A pain inequity exists for Native Americans (NAs), but the mechanisms are poorly understood. The Oklahoma Study of Native American Pain Risk (OK-SNAP) addressed this issue and recruited healthy, pain-free NAs and non-Hispanic Whites (NHWs) to attend 2 laboratory visits and assessed mechanisms consistent with the biopsychosocial model of pain: demographics, physical variables, psychosocial factors, and nociceptive/pain phenotypes. Then participants were surveyed every 6 months to assess for chronic pain onset. Results at the 2-year follow-up found that NAs were ∼3x more likely than NHWs to develop chronic pain. Moreover, psychosocial factors (discrimination, stress, pain-related anxiety), cardiometabolic load (higher body mass index and blood pressure, lower heart rate variability), and impaired inhibition of spinal nociception partly mediated the pain inequity. The present study examined mechanisms of chronic pain at the 5-year follow-up for OK-SNAP. Results found that the NA pain inequity worsened-NAs were 4x more likely to develop chronic pain (OR = 4.025; CI = 1.966, 8.239), even after controlling for baseline age, sex assigned at birth, income, and education. Moreover, serial mediation models replicated paths from the 2-year follow-up that linked psychosocial variables, cardiometabolic load, and impaired inhibition of spinal nociception to chronic pain onset. Further, 2 new significant paths were observed. One linked discrimination, stress, sleep problems, and facilitated pain perception to increased pain risk. The other linked discrimination with higher spinal nociceptive threshold and pain risk. These results provide further evidence for a NA pain inequity and identify multiple psychosocial, cardiometabolic, and pronociceptive targets for primary interventions.

中文翻译：

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美洲原住民疼痛不平等的机制：在俄克拉荷马州美洲原住民疼痛风险研究中前瞻性预测 5 年慢性疼痛发作。


美洲原住民 （NA） 存在痛苦不平等，但对其机制知之甚少。俄克拉荷马州美洲原住民疼痛风险研究 （OK-SNAP） 解决了这个问题，并招募了健康、无痛的 NA 和非西班牙裔白人 （NHW） 参加 2 次实验室访问，并评估了与疼痛的生物心理社会模型一致的机制：人口统计学、物理变量、社会心理因素和伤害感受/疼痛表型。然后每 6 个月对参与者进行一次调查，以评估慢性疼痛的发作。2 年随访的结果发现，NA 患慢性疼痛的可能性是 NHW 的 3 倍。此外，社会心理因素 （歧视、压力、与疼痛相关的焦虑）、心脏代谢负荷 （较高的体重指数和血压、较低的心率变异性） 和脊髓伤害感受的抑制受损部分介导了疼痛不公平。本研究在 OK-SNAP 的 5 年随访中检查了慢性疼痛的机制。结果发现 NA 疼痛不平等恶化 - NA 患慢性疼痛的可能性要高 4 倍 （OR = 4.025;CI = 1.966， 8.239），即使在控制了基线年龄、出生时分配的性别、收入和教育程度之后也是如此。此外，连续中介模型复制了 2 年随访的路径，这些路径将社会心理变量、心脏代谢负荷和脊髓伤害感受抑制受损与慢性疼痛发作联系起来。此外，还观察到 2 条新的重要路径。一项将歧视、压力、睡眠问题和促进疼痛感知与疼痛风险增加联系起来。另一个将歧视与较高的脊髓伤害感受阈值和疼痛风险联系起来。这些结果为 NA 疼痛不公平提供了进一步的证据，并确定了主要干预的多个社会心理、心脏代谢和伤害感受目标。