Ndao-Brumblay S Khady, Green Carmen R
Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
J Natl Med Assoc. 2005 Oct;97(10):1369-77.
Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women.
疼痛流行病学、疼痛阈值、对疼痛管理的态度、应对方式和社会角色方面基于性别的差异已有详尽描述,但对于女性的慢性疼痛体验以及种族所起的作用却知之甚少。本研究使用二级临床数据库对自我报告数据进行回顾性分析,以阐明种族与慢性疼痛女性的疼痛严重程度、抑郁、身体残疾、创伤后应激障碍(PTSD)以及情感困扰之间的关系。根据白人(n = 1088)和黑人(n = 104)成年女性对麦吉尔疼痛问卷、贝克抑郁量表、疼痛残疾指数、创伤后慢性疼痛测试以及西黑文耶鲁多学科疼痛量表项目的回答进行比较。在考虑了社会人口统计学、医学、心理和身体混杂因素后,疼痛严重程度或情感困扰方面不存在显著的种族效应。然而,患有慢性疼痛的黑人女性比患有慢性疼痛的白人女性经历更多的身体损伤(β = 4.622;p < 0.005)。除了家庭/家务责任外,在所有疼痛残疾指数子量表上都发现了类似差异。我们还发现残疾介导了种族与抑郁的关系,因此黑人女性由于更高的残疾程度而相对更容易患抑郁症。由于残疾对慢性疼痛女性及其家庭产生的经济、社会和情感影响,这些发现对黑人女性的慢性疼痛研究及其管理具有重要意义。