The Relationship Between Adverse Life Events and Endogenous Inhibition of Pain and Spinal Nociception: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP)

Psychosocial and cardiometabolic predictors of chronic pain onset in Native Americans: serial mediation analyses of 2-year prospective data from the Oklahoma Study of Native American Pain Risk

“…Although our previous cross-sectional results found that trauma exposure promotes pronociceptive processes, 54,95 trauma exposure was not a significant mediator. This could be a type II error because NAs contributing to the mediation analyses did not experience higher trauma exposure than NHWs, but they did in the full sample.…”

“…In the current study, trauma exposure was operationally defined as having direct exposure (answering "happened to me") to any items on the LEC. Like our previous studies 54,95 and the literature on adverse childhood experiences, 2,49 the number of traumatic events that happened to the participants was summed to generate a cumulative exposure score, with a possible range of 0 to 17. The LEC has been found to have adequate temporal stability, good convergent validity with established measures of trauma history, and shows external validity with measures of distress and PTSD symptoms.…”

“…1). For example, trauma exposure, 54,95 discrimination, 43 pain-related anxiety, 82 situational pain catastrophizing, 107 and cardiometabolic factors (BMI, BP, and heart rate variability [HRV]) 56,83,106 are associated with electrophysiological markers of central sensitization (CS; assessed by temporal summation of nociceptive flexion reflex [TS-NFR]) and/or impaired descending inhibition of spinal nociception (DISN; assessed by NFR inhibition during conditioned pain modulation [CPM-NFR]). Some factors (eg, pain-related anxiety, catastrophizing, or cardiometabolic factors) even provide significant indirect (mediated) paths linking NAs to CS and/or DISN.…”

“…The first tested whether adversity (trauma exposure and discrimination), cognitiveaffective factors (stress, pain-related anxiety, and catastrophizing), and pronociceptive processes (TS-NFR and CPM-NFR) mediated chronic pain onset in NAs. 43,48,54,82,95,107 The second tested whether cardiometabolic factors and pronociceptive processes were mediators. 83…”

“…Cross-sectional results found little evidence of group differences in nociceptive processing that might promote pain risk 85 but did note group differences on several psychosocial and health variables. Native Americans reported experiencing higher rates of adversity (eg, traumatic events 54 and discrimination 42 ), psychological stress, 85 pain-related anxiety and catastrophizing, 84 and cardiometabolic risk factors 56,85 (eg, higher blood pressure [BP] and body mass index [BMI]).…”