The Relationship Between Experienced Discrimination and Pronociceptive Processes in Native Americans: Results From the Oklahoma Study of Native American Pain Risk |
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| Affiliation: | 2. University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, Florida;2. The Laboratory of Membrane Ion Channels and Medicine, Key Laboratory of Cognitive Science, State Ethnic Affairs Commission, College of Biomedical Engineering, South-Central University for Nationalities, Wuhan, Hubei, China;2. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut;3. Department of Occupational Therapy, University of Florida, Gainesville, Florida;4. Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California;5. Department of General Internal Medicine, Stanford University, Stanford, California;6. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut;2. Department of Orthopaedic Surgery, Division of Adult Reconstruction, Duke University, Durham, NC;3. Department of General Internal Medicine, Duke University, Durham, NC;4. Department of Orthopaedic Surgery, Division of Adult Reconstruction, Duke University, Durham, NC;5. Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC;2. Departments of Surgery, Medicine (Rheumatology) and Pediatrics, Northwestern University, Chicago, Illinois;2. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain;3. Faculty of Health Sciences. Universidad Católica de Ávila, Ávila, Spain |
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| 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.PerspectiveThis 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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