The influence of Race on Pain Outcomes

描述（由申请人提供）：在美国，疼痛是人们获得医疗保健的最常见原因，并已被确定为主要的公共卫生问题。尽管如此，调查人员还是发现在疼痛管理方面存在种族和民族差异。在系统的文献综述中，已经发现非裔美国人比白种人更容易经历疼痛治疗不足（Cintron & Morrison, 2006; Ezenwa, Ameringer, Ward, & Serlin, 2006）。疼痛的普遍性也存在种族差异。疾病控制中心的一项研究使用了2002年全国健康访谈调查；研究发现，34%的非裔美国人患有严重的关节炎，而22.6%的白种人患有严重的疼痛（Bolen, Sniezek, Theis, Helmick, & et al., 2005）。与上述报告一致的是，对疼痛的影响存在种族差异。例如，59.6%的非裔美国人与30.3%的白种人相比，疼痛严重到足以影响行为（Riley & Gilbert, 2002）。我的研究项目的总体目标是更好地理解疼痛管理中的种族差异。作为实现这一目标的第一步，我将探讨两种与种族相关的压力源，感知歧视和绝望对疼痛管理差异的影响。感知歧视被定义为长期和常规的不公平待遇经历。绝望是对现在和未来生活的消极期望。本研究将检验一个概念模型中提出的关系，该模型表明种族对疼痛结局（疼痛严重程度、阿片类药物剂量、疼痛治疗满意度和生活质量）的影响是由感知歧视和绝望介导的。本研究的具体目的是：(1)检验种族与疼痛结果之间的关系；(2)检验感知歧视和绝望是否介导种族与疼痛结果之间的关系。本研究将是对慢性非癌性疼痛患者的大型横断面调查数据的二次分析。了解感知歧视和绝望在疼痛管理差异中的作用，可能有助于未来设计文化上适合非洲裔美国人的疼痛管理教育干预措施和文化上敏感的医疗保健提供者教育干预措施。这项研究将有助于减少因治疗不当而引起的公共卫生问题（例如，不必要的痛苦，延迟愈合和延长住院时间）。

DESCRIPTION (provided by applicant): Pain is the most common reason people access healthcare in the United States and has been identified as a major public health problem. Despite this attention, investigators have found racial and ethnic disparities in pain management. In systematic literature reviews, it has been found that African Americans are more at risk than Caucasians for experiencing under-treatment of pain (Cintron & Morrison, 2006; Ezenwa, Ameringer, Ward, & Serlin, 2006). There are also racial differences in the prevalence of pain. In a Center for Disease Control study using the 2002 National Health Interview Survey; it was found that 34% of African Americans compared to 22.6% of Caucasians with arthritis had severe pain (Bolen, Sniezek, Theis, Helmick, & et al., 2005). Consistent with the above report, there are racial differences on the impact of pain. For instance, 59.6% of African Americans compared to 30.3% of Caucasians reported pain severe enough to impact behavior (Riley & Gilbert, 2002). The overall goal of my program of research is to better understand racial disparities in pain management. As a first step toward this goal, I will explore the influence of two race-related stressors, perceived discrimination and hopelessness on disparities in pain management. Perceived discrimination is defined as chronic and routine experiences of unfair treatment. Hopelessness is a negative expectation about one's present and future life. This study will test relationships proposed in a conceptual model which suggests that the effect of race on pain outcomes (pain severity, opioid dose, satisfaction with pain treatment, and quality of life) is mediated by perceived discrimination and hopelessness. The specific aims of this study are (1) to examine the relationship between race and pain outcomes and (2) to test whether perceived discrimination and hopelessness mediate the relationship between race and pain outcomes. This study will be a secondary analysis of data from a large cross-sectional survey of patients with chronic noncancer pain. Understanding the role of perceived discrimination and hopelessness on disparities in pain management may be useful in the future design of culturally appropriate pain management educational interventions for African Americans and culturally sensitive educational interventions for healthcare providers. This study will help reduce the public health problems that arise from poorly treated pain (e.g., unnecessary suffering, delayed healing, and lengthened hospitalization).