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Psychological and brain mechanisms underlying disparities in opioid and non-opioid pain treatment decisions

阿片类药物和非阿片类药物疼痛治疗决策差异背后的心理和大脑机制

基本信息

批准号：
10349457
负责人：
Elizabeth R Losin
金额：
$ 17.06万
依托单位：
UNIVERSITY OF MIAMI CORAL GABLES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10349457
关键词：
Acute Acute Pain Address Affect Analgesics Anterior Area Behavioral Medicine Brain Chronic Clinical Cognitive Cues Drug abuse Education Educational Intervention Effectiveness Empathy Environment Epidemic Ethnic Origin Ethnic group Facial Expression Facial Pain Functional Magnetic Resonance Imaging Gender Goals Hospitals Individual Insula of Reil Intervention K-Series Research Career Programs Literature Mediating Medical Medical Students Methodology Minority Groups Minority Women Nationalities Neurobiology Neurosciences Non-Malignant Not Hispanic or Latino Opioid Opioid Analgesics Pain Pain Measurement Pain intensity Pain management Participant Patients Production Race Recommendation Research Research Personnel Research Training Resources Risk Scanning Sex Bias Standardization Statistical Data Interpretation Stereotyping Stimulus System Testing Text Training Translational Research United States University resources base behavior measurement cancer pain chronic pain clinical application clinical pain demographic disparity design digital effective intervention effective therapy ethnic bias evidence base experience health disparity improved indexing innovation medical schools neurobiological mechanism non-opioid analgesic novel opioid abuse opioid epidemic pain sensitivity patient screening prescription opioid prescription pain reliever psychologic psychosocial relating to nervous system response simulation skills social culture social group treatment disparity willingness

项目摘要

Project Summary Unequal prescribing of opioid and non-opioid analgesics among demographic groups contributes to two major health disparities in the United States. Overprescribing of opioid analgesics to treat both acute and chronic nonmalignant pain, especially in non-Hispanic whites, has fueled the opioid abuse epidemic. Underprescribing of opioid and non-opioid analgesics in minorities and women, even when their use is medically indicated (e.g., acute and cancer pain), reduces the effectiveness of pain management in these groups. In order to mitigate analgesic prescribing disparities and the associated risks of opioid abuse and poor pain management, we must understand the mechanisms underlying these disparities. The current project will test two potential contributors to these pain treatment disparities: 1) clinicians' inaccurate demographic stereotypes about pain sensitivity and tendency to abuse opioids (i.e., the stereotype hypothesis), and 2) reduced activation of clinicians' pain-related neural systems (e.g., anterior cingulate and anterior insula) in response to the pain of demographic outgroup patients (i.e., the vicarious pain hypothesis). Prior studies of mechanisms underlying analgesic prescribing disparities have been limited by the use of experimental paradigms that were low in ecological validity e.g. asking participants to make prescribing decisions based solely on text-based medical vignettes or depictions of individuals feigning pain. Additionally, although the robust fMRI literature on vicarious pain biases is related to biases in pain assessment, vicarious pain biases have not been tested as a potential contributor to biases pain treatment decisions. In the present proposal, these methodological limitations will be addressed and the stereotype and vicarious pain hypotheses will be tested through 3 specific aims. Aim 1 involves the design and production of a more ecologically valid video-based simulated pain assessment and treatment paradigm depicting individuals experiencing genuine pain. Aim 2 includes an fMRI study of the effects of clinicians' (medical students') vicarious pain responses and pain stereotypes on demographic biases in simulated pain assessment and analgesic prescribing, using the video paradigm created in Aim 1. Finally, to determine the clinical applicability of the findings from Aim 2, Aim 3 includes face-to-face pain assessments and treatment recommendations during simulated clinical interactions with standardized patient actors. If the aims of this proposal are achieved, these studies will yield new understanding of the relative contributions of pain-related stereotypes and vicarious pain to analgesic prescribing disparities. These results could indicate whether pain stereotype education, efforts to increase pain empathy, or both should be incorporated into clinician interventions aimed at reducing analgesic prescribing disparities. Through this K01 career development award, the candidate will gain facility in three areas not included in her past training: clinical pain assessment and treatment, multivariate statistical analysis, and behavioral medicine in order to more effectively understand psychosocial and neurobiological mechanisms underlying health disparities in pain and pain management.

项目摘要在人口统计群体中，阿片类和非阿片类止痛药的处方不平等导致了两个主要原因美国的健康差距。阿片类止痛药超量用药治疗急、慢性非恶性疼痛，特别是非西班牙裔白人，助长了阿片类药物滥用的流行。开得太少阿片类和非阿片类镇痛剂在少数族裔和妇女中的使用情况，即使有医学上的指示(例如，急性疼痛和癌症疼痛)，降低了这些群体中疼痛管理的有效性。为了缓解止痛药处方的差异以及阿片类药物滥用和疼痛管理不善的相关风险，我们必须了解这些差异背后的机制。当前的项目将测试两个潜在的贡献者对于这些疼痛治疗差异：1)临床医生关于疼痛敏感性和疼痛敏感性的不准确的人口统计学刻板印象滥用阿片类药物的倾向(即刻板印象假说)，以及2)临床医生疼痛相关的激活减少神经系统(如前扣带回和前脑岛)对人口外群疼痛的反应患者(即代替性疼痛假说)。止痛药处方机制的研究进展差异通过使用生态学效度较低的实验范式来限制，例如要求参与者仅根据基于文本的医学插图或对假装痛苦的个体。此外，尽管关于代替性疼痛偏向的可靠的fMRI文献与疼痛评估中的偏差，代替性疼痛偏差尚未被测试为可能导致疼痛偏差的因素治疗决定。在本提案中，这些方法上的局限性将得到解决，刻板印象和代替性疼痛假说将通过3个具体目标进行检验。目标1涉及设计和制作更具生态有效性的基于视频的模拟疼痛评估和治疗范例描绘了经历真正痛苦的人。目标2包括对临床医生的影响的功能磁共振研究 (医学生)模拟疼痛中的代替性疼痛反应和疼痛刻板印象评估和止痛药处方，使用目标1中创建的视频范式。最后，确定来自目标2、目标3的研究结果的临床适用性包括面对面疼痛评估和治疗在与标准化患者参与者进行模拟临床交互期间提出建议。如果这样做的目的是这些研究将对疼痛相关的相对贡献产生新的理解刻板印象和替代疼痛到止痛药处方的差异。这些结果可能表明疼痛是否刻板印象教育，增加疼痛共鸣的努力，或两者兼而有之，应纳入临床医生旨在减少止痛药处方差异的干预措施。通过这个K01职业发展奖，应聘者将获得过去培训中未包括的三个领域的技能：临床疼痛评估和治疗、多元统计分析和行为医学，以便更有效地了解疼痛和疼痛管理中健康差异的心理社会和神经生物学机制。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Selection and Characterization of Cultural Priming Stimuli for the Activation of Spanish and English Cultural Mindsets among Hispanic/Latino Bilinguals in the United States.

DOI：
10.1027/1864-9335/a000426
发表时间：
2020-11
期刊：
SOCIAL PSYCHOLOGY
影响因子：
1.8
作者：
Gianola, Morgan;Yepes, Beatriz E;Losin, Elizabeth A Reynolds
通讯作者：
Losin, Elizabeth A Reynolds

Doctor trustworthiness influences pain and its neural correlates in virtual medical interactions.

医生的可信度会影响虚拟医疗互动中的疼痛及其神经相关性。

DOI：
10.1093/cercor/bhac281
发表时间：
2023
期刊：
Cerebral cortex (New York, N.Y. : 1991)
影响因子：
0
作者：
Anderson,StevenR;Gianola,Morgan;Medina,NataliaA;Perry,JennaM;Wager,TorD;Losin,ElizabethAReynolds
通讯作者：
Losin,ElizabethAReynolds

Effects of Language Context and Cultural Identity on the Pain Experience of Spanish-English Bilinguals.