Psychological and brain mechanisms underlying disparities in opioid and non-opioid pain treatment decisions

阿片类药物和非阿片类药物疼痛治疗决策差异背后的心理和大脑机制

基本信息

批准号：
10349457
负责人：
Elizabeth R Losin
金额：
$ 17.06万
依托单位：
UNIVERSITY OF MIAMI CORAL GABLES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10349457
关键词：
Acute Acute Pain Address Affect Analgesics Anterior Area Behavioral Medicine Brain Chronic Clinical Cognitive Cues Drug abuse Education Educational Intervention Effectiveness Empathy Environment Epidemic Ethnic Origin Ethnic group Facial Expression Facial Pain Functional Magnetic Resonance Imaging Gender Goals Hospitals Individual Insula of Reil Intervention K-Series Research Career Programs Literature Mediating Medical Medical Students Methodology Minority Groups Minority Women Nationalities Neurobiology Neurosciences Non-Malignant Not Hispanic or Latino Opioid Opioid Analgesics Pain Pain Measurement Pain intensity Pain management Participant Patients Production Race Recommendation Research Research Personnel Research Training Resources Risk Scanning Sex Bias Standardization Statistical Data Interpretation Stereotyping Stimulus System Testing Text Training Translational Research United States University resources base behavior measurement cancer pain chronic pain clinical application clinical pain demographic disparity design digital effective intervention effective therapy ethnic bias evidence base experience health disparity improved indexing innovation medical schools neurobiological mechanism non-opioid analgesic novel opioid abuse opioid epidemic pain sensitivity patient screening prescription opioid prescription pain reliever psychologic psychosocial relating to nervous system response simulation skills social culture social group treatment disparity willingness

项目摘要

Project Summary Unequal prescribing of opioid and non-opioid analgesics among demographic groups contributes to two major health disparities in the United States. Overprescribing of opioid analgesics to treat both acute and chronic nonmalignant pain, especially in non-Hispanic whites, has fueled the opioid abuse epidemic. Underprescribing of opioid and non-opioid analgesics in minorities and women, even when their use is medically indicated (e.g., acute and cancer pain), reduces the effectiveness of pain management in these groups. In order to mitigate analgesic prescribing disparities and the associated risks of opioid abuse and poor pain management, we must understand the mechanisms underlying these disparities. The current project will test two potential contributors to these pain treatment disparities: 1) clinicians' inaccurate demographic stereotypes about pain sensitivity and tendency to abuse opioids (i.e., the stereotype hypothesis), and 2) reduced activation of clinicians' pain-related neural systems (e.g., anterior cingulate and anterior insula) in response to the pain of demographic outgroup patients (i.e., the vicarious pain hypothesis). Prior studies of mechanisms underlying analgesic prescribing disparities have been limited by the use of experimental paradigms that were low in ecological validity e.g. asking participants to make prescribing decisions based solely on text-based medical vignettes or depictions of individuals feigning pain. Additionally, although the robust fMRI literature on vicarious pain biases is related to biases in pain assessment, vicarious pain biases have not been tested as a potential contributor to biases pain treatment decisions. In the present proposal, these methodological limitations will be addressed and the stereotype and vicarious pain hypotheses will be tested through 3 specific aims. Aim 1 involves the design and production of a more ecologically valid video-based simulated pain assessment and treatment paradigm depicting individuals experiencing genuine pain. Aim 2 includes an fMRI study of the effects of clinicians' (medical students') vicarious pain responses and pain stereotypes on demographic biases in simulated pain assessment and analgesic prescribing, using the video paradigm created in Aim 1. Finally, to determine the clinical applicability of the findings from Aim 2, Aim 3 includes face-to-face pain assessments and treatment recommendations during simulated clinical interactions with standardized patient actors. If the aims of this proposal are achieved, these studies will yield new understanding of the relative contributions of pain-related stereotypes and vicarious pain to analgesic prescribing disparities. These results could indicate whether pain stereotype education, efforts to increase pain empathy, or both should be incorporated into clinician interventions aimed at reducing analgesic prescribing disparities. Through this K01 career development award, the candidate will gain facility in three areas not included in her past training: clinical pain assessment and treatment, multivariate statistical analysis, and behavioral medicine in order to more effectively understand psychosocial and neurobiological mechanisms underlying health disparities in pain and pain management.

项目概要人口群体中阿片类和非阿片类镇痛药的不平等处方导致了两个主要问题美国的健康差距。过度使用阿片类镇痛药来治疗急性和慢性非恶性疼痛，尤其是非西班牙裔白人，加剧了阿片类药物滥用的流行。处方不足少数族裔和女性使用阿片类和非阿片类镇痛药，即使有医学指征（例如，急性疼痛和癌性疼痛），降低了这些群体疼痛管理的有效性。为了减轻镇痛处方的差异以及阿片类药物滥用和疼痛管理不善的相关风险，我们必须了解这些差异背后的机制。当前项目将测试两个潜在的贡献者这些疼痛治疗差异：1) 临床医生对疼痛敏感性的不准确的人口刻板印象和滥用阿片类药物的倾向（即刻板印象假设），以及 2) 临床医生疼痛相关的激活减少神经系统（例如前扣带回和前岛叶）对人口外群体疼痛的反应患者（即替代疼痛假说）。镇痛处方机制的先前研究差异因使用生态有效性较低的实验范式而受到限制，例如要求参与者仅根据基于文本的医疗小插曲或描述做出处方决定假装疼痛的人。此外，虽然关于替代性疼痛偏差的强大功能磁共振成像文献与疼痛评估中的偏差，替代性疼痛偏差尚未被测试为导致偏差疼痛的潜在因素治疗决定。在本提案中，将解决这些方法上的局限性，并刻板印象和替代疼痛假设将通过 3 个具体目标进行测试。目标 1 涉及设计和制作更生态有效的基于视频的模拟疼痛评估和治疗范例描绘经历真正痛苦的人。目标 2 包括对临床医生的影响进行功能磁共振成像研究（医学生）模拟疼痛中人口统计学偏差的替代疼痛反应和疼痛刻板印象使用目标 1 中创建的视频范例进行评估和镇痛处方。最后，确定目标 2、目标 3 的研究结果的临床适用性包括面对面的疼痛评估和治疗在与标准化患者参与者的模拟临床互动期间提出建议。如果这个目的如果提案得以实现，这些研究将对疼痛相关的相对贡献产生新的认识镇痛处方差异的刻板印象和替代疼痛。这些结果可以表明疼痛是否临床医生应将刻板印象教育、增加疼痛同理心的努力或两者结合起来旨在减少镇痛处方差异的干预措施。通过这次K01职业发展奖，候选人将在她过去的培训中未包括的三个领域获得便利：临床疼痛评估和治疗、多元统计分析和行为医学，以便更有效地理解疼痛和疼痛管理中健康差异背后的心理社会和神经生物学机制。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Doctor trustworthiness influences pain and its neural correlates in virtual medical interactions.

医生的可信度会影响虚拟医疗互动中的疼痛及其神经相关性。

DOI：
发表时间：
2023-03-21
期刊：
影响因子：
0
作者：
Anderson, Steven R;Gianola, Morgan;Medina, Natalia A;Perry, Jenna M;Wager, Tor D;Losin, Elizabeth A Reynolds
通讯作者：
Losin, Elizabeth A Reynolds

Expressive suppression to pain in others reduces negative emotion but not vicarious pain in the observer.

对他人痛苦的表达性抑制会减少负面情绪，但不会减少观察者的替代痛苦。