Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis.

Goodin, Burel R.; Pham, Quyen Toan; Glover, Toni L.; Sotolongo, Adriana; King, Christopher D.; Sibille, Kimberly T.; Herbert, Matthew S.; Cruz-Almeida, Yenisel; Sanden, Shelley H.; Staud, Roland; Redden, David T.; Bradley, Laurence A.; Fillingim, Roger B.

doi:10.1037/a0031592

Cited by 65 publications

(59 citation statements)

References 42 publications

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“…We previously reported that perceived racial discrimination was inversely associated with heat pain tolerance levels in AA persons with knee OA (11). We hypothesized that this relationship may be related to physiological changes in neuroendocrine functioning as a consequence of chronic stress associated with perceived racial discrimination.…”

Section: Discussionmentioning

confidence: 99%

“…The questionnaire asks, “Have you ever experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior in any of the following situations because of your race, ethnicity, or color?” This question is followed by 9 response options (e.g., at school, getting hired or getting a job, bank loans, etc.). Respondents also chose from the following responses, “never,” “once,” “two or three times,” or “four or more times.” Although there are additional ways to score this questionnaire (16), the frequency of experiences was chosen to be consistent with previous studies (11, 15). …”

Section: Methodsmentioning

confidence: 99%

“…Our efforts to better understand ethnic differences in pain led us to posit that prolonged exposure to chronic stressors among AA individuals, such as perceived racial discrimination, may alter endogenous stress regulatory systems that eventually contribute to enhanced pain sensitivity (11). Indeed, studies of healthy AA persons show that perceived racial discrimination is associated with chronic stress (12), as well as flatter (less healthy) diurnal cortisol rhythms (13).…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, studies of healthy AA persons show that perceived racial discrimination is associated with chronic stress (12), as well as flatter (less healthy) diurnal cortisol rhythms (13). Additionally, perceived racial discrimination is associated with greater body pain (14) and back pain (15), as well as greater heat pain sensitivity among AA individuals with knee OA (11). However, the relationship between perceived racial discrimination and biomarkers of stress exposure, such as cortisol, has never been specifically examined in persons with knee OA.…”

Section: Introductionmentioning

confidence: 99%

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Ethnicity, Cortisol, and Experimental Pain Responses Among Persons With Symptomatic Knee Osteoarthritis

Herbert

Goodin²,

Bulls³

et al. 2017

The Clinical Journal of Pain

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OBJECTIVES While several factors are known to contribute to ethnic differences in pain, relatively little attention has been devoted to physiological factors. Our first aim was to examine the relationship between cortisol and pain responses during a cold-pressor task (CPT) among African American (AA) and non-Hispanic White (NHW) adults with knee osteoarthritis (OA). Our second aim was to assess the relationship between perceived racial discrimination and cortisol among AA participants. METHODS Participants were 91 (56 AA; 35 NHW) community-dwelling adults between the ages of 45 to 85 with knee OA based upon the American College of Rheumatology clinical criteria. Plasma cortisol was measured at 3 time points: 1) baseline, 2) prior to the CPT, and 3) 20-minutes following the CPT. Perceived racial discrimination was measured by the Experiences of Discrimination scale. RESULTS Using linear regression, we found a significant interaction between ethnicity and cortisol prior to the CPT with pain intensity ratings (β = −0.26; P = 0.02). Analysis of simple slopes revealed that cortisol concentrations were negatively associated with pain intensity ratings in NHW participants (β = −0.54; P = 0.001), but not in AA participants (β = −0.15; P = 0.26). Perceived racial discrimination was not related to cortisol concentrations or pain ratings. DISCUSSION Consistent with previous findings in young healthy adults, cold pressor pain responses are related to pre-CPT cortisol concentrations in NHW persons with knee OA but not in their AA counterparts. Additional studies are required to better understand this finding.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ethnicity, Cortisol, and Experimental Pain Responses Among Persons With Symptomatic Knee Osteoarthritis

Herbert

Goodin²,

Bulls³

et al. 2017

The Clinical Journal of Pain

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“…Demographic factors including sex, BMI, and indicators of socioeconomic status have all been shown to contribute to the experience of pain(25–28). Psychosocial factors have also been demonstrated to influence experimental pain, such as depressed mood and subjective experiences of discrimination(29,30). …”

Section: Methodsmentioning

confidence: 99%

Minority Aging and Endogenous Pain Facilitatory Processes

Bulls¹,

Goodin

McNew³

et al. 2015

Pain Med

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Objective The aim of the current study was to examine the relationships among age, ethnicity, and endogenous pain facilitation using temporal summation (TS) responses to mechanical and heat stimuli. Design The present study assessed hyperalgesia and pain facilitation to thermal and mechanical stimuli at the knee and distal sites in 98 pain-free men and women. Participants were drawn from two ethnic (African-Americans, AA; and non-Hispanic whites, NHW) and age groups (19-35 and 45-85). Results Significant main effects of ethnicity were demonstrated for both mechanical and heat modalities (all p’s≤0.05), suggesting that AA participants, relative to NHW counterparts, demonstrated enhanced hyperalgesia. Age differences (older > younger) in hyperalgesia were found in mechanical pain ratings only. Results indicated that mechanical pain ratings significantly increased from first to maximal pain as a function of both age group and ethnicity (all p’s≤0.05), and a significant ethnicity by age interaction for TS of mechanical pain was found at the forearm (p<0.05) and trended towards significance at the knee (p=0.071). Post-hoc tests suggested that results were primarily driven by the older AA participants, who demonstrated the greatest mechanical TS. Additionally, evidence of differences in heat TS due to both ethnicity alone (all p’s≤0.05) and minority aging was also found. Conclusions This study provides evidence suggesting that older AAs demonstrate enhanced pain facilitatory processes, which is important because this group may be at increased risk for development of chronic pain. These results underscore the necessity of testing pain modulatory mechanisms when addressing questions related to pain perception and minority aging.

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Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination

McClendon

Essien

Youk

et al. 2020

Arthritis Care & Research

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Objective. Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain. Methods. We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female sex, African American race, annual income of <$20,000, and/or unemployed due to disability). We used linear regression models and Sobel's test of mediation to examine hypotheses. Results. The mean ± SD number of social disadvantages was 1.3 ± 1.0. Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (P < 0.001 for all). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z = 3.75, P < 0.001) as well as pain severity (Z = 2.24, P = 0.025). Conclusion. Perceived discrimination is an important psychosocial stressor that contributes to worsening OA-related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.

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Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis.

Cited by 65 publications

References 42 publications

Ethnicity, Cortisol, and Experimental Pain Responses Among Persons With Symptomatic Knee Osteoarthritis

Ethnicity, Cortisol, and Experimental Pain Responses Among Persons With Symptomatic Knee Osteoarthritis

Minority Aging and Endogenous Pain Facilitatory Processes

Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination

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