Racial and Socioeconomic Differences in Chronic Low Back Pain

慢性腰痛的种族和社会经济差异

• 批准号: 10656046
• 负责人: Burel R. Goodin
• 金额: $ 70.87万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656046
• 关键词: Acute; Address; Adult; Adverse effects; Anxiety; Attitude; Biological; Black Populations; Black race; Blood Pressure; C-reactive protein; COVID-19; COVID-19 pandemic; Cardiovascular system; Cessation of life; Chronic; Chronic low back pain; Clinical; Data; Discrimination; Disease; Disparity; Disparity population; Distress; Equation; Event; Exposure to; Follow-Up Studies; Friends; Funding; Glycosylated hemoglobin A; Goals; Group Affiliation; Health; Hydrocortisone; Immune; Individual; Life; Literature; Loneliness; Low Back Pain; Measures; Metabolic; Minority Groups; Modeling; Neurosecretory Systems; Not Hispanic or Latino; Pain; Pain management; Pathology; Pattern; Persistent pain; Persons; Physiological; Prevalence; Primary Care Physician; Psychosocial Factor; Race; Reporting; Research; Rest; Risk Factors; Sensory; Severities; Social isolation; Social support; Socialization; Socioeconomic Status; Spirituality; Stigmatization; Stress; Stressful Event; Symptoms; Testing; Time; Tissues; Vertebral column; Violence; Visit; Work; adverse childhood events; allostatic load; chronic pain; clinical pain; clinical predictors; depressive symptoms; disability; experience; follow-up; health care availability; improved; loved ones; low socioeconomic status; minority stress; optimism; pain inhibition; pain sensitivity; pain symptom; peer; perceived stress; promote resilience; prospective; psychologic; psychological distress; psychosocial; racial determinant; racial difference; racial discrimination; racial disparity; racial identity; racial population; racism; resilience factor; social determinants; social influence; social stress; social stressor; socioeconomics; theories

Project Summary/Abstract Low back pain is one of the most common disabling conditions in the world. The worldwide point prevalence of activity-limiting (acute and chronic) low back pain is approximately 12%, which equates to approximately 933 million people globally suffering with low back pain at any given time. Chronic low back pain (cLBP) refers to pain lasting at least twelve weeks or longer, and it is consistently among the top five most common reasons for primary care physician visits. Although some individuals with cLBP have clear pathoanatomic causes of pain, the vast majority of cLBP is “non-specific” and is not accompanied by readily identifiable pathology of the spine or related tissues. Without a clear target for treatment of cLBP, effective pain management can be difficult to achieve. Because objective measures of disease activity have not consistently been strong predictors of clinical symptoms, cLBP provides an excellent model for investigating the influence of social determinants such as racial background and social stress on the progression of pain and disability over time. During our previous funding cycle, we found evidence that non-Hispanic Black (NHB) individuals with cLBP reported significantly greater pain severity and disability than their non-Hispanic White (NHW) counterparts. In addition, we observed racial differences in pain-related psychosocial and biological measures, which were significantly associated with racial group disparities in cLBP severity. Furthermore, racial disparities in cLBP were exacerbated by low socioeconomic status (SES), such that NHBs with low SES demonstrated the absolute greatest burden of cLBP. While our findings demonstrate clear racial differences in cLBP severity and disability between NHBs and NHWs, the findings are largely indirect and cross-sectional. Differences in how cLBP progresses over time between NHBs and NHWs, as well as factors that contribute to cLBP progression, remain poorly understood. Among the multiple factors that inevitably contribute to racial group differences in cLBP, social stress represents a potentially important social determinant of greater cLBP severity and disability in NHBs. For this proposed follow-up study, we will elucidate the contribution of social stress and its biological consequences (i.e., allostatic load) to racial group disparities in cLBP by prospectively assessing the two-year progression of clinical pain and disability, as well as pain-relevant psychosocial functioning among NHBs and NHWs with cLBP. We will use minority stress theory to guide the study aims related to the progression of racial group disparities in cLBP; however, we will also use a recently developed resilience framework to guide inclusion of psychosocial resilience factors that may mitigate the effects of social stress on cLBP in NHBs and/or NHWs.

项目摘要/摘要 腰痛是世界上最常见的残疾条件之一。全球的流行率 活动限制（急性和慢性）下背痛约为12％，约为933 在任何给定的时间慢性下腰痛（CLBP）是指 疼痛至少持续十二周或更长时间，并且始终是前五名的最常见原因 初级保健身体访问。尽管有些患有CLBP的人有明显的疗法疼痛原因，但 绝大多数CLBP是“非特异性”，并且不容易识别脊柱病理 或相关的组织。没有明确治疗CLBP的目标，有效的疼痛管理可能很难 达到。因为疾病活性的客观测量并不是临床的强大预测指标 症状，CLBP为研究社会决定者（例如种族）的影响提供了一个绝佳的模型 随着时间的流逝，背景和社会压力对疼痛和残疾的发展。在我们以前的资金中 循环，我们发现有证据表明，非西班牙裔黑人（NHB）患有CLBP的个体报告明显更大的疼痛 与非西班牙裔白人（NHW）相比，严重性和残疾。此外，我们观察到种族 与疼痛相关的社会心理和生物学措施的差异，与种族显着相关 CLBP严重程度的组分布。此外，CLBP中的种族分布因低而加剧 社会经济地位（SES），使得SES低的NHB表现出绝对最大的CLBP燃烧。 尽管我们的发现表明NHB和NHW之间的CLBP严重性和残疾的种族差异，但 这些发现在很大程度上是间接的和横截面。 CLBP随着时间的推移如何随着时间的推移而差异 NHB和NHWS以及导致CLBP进展的因素仍然知之甚少。在 社会压力不可避免地导致种族群体差异的多种因素，社会压力代表了潜在的 NHB中CLBP严重程度更大和残疾的重要社会决定者。对于这项提出的后续研究， 我们将阐明社会压力及其生物学后果（即同性恋负荷）对种族的贡献 通过前瞻性评估临床疼痛和残疾的两年进展，CLBP的群体差异 以及与CLBP的NHB和NHW中的疼痛相关的社会心理功能。我们将使用少数派压力 指导研究的理论与CLBP中种族群体分布的发展有关；但是，我们会的 还使用最近开发的弹性框架来指导可能包含可能 减轻社会压力对NHB和/或NHW中CLBP的影响。