Sociocultural & biobehavioral influences on pain expression and assessment

社会文化

• 批准号: 10929063
• 负责人: Lauren Atlas
• 金额: $ 13.42万
• 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/10929063
• 关键词: Address; Affect; Arousal; Attention; Behavioral; Biological; Biological Factors; Biological Process; Black Populations; COVID-19 pandemic; Clinic; Clinical; Collaborations; Computer Models; Computer software; Consult; Data; Data Analyses; Data Collection; Databases; Disease; Disparity; Disparity population; Eligibility Determination; Enrollment; Ethnic Origin; Face; Feedback; Fellowship; Female; Foundations; Future; Gender; Gender Identity; Health; Health Personnel; Human; Image; Individual; Instruction; Intervention; Learning; Link; Machine Learning; Manuscripts; Measures; Medical; Minority Groups; Modernization; National Institute of Mental Health; Pain; Pain Measurement; Pain Research; Pain Threshold; Pain management; Participant; Patient Self-Report; Patients; Performance; Persons; Physiological; Population Heterogeneity; Positioning Attribute; Postdoctoral Fellow; Process; Protocols documentation; Provider; Psychophysiology; Publications; Race; Reporting; Research; Research Design; Scientist; Series; Sex Differences; Shapes; Social Processes; Stimulus; Symptoms; Testing; Visual attention; Work; adverse outcome; biobehavior; black men; black women; demographics; directed attention; doctoral student; efficacy testing; experience; forging; gaze; health disparity; healthy volunteer; implicit bias; improved; insight; intersectionality; male; minority patient; neuromechanism; non-verbal; outcome disparities; pain perception; pain reduction; programs; psychosocial; racial difference; racial identity; racism; recruit; response; sex; social; social culture; social factors; social learning; social neuroscience; sociocultural determinant; sociodemographic factors; sociodemographic group; therapy design; visual tracking; 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. During FY22, we completed data collection for the protocols first two sub-studies. During FY23, we focused on data analysis for sub-study 1, and began data collection for the third sub-study. Sub-study 1 measures the association between noxious stimuli, pain, and facial responses. We collected our 100th participant in July of 2022, which completed our anticipated data collection based on the protocol, following numerous setbacks due to the COVID-19 pandemic (see FY22 report for details). 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. The PhD student who led the study graduated and started a postdoctoral fellowship during FY23, and thus we have paused analyses. We have met with scientists in the NIMH Machine Learning Section to consult on facial analyses, and anticipate that this project will be led by new postdoctoral fellows in the Section, in collaboration with the former PhD student. 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 2, which measured how individuals view and judge pain in others that they perceive to be similar or different from them. 60 participants (perceivers) viewed 96 videos of people (targets) undergoing painful stimulation. 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). Perceivers assessed pain using the same scales as the targets, which allowed us to measure whether sociodemographic factors influenced pain assessment accuracy. 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, and we observed interactions between race and gender, consistent with intersectionality. 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. We recently submitted these findings for publication and are awaiting reviews (Dildine et al., Submitted). We also began data-collection on a third sub-study during the FY23. This study builds on sub-study 2, such that healthy volunteers (perceivers) view videos of sub-study 1 participants (targets) experiencing pain and evaluate pain using the same scales as the targets. However, half the participants receive feedback about the targets actual pain on every trial, whereas half the participants receive no feedback. We will measure whether feedback improves pain assessment accuracy, and use computational models to evaluate how individuals learn about other individuals pain. We are also collecting eye-tracking and autonomic data while individuals perform the task. Exploratory analyses will examine relationships between nonverbal pain assessment, gaze position, and arousal. 16 participants have enrolled in the study, including 6 pilots. Data collection will terminate when 46 participants complete the task. Finally, the sub-study 3 task will form the foundation for future studies that will examine neural mechanisms of nonverbal pain assessment, test whether performance-based feedback reduces sociocultural biases in pain assessment, and test whether pain assessment and social learning differ across groups (e.g. healthcare providers versus laypeople, patients versus healthy volunteers).

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。 在2022财年，我们完成了方案前两个子研究的数据收集。在2023财年，我们专注于子研究1的数据分析，并开始为第三个子研究收集数据。 子研究1测量伤害性刺激、疼痛和面部反应之间的关联。我们于2022年7月收集了第100名参与者，在COVID-19大流行导致多次挫折后，完成了我们根据方案的预期数据收集（详情请参阅2022财年报告）。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。领导这项研究的博士生在2023财年毕业并开始博士后研究，因此我们暂停了分析。我们已经与NIMH机器学习部门的科学家会面，就面部分析进行咨询，并预计该项目将由该部门的新博士后研究员与前博士生合作领导。 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随后的子研究2的刺激，该研究测量了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。60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。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）。知觉者使用与目标相同的量表评估疼痛，这使我们能够衡量社会人口因素是否影响疼痛评估的准确性。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，我们观察到种族和性别之间的相互作用，与交叉性一致。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。我们最近提交了这些研究结果以供出版，并正在等待审查（Dildine等人，提交）。 我们还在2023财年开始了第三个子研究的数据收集。本研究建立在子研究2的基础上，使健康志愿者（感知者）观看子研究1参与者（目标）经历疼痛的视频，并使用与目标相同的量表评估疼痛。然而，一半的参与者在每次试验中都会收到关于目标实际疼痛的反馈，而另一半的参与者则没有收到反馈。我们将衡量反馈是否提高了疼痛评估的准确性，并使用计算模型来评估个人如何了解其他人的疼痛。我们还在个人执行任务时收集眼动跟踪和自主数据。探索性分析将检查非语言疼痛评估、凝视位置和唤醒之间的关系。16名参与者参加了这项研究，其中包括6名飞行员。当46名参与者完成任务时，数据收集将终止。 最后，子研究3任务将为未来的研究奠定基础，这些研究将检查非语言疼痛评估的神经机制，测试基于表现的反馈是否减少疼痛评估中的社会文化偏见，并测试疼痛评估和社会学习是否在不同群体之间存在差异（例如，医疗保健提供者与外行，患者与健康志愿者）。