Sensory, Affective, and Catastrophizing Reactions to Multiple Stimulus Modalities: Results from the Oklahoma Study of Native American Pain Risk

Abstract

Native Americans (NAs) have a higher prevalence of chronic pain than any other U.S. racial/ethnic group; however, little is known about the mechanisms for this pain disparity. This study used quantitative sensory testing to assess pain experience in healthy, pain-free adults (n = 137 NAs (87 female), n = 145 non-Hispanic whites (NHW; 68 female)) after painful electric, heat, cold, ischemic, and pressure stimuli. After each stimulus, ratings of pain intensity, sensory pain, affective pain, pain-related anxiety, and situation-specific pain catastrophizing were assessed. The results suggested that NAs reported greater sensory pain in response to suprathreshold electric and heat stimuli, greater pain-related anxiety to heat and ischemic stimuli, and more catastrophic thoughts in response to electric and heat stimuli. Sex differences were also noted; however, with the exception of catastrophic thoughts to cold, these finding were not moderated by race/ethnicity. Together, findings suggest NAs experience heightened sensory, anxiety, and catastrophizing reactions to painful stimuli. This could place NAs at risk for future chronic pain and could ultimately lead to a vicious cycle that maintains pain (eg, pain → anxiety/catastrophizing → pain). PERSPECTIVE: NAs experienced heightened sensory, anxiety, and catastrophizing reactions in response to multiple pain stimuli. Given the potential for anxiety and catastrophic thoughts to amplify pain, this characteristic may place them at risk for pain disorders and could lead to a vicious cycle that maintains pain.

Keywords: Native Americans; Quantitative sensory testing; anxiety; catastrophizing; ethnic differences; pain; pain coping.

Figure 1.

Racial/ethnic differences in pain intensity ratings, sensory ratings, affective ratings, pain-related anxiety, and situation-specific (SS) catastrophizing in response to electric tolerance testing (Elect Tol), suprathreshold electric stimulations (Supra Elect), 3 stimulation series of suprathreshold electric stimulations (Elect Series), heat tolerance testing (Heat Tol), 10-pulses series of suprathreshold heat stimuli (Pain45 series), series of 52°C heat stimuli (52°C series), cold pressor tolerance testing (Cold Tol), ischemia tolerance testing (Isch Tol), and pressure threshold testing (Pressure Thr). For variables that were transformed (e.g., log, square) to address non-normality, the reverse operation was conducted on the means (e.g., 10^X, square root) in order to display them in the original units. MPQ=McGill Pain Questionnaire-Short Form. ^#Racial/ethnic group differences at P<.05. *Racial/ethnic group differences at P<.01.

Figure 2.

Sex differences in pain intensity ratings, sensory ratings, affective ratings, pain-related anxiety, and situation-specific (SS) catastrophizing in response to electric tolerance testing (Elect Tol), suprathreshold electric stimulations (Supra Elect), 3 stimulation series of suprathreshold electric stimulations (Elect Series), heat tolerance testing (Heat Tol), 10-pulse series of suprathreshold heat stimuli (Pain45 series), series of 52°C heat stimuli (52°C series), cold pressor tolerance testing (Cold Tol), ischemia tolerance testing (Isch Tol), and pressure threshold testing (Pressure Thr). For variables that were transformed (e.g., log, square) to address non-normality, the reverse operation was conducted on the means (e.g., 10^X, square root) in order to display them in the original units. MPQ=McGill Pain Questionnaire-Short Form. ^#Sex differences at P<.05. *Sex differences at P<.01.