Racial and Socioeconomic Differences in Chronic Low Back Pain

慢性腰痛的种族和社会经济差异

• 批准号: 9235624
• 负责人: Burel R. Goodin
• 金额: $ 49.89万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-26 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9235624
• 关键词: Address; Advisory Committees; Affect; Biological; Biological Factors; C-reactive protein; Chronic disabling pain; Chronic low back pain; Clinical; Data; Disadvantaged; Discrimination; Documentation; Educational Background; Individual; Low income; Measures; Modeling; Neuraxis; Not Hispanic or Latino; Outcome; Oxytocin; Pain; Perception; Performance; Physical Function; Population; Predictive Factor; Process; Psychosocial Factor; Race; Research; Risk; Risk Factors; Sensory; Severities; Sleep; Social support; Societies; Socioeconomic Status; Stimulus; Subgroup; Symptoms; Testing; Unemployment; United States; United States National Institutes of Health; Vitamin D; base; biopsychosocial; chronic pain; clinical predictors; cost; depressive symptoms; design; disability; disadvantaged population; experience; low socioeconomic status; novel; outcome prediction; psychologic; psychosocial; racial difference; racial discrimination; resilience; response; socioeconomics; theories

Project Summary/Abstract Chronic pain affects more than 100 million people in the United States and produces annual costs up to $635 billion. While pain affects all segments of the population, the burden of chronic pain and associated disability disproportionately affects non-Hispanic Blacks (“Blacks”) compared to non-Hispanic Whites (“Whites”) as well as individuals with low socioeconomic status (SES) compared to those with high SES. Blacks often experience more frequent, severe and disabling chronic pain compared to Whites. Further, SES factors, such as lower levels of education, low income, and unemployment are associated with higher rates of chronic and disabling pain. Despite growing documentation of racial differences in chronic pain outcomes, relatively little research has focused on differences in the experience of chronic low back pain (cLBP) between Blacks and Whites in a socioeconomic context. This is concerning because cLBP is one of the most prevalent and severely disabling painful conditions, yet it remains unclear whether specific disadvantaged subgroups of society such as Blacks with low SES may be at heightened risk for poor cLBP outcomes. The proposed hypotheses are based on the theory of fundamental causes as a socioeconomic framework for explaining why cLBP severity and disability, as well as the factors predicting these outcomes, may differ as a function of racial background. Guided by the theory of fundamental causes, the overall aim of this study is to characterize racial and SES differences in cLBP severity and disability. Further, we aim to examine important biopsychosocial predictors of racial and SES differences in cLBP outcomes. To explore this overall aim, we will first characterize racial and SES differences in cLBP clinical symptoms, perceived disability, and functional performance. Next, we will invoke endogenous pain inhibitory and facilitatory processes using quantitative sensory tests of conditioned pain modulation and temporal summation, respectively. Biologically-driven factors including sleep, vitamin D, oxytocin, and C-reactive protein, in addition to psychosocial factors including depressive symptoms, racial discrimination, perceived injustice, access to social support, and psychological resilience will then be assessed. We will determine whether endogenous pain modulatory processes, as well as important biopsychosocial factors differentially predict cLBP outcomes for Blacks and Whites, and whether the strength of prediction varies according to SES. This study will be the first to directly and comprehensively apply a socioeconomic framework to the study of racial differences in cLBP outcomes. The findings will also provide novel and important information regarding biopsychosocial predictors of racial and SES differences in clinical pain responses and related disability among those with cLBP. Whether these biopsychosocial predictors may subsequently serve as viable treatment targets for cLBP tailored to meet the specific needs of disadvantaged population subgroups can then be addressed in future research.

项目总结/摘要 慢性疼痛影响着美国1亿多人，每年的费用高达635美元。 亿虽然疼痛影响所有人群，但慢性疼痛和相关残疾的负担 与非西班牙裔白人（“白人”）相比，非西班牙裔黑人（“黑人”）也受到不成比例的影响。 社会经济地位（SES）低的人与社会经济地位高的人相比。黑人经常经历 与白人相比，更频繁、更严重和更致残的慢性疼痛。此外，SES因素，如较低的 教育水平、低收入和失业与慢性病和残疾的发生率较高有关。 痛苦尽管越来越多的文献证明慢性疼痛结局的种族差异， 一直专注于黑人和白人之间慢性腰痛（cLBP）的差异， 社会经济背景。这是令人担忧的，因为cLBP是最普遍和最严重的致残性疾病之一。 痛苦的条件，但目前还不清楚是否特定的社会弱势群体，如黑人， SES低的患者发生cLBP不良结局的风险可能更高。提出的假设是基于 基本原因理论作为解释为什么cLBP严重程度和残疾的社会经济框架， 以及预测这些结果的因素，可能因种族背景而异。为指导 基本原因理论，这项研究的总体目标是描述种族和SES差异， cLBP严重程度和残疾。此外，我们的目标是检查重要的生物心理社会预测种族和 SES在cLBP结局中的差异。为了探索这一总体目标，我们将首先描述种族和社会经济地位 cLBP临床症状、感知残疾和功能表现的差异。接下来，我们将调用 使用条件性疼痛的定量感觉测试的内源性疼痛抑制和易化过程 调制和时间求和。生物驱动因素包括睡眠，维生素D， 催产素和C-反应蛋白，以及心理社会因素，包括抑郁症状，种族 歧视，感知到的不公正，获得社会支持和心理弹性， 评估。我们将确定是否内源性疼痛调节过程，以及重要的 生物心理社会因素对黑人和白人的cLBP结果有不同的预测， 预测结果因SES而异。这项研究将是第一次直接和全面地应用一个 社会经济学框架来研究cLBP结果的种族差异。调查结果还将提供 关于临床研究中种族和SES差异的生物心理社会预测因素的新的重要信息 疼痛反应和相关的残疾与cLBP。这些生物心理社会预测因素是否可能 随后作为cLBP的可行治疗目标，以满足弱势群体的特定需求 然后，可以在今后的研究中处理人口亚组问题。