
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3
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Yin Y, Haggerty DL, Zhou S, Atwood BK, Sheets PL. Converging Effects of Chronic Pain and Binge Alcohol Consumption on Anterior Insular Cortex Neurons Projecting to the Dorsolateral Striatum in Male Mice. J Neurosci 2024; 44:e1287232024. [PMID: 38453466 PMCID: PMC11026341 DOI: 10.1523/jneurosci.1287-23.2024] [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: 07/11/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Chronic pain and alcohol use disorder (AUD) are highly comorbid, and patients with chronic pain are more likely to meet the criteria for AUD. Evidence suggests that both conditions alter similar brain pathways, yet this relationship remains poorly understood. Prior work shows that the anterior insular cortex (AIC) is involved in both chronic pain and AUD. However, circuit-specific changes elicited by the combination of pain and alcohol use remain understudied. The goal of this work was to elucidate the converging effects of binge alcohol consumption and chronic pain on AIC neurons that send projections to the dorsolateral striatum (DLS). Here, we used the Drinking-in-the-Dark (DID) paradigm to model binge-like alcohol drinking in mice that underwent spared nerve injury (SNI), after which whole-cell patch-clamp electrophysiological recordings were performed in acute brain slices to measure intrinsic and synaptic properties of AIC→DLS neurons. In male, but not female, mice, we found that SNI mice with no prior alcohol exposure consumed less alcohol compared with sham mice. Electrophysiological analyses showed that AIC→DLS neurons from SNI-alcohol male mice displayed increased neuronal excitability and increased frequency of miniature excitatory postsynaptic currents. However, mice exposed to alcohol prior to SNI consumed similar amounts of alcohol compared with sham mice following SNI. Together, our data suggest that the interaction of chronic pain and alcohol drinking have a direct effect on both intrinsic excitability and synaptic transmission onto AIC→DLS neurons in mice, which may be critical in understanding how chronic pain alters motivated behaviors associated with alcohol.
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Affiliation(s)
- Yuexi Yin
- Medical Neurosciences Graduate Program, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - David L Haggerty
- Medical Neurosciences Graduate Program, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Shudi Zhou
- Medical Neurosciences Graduate Program, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Brady K Atwood
- Medical Neurosciences Graduate Program, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Department of Pharmacology & Toxicology, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Patrick L Sheets
- Medical Neurosciences Graduate Program, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Department of Pharmacology & Toxicology, Indiana University School of Medicine, Indianapolis, Indiana 46202
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Zhou Y, Han S, Kang P, Tobler PN, Hein G. The social transmission of empathy relies on observational reinforcement learning. Proc Natl Acad Sci U S A 2024; 121:e2313073121. [PMID: 38381794 PMCID: PMC10907261 DOI: 10.1073/pnas.2313073121] [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: 08/09/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Theories of moral development propose that empathy is transmitted across individuals. However, the mechanisms through which empathy is socially transmitted remain unclear. Here, we combine computational learning models and functional MRI to investigate whether, and if so, how empathic and non-empathic responses observed in others affect the empathy of female observers. The results of three independent studies showed that watching empathic or non-empathic responses generates a learning signal that respectively increases or decreases empathy ratings of the observer. A fourth study revealed that the learning-related transmission of empathy is stronger when observing human rather than computer demonstrators. Finally, we show that the social transmission of empathy alters empathy-related responses in the anterior insula, i.e., the same region that correlated with empathy baseline ratings, as well as its functional connectivity with the temporoparietal junction. Together, our findings provide a computational and neural mechanism for the social transmission of empathy that accounts for changes in individual empathic responses in empathic and non-empathic social environments.
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Affiliation(s)
- Yuqing Zhou
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Translational Social Neuroscience Unit, Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg 97080, Germany
| | - Shihui Han
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Pyungwon Kang
- Department of Economics and Laboratory for Social and Neural Systems Research, University of Zurich and Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich CH-8006, Switzerland
| | - Philippe N. Tobler
- Department of Economics and Laboratory for Social and Neural Systems Research, University of Zurich and Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich CH-8006, Switzerland
| | - Grit Hein
- Translational Social Neuroscience Unit, Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg 97080, Germany
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Corradi‐Dell'Acqua C, Hofstetter C, Sharvit G, Hugli O, Vuilleumier P. Healthcare experience affects pain-specific responses to others' suffering in the anterior insula. Hum Brain Mapp 2023; 44:5655-5671. [PMID: 37608624 PMCID: PMC10619377 DOI: 10.1002/hbm.26468] [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: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
Medical students and professional healthcare providers often underestimate patients' pain, together with decreased neural responses to pain information in the anterior insula (AI), a brain region implicated in self-pain processing and negative affect. However, the functional significance and specificity of these neural changes remains debated. Across two experiments, we recruited university medical students and emergency nurses to test the role of healthcare experience on the brain reactivity to other's pain, emotions, and beliefs, using both pictorial and verbal cues. Brain responses to self-pain was also assessed and compared with those to observed pain. Our results confirmed that healthcare experience decreased the activity in AI in response to others' suffering. This effect was independent from stimulus modality (pictures or texts), but specific for pain, as it did not generalize to inferences about other mental or affective states. Furthermore, representational similarity and multivariate pattern analysis revealed that healthcare experience impacted specifically a component of the neural representation of others' pain that is shared with that of first-hand nociception, and related more to AI than to other pain-responsive regions. Taken together, our study suggests a decreased propensity to appraise others' suffering as one's own, associated with a reduced recruitment of pain-specific information in AI. These findings provide new insights into neural mechanisms leading to pain underestimation by caregivers in clinical settings.
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Affiliation(s)
- Corrado Corradi‐Dell'Acqua
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE)University of GenevaGenevaSwitzerland
- Geneva Neuroscience CenterUniversity of GenevaGenevaSwitzerland
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
| | - Christoph Hofstetter
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
| | - Gil Sharvit
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
- Swiss Center for Affective Sciences, University of GenevaGenevaSwitzerland
- Balgrist University Hospital and University of ZurichZurichSwitzerland
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne (UHL)LausanneSwitzerland
| | - Patrik Vuilleumier
- Geneva Neuroscience CenterUniversity of GenevaGenevaSwitzerland
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
- Swiss Center for Affective Sciences, University of GenevaGenevaSwitzerland
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6
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Loued-Khenissi L, Martin-Brevet S, Schumacher L, Corradi-Dell'Acqua C. The Effect of Uncertainty on Pain Decisions for Self and Others. Eur J Pain 2022; 26:1163-1175. [PMID: 35290697 PMCID: PMC9322544 DOI: 10.1002/ejp.1940] [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] [Indexed: 11/30/2022]
Abstract
Background Estimating others’ pain is a challenging inferential process, associated with a high degree of uncertainty. While much is known about uncertainty’s effect on self‐regarding actions, its impact on other‐regarding decisions for pain have yet to be characterized. Aim The present study exploited models of probabilistic decision‐making to investigate how uncertainty influences the valuation and assessment of another’s pain. Materials & Methods We engaged 63 dyads (43 strangers and 20 romantic couples) in a task where individual choices affected the pain delivered to either oneself (the agent) or the other member of the dyad. At each trial, agents were presented with cues predicting a given pain intensity with an associated probability of occurrence. Agents either chose a sure (mild decrease of pain) or risky (50% chance of avoiding pain altogether) management option, before bidding on their choice. A heat stimulation was then issued to the target (self or other). Decision‐makers were then asked to rate the pain administered to the target. Results We found that the higher the expected pain, the more risk‐averse agents became, in line with findings in value‐based decision‐making. Furthermore, agents gambled less on another individual’s pain (especially strangers) and placed higher bids on pain relief than they did for themselves. Most critically, the uncertainty associated with expected pain dampened ratings made for strangers’ pain. This contrasted with the effect on an agent’s own pain, for which risk had a marginal hyperalgesic effect. Discussion & Conclusion Overall, our results suggested that risk selectively affects decision‐making on a stranger’s suffering, both at the level of assessment and treatment selection, by (1) leading to underestimation, (2) privileging sure options and (3) altruistically allocating more money to insure the treatment’s success. Significance Uncertainty biases decision‐making but it is unclear if it affects choice behavior on pain for others. In examining this question, we found individuals were generally risk‐seeking when faced with looming pain, but more so for self; and assigned higher monetary values and subjective ratings on another’s pain. However, uncertainty dampened agents’ assessment of a stranger’s pain, suggesting latent variables may contradict overt altruism. This bias may underlie pain underestimation in clinical settings.
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Affiliation(s)
- Leyla Loued-Khenissi
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland.,Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | | | - Luis Schumacher
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland
| | - Corrado Corradi-Dell'Acqua
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland.,Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
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Dirupo G, Totaro S, Richard J, Corradi-Dell'Acqua C. Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis. eLife 2021; 10:63272. [PMID: 33904406 PMCID: PMC8104963 DOI: 10.7554/elife.63272] [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: 09/19/2020] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
Healthcare providers often underestimate patients’ pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust toward patients’ self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people’s pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust toward the expressions’ authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients’ self-reports matched participants’ evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others’ pain at the early stages of medical career.
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Affiliation(s)
- Giada Dirupo
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland.,Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland.,Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Sabrina Totaro
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland
| | - Jeanne Richard
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Department of Psychology, Swiss Distance University Institute, Brig, Switzerland
| | - Corrado Corradi-Dell'Acqua
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland.,Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
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