Sociocultural & biobehavioral influences on pain expression and assessment

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This year, we continued data collection for 17-AT-0155, "Sociocultural & Biobehavioral Influences on Pain Expression and Assessment". 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. In FY19 we had 51 new subjects complete at least one visit for our first sub-study, 33 of which completed all tasks. This places us at 68 total subjects who have completed at least one visit and 48 total completers (one FY18 subject completed the task during FY19). During the first visit, we assess eligibility via eligibility checklist, urine screen, nursing assessment, and a standard clinical interview diagnostic. During the second visit, we use video recording and facial electromyography to measure facial responses to painful stimuli. We administer three types of noxious stimuli: electric shock, thermal pain, and cold water. We are using 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. Following completion, sub-study 1 participants are asked whether they want their images to be included in a database that will be shown to other participants. Images of participants who opt into this database will be used as stimuli for our subsequent sub-studies 2 and 3, which use eye tracking to measure how individuals (both naive participants and medical providers) view and judge pain in others that they perceive to be similar or different from them. Through this, we hope to gain insight on behavioral mediators of health disparities in pain. If we identify targets that contribute to differences in perceived pain, we will use these to develop interventions and see if individuals can improve accuracy in sub-study 3.