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Lévesque-Lacasse A, Desjardins MC, Fiset D, Charbonneau C, Cormier S, Blais C. The Relationship Between the Ability to Infer Another's Pain and the Expectations Regarding the Appearance of Pain Facial Expressions: Investigation of the Role of Visual Perception. THE JOURNAL OF PAIN 2024; 25:250-264. [PMID: 37604362 DOI: 10.1016/j.jpain.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/01/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
Although pain is a commonly experienced and observed affective state, it is frequently misinterpreted, which leads to inadequate caregiving. Studies show the ability at estimating pain in others (estimation bias) and detecting its subtle variations (sensitivity) could emerge from independent mechanisms. While estimation bias is modulated by variables such as empathy level, pain catastrophizing tendency, and overexposure to pain, sensitivity remains unimpacted. The present study verifies if these 2 types of inaccuracies are partly explained by perceptual factors. Using reverse correlation, we measured their association with participants' mental representation of pain, or more simply put, with their expectations of what the face of a person in pain should look like. Experiment 1 shows that both parameters are associated with variations in expectations of this expression. More specifically, the estimation bias is linked with expectations characterized by salient changes in the middle face region, whereas sensitivity is associated with salient changes in the eyebrow region. Experiment 2 reveals that bias and sensitivity yield differences in emotional representations. Expectations of individuals with a lower underestimation tendency are qualitatively rated as expressing more pain and sadness, and those of individuals with a higher level of sensitivity as expressing more pain, anger, and disgust. Together, these results provide evidence for a perceptual contribution in pain inferencing that is independent of other psychosocial variables and its link to observers' expectations. PERSPECTIVE: This article reinforces the contribution of perceptual mechanisms in pain assessment. Moreover, strategies aimed to improve the reliability of individuals' expectations regarding the appearance of facial expressions of pain could potentially be developed, and contribute to decrease inaccuracies found in pain assessment and the confusion between pain and other affective states.
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Affiliation(s)
- Alexandra Lévesque-Lacasse
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Marie-Claude Desjardins
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Daniel Fiset
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Carine Charbonneau
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Stéphanie Cormier
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Caroline Blais
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
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Saumure C, Plouffe-Demers MP, Fiset D, Cormier S, Zhang Y, Sun D, Feng M, Luo F, Kunz M, Blais C. Differences Between East Asians and Westerners in the Mental Representations and Visual Information Extraction Involved in the Decoding of Pain Facial Expression Intensity. AFFECTIVE SCIENCE 2023; 4:332-349. [PMID: 37293682 PMCID: PMC10153781 DOI: 10.1007/s42761-023-00186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/14/2023] [Indexed: 06/10/2023]
Abstract
Effectively communicating pain is crucial for human beings. Facial expressions are one of the most specific forms of behavior associated with pain, but the way culture shapes expectations about the intensity with which pain is typically facially conveyed, and the visual strategies deployed to decode pain intensity in facial expressions, is poorly understood. The present study used a data-driven approach to compare two cultures, namely East Asians and Westerners, with respect to their mental representations of pain facial expressions (experiment 1, N=60; experiment 2, N=74) and their visual information utilization during the discrimination of facial expressions of pain of different intensities (experiment 3; N=60). Results reveal that compared to Westerners, East Asians expect more intense pain expressions (experiments 1 and 2), need more signal, and do not rely as much as Westerners on core facial features of pain expressions to discriminate between pain intensities (experiment 3). Together, those findings suggest that cultural norms regarding socially accepted pain behaviors shape the expectations about pain facial expressions and decoding visual strategies. Furthermore, they highlight the complexity of emotional facial expressions and the importance of studying pain communication in multicultural settings. Supplementary Information The online version contains supplementary material available at 10.1007/s42761-023-00186-1.
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Affiliation(s)
- Camille Saumure
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, CP 1250 succ. Hull, Gatineau, J8X 3X7 Canada
| | - Marie-Pier Plouffe-Demers
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, CP 1250 succ. Hull, Gatineau, J8X 3X7 Canada
- Département de Psychologie, Université du Québec à Montréal, CP 8888 succ. Centre-ville, Montréal, Québec) H3C 3P8 Canada
| | - Daniel Fiset
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, CP 1250 succ. Hull, Gatineau, J8X 3X7 Canada
| | - Stéphanie Cormier
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, CP 1250 succ. Hull, Gatineau, J8X 3X7 Canada
| | - Ye Zhang
- Institute of Psychological Science, Hangzhou Normal University, Hangzhou, Zhejiang China
| | - Dan Sun
- Institute of Psychological Science, Hangzhou Normal University, Hangzhou, Zhejiang China
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Manni Feng
- Institute of Psychological Science, Hangzhou Normal University, Hangzhou, Zhejiang China
| | - Feifan Luo
- Institute of Psychological Science, Hangzhou Normal University, Hangzhou, Zhejiang China
| | - Miriam Kunz
- Department of Medical Psychology & Sociology, University of Augsburg, Augsburg, Germany
| | - Caroline Blais
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, CP 1250 succ. Hull, Gatineau, J8X 3X7 Canada
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Lannon EW, Hellman N, Huber FA, Kuhn BL, Sturycz CA, Palit S, Payne MF, Guereca YM, Toledo T, Shadlow JO, Rhudy JL. Exploration of the trait-activation model of pain catastrophizing in Native Americans: results from the Oklahoma Study of Native American pain risk (OK-SNAP). Scand J Pain 2022; 22:587-596. [PMID: 35289511 PMCID: PMC10165978 DOI: 10.1515/sjpain-2021-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Native Americans (NAs) have the highest prevalence of chronic pain of any racial/ethnic group. This issue has received little attention from the scientific community. One factor that may contribute to racial pain disparities is pain catastrophizing. Pain catastrophizing is a construct related to negative pain outcomes in persons with/without chronic pain. It has been suggested that the relationship between trait catastrophizing and pain is mediated by situation-specific (state) catastrophizing. The present study has 2 aims: (1) to investigate whether state pain catastrophizing mediates the relationship between trait catastrophizing and experimental pain (e.g., cold, ischemic, heat and electric tolerance), and (2) to investigate whether this relationship is stronger for NAs. METHODS 145 non-Hispanic Whites (NHWs) and 137 NAs completed the study. Bootstrapped indirect effects were calculated for 4 unmoderated and 8 moderated mediation models (4 models with path a moderated and 4 with path b). RESULTS Consistent with trait-activation theory, significant indirect effects indicated a tendency for trait catastrophizing to be associated with greater state catastrophizing which in turn is associated with reduced pain tolerance during tonic cold (a × b=-0.158) and ischemia stimuli (a × b=-0.126), but not during phasic electric and heat stimuli. Moderation was only noted for the prediction of cold tolerance (path a). Contrary to expectations, the indirect path was stronger for NHWs (a × b for NHW=-.142). CONCLUSIONS Together, these findings suggest that state catastrophizing mediates the relationship between trait catastrophizing and some measures of pain tolerance but this indirect effect was non-significant for NAs.
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Affiliation(s)
- Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Stanford University, 450 Serra Mall, Stanford, Stanford, CA94305, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Shreela Palit
- University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH, USA
| | - Yvette M Guereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Tyler Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Rhudy JL, Huber FA, Toledo TA, Kell PA, Street EN, Shadlow JO. 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. Pain 2022; 163:e654-e674. [PMID: 34433767 PMCID: PMC8866534 DOI: 10.1097/j.pain.0000000000002458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain results in considerable suffering, as well as significant economic and societal costs. Previous evidence suggests that Native Americans (NAs) have higher rates of chronic pain than other U.S. racial or ethnic groups, but the mechanisms contributing to this pain disparity are poorly understood. The Oklahoma Study of Native American Pain Risk was developed to address this issue and recruited healthy, pain-free NAs and non-Hispanic Whites. Cross-sectional analyses identified several measures of adversity (eg, trauma and discrimination), cognitive-affective factors (perceived stress and pain-related anxiety/catastrophizing), and cardiometabolic factors (eg, body mass index, blood pressure, and heart rate variability) that were associated with pronociceptive processes (eg, central sensitization, descending inhibition, and hyperalgesia). Every 6-months after enrollment, eligible participants (N = 277) were recontacted and assessed for the onset of chronic pain. This study examines predictors of chronic pain onset in the 222 participants (80%) who responded over the first 2 years. The results show that NAs developed chronic pain at a higher rate than non-Hispanic Whites (OR = 2.902, P < 0.05), even after controlling for age, sex, income, and education. Moreover, serial mediation models identified several potential pathways to chronic pain onset within the NA group. These paths included perceived discrimination, psychological stress, pain-related anxiety, a composite measure of cardiometabolic risk, and impaired descending inhibition of spinal nociception (assessed from conditioned pain modulation of the nociceptive flexion reflex). These results provide the first prospective evidence for a pain disparity in NAs that seems to be promoted by psychosocial, cardiometabolic, and pronociceptive mechanisms.
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Affiliation(s)
- Jamie L. Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Tyler A. Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Parker A. Kell
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Erin N. Street
- The University of Tulsa, Department of Psychology, Tulsa, OK
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Huber FA, Kell PA, Kuhn BL, Lannon EW, Palit S, Payne MF, Hellman N, Sturycz CA, Güereca YM, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. The Association Between Adverse Life Events, Psychological Stress, and Pain-Promoting Affect and Cognitions in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J Racial Ethn Health Disparities 2022; 9:215-226. [PMID: 33428157 PMCID: PMC8272727 DOI: 10.1007/s40615-020-00945-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
Native Americans (NAs) experience higher rates of chronic pain. To examine the mechanisms for this pain inequity, we have previously shown that NAs report higher levels of pain-related anxiety and pain catastrophizing, which are in turn related to pronociceptive (pain-promoting) processes. But, it is currently unclear why NAs would report greater pain-related anxiety and catastrophizing. Given that NAs are also more likely to experience adverse life events (ALEs) and associated psychological distress, it was hypothesized that higher anxiety/catastrophizing in NAs would be partially explained by higher rates of ALEs and psychological distress. Structural equation modeling was used to analyze these pathways (NA ethnicity ➔ ALEs ➔ psychological distress ➔ pain anxiety/catastrophizing) in 305 healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Pain-related anxiety and situational pain catastrophizing were assessed in response to a variety of painful tasks. The Life Events Checklist was used to assess cumulative exposure to ALEs that directly happened to each participant. A latent psychological distress variable was modeled from self-reported perceived stress and psychological symptoms. Results found that NAs experienced more ALEs and greater psychological distress which was associated with higher rates of pain-related anxiety and pain catastrophizing. Notably, NAs did not report greater psychological distress when controlling for ALE exposure. This suggests that a higher risk of chronic pain in NAs may be due, in part, to psychological distress, pain-related anxiety, and pain catastrophizing that are promoted by exposure to ALEs. These results highlight several targets for intervention to decrease NA pain risk.
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Affiliation(s)
- Felicitas A Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
- Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Cassandra A Sturycz
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Burkhart J Hahn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
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Rhudy JL, Kuhn BL, Demuth MJ, Huber FA, Hellman N, Toledo TA, Lannon EW, Palit S, Payne MF, Sturycz CA, Kell PA, Guereca YM, Street EN, Shadlow JO. Are Cardiometabolic Markers of Allostatic Load Associated With Pronociceptive Processes in Native Americans?: A Structural Equation Modeling Analysis From the Oklahoma Study of Native American Pain Risk. THE JOURNAL OF PAIN 2021; 22:1429-1451. [PMID: 34033965 PMCID: PMC8578174 DOI: 10.1016/j.jpain.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Native Americans (NAs) experience higher rates of chronic pain than the general U.S. population, but the risk factors for this pain disparity are unknown. NAs also experience high rates of stressors and cardiovascular and metabolic health disparities (eg, diabetes, cardiovascular disease) consistent with allostatic load (stress-related wear-and-tear on homeostatic systems). Given that allostatic load is associated with chronic pain, then allostatic load may contribute to their pain disparity. Data from 302 healthy, pain-free men and women (153 NAs, 149 non-Hispanic Whites [NHW]) were analyzed using structural equation modeling to determine whether cardiometabolic allostatic load (body mass index, blood pressure, heart rate variability) mediated the relationship between NA ethnicity and experimental measures of pronociceptive processes: temporal summation of pain (TS-pain) and the nociceptive flexion reflex (TS-NFR), conditioned pain modulation of pain (CPM-pain) and NFR (CPM-NFR), and pain tolerance. Results indicated that NAs experienced greater cardiometabolic allostatic load that was related to enhanced TS-NFR and impaired CPM-NFR. Cardiometabolic allostatic load was unrelated to measures of pain perception (CPM-pain, TS-pain, pain sensitivity). This suggests cardiometabolic allostatic load may promote spinal sensitization in healthy NAs, that is not concomitant with pain sensitization, perhaps representing a unique pain risk phenotype in NAs. PERSPECTIVE: Healthy, pain-free Native Americans experienced greater cardiometabolic allostatic load that was associated with a pronociceptive pain phenotype indicative of latent spinal sensitization (ie, spinal sensitization not associated with hyperalgesia). This latent spinal sensitization could represent a pain risk phenotype for this population.
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Affiliation(s)
- Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma.
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio
| | | | - Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Yvette M Guereca
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
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Kell PA, Hellman N, Huber FA, Lannon EW, Kuhn BL, Sturycz CA, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. 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). THE JOURNAL OF PAIN 2021; 22:1097-1110. [PMID: 33819573 PMCID: PMC8419014 DOI: 10.1016/j.jpain.2021.03.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Adverse life events (ALEs) are a risk factor for chronic pain; however, mechanisms underlying this association are not understood. This study examined whether cumulative ALE exposure impairs endogenous inhibition of pain (assessed from pain report) and spinal nociception (assessed from nociceptive flexion reflex; NFR) in healthy, pain-free Native Americans (n = 124) and non-Hispanic Whites (n = 129) during a conditioned pain modulation (CPM) task. Cumulative ALE exposure was assessed prior to testing by summing the number of potentially traumatic events experienced by each participant across their lifespan. Multilevel modeling found that ALEs were associated with NFR modulation during the CPM task even after controlling for general health, body mass index, sex, age, blood pressure, sleep quality, stimulation intensity, stimulus number, perceived stress, and psychological distress. Low exposure to ALEs was associated with NFR inhibition, whereas high exposure to ALEs was associated with NFR facilitation. By contrast, pain perception was inhibited during the CPM task regardless of the level of ALE exposure. Race/ethnicity did not moderate these results. Thus, ALEs may be pronociceptive for both Native Americans and non-Hispanic Whites by impairing descending inhibition of spinal nociception. This could contribute to a chronic pain risk phenotype involving latent spinal sensitization. PERSPECTIVE: This study found that adverse life events were associated with impaired descending inhibition of spinal nociception in a sample of Native Americans and non-Hispanic Whites. These findings expand on previous research linking adversity to chronic pain risk by identifying a proximate physiological mechanism for this association.
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Affiliation(s)
- Parker A Kell
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Natalie Hellman
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Edward W Lannon
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Bethany L Kuhn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Tyler A Toledo
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Burkhart J Hahn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma.
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Toledo TA, Kuhn BL, Payne MF, Lannon EW, Palit S, Sturycz CA, Hellman N, Güereca YM, Demuth MJ, Huber F, Shadlow JO, Rhudy JL. The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2020; 54:575-594. [PMID: 32073117 PMCID: PMC7414293 DOI: 10.1093/abm/kaaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Conditioned pain modulation (CPM) is a task that involves measuring pain in response to a test stimulus before and during a painful conditioning stimulus (CS). The CS pain typically inhibits pain elicited by the test stimulus; thus, this task is used to assess endogenous pain inhibition. Moreover, less efficient CPM-related inhibition is associated with chronic pain risk. Pain catastrophizing is a cognitive-emotional process associated with negative pain sequelae, and some studies have found that catastrophizing reduces CPM efficiency. PURPOSE The current study examined the relationship between catastrophizing (dispositional and situation specific) and CPM-related inhibition of pain and the nociceptive flexion reflex (NFR; a marker of spinal nociception) to determine whether the catastrophizing-CPM relationship might contribute to the higher risk of chronic pain in Native Americans (NAs). METHODS CPM of pain and NFR was assessed in 124 NAs and 129 non-Hispanic Whites. Dispositional catastrophizing was assessed at the beginning of the test day, whereas situation-specific catastrophizing was assessed in response to the CS, as well as painful electric stimuli. RESULTS Situation-specific, but not dispositional, catastrophizing led to less NFR inhibition but more pain inhibition. These effects were not moderated by race, but mediation analyses found that: (a) the NA race was associated with greater situation-specific catastrophizing, which led to less NFR inhibition and more pain inhibition, and (b) situation-specific catastrophizing was associated with greater CS pain, which led to more pain inhibition. CONCLUSIONS Catastrophizing may contribute to NA pain risk by disrupting descending inhibition.
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Affiliation(s)
- Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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9
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Rhudy JL, Arnau RC, Huber FA, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, Hellman N, Guereca YM, Toledo TA, Shadlow JO. Examining Configural, Metric, and Scalar Invariance of the Pain Catastrophizing Scale in Native American and Non-Hispanic White Adults in the Oklahoma Study of Native American Pain Risk (OK-SNAP). J Pain Res 2020; 13:961-969. [PMID: 32440202 PMCID: PMC7221415 DOI: 10.2147/jpr.s242126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Native Americans (NAs) have a higher prevalence of chronic pain than other US racial/ethnic groups, but the mechanisms contributing to this pain disparity are under-researched. Pain catastrophizing is one of the most important psychosocial predictors of negative pain outcomes, and the Pain Catastrophizing Scale (PCS) has been established as a reliable and valid measure of the pain catastrophizing construct. However, before the PCS can be used to study pain risk in NAs, it is prudent to first determine whether the established 3-factor structure of the PCS also holds true for NAs. METHODS The current study examined the measurement (configural, metric, and scalar) invariance of the PCS in a healthy, pain-free sample of 138 NA and 144 non-Hispanic white (NHW) participants. RESULTS Results suggest that the previously established 3-factor solution fits for both groups (configural invariance) and that the factor loadings were equivalent across groups (metric invariance). Scalar invariance was also established, except for 1 minor scalar difference in a single threshold for item 3 (suggesting NHWs were more likely to respond with a 4 on that item than NAs). DISCUSSION Results provide additional evidence for the psychometric properties of the PCS and suggest it can be used to study pain catastrophizing in healthy, pain-free NA samples.
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Affiliation(s)
- Jamie L Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Randolph C Arnau
- University of Southern Mississippi, Department of Psychology, Hattiesburg, MS, USA
| | | | - Edward W Lannon
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Bethany L Kuhn
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Shreela Palit
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Michael F Payne
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Natalie Hellman
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Yvette M Guereca
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Tyler A Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Joanna O Shadlow
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
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10
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Rhudy JL, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, Hellman N, Güereca YM, Toledo TA, Huber F, Demuth MJ, Hahn BJ, Chaney JM, Shadlow JO. Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: main findings from the Oklahoma Study of Native American Pain Risk. Pain 2020; 161:388-404. [PMID: 31977838 PMCID: PMC7001897 DOI: 10.1097/j.pain.0000000000001715] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Native Americans (NAs) have a higher prevalence of chronic pain than other U.S. racial/ethnic groups, but there have been few attempts to understand the mechanisms of this pain disparity. This study used a comprehensive battery of laboratory tasks to assess peripheral fiber function (cool/warm detection thresholds), pain sensitivity (eg, thresholds/tolerances), central sensitization (eg, temporal summation), and pain inhibition (conditioned pain modulation) in healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Multiple pain stimulus modalities were used (eg, cold, heat, pressure, ischemic, and electric), and subjective (eg, pain ratings and pain tolerance) and physiological (eg, nociceptive flexion reflex) outcomes were measured. There were no group differences on any measure, except that NAs had lower cold-pressor pain thresholds and tolerances, indicating greater pain sensitivity than NHWs. These findings suggest that there are no group differences between healthy NAs and NHWs on peripheral fiber function, central sensitization, or central pain inhibition, but NAs may have greater sensitivity to cold pain. Future studies are needed to examine potential within-group factors that might contribute to NA pain risk.
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Affiliation(s)
- Jamie L. Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Bethany L. Kuhn
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Shreela Palit
- The University of Tulsa, Department of Psychology, Tulsa, OK
- University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL
| | - Michael F. Payne
- The University of Tulsa, Department of Psychology, Tulsa, OK
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH
| | | | - Natalie Hellman
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Tyler A. Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Felicitas Huber
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Mara J. Demuth
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - John M. Chaney
- Oklahoma State University, Department of Psychology, Stillwater, OK
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11
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Rhudy JL, Huber F, Kuhn BL, Lannon EW, Palit S, Payne MF, Hellman N, Sturycz CA, Güereca YM, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO. Pain-related anxiety promotes pronociceptive processes in Native Americans: bootstrapped mediation analyses from the Oklahoma Study of Native American Pain Risk. Pain Rep 2020; 5:e808. [PMID: 32072102 PMCID: PMC7004502 DOI: 10.1097/pr9.0000000000000808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Evidence suggests Native Americans (NAs) experience higher rates of chronic pain than the general US population, but the mechanisms contributing to this disparity are poorly understood. Recently, we conducted a study of healthy, pain-free NAs (n = 155), and non-Hispanic whites (NHWs, n = 150) to address this issue and found little evidence that NAs and NHWs differ in pain processing (assessed from multiple quantitative sensory tests). However, NAs reported higher levels of pain-related anxiety during many of the tasks. OBJECTIVE The current study is a secondary analysis of those data to examine whether pain-related anxiety could promote pronociceptive processes in NAs to put them at chronic pain risk. METHODS Bootstrapped indirect effect tests were conducted to examine whether pain-related anxiety mediated the relationships between race (NHW vs NA) and measures of pain tolerance (electric, heat, ischemia, and cold pressor), temporal summation of pain and the nociceptive flexion reflex (NFR), and conditioned pain modulation of pain/NFR. RESULTS Pain-related anxiety mediated the relationships between NA race and pain tolerance and conditioned pain modulation of NFR. Exploratory analyses failed to show that race moderated relationships between pain-related anxiety and pain outcomes. CONCLUSION These findings imply that pain-related anxiety is not a unique mechanism of pain risk for NAs, but that the greater tendency to experience pain-related anxiety by NAs impairs their ability to engage descending inhibition of spinal nociception and decreases their pain tolerance (more so than NHWs). Thus, pain-related anxiety may promote pronociceptive processes in NAs to place them at risk for future chronic pain.
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Affiliation(s)
- Jamie L. Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Bethany L. Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Edward W. Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Community Dentistry & Behavioral Science, University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL, USA
| | - Michael F. Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | | | - Tyler A. Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Mara J. Demuth
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Burkhart J. Hahn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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12
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Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation. Pain Rep 2019; 4:e773. [PMID: 31875181 PMCID: PMC6882573 DOI: 10.1097/pr9.0000000000000773] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Higher physical activity (PA) and lower sedentary behaviour (SB) levels have demonstrated beneficial effects on temporal summation (TS) and conditioned pain modulation (CPM) in healthy adults. This cross-sectional study investigated the relationships between PA and SB and TS/CPM responses in individuals with chronic musculoskeletal pain. Methods: Sixty-seven middle-aged and older adults with chronic musculoskeletal pain were recruited from the community. Questionnaires measuring demographics, pain, and psychological measures were completed. Physical activity/SB levels were measured using the International Physical Activity Questionnaire—short form and Sedentary Behaviour Questionnaire, respectively. Semmes monofilament was used to assess mechanical TS (MTS) at the most symptomatic (MTS-S) and a reference region (MTS-R); change in the pain scores (baseline-10th application) was used for analysis. Conditioned pain modulation procedure involved suprathreshold pressure pain threshold (PPT-pain4) administered before and after (CPM30sec, CPM60sec, and CPM90sec) conditioning stimulus (2 minutes; ∼12°C cold bath immersion). For analysis, PPT-pain4 (%) change scores were used. Results: PPT-pain4 (%) change scores at CPM30sec and CPM60sec demonstrated significant weak positive correlations with SB levels and weak negative correlations with PA measures. After adjusting for confounding variables, a significant positive association was found between SB (h/d) and PPT-pain4 (%) change scores at CPM30sec and CPM60sec. No significant associations between MTS and PA/SB measures. Conclusion: Sedentariness is associated with higher pain inhibitory capacity in people with chronic musculoskeletal pain. The observed relationship may be characteristic of a protective (sedentary) behaviour to enhance pain modulatory mechanism. Prospective longitudinal studies using objective PA/SB measures are required to validate the observed relationship in a larger sample size.
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Sturycz CA, Hellman N, Payne MF, Kuhn BL, Hahn B, Lannon EW, Palit S, Güereca YM, Toledo TA, Shadlow JO, Rhudy JL. Race/Ethnicity Does Not Moderate the Relationship Between Adverse Life Experiences and Temporal Summation of the Nociceptive Flexion Reflex and Pain: Results From the Oklahoma Study of Native American Pain Risk. THE JOURNAL OF PAIN 2019; 20:941-955. [PMID: 30776495 DOI: 10.1016/j.jpain.2019.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/22/2022]
Abstract
Adverse life experiences (ALEs) are associated with hyperalgesia and chronic pain, but the underlying mechanisms are poorly understood. One potential mechanism is hyperexcitability of spinal neurons (ie, central sensitization). Given that Native Americans (NAs) are more likely to have ALEs and to have a higher prevalence of chronic pain, the relationship between ALEs and spinal hyperexcitability might contribute to their pain risk. The present study assessed temporal summation of the nociceptive flexion reflex (TS-NFR; a correlate of spinal hyperexcitability) and pain (TS-Pain) in 246 healthy, pain-free non-Hispanic whites and NAs. The Life Events Checklist was used to assess the number of ALEs. Multilevel growth models were used to predict TS-NFR and TS-Pain, after controlling for age, perceived stress, psychological problems, negative and positive affect, and painful stimulus intensity. ALEs and negative affect were significantly associated with greater pain, but not enhanced TS-Pain. By contrast, ALEs were associated with enhanced TS-NFR. Race did not moderate these relationships. This finding implies that ALEs promote hyperalgesia as a result of increased spinal neuron excitability. Although relationships between ALEs and the nociceptive flexion reflex/pain were not stronger in NAs, given prior evidence that NAs experience more ALEs, this factor might contribute to the higher prevalence of chronic pain in NAs. PERSPECTIVE: This study found a dose-dependent relationship between ALEs and spinal neuron excitability. Although the relationship was not stronger in NAs than non-Hispanic whites, given prior evidence that NAs experience more ALEs, this could contribute to the higher prevalence of chronic pain in NAs.
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Affiliation(s)
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Burkhart Hahn
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma.
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