Chronic pain results in considerable suffering, as well as significant economic and societal costs. Prior evidence suggests that Native Americans (NAs) have higher rates of chronic pain than other U.S. racial/ethnic groups, but the mechanisms contributing to this pain disparity are poorly understood. The Oklahoma Study of Native American Pain Risk was developed to address this issue and recruited healthy, pain-free NAs and non-Hispanic Whites (NHWs). Cross-sectional analyses identified several measures of adversity (eg, trauma, discrimination), cognitive-affective factors (perceived stress, pain-related anxiety/catastrophizing), and cardiometabolic factors (eg, body mass index, blood pressure, heart rate variability) that were associated with pronociceptive processes (eg, central sensitization, descending inhibition, hyperalgesia). Every 6-months following enrollment, eligible participants (N=277) were recontacted and assessed for the onset of chronic pain. The present study examines predictors of chronic pain onset in the 222 (80%) who responded over the first 2-years. Results found that NAs developed chronic pain at a higher rate than NHWs (OR=2.902, p<.05), even after controlling for age, sex, income, and education. Moreover, serial mediation models identified several potential pathways to chronic pain onset within the NA group. These paths included perceived discrimination, psychological stress, pain-related anxiety, a composite measure of cardiometabolic risk, and impaired descending inhibition of spinal nociception (assessed from conditioned pain modulation of the nociceptive flexion reflex). These results provide the first prospective evidence for a pain disparity in NAs that seems to be promoted by psychosocial, cardiometabolic, and pronociceptive mechanisms.

中文翻译：

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美洲原住民慢性疼痛发作的心理社会和心脏代谢预测因素：对俄克拉荷马州美洲原住民疼痛风险研究的 2 年前瞻性数据进行系列中介分析。

慢性疼痛会导致相当大的痛苦以及巨大的经济和社会成本。先前的证据表明，美洲原住民 (NA) 的慢性疼痛发生率高于美国其他种族/族裔群体，但造成这种疼痛差异的机制却知之甚少。俄克拉荷马州美洲原住民疼痛风险研究旨在解决这一问题，并招募了健康、无痛的原住民和非西班牙裔白人 (NHW)。横断面分析确定了逆境（例如创伤、歧视）、认知情感因素（感知压力、与疼痛相关的焦虑/灾难化）和心脏代谢因素（例如体重指数、血压、心率变异性）的几种衡量标准与伤害感受过程（例如中枢敏化、下行抑制、痛觉过敏）相关。入组后每 6 个月，就会重新联系符合条件的参与者 (N=277) 并评估其慢性疼痛的发作情况。本研究对 222 名 (80%) 在头 2 年内做出反应的人进行了慢性疼痛发作的预测因素分析。结果发现，即使在控制了年龄、性别、收入和教育程度后，NA 出现慢性疼痛的比率也高于 NHW（OR = 2.902，p<0.05）。此外，系列中介模型确定了 NA 组内慢性疼痛发作的几种潜在途径。这些路径包括感知歧视、心理压力、与疼痛相关的焦虑、心脏代谢风险的综合测量以及脊髓伤害感受的下行抑制受损（通过伤害感受屈曲反射的条件性疼痛调节来评估）。这些结果为 NA 中的疼痛差异提供了第一个前瞻性证据，这种差异似乎是由心理社会、心脏代谢和促伤害感受机制促进的。