Oklahoma Study of Native American Pain Risk III: Stress and Resilience (OK-SNAPIII)

The Impact of Structural Racism and Discrimination (SRD) on Mechanisms of the Native American Pain Disparity

The goal of this observational study is to learn about the relationship between environmental structural racism and discrimination and chronic pain risk in Native American adults. The main questions it aims to answer are:

1. How does environmental structural racism and discrimination affect chronic pain-promoting mechanisms in Native Americans?
2. What psychosocial factors buffer the negative effects of environmental structural racism and discrimination on chronic pain-promoting mechanisms?

Study Overview

• Status: Recruiting
• Conditions: Pain; Discrimination, Racial; Stress Physiology

Detailed Description

Native Americans experience higher rates of chronic pain than the general U.S. population, and previous research has shown that pain-free Native Americans transition to chronic pain at almost three times the rate of non-Hispanic Whites. Yet, little is known about the mechanisms that contribute to this pain disparity.

This study aims to better understand the role of environmental and society-wide stressors, like structural racism and discrimination, in contributing to this pain disparity. It is believed that these environmental and social stressors may contribute to chronic pain risk by increasing an individual's mental and physical stress levels. In turn, increased stress may alter how an individual responds to pain, both physically and emotionally, which may place them at greater risk for developing chronic pain in the future.

• Study Type: Observational
• Enrollment (Estimated): 220

Contacts and Locations

• Study Contact: Name: PLAN Lab; Phone Number: 918-660-3048; Email: tulsa.plan@gmail.com
• Study Contact Backup: Name: Jamie L Rhudy, PhD; Phone Number: 918-660-3050; Email: jamie-rhudy@ouhsc.edu

Study Locations

• United States
  • Oklahoma
    • Tulsa, Oklahoma, United States, 74135
      • Recruiting
      • University of Oklahoma - Schusterman Center
      • Contact: PLAN Lab; Phone Number: 918-660-3048; Email: tulsa.plan@gmail.com
      • Contact: Jamie L Rhudy, PhD; Phone Number: 918-660-3050; Email: jamie-rhudy@ouhsc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Participants will be adults who self-identify as Native American/American Indian.

Description

Inclusion Criteria:

• Self-identify as Native American/American Indian

Exclusion Criteria:

• <18 years of age
• Self-reported history of cardiovascular, neuroendocrine, musculoskeletal, or neurological disorders
• Surrent chronic pain, defined as persistent, bothersome pain on more days than not for at least 3 months)
• Self-reported current substance dependence
• Sse of medication that could interfere with testing (e.g., recent use of analgesics, antidepressants, or anti-anxiety medications)
• Inability to speak English
• Current psychosis (assessed by Psychosis Screening Questionnaire)
• Serious cognitive impairment (assessed by <20 score on the Montreal Cognitive Assessment [MoCA])
• Possible peripheral neuropathy (assessed by nerve conduction study)

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Native Americans; Native Americans / American Indians

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain inhibition	Pain inhibition will be assessed using a conditioned pain modulation task with cold water as the conditioning stimulus and electric stimulations as the test stimulus.	baseline
Inhibition of pain-related spinal reflex	Pain-related spinal reflex inhibition assessed from electromyogram will be assessed using a conditioned pain modulation task with cold water as the conditioning stimulus and electric stimulations as the test stimulus.	baseline
Inhibition of pain-evoked cortical potentials	Inhibition of pain-evoked cortical potentials from electroencephalography will be assessed using a conditioned pain modulation task with cold water as the conditioning stimulus and electric stimulations as the test stimulus.	baseline
Psychological stress	A single latent variable measuring psychological stress will be created using principal components analysis to combine scores from three self-report questionnaires: the Perceived Stress Scale (PSS), the Global Distress Index of the Symptom Checklist-90-Revised (SCL-90-R), and the PTSD Checklist-Civilian (PCL-C).	baseline
Somatic threat sensitivity	A single latent variable measuring somatic threat sensitivity will be created using principal components analysis to combine scores from the Pain Catastrophizing Scale and a pain-related anxiety visual analog scale.	baseline
Allostatic load	A single latent variable for allostatic load will be created using principal components analysis to combine cardiovascular (i.e., resting blood pressure and heart rate, stress-evoked blood pressure and heart rate, and a fasting lipids profile [HDL, LDL total cholesterol, and triglycerides]), metabolic (i.e., BMI, waist-to-hip ratio, HbA1c), neuroendocrine (i.e., diurnal salivary cortisol, stress-evoked salivary cortisol), immune (i.e., hs-CRP), and parasympathetic (i.e., resting heart rate variability) variables.	baseline
Environmental structural racism and discrimination	An index comprised of 11 environmental justice variables from the Environmental Protection Agency's publicly available Environmental Screening and Mapping Tool (EJSCREEN) will be created for each participant at the 2010 Census Block Group level. The 11 variables will be combined into a single index using principal components analysis.	baseline
Cultural connectedness	A single latent variable of cultural connectedness will be created using principal components analysis to combine scores from five self-report scales: the Cultural Connectedness Scale, the Community Mastery Scale, the Vancouver Index of Acculturation, the American Indian Enculturation Scale, and the Native American Spirituality Scale	baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Temporal summation of pain	Temporal summation of pain will be measured by assessing the change in a participant's pain ratings in response identical noxious stimuli delivered in rapid succession.	baseline
Temporal summation of spinal nociception	Temporal summation of spinal nociception will be measured by assessing the change in a participant's pain-related reflex magnitude (assessed from electromyography) in response identical noxious stimuli delivered in rapid succession.	baseline
Pain tolerance	Pain tolerance will be measured with ischemic and cold pain tasks. Participants will continuously rate their pain in response to painful tonic stimuli, and pain tolerance will be quantified as the time (in seconds) that it takes for participants to report that they can no longer tolerate the pain.	basline

Collaborators and Investigators

• Sponsor: University of Oklahoma
• Collaborators: University of Tulsa; Oklahoma State University
• Investigators: Principal Investigator: Jamie L Rhudy, PhD, University of Oklahoma

Study record dates

Study Major Dates

• Study Start (Actual): February 3, 2023
• Primary Completion (Estimated): March 31, 2027
• Study Completion (Estimated): March 31, 2027

Study Registration Dates

• First Submitted: January 24, 2023
• First Submitted That Met QC Criteria: February 1, 2023
• First Posted (Actual): February 10, 2023

Study Record Updates

• Last Update Posted (Actual): April 2, 2025
• Last Update Submitted That Met QC Criteria: March 27, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Quantitative sensory testing; Stress reactivity; Structural racism and discrimination
• Other Study ID Numbers: HSC16494/TU2229

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Immediately following publication of all findings, the data will be freely available to any researcher who requests a copy. All data files will be de-identified so there is no possibility of connecting the information with the original participants. The electronic data will be stored as de-identified SPSS data files or Excel data files. The raw (i.e., unprocessed) physiology data (e.g., EMG, EKG, EEG) will also be made available to interested researchers. These raw data files will be stored as de-identified files. To obtain access to the data, interested parties can contact the PI (jamie-rhudy@utulsa.edu).
• IPD Sharing Time Frame: De-identified data will become available following publication of all findings (around 6/1/2030).
• IPD Sharing Access Criteria: To obtain access to the data, interested parties can contact the PI (jamie-rhudy@utulsa.edu).

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No