“Neural and Sociocultural Mediators of Ethnic Differences in Pain”
The common belief that African Americans feel less pain has been related to undertreatment of pain in this ethnic group, which contributes to widespread and persistent racial and ethnic health disparities. Paradoxically, African Americans actually report more pain than White Americans in both clinical and laboratory settings. In this study, we examined nociceptive sensitivity by looking at the activity in brain regions previously linked to nociception in whole-brain analyses and tested responses in a multivariate fMRI activity pattern that closely tracks the intensity and affect of evoked nociceptive pain, termed the neurologic pain signature (NPS). Our findings suggest that the link between chronic pain and ethnic differences in pain sensitivity may lie in the chronic stress associated with discrimination.
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Abstract
Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity- and gender-balanced sample of African Americans, Hispanics and non-Hispanic Whites using functional magnetic resonance imaging during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased frontostriatal circuit activations associated with pain rating, discrimination, experimenter trust and extranociceptive aspects of pain elsewhere. In contrast, the neurologic pain signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extranociceptive central pain mechanisms and suggest that nociceptive pain processing may be similar across ethnicities.