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：
9882988
负责人：
Elizabeth R Losin
金额：
$ 17.12万
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/9882988
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 Nationalities Neurobiology Neurosciences Non-Malignant Not Hispanic or Latino Opioid Opioid Analgesics Pain Pain Measurement Pain intensity Pain management Participant Patients Population 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 Woman base behavior measurement cancer pain chronic pain clinical application clinical pain 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 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.

项目摘要人口组中阿片类药物和非阿片类镇痛药的不平等处方有助于两个主要的美国的健康差异。阿片类镇痛药的过度处方治疗急性和慢性非恶性疼痛，尤其是在非西班牙裔白人中，加剧了阿片类药物滥用的流行。处方不足少数群体和妇女的阿片类药物和非阿片类镇痛药，即使在医学上使用它们的使用（例如，急性和癌症疼痛），降低了这些组疼痛管理的有效性。为了减轻镇痛药的处方差异以及阿片类药物滥用和疼痛管理不良的相关风险，我们必须了解这些差异的基础机制。当前项目将测试两个潜在的贡献者对于这些疼痛治疗差异：1）临床医生关于疼痛敏感性和滥用阿片类药物的趋势（即刻板印象假设），2）临床医生与疼痛有关的激活减少神经系统（例如，前扣带回和前岛）响应人口统计学的疼痛患者（即替代性疼痛假设）。先前研究镇痛处方的机制使用生态有效性低的实验范例，例如，差异受到限制。要求参与者仅根据基于文本的医疗小插曲或描述假装疼痛的人。此外，尽管关于替代性疼痛偏见的强大FMRI文献与疼痛评估中的偏见，毒性疼痛偏见尚未被测试是导致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刻板印象和替代性疼痛假设将通过3个特定目标进行检验。 AIM 1涉及设计和生产更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个人。 AIM 2包括对临床医生的影响的fMRI研究（医学生）对模拟疼痛中人口偏见的替代性疼痛反应和疼痛刻板印象使用AIM 1中创建的视频范式进行评估和镇痛处方。最后，确定 AIM 2，AIM 3的发现的临床适用性包括面对面的疼痛评估和治疗模拟与标准化患者参与者的临床相互作用期间的建议。如果目的提出了建议，这些研究将对与疼痛相关的相对贡献产生新的了解刻板印象和替代性痛苦的处方差异。这些结果可能表明疼痛是否刻板印象教育，增加疼痛同理心的努力或两者都应纳入临床医生旨在减少镇痛处方差异的干预措施。通过这个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中获得设施：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的基础的社会心理和神经生物学机制。