Racial/ethnic differences in experimental pain sensitivity and associated factors - Cardiovascular responsiveness and psychological status

Hee Jun Kim, Joel D Greenspan, Richard Ohrbach, Roger B Fillingim, William Maixner, Cynthia L Renn, Meg Johantgen, Shijun Zhu, Susan G Dorsey, Hee Jun Kim, Joel D Greenspan, Richard Ohrbach, Roger B Fillingim, William Maixner, Cynthia L Renn, Meg Johantgen, Shijun Zhu, Susan G Dorsey

Abstract

This study evaluated the contributions of psychological status and cardiovascular responsiveness to racial/ethnic differences in experimental pain sensitivity. The baseline measures of 3,159 healthy individuals-non-Hispanic white (NHW): 1,637, African-American (AA): 1,012, Asian: 299, and Hispanic: 211-from the OPPERA prospective cohort study were used. Cardiovascular responsiveness measures and psychological status were included in structural equation modeling based mediation analyses. Pain catastrophizing was a significant mediator for the associations between race/ethnicity and heat pain tolerance, heat pain ratings, heat pain aftersensations, mechanical cutaneous pain ratings and aftersensations, and mechanical cutaneous pain temporal summation for both Asians and AAs compared to NHWs. HR/MAP index showed a significant inconsistent (mitigating) mediating effect on the association between race/ethnicity (AAs vs. NHWs) and heat pain tolerance. Similarly, coping inconsistently mediated the association between race/ethnicity and mechanical cutaneous pain temporal summation in both AAs and Asians, compared to NHWs. The factor encompassing depression, anxiety, and stress was a significant mediator for the associations between race/ethnicity (Asians vs. NHWs) and heat pain aftersensations. Thus, while pain catastrophizing mediated racial/ethnic differences in many of the QST measures, the psychological and cardiovascular mediators were distinctly restrictive, signifying multiple independent mechanisms in racial/ethnic differences in pain.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Components resulting from principal component…
Fig 1. Components resulting from principal component analysis (red lines) and parallel analysis (black lines).
Note. Upper left: pain sensitivity data, Upper right: cardiovascular responsiveness data, Bottom: psychological status data.
Fig 2. Mediation model for AA-NHW differences…
Fig 2. Mediation model for AA-NHW differences in heat pain tolerance.
Note. Pain Catastrophizing (PC) partially mediated the association between AA-NHW differences in heat pain tolerance, indicating that AA-NHW differences in heat pain tolerance were partially explained by higher PC in AAs; HR/MAP index negatively mediated the association, indicating that lower HR/MAP index (higher baroreflex set point) in AAs partially suppressed AA-NHW differences in heat pain tolerance. Path values represent standardized beta coefficients (*p Mk=a0+akX+covariates+εk;k=1,2,…,4 Y=b0+bkMk+c′X+covariates+ε;k=1,2,…,4 Where age, gender, BMI, study site, and education and income level were entered as covariates. The product of akbk represents the indirect effect for kth mediator and c’ the direct effect.
Fig 3. Mediation model for Asian-NHW differences…
Fig 3. Mediation model for Asian-NHW differences in heat pain aftersensations.
Note. Depression, Anxiety, and Stress (DAS) and Pain Catastrophizing (PC) partially mediated the association between Asian-NHW and heat pain ratings, indicating that Asian-NHW differences in heat pain aftersensations were partially explained by higher levels of DAS and PC in Asians. Path values represent standardized beta coefficients (*p

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