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: 10656046
• 负责人: Burel R. Goodin
• 金额: $ 70.87万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656046
• 关键词: Acute; Address; Adult; Adverse effects; Anxiety; Attitude; Biological; Black Populations; Black race; Blood Pressure; C-reactive protein; COVID-19; COVID-19 pandemic; Cardiovascular system; Cessation of life; Chronic; Chronic low back pain; Clinical; Data; Discrimination; Disease; Disparity; Disparity population; Distress; Equation; Event; Exposure to; Follow-Up Studies; Friends; Funding; Glycosylated hemoglobin A; Goals; Group Affiliation; Health; Hydrocortisone; Immune; Individual; Life; Literature; Loneliness; Low Back Pain; Measures; Metabolic; Minority Groups; Modeling; Neurosecretory Systems; Not Hispanic or Latino; Pain; Pain management; Pathology; Pattern; Persistent pain; Persons; Physiological; Prevalence; Primary Care Physician; Psychosocial Factor; Race; Reporting; Research; Rest; Risk Factors; Sensory; Severities; Social isolation; Social support; Socialization; Socioeconomic Status; Spirituality; Stigmatization; Stress; Stressful Event; Symptoms; Testing; Time; Tissues; Vertebral column; Violence; Visit; Work; adverse childhood events; allostatic load; chronic pain; clinical pain; clinical predictors; depressive symptoms; disability; experience; follow-up; health care availability; improved; loved ones; low socioeconomic status; minority stress; optimism; pain inhibition; pain sensitivity; pain symptom; peer; perceived stress; promote resilience; prospective; psychologic; psychological distress; psychosocial; racial determinant; racial difference; racial discrimination; racial disparity; racial identity; racial population; racism; resilience factor; social determinants; social influence; social stress; social stressor; socioeconomics; theories

Project Summary/Abstract Low back pain is one of the most common disabling conditions in the world. The worldwide point prevalence of activity-limiting (acute and chronic) low back pain is approximately 12%, which equates to approximately 933 million people globally suffering with low back pain at any given time. Chronic low back pain (cLBP) refers to pain lasting at least twelve weeks or longer, and it is consistently among the top five most common reasons for primary care physician visits. Although some individuals with cLBP have clear pathoanatomic causes of pain, the vast majority of cLBP is “non-specific” and is not accompanied by readily identifiable pathology of the spine or related tissues. Without a clear target for treatment of cLBP, effective pain management can be difficult to achieve. Because objective measures of disease activity have not consistently been strong predictors of clinical symptoms, cLBP provides an excellent model for investigating the influence of social determinants such as racial background and social stress on the progression of pain and disability over time. During our previous funding cycle, we found evidence that non-Hispanic Black (NHB) individuals with cLBP reported significantly greater pain severity and disability than their non-Hispanic White (NHW) counterparts. In addition, we observed racial differences in pain-related psychosocial and biological measures, which were significantly associated with racial group disparities in cLBP severity. Furthermore, racial disparities in cLBP were exacerbated by low socioeconomic status (SES), such that NHBs with low SES demonstrated the absolute greatest burden of cLBP. While our findings demonstrate clear racial differences in cLBP severity and disability between NHBs and NHWs, the findings are largely indirect and cross-sectional. Differences in how cLBP progresses over time between NHBs and NHWs, as well as factors that contribute to cLBP progression, remain poorly understood. Among the multiple factors that inevitably contribute to racial group differences in cLBP, social stress represents a potentially important social determinant of greater cLBP severity and disability in NHBs. For this proposed follow-up study, we will elucidate the contribution of social stress and its biological consequences (i.e., allostatic load) to racial group disparities in cLBP by prospectively assessing the two-year progression of clinical pain and disability, as well as pain-relevant psychosocial functioning among NHBs and NHWs with cLBP. We will use minority stress theory to guide the study aims related to the progression of racial group disparities in cLBP; however, we will also use a recently developed resilience framework to guide inclusion of psychosocial resilience factors that may mitigate the effects of social stress on cLBP in NHBs and/or NHWs.

项目摘要/摘要 腰痛是世界上最常见的致残性疾病之一。全球范围内流行性出血热流行情况 限制活动的(急性和慢性)下腰痛约为12%，相当于约933 全球任何时候都有数以百万计的人遭受下腰痛之苦。慢性下腰痛(CLBP)指 疼痛持续至少12周或更长时间，它一直是最常见的五个原因之一 初级保健医生就诊。尽管一些慢性下腰痛患者有明确的疼痛病理解剖原因， 绝大多数慢性腰椎病是“非特异性的”，并且不伴有明显的脊柱病变。 或相关组织。如果cLBP没有明确的治疗目标，有效的疼痛管理可能很难 实现。因为疾病活跃度的客观测量并不总是强烈地预测临床 症状，cLBP为研究种族等社会决定因素的影响提供了一个极好的模型 关于疼痛和残疾随时间的进展的背景和社会压力。在我们之前的资助期间 周期，我们发现有证据表明，患有cLBP的非西班牙裔黑人(NHB)患者报告的疼痛明显更大 严重程度和残疾程度高于非西班牙裔白人(NHW)。此外，我们还观察到种族问题 与疼痛相关的心理社会和生物措施的差异，这与种族显著相关 CLBP严重程度的组间差异。此外，cLBP中的种族差异因低而加剧 社会经济地位(SES)，即SES低的NHBs绝对是cLBP的最大负担。 虽然我们的研究结果表明，在慢性腰背痛严重程度和残疾方面，NHBs和NHW之间存在明显的种族差异， 这些发现在很大程度上是间接的和横截面的。CLBP如何随着时间的推移而不同 NHBs和NHW以及促进cLBP进展的因素仍然知之甚少。在这些人中 多种因素不可避免地导致cLBP的种族差异，社会压力代表着潜在的 影响慢性腰背痛严重程度和残疾的重要社会决定因素。对于这项拟议的后续研究， 我们将阐明社会压力及其生物学后果(即，动态平衡负荷)对种族的贡献 通过前瞻性评估临床疼痛和残疾的两年进展，cLBP的组差异，如 以及患有慢性下腰痛的NHBs和NHW之间与疼痛相关的心理社会功能。我们将使用小众重音 理论来指导这项研究的目的，与cLBP中种族群体差异的进展有关；然而，我们将 还使用最近开发的复原力框架来指导纳入心理社会复原力因素，这些因素可能 减轻社会压力对NHBs和/或NHW中cLBP的影响。