睡眠问题在美籍印第安人心理社会压力与疼痛易化之间起中介作用：来自俄克拉荷马州美籍印第安人疼痛风险研究的结构方程模型分析。
Sleep Problems Mediate the Relationship Between Psychosocial Stress and Pain Facilitation in Native Americans: A Structural Equation Modeling Analysis from the Oklahoma Study of Native American Pain Risk.
机构信息
Department of Psychology, The University of Tulsa, Tulsa, OK, USA.
出版信息
Ann Behav Med. 2022 Nov 5;56(11):1116-1130. doi: 10.1093/abm/kaac034.
BACKGROUND
Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset.
PURPOSE
This study examined the effects of psychological stress and sleep problems on subjective and physiological measures of pain processing in NAs and NHWs.
METHODS
Structural equation modeling was used to determine whether ethnicity (NA or NHW) was associated with psychological stress or sleep problems and whether these variables were related to conditioned pain modulation of pain perception (CPM-pain) and the nociceptive flexion reflex (CPM-NFR), temporal summation of pain (TS-pain) and NFR (TS-NFR), and pain tolerance in a sample of 302 (153 NAs) pain-free participants.
RESULTS
NAs experienced more psychological stress (Estimate = 0.027, p = .009) and sleep problems (Estimate = 1.375, p = .015) than NHWs. When controlling for age, sex, physical activity, BMI, and general health, NA ethnicity was no longer related to greater sleep problems. Psychological stress was also related to sleep problems (Estimate = 30.173, p = <.001) and psychological stress promoted sleep problems in NAs (indirect effect = 0.802, p = .014). In turn, sleep problems were associated with greater TS-pain (Estimate = 0.714, p = .004), but not other pain measures.
CONCLUSIONS
Sleep problems may contribute to chronic pain risk by facilitating pain perception without affecting facilitation of spinal neurons or endogenous inhibition of nociceptive processes. Since psychological stress promoted pain facilitation via enhanced sleep problems, efforts to reduce psychological stress and sleep problems among NAs may improve health outcomes.
背景
与非西班牙裔白人（NHW）相比，美洲原住民（NA）更易经历慢性疼痛；然而，导致 NA 易患慢性疼痛的直接原因仍难以确定。由于几个世纪以来的逆境、歧视和边缘化，NA 比 NHW 报告更大的心理压力，这可能使他们面临睡眠问题的风险，而睡眠问题是慢性疼痛发作的一个公认的危险因素。
目的
本研究旨在探讨心理压力和睡眠问题对 NA 和 NHW 人群疼痛处理的主观和生理测量的影响。
方法
采用结构方程模型来确定种族（NA 或 NHW）是否与心理压力或睡眠问题相关，以及这些变量是否与条件性疼痛调制的疼痛感知（CPM-pain）和伤害性屈反射（CPM-NFR）、疼痛的时间总和（TS-pain）和 NFR（TS-NFR）以及疼痛耐受力相关，该研究纳入了 302 名（153 名 NA）无痛参与者。
结果
与 NHW 相比，NA 经历了更多的心理压力（估计值=0.027，p=0.009）和睡眠问题（估计值=1.375，p=0.015）。在控制年龄、性别、身体活动、BMI 和总体健康状况后，NA 种族与更大的睡眠问题不再相关。心理压力也与睡眠问题相关（估计值=30.173，p<0.001），并且心理压力促进了 NA 人群的睡眠问题（间接效应=0.802，p=0.014）。反过来，睡眠问题与更大的 TS-pain 相关（估计值=0.714，p=0.004），但与其他疼痛测量无关。
结论
睡眠问题可能通过促进疼痛感知而不是影响脊髓神经元的易化或伤害性过程的内源性抑制来增加慢性疼痛的风险。由于心理压力通过增强睡眠问题促进了疼痛易化，因此减少 NA 人群中的心理压力和睡眠问题的努力可能会改善健康结果。
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