Racial disparities in pain experience: Neuroimaging and behavioral investigations

描述（由申请人提供）：种族差异存在于疼痛的医疗保健治疗的可及性和质量方面（例如Todd等人，1993年和2000年），这种疾病对美国人的影响超过心脏病、糖尿病和癌症的总和（CDC， 2006年）。与白人美国人相比，非裔美国人经历临床疼痛（Edwards et al., 2001）和实验疼痛的程度更大，频率更高，可能是由于遗传和环境因素，但更有可能在医疗机构中对疼痛治疗不足（Green et al., 2003; Bonham, 2001）。疼痛的种族差异可能源于两方面的基本生物学差异：一是不同种族群体对疼痛的体验和感知，二是医疗保健专业人员对不同种族群体的疼痛的感知和治疗。首先，非裔美国人更有可能患有伴有镰状细胞病的急性和慢性疼痛，镰状细胞病是一种遗传性血液疾病，其特征是血红蛋白S （Hb S）占主导地位，由2-珠蛋白基因的单个SNP突变引起（Kwiatkowski, 2005）。其次，由于这些负面的刻板印象，非裔美国人通常会在人际和工作环境中遇到更多的种族歧视或基于种族的社会痛苦，这降低了健康，增加了死亡率（Williams等人，1997），并可能导致该人群对身体疼痛的敏感性和经验增加。第三，种族刻板印象和偏见也会影响对疼痛的感知和医学判断（Freeman & Payne, 2000, van Ryn & Burke, 2000），导致对疼痛的治疗不足或不恰当，尤其是对非洲裔美国人（Freeman & Payne, 2000）。最后，潜在的困难或无法随时接受适当的疼痛治疗可能导致非裔美国人不信任或避免医疗环境（Corbie-Smith, Thomas, St George, 2002），这可能进一步加剧现有或新出现的疼痛状况，并导致持续的疼痛种族差异。这一系列神经成像和行为研究的目的是调查种族对疼痛感知和体验的神经反应的影响，以及种族刻板印象和偏见是否会影响医生和普通人对他人身体疼痛的反应。该研究的发现可能对解决不同种族人群在疼痛体验和护理方面的健康差异的神经生物学和心理机制具有重要意义。

DESCRIPTION (provided by applicant): Racial disparities exist in access to and quality of health care treatment of pain (e.g. Todd et al., 1993 & 2000), a medical condition that affects more Americans than heart disease, diabetes, and cancer combined (CDC, 2006). Compared to Caucasian-Americans, African Americans experience clinical (Edwards et al., 2001) and experimental pain to a greater extent and with greater frequency, likely due to both genetic and environmental factors, and yet are more likely to be undertreated for pain in medical settings (Green et al., 2003; Bonham, 2001). Racial disparities in pain may result from both basic biological differences in how pain is experienced and perceived across racial groups as well as how the pain of different racial groups is perceived and treated in medical settings by healthcare professionals. First, African-Americans are more likely to suffer from acute and chronic pain that accompanies sickle cell disease, a genetic blood disorder characterized by the predominance of hemoglobin S (Hb S) arising from a known mutation of a single SNP of the 2-globin gene (Kwiatkowski, 2005). Second, due to these negative stereotypes, African-Americans typically encounter increased experience with racial discrimination or race-based social pain in interpersonal and work settings, which decreases health, increases mortality (Williams et al., 1997), and may lead to increased sensitivity to and experience of physical pain in this population. Third, racial stereotypes and prejudice can also affect perception and medical judgments of pain (Freeman & Payne, 2000, van Ryn & Burke, 2000), leading to under or inappropriate treatment of pain conditions particularly for African-Americans (Freeman & Payne, 2000). Finally, the potential difficulty or inability to readily receive appropriate medical treatment for pain can lead African-Americans to mistrust or avoid medical settings (Corbie-Smith, Thomas, St George, 2002) which may further exacerbate existing or emerging pain conditions and lead to persistent racial disparities in pain. The aim of the proposed series of neuroimaging and behavioral studies is to investigate the effect of race on the neural response to pain perception and experience, as well as whether racial stereotypes and prejudice affect how both doctors and lay people respond to the physical pain of others. Findings from the proposed research may have important implications for addressing the neurobiological and psychological mechanisms underlying population health disparities in pain experience and care across racial groups. PUBLIC HEALTH RELEVANCE: Racial disparities exist in the experience and medical treatment of pain, a medical condition that affects more Americans than heart disease, diabetes, and cancer combined (CDC, 2006) (e.g. Todd et al., 1993 & 2000). The aim of the proposed series of studies is to investigate the effect of race on the neural response to physical pain perception and experience, and to examine the effects of racial stereotyping and prejudice on pain perception and diagnosis in a medical and non-medical setting.