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

结构性种族主义和歧视（SRD）对美洲原住民痛苦差异机制的影响

• 批准号: 10474013
• 负责人: Jamie Lynn Rhudy
• 金额: $ 51.49万
• 依托单位: UNIVERSITY OF TULSA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474013
• 关键词: Address; Arthritis; Back Pain; Brain; Buffers; Cardiovascular Diseases; Cardiovascular system; Censuses; Chronic Disease; Colonialism; Communities; Data; Diabetes Mellitus; Discrimination; Electrophysiology (science); Environment; Environmental Impact; Environmental Pollution; Event; Excision; Exposure to; Generations; Genocides; Hypertension; Indigenous; Individual; Industrial Waste; Institutional Review Boards; Intervention; Justice; Lead; Link; Measures; Mediating; Mental Health; Methods; Modeling; Native Americans; Nature; Neuraxis; Neurons; Neurosecretory Systems; Nociception; Not Hispanic or Latino; Pain; Pain-Free; Participant; Pathway interactions; Patient Self-Report; Phenotype; Physiological; Policies; Pollution; Population; Psychological Stress; Psychosocial Stress; Public Policy; Reflex action; Research; Research Proposals; Resources; Risk; Role; Spinal; Spine pain; Stress; Structural Racism; System; Underserved Population; Work; allostatic load; cardiometabolism; central sensitization; chronic pain; community engaged research; design; disability; experience; hazard; health disparity; innovation; insight; pain chronification; pain inhibition; pain processing; pain signal; perceived discrimination; perceived stress; physical conditioning; precision medicine; prevent; prospective; psychosocial; racism; resilience; response

07. Project Summary/Abstract This proposal will explore the role of structural racism and discrimination (SRD) in the Native American (NA) chronic pain disparity. NAs experience higher rates of chronic pain than the general U.S. population and we have shown that pain-free NAs are ~3x more likely than non-Hispanic Whites (NHWs) to prospectively develop chronic pain. Our work over the past decade has identified several factors (discrimination, psychological stress, somatic threat sensitivity, cardiometabolic allostatic load) that work collectively to promote a unique NA pain risk phenotype we call “silent” spinal sensitization (sensitization of spinal pain neurons without sensitization of pain experience). This discovery represents a paradigm shift in how NA pain risk is conceptualized because it is not detectible by pain self-report. NAs have suffered generations of SRD due to colonization (eg, genocide, cultural oppression), including forced removal from sacred lands and policies that lead to desecration of their environment. The traditional NA worldview involves an intimate relationship with the environment in which all of nature is interconnected. Within this worldview, environmental desecration is akin to desecration of the body/soul. This proposal will demonstrate the impact of environmental SRD (racialized distribution of environmental pollutions/hazards) on mechanisms of the NA pain disparity (Aim 1). The EPA's 11 environmental (in)justice variables will be leveraged to form a societal-level latent variable representing Racialized Environmental Desecration that will be linked to participants via geocoding. Our preliminary work shows this variable: a) explains 87% of the variance in the original 11 variables, b) correlates with the proportion of NAs within a census region suggesting it assesses racialized NA exposure to pollution, and c) promotes silent spinal sensitization in NAs, but not NHWs. However, these pilot data must be replicated to address limitations. Our study will model silent spinal sensitization using state-of-the art methods to assess central sensitization, endogenous pain inhibition, and subjective pain experience. Physiological markers of spinal (nociceptive flexion reflex) and supraspinal (pain-evoked cortical potentials) pain processing will be used to verify the level of the neuraxis where sensitization occurs. Allostatic load will be comprehensively assessed from multiple systems, including neuroendocrine and cardiovascular responses to psychosocial stress. To address the lack of research on NA pain resiliency, we will determine if a NA-specific resource (ie, cultural connectedness) buffers against SRD and its negative consequences (Aim2). Results will a) address an understudied health disparity in an underserved population, b) help guide policy decisions to reduce the NA pain disparity, c) support a paradigm shift in how NA pain risk is conceptualized, d) identify targetable mechanisms to inform a precision medicine approach to prevent NA pain and disability, and e) identify resiliency factors to reduce the impact of SRD on NA chronic pain risk mechanisms. This community engaged research involves input from NA community partners (Indigenous Advisory Council, tribal IRBs) in the design, execution, and dissemination of the work.

07. 项目总结/摘要 该提案将探讨结构性种族主义和歧视 (SRD) 在美洲原住民 (NA) 中的作用 慢性疼痛差异。北美地区的慢性疼痛发生率高于美国普通人群，我们 研究表明，无痛 NA 的未来发展可能性是非西班牙裔白人 (NHW) 的 3 倍 慢性疼痛。我们过去十年的工作已经确定了几个因素（歧视、心理压力、 躯体威胁敏感性、心脏代谢稳态负荷）共同促进独特的 NA 疼痛风险 我们称之为“沉默”脊髓敏化的表型（脊髓疼痛神经元的敏化，但没有疼痛的敏化） 经验）。这一发现代表了 NA 疼痛风险概念化的范式转变，因为它不是 可通过疼痛自我报告来检测。由于殖民化（例如种族灭绝、文化灭绝），北美地区遭受了几代人的SRD。 压迫），包括强迫他们离开圣地和导致亵渎他们的政策 环境。传统的 NA 世界观涉及与环境的密切关系，其中所有的 自然是相互关联的。在这种世界观中，对环境的亵渎类似于对自然的亵渎。 身体/灵魂。该提案将展示环境 SRD（种族化分配）的影响 环境污染/危害）对 NA 疼痛差异机制的影响（目标 1）。 EPA 11 项环保 （内）正义变量将被用来形成代表种族化的社会层面的潜在变量 环境亵渎将通过地理编码与参与者联系起来。我们的初步工作表明了这一点 变量：a) 解释了原始 11 个变量中 87% 的方差，b) 与 NA 的比例相关 在一个人口普查区域内，表明它评估了种族化的 NA 暴露于污染的情况，并且 c) 促进了沉默的脊柱 NA 中的敏感性，但 NHW 中没有。然而，必须复制这些试点数据以解决局限性。我们的 研究将使用最先进的方法来模拟无声脊柱敏化，以评估中枢敏化， 内源性疼痛抑制和主观疼痛体验。脊柱生理标志物（伤害性屈曲 反射）和脊髓上（疼痛诱发的皮质电位）疼痛处理将用于验证 发生敏化的神经轴。将从多个系统综合评估静态负荷， 包括神经内分泌和心血管对心理社会压力的反应。解决研究不足的问题 关于 NA 疼痛弹性，我们将确定 NA 特定资源（即文化连通性）是否可以缓冲 SRD 及其负面后果（目标 2）。结果将 a) 解决一个未充分研究的健康差异问题 服务不足的人群，b) 帮助指导政策决策，以减少 NA 疼痛差异，c) 支持范例 NA 疼痛风险概念化方式的转变，d) 确定有针对性的机制来为精准医疗提供信息 预防 NA 疼痛和残疾的方法，以及 e) 确定弹性因素以减少 SRD 对 NA 的影响 慢性疼痛风险机制。这项社区参与的研究涉及 NA 社区合作伙伴的意见 （土著咨询委员会、部落 IRB）参与工作的设计、执行和传播。