TY - JOUR
T1 - Multiple Levels of Suffering
T2 - Discrimination in Health-Care Settings is Associated with Enhanced Laboratory Pain Sensitivity in Sickle Cell Disease
AU - Mathur, Vani A.
AU - Kiley, Kasey B.
AU - Haywood, Carlton
AU - Bediako, Shawn M.
AU - Lanzkron, Sophie
AU - Carroll, C. Patrick
AU - Buenaver, Luis F.
AU - Pejsa, Megan
AU - Edwards, Robert R.
AU - Haythornthwaite, Jennifer A.
AU - Campbell, Claudia M.
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/11/28
Y1 - 2016/11/28
N2 - Objective: People living with sickle cell disease (SCD) experience severe episodic and chronic pain and frequently report poor interpersonal treatment within health-care settings. In this particularly relevant context, we examined the relationship between perceived discrimination and both clinical and laboratory pain. Methods: Seventy-one individuals with SCD provided self-reports of experiences with discrimination in health-care settings and clinical pain severity, and completed a psychophysical pain testing battery in the laboratory. Results: Discrimination in health-care settings was correlated with greater clinical pain severity and enhanced sensitivity to multiple laboratory-induced pain measures, as well as stress, depression, and sleep. After controlling for relevant covariates, discrimination remained a significant predictor of mechanical temporal summation (a marker of central pain facilitation), but not clinical pain severity or suprathreshold heat pain response. Furthermore, a significant interaction between experience with discrimination and clinical pain severity was associated with mechanical temporal summation; increased experience with discrimination was associated with an increased correlation between clinical pain severity and temporal summation of pain. Discussion: Perceived discrimination within health-care settings was associated with pain facilitation. These findings suggest that discrimination may be related to increased central sensitization among SCD patients, and more broadly that health-care social environments may interact with pain pathophysiology.
AB - Objective: People living with sickle cell disease (SCD) experience severe episodic and chronic pain and frequently report poor interpersonal treatment within health-care settings. In this particularly relevant context, we examined the relationship between perceived discrimination and both clinical and laboratory pain. Methods: Seventy-one individuals with SCD provided self-reports of experiences with discrimination in health-care settings and clinical pain severity, and completed a psychophysical pain testing battery in the laboratory. Results: Discrimination in health-care settings was correlated with greater clinical pain severity and enhanced sensitivity to multiple laboratory-induced pain measures, as well as stress, depression, and sleep. After controlling for relevant covariates, discrimination remained a significant predictor of mechanical temporal summation (a marker of central pain facilitation), but not clinical pain severity or suprathreshold heat pain response. Furthermore, a significant interaction between experience with discrimination and clinical pain severity was associated with mechanical temporal summation; increased experience with discrimination was associated with an increased correlation between clinical pain severity and temporal summation of pain. Discussion: Perceived discrimination within health-care settings was associated with pain facilitation. These findings suggest that discrimination may be related to increased central sensitization among SCD patients, and more broadly that health-care social environments may interact with pain pathophysiology.
KW - Clinical pain
KW - patient provider interaction
KW - quantitative sensory testing
KW - racial discrimination
KW - temporal summation
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U2 - 10.1097/AJP.0000000000000361
DO - 10.1097/AJP.0000000000000361
M3 - Article
C2 - 26889615
AN - SCOPUS:84958817540
SN - 0749-8047
VL - 32
SP - 1076
EP - 1085
JO - Clinical Journal of Pain
JF - Clinical Journal of Pain
IS - 12
ER -