Ethnic Differences in Responses to Painful Stimuli

描述（由申请人提供）：在许多急性和慢性疾病中观察到临床疼痛的种族差异，非洲裔美国人通常报告更高程度的疼痛和残疾。虽然多种因素不可避免地决定了这些种族差异，但我们提出内源性疼痛调节的种族差异可能是一个重要的因素。在之前的资助周期中，我们收集了大量证据，记录了健康的非裔美国人、西班牙裔美国人和非西班牙裔白人在实验性疼痛敏感性和内源性疼痛调节方面的差异。与非西班牙裔白人相比，这两个少数群体对阈值以上的热、冷和缺血刺激都表现出更大的敏感性。此外，与非西班牙裔白人相比，非裔美国人表现出较低的弥漫性有害抑制控制（DNIC），表明疼痛抑制能力减弱。在这一竞争性更新应用中，我们建议通过解决以下具体目标将我们的研究结果转化为临床人群：1)在老年非洲裔美国人和非西班牙裔白人膝关节骨关节炎（OA）患者中，研究实验疼痛敏感性、内源性疼痛抑制、临床疼痛和疼痛相关残疾的种族差异。为了实现这一目标，我们将获得疼痛感知和疼痛抑制的心理物理测量（即弥漫性有害抑制控制，DNIC）以及临床疼痛和残疾的测量；2)确定老年非洲裔美国人和非西班牙裔白人膝关节OA患者在生物、心理和社会文化因素方面的差异及其对疼痛敏感性、疼痛抑制、临床疼痛和残疾的影响；3)确定疼痛敏感性和疼痛抑制的实验室测量与生物学、心理和社会文化因素的结合是否介导了老年非洲裔美国人和非西班牙裔白人膝关节OA患者临床疼痛和疼痛相关残疾的种族差异。我们预计，相对于非西班牙裔白人，非洲裔美国人将报告更高水平的oa相关疼痛和残疾，这些临床疼痛和残疾的差异将由实验室疼痛敏感性和疼痛抑制测量的种族差异以及生物和社会心理变量共同介导。支持我们的假设将为内源性疼痛调节的实验室测量的临床应用提供新的信息，以解释oa相关疼痛和残疾的种族差异。

DESCRIPTION (provided by applicant): Ethnic differences in clinical pain have been observed across numerous acute and chronic conditions, with African Americans often reporting higher levels of pain and disability. While multiple factors inevitably determine these ethnic differences, we have proposed that ethnic differences in endogenous pain modulation may represent an important contributor. During the previous funding cycle, we have gathered substantial evidence documenting differences in experimental pain sensitivity and endogenous pain modulation in a population of healthy African Americans, Hispanic Americans, and non-Hispanic whites. Relative to non- Hispanic whites, both minority groups evinced significantly greater sensitivity to suprathreshold heat, cold, and ischemic stimuli. Moreover, compared to non-Hispanic whites, African Americans showed reduced diffuse noxious inhibitory controls (DNIC), suggesting diminished pain inhibitory capacity. In this competing renewal application, we propose to translate our findings to a clinical population by addressing the following specific aims: 1) to characterize ethnic differences in experimental pain sensitivity, endogenous pain inhibition, clinical pain and pain-related disability among older African Americans and non-Hispanic whites with knee osteoarthritis (OA). In order to accomplish this aim, we will obtain psychophysical measures of pain perception and pain inhibition (i.e. diffuse noxious inhibitory controls, DNIC) as well as measures of clinical pain and disability; 2) to determine ethnic group differences in biological, psychological, and sociocultural factors and their contribution to pain sensitivity, pain inhibition, and clinical pain and disability among older African Americans and non-Hispanic whites with knee OA; and 3) to determine whether the combination of laboratory measures of pain sensitivity and pain inhibition along with biological, psychological and sociocultural factors mediate ethnic group differences in clinical pain and pain-related disability among older African Americans and non-Hispanic whites with knee OA. We anticipate that, relative to non-Hispanic whites, African Americans will report higher levels of OA-related pain and disability, and these differences in clinical pain and disability will be mediated by ethnic group differences in laboratory measures of pain sensitivity and pain inhibition, in combination with biological and psychosocial variables. Support for our hypotheses will provide novel information regarding the clinical utility of laboratory measures of endogenous pain modulation for explaining ethnic group differences in OA-related pain and disability.