Racial disparities in pain experience: Neuroimaging and behavioral investigations

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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.