The Impact of Structural Racism and Discrimination (SRD) on Mechanisms of the Native American Pain Disparity

07.项目摘要/摘要 该提案将探讨结构性种族主义和歧视(SRD)在美洲原住民(NA)中的作用 慢性疼痛差异。NAS经历慢性疼痛的比率比普通美国人更高，我们 已经表明，无痛性非酒精性鼻炎发生的可能性是非西班牙裔白人(NHW)的约3倍 慢性疼痛。我们在过去十年的工作发现了几个因素(歧视、心理压力、 躯体威胁敏感性、心脏代谢平衡负荷)，共同促进独特的NA疼痛风险 我们称之为“沉默的”脊髓敏化(对脊髓痛神经元的敏化而不是对疼痛的敏化 经验)。这一发现代表了NA疼痛风险被概念化的范式转变，因为它不是 通过疼痛自我报告可以察觉到。由于殖民(例如种族灭绝、文化)，NAS遭受了几代人的SRD 压迫)，包括强行驱逐圣地和导致亵渎他们的土地的政策 环境。传统的自然生态世界观涉及到与环境的亲密关系，在这种关系中，所有 大自然是相互联系的。在这种世界观中，亵渎环境类似于亵渎 身体/灵魂。本提案将展示环境SRD(种族主义分配)的影响 环境污染/危害)对NA疼痛差异的机制(目标1)。美国环保署的11项环境保护措施 (In)将利用正义变量形成一个社会层面的潜在变量，代表种族主义 将通过地理编码链接到参与者的环境亵渎行为。我们的初步工作说明了这一点 变量：a)解释原始11个变量中87%的方差，b)与Nas的比例相关 在人口普查区域内，建议它评估种族主义的NA污染暴露，以及c)促进沉默的脊椎 NAS中的敏化，但不是NHW。然而，必须复制这些试点数据以解决限制。我们的 这项研究将使用最先进的方法模拟无声的脊髓敏化，以评估中枢敏化， 内源性疼痛抑制，主观疼痛体验。脊柱(伤害性屈曲)的生理标志 反射)和棘上(疼痛诱发的皮质电位)疼痛处理将被用来验证 发生敏感化的神经轴。平衡负荷将从多个系统进行综合评估， 包括神经内分泌和心血管对心理社会压力的反应。解决缺乏研究的问题 关于NA疼痛的恢复力，我们将确定NA特定的资源(即，文化连接性)是否可以缓冲 SRD及其负面后果(AIM2)。结果将a)解决未被充分研究的健康差距 服务不足的人口，b)帮助指导政策决策，以减少NA疼痛差距，c)支持一种范式 转变NA疼痛风险的概念，d)确定为精确医学提供信息的有针对性的机制 预防NA疼痛和残疾的方法，以及e)确定弹性因素，以减少SRD对NA的影响 慢性疼痛风险机制。这项社区参与的研究涉及来自北美社区合作伙伴的意见。 (土著咨询委员会、部落IRBs)参与设计、执行和传播这项工作。

07. Project Summary/Abstract This proposal will explore the role of structural racism and discrimination (SRD) in the Native American (NA) chronic pain disparity. NAs experience higher rates of chronic pain than the general U.S. population and we have shown that pain-free NAs are ~3x more likely than non-Hispanic Whites (NHWs) to prospectively develop chronic pain. Our work over the past decade has identified several factors (discrimination, psychological stress, somatic threat sensitivity, cardiometabolic allostatic load) that work collectively to promote a unique NA pain risk phenotype we call “silent” spinal sensitization (sensitization of spinal pain neurons without sensitization of pain experience). This discovery represents a paradigm shift in how NA pain risk is conceptualized because it is not detectible by pain self-report. NAs have suffered generations of SRD due to colonization (eg, genocide, cultural oppression), including forced removal from sacred lands and policies that lead to desecration of their environment. The traditional NA worldview involves an intimate relationship with the environment in which all of nature is interconnected. Within this worldview, environmental desecration is akin to desecration of the body/soul. This proposal will demonstrate the impact of environmental SRD (racialized distribution of environmental pollutions/hazards) on mechanisms of the NA pain disparity (Aim 1). The EPA's 11 environmental (in)justice variables will be leveraged to form a societal-level latent variable representing Racialized Environmental Desecration that will be linked to participants via geocoding. Our preliminary work shows this variable: a) explains 87% of the variance in the original 11 variables, b) correlates with the proportion of NAs within a census region suggesting it assesses racialized NA exposure to pollution, and c) promotes silent spinal sensitization in NAs, but not NHWs. However, these pilot data must be replicated to address limitations. Our study will model silent spinal sensitization using state-of-the art methods to assess central sensitization, endogenous pain inhibition, and subjective pain experience. Physiological markers of spinal (nociceptive flexion reflex) and supraspinal (pain-evoked cortical potentials) pain processing will be used to verify the level of the neuraxis where sensitization occurs. Allostatic load will be comprehensively assessed from multiple systems, including neuroendocrine and cardiovascular responses to psychosocial stress. To address the lack of research on NA pain resiliency, we will determine if a NA-specific resource (ie, cultural connectedness) buffers against SRD and its negative consequences (Aim2). Results will a) address an understudied health disparity in an underserved population, b) help guide policy decisions to reduce the NA pain disparity, c) support a paradigm shift in how NA pain risk is conceptualized, d) identify targetable mechanisms to inform a precision medicine approach to prevent NA pain and disability, and e) identify resiliency factors to reduce the impact of SRD on NA chronic pain risk mechanisms. This community engaged research involves input from NA community partners (Indigenous Advisory Council, tribal IRBs) in the design, execution, and dissemination of the work.