Racial and Socioeconomic Differences in Chronic Low Back Pain

项目摘要/摘要 慢性疼痛在美国影响着1亿多人，每年产生的成本高达635美元 十亿美元。虽然疼痛影响到人口的所有部分，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)受到的影响也不成比例 与社会经济地位高的人相比，社会经济地位低的人。黑人经常经历 与白人相比，慢性疼痛更频繁、更严重、更致残。此外，SES因素，如较低 教育水平、低收入和失业与较高的慢性病和致残率有关 疼痛。尽管关于慢性疼痛结局的种族差异的文献越来越多，但相对较少的研究 关注了黑人和白人在慢性下腰痛(CLBP)体验上的差异 社会经济背景。这是令人担忧的，因为cLBP是最普遍和严重禁用的 痛苦的状况，但仍不清楚是否有特定的社会弱势群体，如黑人 SES低可能是cLBP预后不良的高危因素。提出的假设是基于 基本病因理论作为解释慢性下腰痛严重程度和残疾的社会经济学框架， 以及预测这些结果的因素，可能会随着种族背景的不同而不同。在指导下 基本原因理论，这项研究的总体目标是表征种族和SES的差异 CLBP的严重程度和残疾。此外，我们的目标是检查重要的生物心理社会预测因子 CLBP结局中的SES差异。为了探索这一总体目标，我们将首先描述种族和SES的特征 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 条件性疼痛定量感觉测试的内源性疼痛抑制和易化过程 分别是调制和时间求和。生物驱动因素包括睡眠、维生素D、 催产素和C反应蛋白，以及包括抑郁症状、种族因素在内的心理社会因素 然后，歧视、感觉到的不公正、获得社会支持的机会和心理韧性将 评估过了。我们将确定内源性疼痛的调节过程是否以及 生物、心理和社会因素不同地预测黑人和白人的cLBP结局，以及 根据社会经济地位的不同，预测的程度也不同。这项研究将是第一个直接和全面地应用 研究cLBP结果种族差异的社会经济学框架。调查结果还将提供 关于临床中种族和SES差异的生物心理社会预测因子的新的和重要的信息 慢性下腰痛患者的疼痛反应和相关残疾。这些生物、心理和社会预测指标是否可能 从而成为cLBP的可行治疗目标，以满足弱势群体的具体需求 然后，人口亚群可以在未来的研究中得到解决。

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.