Native American Pain Disparities: Exploring Nociceptive Processing Differences

美洲原住民的疼痛差异：探索伤害感受处理差异

• 批准号: 8693014
• 负责人: Jamie Lynn Rhudy
• 金额: $ 30.35万
• 依托单位: UNIVERSITY OF TULSA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8693014
• 关键词: African American; Alaska Native; Awareness; Blood; Clinical; Conscious; Control Groups; Data; Detection; Economic Burden; Emotional; Emotions; Ensure; Future; Health; Heating; Heredity; High Prevalence; Hispanics; Individual; Individual Differences; Injury; Intervention; Ischemia; Measures; Mediating; Methods; Minority; Minority Groups; Modality; Native Americans; Nociception; Not Hispanic or Latino; Outcome; Pain; Pain Research; Pain Threshold; Pain-Free; Paper; Participant; Physiological; Physiological Processes; Population; Prevalence; Process; Publishing; Reaction; Recruitment Activity; Reflex action; Regulation; Relative (related person); Reporting; Research; Resources; Risk; Risk Factors; Sampling; Sensory; Severity of illness; Signal Transduction; Spinal; Spinal Cord; Stimulus; Testing; Tissues; abstracting; central sensitization; chronic pain; directed attention; disability; exhaust; experience; health care service utilization; health disparity; improved; innovation; mechanical pressure; minority health; pain inhibition; pressure; prevent; productivity loss; quantum; response

DESCRIPTION (provided by applicant): Exploring Nociceptive Processing Differences 7.0. Project Summary/Abstract Native Americans (NAs) have a higher prevalence of pain than non-Hispanic whites and other U.S. minority groups. Yet, there is a lack of pain research in NAs, with only 28 papers on pain published in over 30 years. Moreover, no study has assessed pain processing to identify whether pain sensitivity (conscious pain experience), central sensitization (augmented pain signaling in the CNS), and/or CNS pain inhibition (descending pain modulation) contribute to this disparity. Our pilot data indicate that relative to non-Hispanic whites, NAs have lower pain sensitivity (e.g., higher pain tolerance) and show reduced central sensitization (reduced CNS response to pain) on a physiological measure (i.e., temporal summation of the nociceptive flexion reflex). This suggests their CNS responds differently to noxious input, which could have significant clinical implications. Specifically, being less pain sensitive may place NAs at risk for chronic pain because they could have difficulty detecting and preventing tissue damage and/or protecting tissue damage once it has occurred. However, results from these pilot data need to be replicated in a larger sample. Aim 1 will be to determine whether healthy, pain-free Native Americans (n=120) have lowered pain sensitivity, reduced central sensitization, and enhanced pain inhibitory processes relative to a non-Hispanic white control group (n=120). Testing will occur across two sessions using well-validated, state-of-the-art, quantitative sensory testing methods to assess pain processing from subjective (e.g., pain report) and physiological (nociceptive flexion reflex) pain outcomes. Pain sensitivity will be comprehensively assessed from pain threshold, tolerance, and report in response to multiple stimulus modalities (heat, cold, mechanical pressure, ischemia, electrocutaneous). Central sensitization will be assessed from: 1) temporal summation of heat pain (a subjective measure of sensitization), 2) nociceptive flexion reflex threshold (NFR, a physiological measure of spinal nociception), and 3) temporal summation of NFR (a physiological measure of spinal cord hyperexcitability). CNS inhibition of pain and NFR will be assessed from: 1) conditioned pain modulation (i.e., pain inhibits pain) and 2) emotional controls of nociception (i.e., pleasant emotions inhibit pain, unpleasant emotions enhance pain). Aim 2 is to identify individual differences that contribute to altered pain processing in NAs. Thus, pain coping (e.g., pain catastrophizing), sociocultural variables (e.g., ethnic identity), and heredity (i.e., blood quantu level) will be examined to determine whether they are associated with group differences in pain. This research is expected to impact minority health disparities in at least 5 ways: 1) identify mechanisms contributing to pain disparities in NAs, 2) determine if pain disparities in NAs result from physiological processes (e.g., CNS pain inhibition), 3) provide evidence that pain risk is physiologically different in NAs thus identifying the need for tailored interventions, 4) inform methods to assess NAs at-risk for chronic pain, and 5) promote interventions to eliminate pain disparity in NAs.

描述（由申请人提供）：探索伤害性加工差异 7.0。项目摘要/摘要 美洲原住民 (NA) 的疼痛患病率高于非西班牙裔白人和其他美国少数群体。然而，NAs 缺乏疼痛研究，30 多年来仅发表了 28 篇关于疼痛的论文。此外，还没有研究评估疼痛处理，以确定疼痛敏感性（有意识的疼痛体验）、中枢敏化（中枢神经系统中增强的疼痛信号）和/或中枢神经系统疼痛抑制（下行疼痛调节）是否会导致这种差异。我们的试验数据表明，相对于非西班牙裔白人，NA 的疼痛敏感性较低（例如，较高的疼痛耐受性），并且在生理测量（即伤害性屈曲反射的时间总和）上表现出中枢敏化降低（中枢神经系统对疼痛的反应降低） ）。这表明他们的中枢神经系统对有害输入的反应不同，这可能具有重大的临床意义。具体来说，对疼痛不太敏感可能会使 NA 面临慢性疼痛的风险，因为它们可能难以检测和预防组织损伤和/或在组织损伤发生后对其进行保护。然而，这些试点数据的结果需要在更大的样本中复制。目标 1 是确定与非西班牙裔白人对照组 (n=120) 相比，健康、无痛的美洲原住民 (n=120) 是否具有降低疼痛敏感性、减少中枢敏化以及增强疼痛抑制过程的能力。测试将在两个疗程中进行，使用经过充分验证的、最先进的定量感觉测试方法，以评估主观（例如疼痛报告）和生理（伤害性屈曲反射）疼痛结果的疼痛处理。疼痛敏感性将从疼痛阈值、耐受性和对多种刺激方式（热、冷、机械压力、缺血、皮电）的反应报告中进行综合评估。中枢敏化将根据以下指标进行评估：1) 热痛的时间总和（敏化的主观测量），2) 伤害性屈曲反射阈值（NFR，脊髓伤害感受的生理测量），以及 3) NFR 的时间总和（一种生理测量）脊髓过度兴奋）。中枢神经系统对疼痛和 NFR 的抑制将从以下方面进行评估：1）条件性疼痛调节（即疼痛抑制疼痛）和 2）伤害感受的情绪控制（即愉快的情绪抑制疼痛，不愉快的情绪增强疼痛）。目标 2 是确定导致 NA 疼痛处理改变的个体差异。因此，将检查疼痛应对（例如，疼痛灾难化）、社会文化变量（例如，种族认同）和遗传（例如，血量水平），以确定它们是否与疼痛的群体差异相关。这项研究预计将以至少 5 种方式影响少数族裔的健康差异：1）确定导致 NA 中疼痛差异的机制，2）确定 NA 中的疼痛差异是否由生理过程（例如中枢神经系统疼痛抑制）引起，3）提供证据NA 中的疼痛风险在生理上是不同的，因此确定需要量身定制的干预措施，4) 提供评估有慢性疼痛风险的 NA 的方法，以及 5) 促进消除疼痛的干预措施NA 的差异。