Sociocultural & biobehavioral influences on pain expression and assessment

社会文化

• 批准号: 10700658
• 负责人: Lauren Atlas
• 金额: $ 19.4万
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700658
• 关键词: Address; Affect; Atlases; Attention; Behavioral; Biological; Biological Process; Black Populations; COVID-19 pandemic; Clinic; Clinical; Code; Computer software; Data Analyses; Data Collection; Databases; Disease; Eligibility Determination; Enrollment; Esthesia; Ethnic Origin; Face; Feedback; Female; Foundations; Gender; Gender Identity; Health; Health Personnel; Human; Image; Individual; Instruction; Intervention; Light; Link; Manuscripts; Masks; Measures; Medical; Modernization; Modification; Outcome; Pain; Pain Measurement; Pain Research; Pain Threshold; Pain management; Participant; Patient Self-Report; Persons; Physiological; Population Heterogeneity; Postdoctoral Fellow; Preparation; Procedures; Process; Protocols documentation; Provider; Psychophysiology; Race; Reporting; Research; Research Design; Series; Sex Differences; Shapes; Social Processes; Stimulus; Symptoms; Testing; Time; Visual attention; Work; adverse outcome; biobehavior; black men; black women; demographics; directed attention; disadvantaged population; doctoral student; efficacy testing; experience; falls; health disparity; healthy volunteer; implicit bias; improved; insight; male; minority patient; pain perception; pain reduction; pandemic disease; programs; psychosocial; racial difference; racial identity; racism; recruit; response; screening; sex; social; social culture; social factors; social neuroscience; sociodemographic factors; sociodemographic group; telehealth; therapy design; tool; volunteer

This protocol measures pain-related facial responses in a diverse population to measure whether nonverbal responses to pain vary as a function of biological and sociocultural factors. We will then measure whether individuals (both healthy volunteers and medical providers) pay attention to different features of pain or assess pain differently in in-group relative to out-group individuals, and whether we can develop interventions to reduce any biases in attention or pain assessment. This year, we completed data collection for our first sub-study on the protocol (which was halted for one year in light of the COVID-19 pandemic) and completed the second sub-study using remote data collection tools. We made numerous adjustments to be able to resume data collection on our first sub-study, which measures the association between noxious stimuli, pain, and facial responses. Of course measuring facial responses would not be possible if participants wore masks, and therefore we made physical modifications to our testing room in order to safely administer pain with the participant in one room and the experimenter in another adjacent room. The study was on hold from March through September of 2020, then we spent two months adjusting procedures and implementing telehealth and e-screening to reduce in person testing time. We collected two participants in November of 2020, then were required to halt healthy volunteer research again until April 2021. We resumed data collection on the first sub-study, but accrual is quite slow in light of the pandemic, and we finally collected our 100th participant in July of 2022 after much work from the entire study team. Although our final enrollment did not achieve equal numbers across our key racial and gender demographics (i.e. 20 participants per group for Black male, Black female, White male, White female), difficulties in recruiting individuals from minoritized groups are well documented, and we will be explicit about our recruitment efforts and restricted eligibility and enrollment when we submit the manuscript. We will use specialized software to measure facial responses via video and to avoid implicit biases that could affect results if we used human coders. We will measure whether sex differences are observed in facial responses that are similar to sex differences in pain, as well as whether we see differences in facial responses or sex differences as a function of race, ethnicity, or identity centrality of race or sex. We anticipate data analyses and manuscript preparation will be complete this fall as the PhD student leading the study will be starting a postdoc shortly. Following completion, sub-study 1 participants were asked whether they want their images to be included in a database that will be shown to other participants. Images of a subset of participants who opted into this database were used as stimuli for a subsequent sub-study (sub-study 2), which measure how individuals view and judge pain in others that they perceive to be similar or different from them. 54 participants (perceivers) viewed 96 videos of people (targets) undergoing painful stimulation and provided ratings of whether the target was in pain or not and how intense the sensation was. These ratings were compared with targets actual pain ratings to allow us to measure not only pain assessment but also its accuracy. There were 12 targets from 4 sociodemographic groups: Black male, Black female, White male, White female (3 targets per group, 2 innocuous and 2 painful videos per participant). This allowed us to measure whether sociodemographic factors influenced pain assessment. We found that perceivers attributed less pain to Black individuals relative to White individuals, and were less accurate in rating pain in Black individuals. This finding mimics the well documented health disparities in pain that are observed in clinical settings and previous research. Participants also over-estimated pain in female individuals relative to males, in contrast to disparities observed in the clinic. We also found that racial differences in pain assessment were stronger for individuals who reported higher values in the modern racism scale, and that group membership (i.e. whether an individual self-reported the same racial or gender identity as the person in the video) did not impact assessment. A manuscript reporting these findings is currently in preparation (Dildine, Antkiewicz, Brookes, Olssen, and Atlas) and will be submitted within the next month.

该协议措施疼痛相关的面部反应，在不同的人群，以衡量是否疼痛的非语言反应不同的生物和社会文化因素的功能。然后，我们将测量个体（包括健康志愿者和医疗服务提供者）是否注意疼痛的不同特征，或者在组内相对于组外个体对疼痛进行不同的评估，以及我们是否可以制定干预措施来减少注意力或疼痛评估中的任何偏见。 今年，我们完成了方案第一个子研究的数据收集（由于COVID-19大流行而暂停了一年），并使用远程数据收集工具完成了第二子研究。 我们做了许多调整，以便能够在我们的第一个子研究中恢复数据收集，该研究测量了有害刺激，疼痛和面部反应之间的关联。当然，如果参与者戴着面具，测量面部反应是不可能的，因此我们对测试室进行了物理改造，以便安全地管理疼痛，参与者在一个房间，实验者在另一个相邻的房间。 这项研究从2020年3月到9月暂停，然后我们花了两个月的时间调整程序，实施远程医疗和电子筛查，以减少亲自测试的时间。我们在2020年11月收集了两名参与者，然后被要求再次停止健康志愿者研究，直到2021年4月。我们恢复了第一个子研究的数据收集，但鉴于疫情，数据收集速度相当缓慢，经过整个研究团队的大量工作，我们终于在2022年7月收集了第100名参与者。尽管我们的最终入组人数在我们的关键种族和性别人口统计学中没有达到相等的人数（即，黑人男性、黑人女性、白色男性、白色女性每组20名受试者），但从少数群体中招募个体的困难是有据可查的，我们将在提交手稿时明确说明我们的招募工作和受限的资格和入组情况。我们将使用专门的软件来通过视频测量面部反应，并避免使用人类编码器时可能影响结果的隐含偏见。我们将测量在面部反应中是否观察到与疼痛中的性别差异相似的性别差异，以及我们是否将面部反应或性别差异的差异视为种族，民族或种族或性别的身份中心性的函数。 我们预计数据分析和手稿准备将在今年秋天完成，因为领导这项研究的博士生将很快开始博士后工作。 完成后，子研究1的参与者被问及他们是否希望将他们的图像包含在将向其他参与者显示的数据库中。选择进入该数据库的一部分参与者的图像被用作后续子研究（子研究2）的刺激，该子研究测量个人如何看待和判断他们认为与他们相似或不同的其他人的疼痛。54名参与者（感知者）观看了96段经历痛苦刺激的人（目标）的视频，并对目标是否疼痛以及感觉有多强烈进行了评级。将这些评分与目标实际疼痛评分进行比较，使我们不仅能够衡量疼痛评估，而且能够衡量其准确性。有12个目标来自4个社会人口学群体：黑人男性、黑人女性、白色男性、白色女性（每组3个目标，每个参与者2个无害视频和2个痛苦视频）。这使我们能够衡量社会人口因素是否影响疼痛评估。我们发现，感知器归因于黑人个体相对于白色个体的疼痛较少，并且在黑人个体的疼痛评级中不太准确。这一发现模拟了在临床环境和以前的研究中观察到的疼痛中有据可查的健康差异。参与者还高估了女性个体相对于男性的疼痛，与临床观察到的差异相反。我们还发现，对于在现代种族主义量表中报告较高值的个人，疼痛评估的种族差异更大，并且小组成员资格（即个人是否自我报告与视频中的人相同的种族或性别身份）不会影响评估。报告这些发现的手稿目前正在准备中（Dildine，Antkiewicz，Brookes，Olssen和Atlas），并将在下个月内提交。