关键词: Central sensitization Native Americans conditioned pain modulation descending inhibition discrimination ethnic differences temporal summation

Mesh : Humans Nociception / physiology Oklahoma Pain / psychology Pain Measurement / methods Pain Threshold / physiology Reflex / physiology American Indian or Alaska Native

来  源:   DOI:10.1016/j.jpain.2021.12.010   PDF(Pubmed)

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.
摘要:
美洲原住民(NAs)的疼痛率高于美国普通人群。已经发现增加的中枢致敏和减少的疼痛抑制是增加疼痛风险的前兆感受过程;然而,很少关注社会心理因素的影响。在其他少数群体中,歧视是与疼痛增加相关的心理社会因素;然而,目前尚不清楚它是否也会促进NAs的疼痛。这项研究分析了269名健康人士的数据,无痛参与者(N=134非西班牙裔白人[NHW],N=135NAs)来自俄克拉荷马州美国原住民疼痛风险研究。使用日常歧视量表(EDS)测量有经验的歧视。通过脊柱敏感性的静态测量(伤害性屈曲反射[NFR]阈值,3-刺激NFR阈值),疼痛的时间总和(TS-疼痛)和伤害性屈曲反射(TS-NFR),和疼痛的条件性疼痛调节(CPM-疼痛)和NFR(CPM-NFR)。结果表明,更大的歧视与增强的TS-NFR和受损的CPM-NFR相关,但与脊柱敏感性的静态测量或疼痛调节的测量无关(TS-疼痛,CPM-疼痛)。尽管歧视对结果的影响在两组中相似(不受种族限制),NA经历了更高水平的歧视,因此歧视介导了种族与CPM-NFR受损之间的关系。这表明经历的歧视可能会促进NA中的疼痛风险表型,该表型涉及由于脊髓伤害感受的抑制受损而导致的脊髓致敏而没有疼痛经历的致敏。观点:这项研究发现,歧视与脊髓致敏和脊髓伤害感受下降抑制有关。这些发现加强了我们对少数群体不成比例地经历的社会压力源如何导致疼痛结果的理解。
公众号