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

07.项目总结/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的慢性疼痛发生率高于美国普通人群， 已经表明，无痛NAs比非西班牙裔白人（NHWs）前瞻性发展的可能性高3倍 慢性疼痛我们在过去十年中的工作已经确定了几个因素（歧视，心理压力， 躯体威胁敏感性、心脏代谢非稳态负荷）共同作用，以促进独特的NA疼痛风险 表型我们称之为“沉默的”脊髓敏化（脊髓疼痛神经元的敏化而没有疼痛的敏化 经验）。这一发现代表了NA疼痛风险如何概念化的范式转变，因为它不是 可通过疼痛自我报告检测到。由于殖民化（例如种族灭绝、文化灭绝）， 压迫），包括强迫迁离圣地和导致亵渎其宗教信仰的政策。 环境传统的NA世界观涉及到与环境的亲密关系， 大自然是相互联系的。在这种世界观中，环境亵渎类似于对自然的亵渎。 身体/灵魂本提案将展示环境SRD（种族化分布）的影响， 环境污染/危害）对NA疼痛差异机制的影响（目标1）。环境保护局11 （不）正义变量将被利用，以形成一个社会层面的潜在变量，代表种族化 将通过地理编码与参与者联系起来的环境亵渎。我们的初步工作表明， 变量：a）解释了原始11个变量中87%的方差，B）与NA的比例相关 在一个人口普查区域内，这表明它评估了种族化的NA暴露于污染，和c）促进沉默的脊髓 在NAs中，但不是NHWs。但是，必须复制这些试验数据以解决局限性。我们 本研究将使用最先进的方法模拟无声脊髓致敏以评估中枢致敏， 内源性疼痛抑制和主观疼痛体验。脊柱（伤害性屈曲）的生理标志物 反射）和脊髓上（疼痛诱发皮层电位）疼痛处理将用于验证 发生致敏的神经轴。将从多个系统综合评估非稳态负荷， 包括对心理社会压力的神经内分泌和心血管反应。为了解决缺乏研究的问题， 关于NA疼痛弹性，我们将确定NA特定资源（即，文化连通性）是否对 SRD及其负面后果（目标2）。结果将：a）解决一个未充分研究的健康差距， 服务不足的人群，B）帮助指导政策决策，以减少NA疼痛差异，c）支持一个范例 NA疼痛风险如何概念化的转变，d）确定可靶向机制，以告知精确医学 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NA社区合作伙伴的投入 （土著咨询理事会、部落IRB）参与设计、执行和宣传工作。

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.