Racial disparities in pain experience: Neuroimaging and behavioral investigations

描述(由申请人提供)：在获得疼痛的机会和医疗保健治疗的质量方面存在种族差异(例如，Todd等人，1993和2000年)，这种疾病影响的美国人比心脏病、糖尿病和癌症的总和还要多(CDC，2006)。与高加索美国人相比，非裔美国人经历临床疼痛和实验性疼痛的程度更大，频率更高，可能是由于遗传和环境因素，但在医疗环境中更有可能因疼痛而得不到足够的治疗(Green等人，2003；Bonham，2001)。疼痛方面的种族差异可能是由于在不同种族群体之间感受和感知疼痛的基本生物学差异，以及医疗专业人员在医疗环境中如何感知和治疗不同种族群体的疼痛。首先，非洲裔美国人更有可能患有镰状细胞病所伴随的急性和慢性疼痛，这是一种遗传性血液疾病，其特征是主要是由于2-珠蛋白基因的单一SNP的已知突变而引起的S(HB S)(Kwiatkowski，2005年)。其次，由于这些负面的刻板印象，非洲裔美国人在人际和工作环境中通常会遇到更多的种族歧视或基于种族的社会痛苦，这会降低健康，增加死亡率(Williams等人，1997年)，并可能导致对这一人群中身体疼痛的敏感性和体验的增加。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)，导致对疼痛状况的治疗不足或不适当，特别是对非裔美国人(Freeman&Payne，2000)。最后，潜在的困难或无法接受适当的疼痛治疗可能导致非裔美国人不信任或回避医疗环境(Corbie-Smith，Thomas，St George，2002)，这可能会进一步加剧现有的或新出现的疼痛状况，并导致在疼痛方面持续存在的种族差异。拟议中的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门外汉对他人身体疼痛的反应。拟议研究的结果可能对解决不同种族群体在疼痛体验和护理方面的人群健康差异的神经、生物学和心理机制具有重要影响。 公共卫生相关性：在疼痛的体验和医疗方面存在种族差异，这种疾病影响的美国人比心脏病、糖尿病和癌症加起来还多(CDC，2006年)(例如，Todd等人，1993和2000年)。这一系列研究的目的是调查种族对身体疼痛感知和体验的神经反应的影响，并考察种族刻板印象和偏见在医疗和非医疗环境中对疼痛感知和诊断的影响。

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.