Psychological and brain mechanisms underlying disparities in opioid and non-opioid pain treatment decisions

阿片类药物和非阿片类药物疼痛治疗决策差异背后的心理和大脑机制

• 批准号: 9882988
• 负责人: Elizabeth R Losin
• 金额: $ 17.12万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9882988
• 关键词: Acute; Acute Pain; Address; Affect; Analgesics; Anterior; Area; Behavioral Medicine; Brain; Chronic; Clinical; Cognitive; Cues; Drug abuse; Education; Educational Intervention; Effectiveness; Empathy; Environment; Epidemic; Ethnic Origin; Ethnic group; Facial Expression; Facial Pain; Functional Magnetic Resonance Imaging; Gender; Goals; Hospitals; Individual; Insula of Reil; Intervention; K-Series Research Career Programs; Literature; Mediating; Medical; Medical Students; Methodology; Minority; Nationalities; Neurobiology; Neurosciences; Non-Malignant; Not Hispanic or Latino; Opioid; Opioid Analgesics; Pain; Pain Measurement; Pain intensity; Pain management; Participant; Patients; Population; Production; Race; Recommendation; Research; Research Personnel; Research Training; Resources; Risk; Scanning; Sex Bias; Standardization; Statistical Data Interpretation; Stereotyping; Stimulus; System; Testing; Text; Training; Translational Research; United States; University resources; Woman; base; behavior measurement; cancer pain; chronic pain; clinical application; clinical pain; design; digital; effective intervention; effective therapy; ethnic bias; evidence base; experience; health disparity; improved; indexing; innovation; medical schools; neurobiological mechanism; non-opioid analgesic; novel; opioid abuse; opioid epidemic; pain sensitivity; patient screening; prescription opioid; psychologic; psychosocial; relating to nervous system; response; simulation; skills; social culture; social group; treatment disparity; willingness

Project Summary Unequal prescribing of opioid and non-opioid analgesics among demographic groups contributes to two major health disparities in the United States. Overprescribing of opioid analgesics to treat both acute and chronic nonmalignant pain, especially in non-Hispanic whites, has fueled the opioid abuse epidemic. Underprescribing of opioid and non-opioid analgesics in minorities and women, even when their use is medically indicated (e.g., acute and cancer pain), reduces the effectiveness of pain management in these groups. In order to mitigate analgesic prescribing disparities and the associated risks of opioid abuse and poor pain management, we must understand the mechanisms underlying these disparities. The current project will test two potential contributors to these pain treatment disparities: 1) clinicians' inaccurate demographic stereotypes about pain sensitivity and tendency to abuse opioids (i.e., the stereotype hypothesis), and 2) reduced activation of clinicians' pain-related neural systems (e.g., anterior cingulate and anterior insula) in response to the pain of demographic outgroup patients (i.e., the vicarious pain hypothesis). Prior studies of mechanisms underlying analgesic prescribing disparities have been limited by the use of experimental paradigms that were low in ecological validity e.g. asking participants to make prescribing decisions based solely on text-based medical vignettes or depictions of individuals feigning pain. Additionally, although the robust fMRI literature on vicarious pain biases is related to biases in pain assessment, vicarious pain biases have not been tested as a potential contributor to biases pain treatment decisions. In the present proposal, these methodological limitations will be addressed and the stereotype and vicarious pain hypotheses will be tested through 3 specific aims. Aim 1 involves the design and production of a more ecologically valid video-based simulated pain assessment and treatment paradigm depicting individuals experiencing genuine pain. Aim 2 includes an fMRI study of the effects of clinicians' (medical students') vicarious pain responses and pain stereotypes on demographic biases in simulated pain assessment and analgesic prescribing, using the video paradigm created in Aim 1. Finally, to determine the clinical applicability of the findings from Aim 2, Aim 3 includes face-to-face pain assessments and treatment recommendations during simulated clinical interactions with standardized patient actors. If the aims of this proposal are achieved, these studies will yield new understanding of the relative contributions of pain-related stereotypes and vicarious pain to analgesic prescribing disparities. These results could indicate whether pain stereotype education, efforts to increase pain empathy, or both should be incorporated into clinician interventions aimed at reducing analgesic prescribing disparities. Through this K01 career development award, the candidate will gain facility in three areas not included in her past training: clinical pain assessment and treatment, multivariate statistical analysis, and behavioral medicine in order to more effectively understand psychosocial and neurobiological mechanisms underlying health disparities in pain and pain management.

项目摘要 人口统计学群体中阿片类和非阿片类镇痛药处方的不平等导致了两个主要的 美国的健康差距。过量使用阿片类镇痛药治疗急性和慢性 非恶性疼痛，特别是在非西班牙裔白人中，助长了阿片类药物滥用的流行。开药不足 阿片类和非阿片类镇痛药在少数群体和妇女中的使用，即使在医学上有使用指征（例如， 急性和癌症疼痛），降低了这些群体中疼痛管理的有效性。为了减轻 止痛药处方的差异和阿片类药物滥用和疼痛管理不良的相关风险，我们必须 了解这些差异背后的机制。目前的项目将测试两个潜在的贡献者 这些疼痛治疗的差异：1）临床医生对疼痛敏感性的不准确的人口定型观念， 滥用阿片类药物的倾向（即，刻板印象假说），和2）减少激活临床医生的疼痛相关 神经系统（例如，前扣带回和前扣带回）对人口统计学外组疼痛的反应 患者（即，替代性疼痛假说）。镇痛药处方机制的既往研究 通过使用生态有效性低的实验范例， 要求参与者仅根据基于文本的医疗小插曲或描述做出处方决定 假装疼痛的人此外，尽管关于替代性疼痛偏见的功能磁共振成像文献与以下因素有关： 疼痛评估中的偏差，替代性疼痛偏差尚未被测试为疼痛偏差的潜在贡献者 治疗决定。本提案将处理这些方法上的局限性， 将通过3个具体目标来检验刻板印象和替代性疼痛假设。目标1涉及设计和 制作一个更生态有效的基于视频的模拟疼痛评估和治疗范例 描绘的是经历真正痛苦的人目的2包括临床医生的影响的fMRI研究， （医学生）替代性疼痛反应和疼痛刻板印象对模拟疼痛中人口统计学偏见的影响 评估和镇痛处方，使用目标1中创建的视频范例。最后，为了确定 目标2、目标3中发现的临床适用性包括面对面疼痛评估和治疗 在与标准化患者参与者的模拟临床交互期间提供建议。如果这件事的目的 这些研究将产生新的理解疼痛相关的相对贡献， 刻板印象和替代疼痛止痛处方的差异。这些结果可以表明疼痛是否 刻板印象教育，努力增加疼痛同情，或两者兼而有之，应纳入临床医生 旨在减少止痛药处方差异的干预措施。通过这个K01职业发展奖， 候选人将获得三个领域的设施不包括在她过去的培训：临床疼痛评估和 治疗，多元统计分析和行为医学，以便更有效地了解 疼痛和疼痛管理中健康差异的心理社会和神经生物学机制。