Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
J Racial Ethn Health Disparities. 2023 Dec;10(6):2718-2730. doi: 10.1007/s40615-022-01449-6. Epub 2022 Nov 9.
The tendency to ruminate, magnify, and experience helplessness in the face of pain - known as pain catastrophizing - is a strong predictor of pain outcomes and is associated with adversity. The ability to maintain functioning despite adversity - referred to as resilience - also influences pain outcomes. Understanding the extent to which pain catastrophizing and resilience influence relations between adversity and daily pain in healthy African-American adults could improve pain risk assessment and mitigate racial disparities in the transition from acute to chronic pain. This study included 160 African-American adults (98 women). Outcome measures included daily pain intensity (sensory, affective) and pain impact on daily function (pain interference). Adversity measures included childhood trauma exposure, family adversity, chronic burden from recent stressors, and ongoing perceived stress. A measure of lifetime racial discrimination was also included. Composite scores were created to capture early-life adversity (childhood trauma, family adversity) versus recent-life adversity (perceived stress, chronic burden). Increased pain catastrophizing was correlated with increased adversity (early and recent), racial discrimination, pain intensity, and pain interference. Decreased pain resilience was correlated with increased recent-life adversity (not early-life adversity or racial discrimination) and correlated with increased pain intensity (not pain-related interference). Bootstrapped multiple mediation models revealed that relationships between all adversity/discrimination and pain outcomes were mediated by pain catastrophizing. Pain resilience, however, was not a significant mediator in these models. These findings highlight opportunities for early interventions to reduce cognitive-affective-behavioral risk factors for persisting daily pain among African-American adults with greater adversity exposure by targeting pain catastrophizing.
在面对疼痛时，沉思、放大和体验无助的倾向——即疼痛灾难化——是疼痛结果的强有力预测指标，并与逆境有关。尽管面临逆境，但仍能保持功能的能力——即韧性——也会影响疼痛结果。了解疼痛灾难化和韧性在健康的非裔美国成年人中逆境与日常疼痛之间的关系中的影响程度，可以改善疼痛风险评估，并减轻从急性到慢性疼痛的种族差异。本研究包括 160 名非裔美国成年人（98 名女性）。结果测量包括日常疼痛强度（感觉、情感）和疼痛对日常功能的影响（疼痛干扰）。逆境测量包括儿童期创伤暴露、家庭逆境、近期压力源带来的慢性负担以及持续的感知压力。还包括一项终生种族歧视测量。创建了综合评分来捕捉早期生活逆境（儿童期创伤、家庭逆境）与近期生活逆境（感知压力、慢性负担）。增加的疼痛灾难化与增加的逆境（早期和近期）、种族歧视、疼痛强度和疼痛干扰有关。降低的疼痛韧性与近期生活逆境（而不是早期生活逆境或种族歧视）有关，与疼痛强度增加（而不是与疼痛相关的干扰）有关。Bootstrapped 多重中介模型表明，所有逆境/歧视与疼痛结果之间的关系均通过疼痛灾难化来介导。然而，在这些模型中，疼痛韧性并不是一个重要的中介因素。这些发现强调了通过针对疼痛灾难化，为面临更多逆境的非裔美国成年人提供早期干预的机会，以降低持续日常疼痛的认知-情感-行为风险因素。
