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本文引用的文献

1
The Relationship Between Experienced Discrimination and Pronociceptive Processes in Native Americans: Results From the Oklahoma Study of Native American Pain Risk.美国原住民中经历的歧视与伤害感受性过程之间的关系：来自美国原住民疼痛风险俄克拉荷马州研究的结果。
J Pain. 2022 Jun;23(6):1006-1024. doi: 10.1016/j.jpain.2021.12.010. Epub 2022 Jan 10.
2
Discrimination and Sleep Impairment in American Indians and Alaska Natives.美国印第安人和阿拉斯加原住民中的歧视与睡眠障碍。
Ann Behav Med. 2022 Aug 30;56(9):969-976. doi: 10.1093/abm/kaab097.
3
Are Cardiometabolic Markers of Allostatic Load Associated With Pronociceptive Processes in Native Americans?: A Structural Equation Modeling Analysis From the Oklahoma Study of Native American Pain Risk.心脏代谢性应激生物标志物与美洲原住民的伤害感受过程有关吗？来自美国俄克拉荷马州美洲原住民疼痛风险研究的结构方程模型分析。
J Pain. 2021 Nov;22(11):1429-1451. doi: 10.1016/j.jpain.2021.04.014. Epub 2021 May 24.
4
The Relationship Between Adverse Life Events and Endogenous Inhibition of Pain and Spinal Nociception: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP).不良生活事件与疼痛和脊髓伤害感受的内源性抑制之间的关系：来自美国原住民疼痛风险俄克拉荷马研究（OK-SNAP）的研究结果。
J Pain. 2021 Sep;22(9):1097-1110. doi: 10.1016/j.jpain.2021.03.146. Epub 2021 Apr 2.
5
The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk.疼痛灾难化对美国原住民疼痛内抑制和脊髓伤害感受的影响：来自俄克拉荷马州美国原住民疼痛风险研究的结果。
Ann Behav Med. 2020 Aug 8;54(8):575-594. doi: 10.1093/abm/kaaa004.
6
Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: main findings from the Oklahoma Study of Native American Pain Risk.评估美洲原住民的周围纤维、疼痛敏感性、中枢敏化和下行抑制：来自俄克拉荷马州美洲原住民疼痛风险研究的主要发现。
Pain. 2020 Feb;161(2):388-404. doi: 10.1097/j.pain.0000000000001715.
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Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants.完全睡眠剥夺会增加疼痛敏感性，损害条件性疼痛调节，并促进健康参与者的疼痛时程总和。
PLoS One. 2019 Dec 4;14(12):e0225849. doi: 10.1371/journal.pone.0225849. eCollection 2019.
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Discrimination in the United States: Experiences of Native Americans.美国的歧视：美国原住民的经历。
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The Decline of Endogenous Pain Modulation With Aging: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation.内源性疼痛调制随年龄衰退：时程总和与条件性疼痛调制的荟萃分析。
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Factors associated with fatigue in patients with insomnia.失眠症患者疲劳相关因素。
J Psychiatr Res. 2019 Oct;117:24-30. doi: 10.1016/j.jpsychires.2019.06.021. Epub 2019 Jun 28.

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.

DOI:10.1093/abm/kaac034
PMID:35775809
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9924047/
Abstract

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.

摘要

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。