Race effects on temporal summation to heat pain in youth

Morris, Matthew C.; Walker, Lynn S.; Bruehl, Stephen; Hellman, Natalie; Sherman, Amanda L.; Rao, Uma

doi:10.1097/j.pain.0000000000000129

Cited by 23 publications

(18 citation statements)

References 42 publications

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“…A recent study has since replicated this finding (22). Although one recent study found no racial differences in temporal summation to heat pain among youth ages 10–17 (23), this is consistent with the hypothesis that long-term exposure to chronic stress may explain AAs’ increased pain sensitivity.…”

Section: Introductionsupporting

confidence: 81%

The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

et al. 2017

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Objective To examine the role of psychosocial factors in mediating the relationship between African American (AA) race and both increased pain sensitivity and blunted stress reactivity. Methods Participants included 133 AA and non-Hispanic White (nHW) individuals (mean (SD) age = 37 (9)) matched for age, sex and socioeconomic status. Participants underwent mental stress testing (Trier Social Stress Test) while cardiovascular, hemodynamic, and neuroendocrine reactivity were measured. Participants completed questionnaires assessing potential sources of psychosocial stress and were tested for pain responses to cold pain and the temporal summation of heat pulses. Mediation analyses were used to determine the extent to which exposure to psychosocial stress accounted for the observed racial differences in stress reactivity and pain. Results Chronic stress exposure and reactivity to mental stress was largely similar among AAs and nHWs; however, AAs exhibited heightened pain to both cold (p = .012) and heat (p = .004). Racial differences in the relationship between stress reactivity and pain were also observed: while greater stress reactivity was associated with decreased pain among nHWs, reactivity was either unrelated to or even positively associated with pain among AAs (e.g. r = −.21 among nHWs and r = .41 among AAs for stroke volume reactivity and cold pressor intensity). Adjusting for minor racial differences in chronic psychosocial stress did not change these findings. Conclusion Accounting for psychosocial factors eliminated racial differences in stress reactivity but not racial differences in sensitivity to experimental pain tasks. Increased exposure to chronic stress may not explain AAs’ increased pain sensitivity in laboratory settings.

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Section: Introductionsupporting

confidence: 81%

The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

et al. 2017

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“…If findings from our research group showing enhanced CPM and decreased temporal summation of second pain in African-American youth [37] are replicated by others, an intriguing possibility emerges: that African-American youth display an anti-nociceptive pain modulation profile. Such a profile conflicts with evidence of enhanced evoked pain responsiveness and greater clinical pain severity in African-American adults compared to Non-Hispanic White adults [13].…”

Section: Discussionmentioning

confidence: 83%

“…A second gap in the literature is that few evoked pain studies have been conducted in healthy youth [2,31,36]. One study found that African-American youth reported lower evoked pain intensity than Non-Hispanic White youth [31], and we have recently reported diminished temporal summation of second pain in African-American compared to Non-Hispanic White youth [37]. To our knowledge, whether racial differences in CPM are present in youth without chronic pain has not been examined.…”

mentioning

confidence: 99%

Race Effects on Conditioned Pain Modulation in Youth

Morris¹,

Walker²,

Bruehl³

et al. 2015

The Journal of Pain

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Race and ethnicity shape the experience of pain in adults, with African Americans typically exhibiting greater pain intensity and evoked pain responsiveness than Non-Hispanic Whites. However, it remains unclear whether there are racial differences in conditioned pain modulation (CPM) and if these are present in youth. CPM refers to a reduction in perceived pain intensity for a test stimulus during application of a conditioning stimulus and may be especially relevant in determining risk for chronic pain. The present study assessed CPM to evoked thermal pain in 78 healthy youth (ages 10 to 17), 51% of whom were African American and 49% were Non-Hispanic White. African-American youth reported lower mean conditioning pain ratings than Non-Hispanic White youth, controlling for mean pre-conditioning pain ratings, which is consistent with stronger CPM. Multilevel models demonstrated stronger CPM effects in African-American than Non-Hispanic White youth, as evident in more rapid within-person decreases in pain ratings during the conditioning phase. These findings suggest that diminished CPM likely does not account for the enhanced responsiveness to evoked thermal pain observed in African-American youth. These results may have implications for understanding racial differences in chronic pain experience in adulthood. Perspective This study evaluated conditioned pain modulation to evoked thermal pain in African-American and Non-Hispanic White youth. Findings could have implications for the development of personalized chronic pain treatment strategies that are informed by race and ethnicity.

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“…Few evoked pain studies have been conducted in healthy youth [4,26,28,34] and only two have examined CPM [29,42]. Relatively little is known about experimental pain responses in youth with FAP.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

“…Diminished CPM (relative to control samples) has been observed in a variety of chronic pain conditions, including fibromyalgia [19,22], temporomandibular disorder [17], and chronic headache [32]. Impaired CPM has also been found in adults with IBS [14,17,31,51] and is linked to greater distress and discomfort in these individuals [15].Few evoked pain studies have been conducted in healthy youth [4,26,28,34] and only two have examined CPM [29,42]. Relatively little is known about experimental pain responses in youth with FAP.…”

mentioning

confidence: 99%

(236) Impaired conditioned pain modulation in youth with functional abdominal pain

Morris

Walker

Bruehl

et al. 2016

The Journal of Pain

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Functional abdominal pain (FAP) is associated with enhanced pain responsiveness. Although impaired conditioned pain modulation (CPM) characterizes adults with a variety of chronic pain conditions, relatively little is known about CPM in youth with FAP. The present study assessed CPM to evoked thermal pain in 140 youth (ages 10 to 17), 63 of whom had FAP and 77 of whom were healthy controls. Multilevel models demonstrated weaker CPM effects in FAP than healthy youth, as evident in slower within-person decreases in pain ratings during the conditioning phase. Weaker CPM effects were associated with greater somatic symptom severity and functional disability. Pain responses in FAP youth were heterogeneous, with 43% of youth showing an unexpected increase in pain ratings during the conditioning phase, suggesting sensitization rather than CPM-related pain inhibition. These findings highlight directions for future research on the emergence and maintenance of FAP in youth. Keywordsfunctional abdominal pain; FAP; CPM; DNIC; adolescents Functional abdominal pain (FAP) refers to either episodic or continuous abdominal pain that remains medically unexplained despite thorough physical examination [36]. According to a recent meta-analysis, FAP is common in youth, with a worldwide pooled prevalence rate of 13.5% [18]. Many youth with FAP either meet current Rome III criteria for functional Corresponding Author: Uma Rao, M.D., Address: University of Tennessee, CMHSRC, 122 Henson Hall, 1618 West Cumberland Avenue, Knoxville, Phone: (865) FAX: (865) 974-1662, urao@utk.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript gastrointestinal disorders, including irritable bowel syndrome (IBS), functional dyspepsia and abdominal migraine [2], or are at increased risk for developing functional gastrointestinal disorders over time [48]. FAP in youth is associated with significant functional disability, reflected in part by school absences [36], and is often persistent despite frequent utilization of health care services [13]. Although a variety of biological and psychosocial factors [48,49] have been implicated in the development and maintenance of FAP in youth, little is known about the impact of altered pain modulatory systems.Experimental pain responses, which may index functioning in pain modulatory systems, have proven useful as biomarkers of risk for chronic pain by discriminating clinical pain populations from healthy controls, correlating with changes in clinical pain, and predicting the development of chronic pain [11]. Pro-nociceptive pain modulation profiles are characterized by decreased inhibition and/or increased temporal summation to evoked pain [53]. One experimental method used to detect dysfunction in descending inhibitory pain modulatory systems is conditioned pain modulation (CPM; previously termed diffuse noxious inhibitory controls or DNIC), which refers to a reduction in perceived pain intensity for a test stimulus during application of a conditioning stimulus to...

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Race effects on temporal summation to heat pain in youth

Cited by 23 publications

References 42 publications

The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

Race Effects on Conditioned Pain Modulation in Youth

(236) Impaired conditioned pain modulation in youth with functional abdominal pain

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