Abstract
This study examined the negative impact of social discrimination on the time to pain tolerance during experimentally induced cold pressor pain among healthy individuals. It was hypothesized that the degree to which one catastrophized about pain would exacerbate the negative impact of a history discriminatory experiences on pain tolerance, and that this interaction would be different between individuals of a racial and ethnic minority and non-Hispanic white individuals (thus testing catastrophizing as a moderated moderator). Higher levels of discrimination were positively related to catastrophic thinking about pain, and there was a significant negative relationship between the level of experienced discrimination and time to pain tolerance. Pain catastrophizing emerged as a significant moderator in that when pain catastrophizing levels were high, there was no association between social discrimination and pain tolerance. A history of social discrimination was significantly associated with reduced pain tolerance at low and moderate levels of pain catastrophizing. Racial minority status did not significantly alter this moderating relationship. Implications for the importance of assessing sociocultural variables, such as experiencing social discrimination in the clinical assessment of the individual with pain are outlined.
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Data is housed at the University of Montevallo and is available upon request.
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References
Aslaksen, P. M., Myrbakk, I. N., Høifødt, R. S., & Flaten, M. A. (2007). The effect of experimenter gender on autonomic and subjective responses to pain stimuli. Pain, 129, 260–268.
Asmundson, G. J., Carleton, R. N., & Ekong, J. (2005). Dot-probe evaluation of selective attentional processing of pain cues in patients with chronic headaches. Pain, 114, 250–256.
Asmundson, G. J. G., & Katz, J. (2009). Understanding the co-occurrence of anxiety disorders and chronic pain: State-of-the-art. Depression and Anxiety, 26, 888–901.
Bakhshaie, J., Rogers, A. H., Mayorga, N. A., Ditre, J., Rodríguez-Cano, R., Ruiz, A. C., et al. (2019). Perceived racial discrimination and pain intensity/disability among economically disadvantaged Latinos in a federally qualified health center: The role of anxiety sensitivity. Journal of Immigrant and Minority Health, 21, 21–29. https://doi.org/10.1007/s10903-018-0715-8
Bernardes, S. F., Forgeron, P., Fournier, K., & Reszel, J. (2017). Beyond solicitousness: A comprehensive review on informal pain-related social support. Pain, 158, 2066–2076. https://doi.org/10.1097/j.pain.0000000000001033
Brennstuhl, M. J., Tarquinio, C., & Montel, S. (2015). Chronic pain and PTSD: Evolving views on their comorbidity. Perspectives in Psychiatric Care, 51, 295–304. https://doi.org/10.1111/ppc.12093
Brondolo, E., Hausmann, L. R. M., Jhalani, J., Pencille, M., Atencio-Bacayon, J., Kumar, A., et al. (2011). Dimensions of perceived racism and self-reported health: Examination of racial/ethnic differences and potential mediators. Annals of Behavioral Medicine, 42, 14–28. https://doi.org/10.1007/s12160-011-9265-1
Buckingham, A., & Richardson, E. J. (2021). The relationship between psychological resilience and pain threshold and tolerance: Optimism and grit as moderators. Journal of Clinical Psychology in Medical Settings, 28, 518–528.
Burgess, D. J., Grill, J., Noorbaloochi, S., Griffin, J. M., Ricards, J., van Ryn, M., & Partin, M. R. (2009). The effect of perceived racial discrimination on bodily pain among older African American men. Pain Medicine, 10, 1341–1352. https://doi.org/10.1111/j.1526-4637.2009.00742.x
Burke, N. N., Finn, D. P., McGuire, B. E., & Roche, M. (2017). Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms. Journal of Neuroscience Research, 95, 1257–1270. https://doi.org/10.1002/jnr.23802
Calhoun, A. (2021). Medical education must start teaching about racism. Yale Journal of Biology and Medicine, 94, 143–146.
Casey, L. S., Reisner, S. L., Findling, M. G., Blendon, R. J., Benson, J. M., Sayde, J. M., et al. (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research, 54, 1454–1466. https://doi.org/10.1111/1475-6773.13229
Chae, D. H., Lincoln, K. D., & Jackson, J. S. (2011). Discrimination, attribution, and racial group identification: Implications for psychological distress among Black Americans in the National Survey of American Life (2001–2003). American Journal of Orthopsychiatry, 81, 498–506.
Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., et al. (2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morbidity and Mortality Weekly Report, 67, 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2
Dale, S. K., & Safren, S. A. (2019). Gendered racial microaggressions predict post-traumatic stress disorder symptoms and cognitions among Black women living with HIV. Psychological Trauma, 11, 685–694. https://doi.org/10.1037/tra0000467
de Williams, A. C. C., & Craig, K. D. (2016). Updating the definition of pain. Pain, 157, 2420–2423. https://doi.org/10.1097/j.pain.0000000000000613
Deyo, R. A., Smith, D. H., Johnson, E. S., Donovan, M., Tillotson, C. J., Yang, X., et al. (2011). Opioids for back pain patients: Primary care prescribing patterns and use of services. Journal of the American Board of Family Medicine, 24, 717–727. https://doi.org/10.3122/jabfm.2011.06.100232
Doleys, D. M. (2000). Chronic pain. In R. G. Frank & T. R. Elliott (Eds.), Handbook of rehabilitation psychology (pp. 185–203). American Psychological Association.
Earp, B. D., Monrad, J. T., LaFrance, M., Bargh, J. A., Cohen, L. L., & Richeson, J. A. (2019). Gender bias in pediatric pain assessment. Journal of Pediatric Psychology, 44, 403–414. https://doi.org/10.1093/jpepsy/jsy104
Edwards, R. R. (2008). The association of perceived discrimination with low back pain. Journal of Behavioral Medicine, 31, 379–389. https://doi.org/10.1007/s10865-008-9160-9
Edwards, R. R., Bingham, C. O., Bathon, J., & Haythornthwaite, J. A. (2006). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis & Rheumatism, 55, 325–332.
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016). The role of psychosocial processes in the development and maintenance of chronic pain. Journal of Pain, 17, T70-92. https://doi.org/10.1016/j.jpain.2016.01.001
Essed, P. (1991). Understanding everyday racism. Sage.
Goodin, B. R., Pham, Q. T., Glover, T. L., Sotolongo, A., King, C. D., Sibille, K. T., et al. (2013). Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis. Health Psychology, 32, 1117–1126. https://doi.org/10.1037/a0031592
Hammarström, A., Haukenes, I., Wiklund, A. F., Lehti, A., Wiklund, M., Evengård, B., & Stålnacke, B. M. (2014). Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs. PLoS ONE, 9, e97134. https://doi.org/10.1371/journal.pone.0097134
Hayes, A. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 639–665.
Hirsh, A. T., Alqudah, A. F., Stutts, L. A., & Robinson, M. E. (2008). Virtual human technology: Capturing sex, race, and age influences in individual pain decision policies. Pain, 140, 231–238. https://doi.org/10.1016/j.pain.2008.09.010
Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of National Academy of Sciences of the United States of America, 113, 4296–4301.
Hogaboom, N., Fyffe, D. C., Botticello, A. L., Worobey, L. A., & Boninger, M. L. (2019). A cross-sectional study to investigate the effects of perceived discrimination in the health care setting on pain and depressive symptoms in wheelchair users with spinal cord injury. Archives of Physical Medicine & Rehabilitation, 100, 2233–2243. https://doi.org/10.1016/j.apmr.2019.06.016
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and Commitment Therapy (ACT) for chronic pain: A systematic review and meta-analyses. Clinical Journal of Pain, 33, 552–568.
Jensen, M. P., & Karoly, P. (2011). Self-report scales and procedures for assessing pain in adults. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (3rd ed., pp. 15–34). Guilford.
Jensen, M. P., Turner, J. A., Romano, J. M., & Karoly, P. (1991). Coping with chronic pain: A critical review of the literature. Pain, 47, 249–283.
Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A., & Perri, L. M. (2004). Psychological aspects of persistent pain: Current state of the science. Journal of Pain, 5, 195–211. https://doi.org/10.1016/j.jpain.2004.02.576
Keogh, E., & Cochrane, M. (2002). Anxiety sensitivity, cognitive biases, and the experience of pain. Journal of Pain, 3, 320–329.
Kim, H. J., Yang, G. S., Greenspan, J. D., Downton, K. D., Griffith, K. A., Renn, C. L., et al. (2017). Racial and ethnic differences in experimental pain sensitivity: Systematic review and meta-analysis. Pain, 158, 194–211. https://doi.org/10.1097/j.pain.0000000000000731
Mathur, V. A., Kiley, K. B., Haywood, C., Bediako, S. M., Lanzkron, S., Carroll, C. P., et al. (2016). Multiple levels of suffering: Discrimination in health-care settings is associated with enhanced laboratory pain sensitivity in sickle cell disease. Clinical Journal of Pain, 32, 1076–1085. https://doi.org/10.1097/AJP.0000000000000361
McClendon, J., Essien, U. R., Youk, A., Ibrahim, S. A., Vina, E., Kwoh, K., & Hausmann, L. R. M. (2020). Cumulative disadvantage and disparities in depression and pain among veterans with osteoarthritis: The role of perceived discrimination. Arthritis Care & Research. https://doi.org/10.1002/acr.24481
Mehok, L. E., Miller, M. M., Trost, Z., Goubert, L., De Ruddere, L., & Hirsh, A. T. (2019). Pain intensity and attribution mediate the impact of patient weight and gender on activity recommendations for chronic pain. Journal of Pain Research, 12, 2743–2753. https://doi.org/10.2147/JPR.S218761
Melzack, R. (1999). From the gate to the Neuromatrix. Pain, 6, S11-126.
Melchior, M., Juif, P. E., Gazzo, G., Petit-Demoulière, N., Chavant, V., Lacaud, A., Goumon, Y., Charlet, A., Lelièvre, V., & Poisbeau, P. (2018). Pharmacological rescue of nociceptive hypersensitivity and oxytocin analgesia impairment in a rat model of neonatal maternal separation. Pain, 159, 2630–2640. https://doi.org/10.1097/j.pain.0000000000001375
Merskey, H. (1986). Classification of chronic pain: Description of chronic pain syndromes and definitions of pain terms. Pain, S1–S225.
Mezei, L., & Murinson, B. B. (2011). Pain education in North American medical schools. Journal of Pain, 12, 1199–1208. https://doi.org/10.1016/j.jpain.2011.06.006
Ong, W. J., Kwan, Y. H., Lim, Z. Y., Thumboo, J., Yeo, S. J., Yeo, W., Wong, S. B., & Leung, Y. Y. (2020). Measurement properties of Pain Catastrophizing Scale in patients with knee osteoarthritis. Clinical Rheumatology. https://doi.org/10.1007/s10067-020-05163-8
Oosterman, J. M., Dijkerman, C. H., Roy, P. C., Kessels, R. P., & Scherder, E. J. (2010). A unique association between cognitive inhibition and pain sensitivity in healthy participants. European Journal of Pain, 10, 1046–1105.
Otis, J. (2007). Managing chronic pain: A cognitive-behavioral therapy approach. Oxford University Press.
Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35, 888–901.
Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135, 531–554. https://doi.org/10.1037/a0016059
Pieritz, K., Rief, W., & Euteneuer, F. (2015). Childhood adversities and laboratory pain perception. Neuropsychiatric Disease and Treatment, 11, 2109–2116. https://doi.org/10.2147/NDT.S87703
Pieterse, A. L., Carter, R. T., Evans, S. A., & Walter, R. A. (2010). An exploratory examination of the associations among racial and ethnic discrimination, racial climate, and trauma-related symptoms in a college student population. Journal of Counseling Psychology, 57, 255–263. https://doi.org/10.1037/a0020040
Polanco-Roman, L., Danies, A., & Anglin, D. M. (2016). Racial discrimination as race-based trauma, coping strategies, and dissociative symptoms among emerging adults. Psychological Trauma, 8, 609–617.
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9, 745–758. https://doi.org/10.1586/ERN.09.34
Richardson, E. J., & Redden, D. T. (2014). Moving toward multiple site outcomes in spinal cord injury: An issue of clustered observations in trial design and analysis. Journal of Spinal Cord Medicine, 37, 278–287. https://doi.org/10.1179/2045772313Y.0000000165
Richardson, E. J., Ness, T. J., Doleys, D. M., Baños, J. H., Cianfrini, L., & Richards, J. S. (2009). Depressive symptoms and pain evaluations among persons with chronic pain: Catastrophizing, but not pain acceptance, shows significant effects. Pain, 147, 147–152. https://doi.org/10.1016/j.pain.2009.08.030
Robinson, M. E., & Wise, E. A. (2003). Gender bias in the observation of experimental pain. Pain, 104, 259–264. https://doi.org/10.1016/s0304-3959(03)00014-9
Rodriguez, A., Agardh, A., & Asamoah, B. O. (2018). Self-reported discrimination in health-care settings based on recognizability as transgender: A cross-sectional study among transgender U.S. citizens. Archives of Sexual Behavior, 47, 973–985. https://doi.org/10.1007/s10508-017-1028-z
Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). “Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Research & Management. https://doi.org/10.1155/2018/6358624
Sharp, T. J., & Harvey, A. G. (2001). Chronic pain and posttraumatic stress disorder: Mutual maintenance? Clinical Psychology Review, 21, 857–877. https://doi.org/10.1016/s0272-7358(00)00071-4
Simons, L., Elman, I., & Borsook, D. (2014). Psychological processing in chronic pain: A neural systems approach. Neuroscience & Biobehavioral Reviews, 39, 61–78. https://doi.org/10.1016/j.neubiorev.2013.12.006
SteelFisher, G. K., Findling, M. G., Bleich, S. N., Casey, L. S., Blendon, R. J., Benson, J. M., Sayde, J. M., & Carolyn Miller, C. (2019). Gender discrimination in the United States: Experiences of women. Health Services Research, 54, 1442–1453. https://doi.org/10.1111/1475-6773.13217
Stewart, M. O., Karlin, B. E., Murphy, J. L., Raffa, S. D., Miller, S. A., McKellar, J., & Kerns, R. D. (2015). National dissemination of cognitive-behavioral therapy for chronic pain in veterans. Clinical Journal of Pain, 31, 722–729.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.
Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., et al. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17, 52–64.
Tait, R. C., & Chibnall, J. T. (2014). Racial/ethnic disparities in the assessment and treatment of pain: Psychosocial perspectives. American Psychologist, 69(2), 131–141. https://doi.org/10.1037/a0035204
Terry, E. L., Dottington Fullwood, M., Booker, S. Q., Cardoso, J. S., Sibille, K. T., Glover, T. L., et al. (2020). Everyday discrimination in adults with knee pain: The role of perceived stress and pain catastrophizing. Journal of Pain Research, 13, 883–895. https://doi.org/10.2147/JPR.S235632
Thorn, B. E. (2020). Ronald Melzack Award Lecture: Putting the brain to work in cognitive behavioral therapy for chronic pain. Pain, 161, S27. https://doi.org/10.1097/j.pain.0000000000001839
Thorn, B. E., Pence, L. B., Ward, L. C., Kilgo, G., Clements, K. L., Cross, T. H., Davis, A. M., & Tsui, P. W. (2007). A randomized clinical trial of targeted cognitive behavioral treatment to reduce catastrophizing in chronic headache sufferers. Journal of Pain, 8, 938–949.
Trost, Z., Strachan, E., Sullivan, M., Vervoort, T., Avery, A. R., & Afari, N. (2015). Heritability of pain catastrophizing and associations with experimental pain outcomes: A twin study. Pain, 156, 514–520. https://doi.org/10.1097/01.j.pain.0000460326.02891.fc
Turk, D. C., & Gatchel, R. J. (2018). Psychological approaches to pain management (3rd ed.). Guilford Publications.
Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70, 678–690.
Turk, D. C., Filligim, R. B., Ohrbach, R., & Patel, K. V. (2016). Assessment of psychosocial and functional impact of chronic pain. Journal of Pain, 17, T21–T49.
Turner, J., & Aaron, L. (2001). Pain-related catastrophizing: What is it? Clinical Journal of Pain, 17, 65–71.
Van Damme, S., Crombez, G., & Eccleston, C. (2004). Disengagement from pain: The role of catastrophic thinking about pain. Pain, 10, 70–76.
Vervoort, T., Trost, Z., Prkachin, K. M., & Mueller, S. C. (2013). Attentional processing of other’s facial display of pain: An eye tracking study. Pain, 154, 836–844.
Wei, M., Wang, K. T., Heppner, P. P., & Du, Y. (2012). Ethnic and mainstream social connectedness, perceived racial discrimination, and post-traumatic stress symptoms. Journal of Counseling Psychology, 59, 486–493.
Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20–47. https://doi.org/10.1007/s10865-008-9185-0
Williams, D. R., Lawrence, J. A., Davis, B. A., & Vu, C. (2019). Understanding how discrimination can affect health. Health Services Research, 54, 1374–1388. https://doi.org/10.1111/1475-6773.13222
Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress, and discrimination. Journal of Health Psychology, 2, 335–351.
Yang, Z., Jackson, T., Gao, X., & Chen, H. (2012). Identifying selective visual attention biases related to fear of pain by tracking eye movements within a dot-probe paradigm. Pain, 153, 1742–1748.
Ziadni, M. S., Sturgeon, J. A., Bissell, D., Guck, A., Martin, K. J., Scott, W., & Trost, Z. (2020). Injustice appraisal, but not pain catastrophizing, mediates the relationship between perceived ethnic discrimination and depression and disability in low back pain. Journal of Pain, 21, 582–592. https://doi.org/10.1016/j.jpain.2019.09.007
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EJR, ZT and MP were involved in study conception and design. EJR and AW were involved in material preparation and data collection. EJR, ZT, MP and AW contributed to analysis, writing the manuscript and approval of the final draft.
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Richardson, E.J., Trost, Z., Payne, M. et al. The Negative Effect of Social Discrimination on Pain Tolerance and the Moderating Role of Pain Catastrophizing. J Clin Psychol Med Settings 30, 169–181 (2023). https://doi.org/10.1007/s10880-022-09860-1
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DOI: https://doi.org/10.1007/s10880-022-09860-1