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(908)
Abstracts
S77
(907) Relationship of ethnicity and coping style to laboratory pain stimuli among healthy children
(909) Spouse responses to pain and well behavior predict functioning in patients with chronic pain
S Kim, J Tsao, N Turk, Q Lu, C Myers, L Zeltzer; UCLA Pediatric Pain Program, Los Angeles, CA Ethnic-related differences in pain in adults have been documented: African-Americans report higher levels of clinical pain and show greater experimental pain sensitivity compared to Caucasians. However, the possible moderating effect of coping style on this relationship has received less attention and few studies have included children. We examined healthy children’s responses to laboratory pain tasks (cold pressor, thermal heat, and pressure) and the contribution of coping style to ethnic differences in pain responses. Coping style was categorized as ‘attender’ (e.g., attending to sensory aspects of the task) or ‘distractor’ (e.g., cognitive distraction) based on the primary coping strategy children reported using during the cold task. Our sample included 123 children (50% male, mean age 12.9 yr (SD ⫽ 3.0), range 8-18 yr) with an ethnic breakdown of 73% Caucasian (n⫽90) and 27% African-American (n⫽33). Using multiple regression analyses, pain tolerance and self-report rating of pain intensity were modeled separately for the pain tasks. Coping style, ethnicity, and their interaction were entered as independent variables, controlling for age. No independent variable predicted pain tolerance. For heat intensity, there was a significant main effect for ethnicity [F(1, 122) ⫽ 7.34, p ⫽ .008], with African-Americans reporting lower intensity. There were no significant coping style differences across ethnic groups. However, the coping-by-ethnicity interaction predicted pressure intensity only [F(3, 122) ⫽ 5.90, p ⫽ .017]. African-American distractors reported increased pressure pain relative to Caucasian distractors, whereas African-American attenders reported decreased pressure intensity compared to Caucasian attenders. The interaction effects for cold and heat intensity approached significance (p⫽0.061). The present findings are at odds with prior work showing increased pain sensitivity in African-Americans and increased pain tolerance in distractors. Our current findings point to a moderating effect of coping style when predicting laboratory pain outcome differences across ethnic groups among children and adolescents.
K Raichle, J Romano, M Jensen; University of Washington School of Medicine, Seattle, WA Research supports operant models of chronic pain, suggesting that spouse responses to pain behaviors can influence functioning and disability in persons with chronic pain, yet there has been no systematic examination of the impact of spouse responses to well behavior. Thus, the goal of the current study was to examine the differential impact of spouse responses to both pain and well behaviors. Ninety-four patients with chronic musculoskeletal pain and their spouses or intimate partners completed questionnaires assessing demographic variables, illness-related physical functioning, depression, pain intensity, and pain behaviors. The Spouse Response Inventory, a recently developed and validated scale, was used to assess solicitous and negative responses to pain behavior, as well as facilitative and negative responses to well behavior. Multiple regression analyses were used to examine the associations between these response styles and patient depression, functioning, and pain behavior. Demographic variables and pain severity were controlled in these analyses. Negative responses to pain behavior were associated with more depressive symptomatology ( ⫽ .36, p ⬍ .01) and greater patient reported pain behavior ( ⫽ .23, p ⬍ .05). Solicitous responses to pain behavior were associated with greater reports of patient pain behavior by both patient and spouse (s ⫽ .27, ps ⬍ .05). Alternatively, facilitative responses to well behavior were associated with fewer reports of patient pain behavior by both patient and spouse (s ⫽ ⫺.26 and ⫺.30, respectively, ps ⬍ .05). Finally, negative responses to well behavior was associated with greater illness-related physical dysfunction ( ⫽ .23, p ⬍ .01) and spouse reports of patient pain behavior ( ⫽ .30, p ⬍ .01). The current study lends further support for the potential impact of spousal responses to pain behavior and implicates the need to further examine responses to well behavior that encourage and promote functioning.
(908) Association between race, neighborhood SES and chronic pain in black and white elders
(910) Ethnicity and pain: Experimental pain narratives
C Green, M Fuentes; University of Michigan, Ann Arbor, MI The association between race, neighborhood socioeconomic status (nSES) and chronic pain has not been examined. Previous studies have shown that higher nSES is associated with improved health, especially at older ages. Because of the demonstrated link between nSES and health in the elderly, we assessed the relative roles of nSES and race in the chronic pain experience. Using the UM Pain Clinic Database from 19932000 and the 1990 Census, we examine the role of black or white race and nSES on chronic pain and its sequelae for a sample aged 50 and over. We used structural equation modeling (SEM) to examine disparities and the relative contributions of race and nSES to chronic pain. Univariate analysis showed blacks had significantly more affective pain, pain-related disability and mood disorders than whites. SEM showed blacks lived in a lower SES neighborhood, with a stronger association for those over age 65. Living in a lower SES neighborhood was associated with increased pain severity, pain-related disability and mood disorders. Race was independently associated with affective pain as well as indirectly associated through nSES. Racial disparities in pain-related disability were mediated by nSES. Black race was not associated with more mood disorders, but with living in a lower SES neighborhood which was in turn associated with more mood disorders. Neither race nor nSES are singularly important factors in the chronic pain experience. Both race and nSES are important when examining chronic pain patients. Interventions designed to improve nSES would likely reduce racial disparities in the chronic pain experience for older black and white Americans.
R Gibson, R Harris, B Rahim-Williams, D Herrera, C Campbell, K Virtusio, J Riley III, B Hastie, R Fillingim; University of Florida, Gainesville, FL A recent study of experimental pain suggests expectations of pain experiences contribute to differences in response to painful stimuli in experimental settings. In addition, factors such as gender and ethnicity/ culture have also been found to have an impact on the perception of pain experiences. These expectations can be confounding factors in experimental pain research. It is therefore important to understand and relate participant expectations to experimental pain situations. As part of a larger study of healthy volunteers that examines gender and ethnic difference in response to experimental pain participants responded to a structured, open-ended interview. The participants were asked to describe past physical pain experiences and to compare their responses to those of other genders and ethnicities. Participants in the study selfidentified as belonging to one of three ethnic groups: Non-Hispanic White (n⫽23), African American (n⫽22) or Hispanic (n⫽20). Each ethnic group contained both male and female participants. Interviews were coded using Atlas-ti and analysis included a comparison of responses, themes and narratives between and among gender and ethnic groups. Differences were observed in the type of pain experiences recalled with men reporting more sports or trauma injuries and women generally reporting menstrual or somatic pain. Expectations of pain tolerance also varied by gender and ethnicity. Participant responses reflected the belief that men were expected to tolerated pain better than women, however many women in the study reported having a higher pain tolerance than their male peers. This belief was also expressed for various ethnicities. Participants often described their pain experiences in a narrative context. The unique aspects of the acute pain narratives are discussed within the context of the chronic pain narrative literature. The results of this study suggest that a qualitative research approach provides a unique understanding of cultural values and expectations that can affect experimental pain responses.
S77
(907) Relationship of ethnicity and coping style to laboratory pain stimuli among healthy children
(909) Spouse responses to pain and well behavior predict functioning in patients with chronic pain
S Kim, J Tsao, N Turk, Q Lu, C Myers, L Zeltzer; UCLA Pediatric Pain Program, Los Angeles, CA Ethnic-related differences in pain in adults have been documented: African-Americans report higher levels of clinical pain and show greater experimental pain sensitivity compared to Caucasians. However, the possible moderating effect of coping style on this relationship has received less attention and few studies have included children. We examined healthy children’s responses to laboratory pain tasks (cold pressor, thermal heat, and pressure) and the contribution of coping style to ethnic differences in pain responses. Coping style was categorized as ‘attender’ (e.g., attending to sensory aspects of the task) or ‘distractor’ (e.g., cognitive distraction) based on the primary coping strategy children reported using during the cold task. Our sample included 123 children (50% male, mean age 12.9 yr (SD ⫽ 3.0), range 8-18 yr) with an ethnic breakdown of 73% Caucasian (n⫽90) and 27% African-American (n⫽33). Using multiple regression analyses, pain tolerance and self-report rating of pain intensity were modeled separately for the pain tasks. Coping style, ethnicity, and their interaction were entered as independent variables, controlling for age. No independent variable predicted pain tolerance. For heat intensity, there was a significant main effect for ethnicity [F(1, 122) ⫽ 7.34, p ⫽ .008], with African-Americans reporting lower intensity. There were no significant coping style differences across ethnic groups. However, the coping-by-ethnicity interaction predicted pressure intensity only [F(3, 122) ⫽ 5.90, p ⫽ .017]. African-American distractors reported increased pressure pain relative to Caucasian distractors, whereas African-American attenders reported decreased pressure intensity compared to Caucasian attenders. The interaction effects for cold and heat intensity approached significance (p⫽0.061). The present findings are at odds with prior work showing increased pain sensitivity in African-Americans and increased pain tolerance in distractors. Our current findings point to a moderating effect of coping style when predicting laboratory pain outcome differences across ethnic groups among children and adolescents.
K Raichle, J Romano, M Jensen; University of Washington School of Medicine, Seattle, WA Research supports operant models of chronic pain, suggesting that spouse responses to pain behaviors can influence functioning and disability in persons with chronic pain, yet there has been no systematic examination of the impact of spouse responses to well behavior. Thus, the goal of the current study was to examine the differential impact of spouse responses to both pain and well behaviors. Ninety-four patients with chronic musculoskeletal pain and their spouses or intimate partners completed questionnaires assessing demographic variables, illness-related physical functioning, depression, pain intensity, and pain behaviors. The Spouse Response Inventory, a recently developed and validated scale, was used to assess solicitous and negative responses to pain behavior, as well as facilitative and negative responses to well behavior. Multiple regression analyses were used to examine the associations between these response styles and patient depression, functioning, and pain behavior. Demographic variables and pain severity were controlled in these analyses. Negative responses to pain behavior were associated with more depressive symptomatology ( ⫽ .36, p ⬍ .01) and greater patient reported pain behavior ( ⫽ .23, p ⬍ .05). Solicitous responses to pain behavior were associated with greater reports of patient pain behavior by both patient and spouse (s ⫽ .27, ps ⬍ .05). Alternatively, facilitative responses to well behavior were associated with fewer reports of patient pain behavior by both patient and spouse (s ⫽ ⫺.26 and ⫺.30, respectively, ps ⬍ .05). Finally, negative responses to well behavior was associated with greater illness-related physical dysfunction ( ⫽ .23, p ⬍ .01) and spouse reports of patient pain behavior ( ⫽ .30, p ⬍ .01). The current study lends further support for the potential impact of spousal responses to pain behavior and implicates the need to further examine responses to well behavior that encourage and promote functioning.
(908) Association between race, neighborhood SES and chronic pain in black and white elders
(910) Ethnicity and pain: Experimental pain narratives
C Green, M Fuentes; University of Michigan, Ann Arbor, MI The association between race, neighborhood socioeconomic status (nSES) and chronic pain has not been examined. Previous studies have shown that higher nSES is associated with improved health, especially at older ages. Because of the demonstrated link between nSES and health in the elderly, we assessed the relative roles of nSES and race in the chronic pain experience. Using the UM Pain Clinic Database from 19932000 and the 1990 Census, we examine the role of black or white race and nSES on chronic pain and its sequelae for a sample aged 50 and over. We used structural equation modeling (SEM) to examine disparities and the relative contributions of race and nSES to chronic pain. Univariate analysis showed blacks had significantly more affective pain, pain-related disability and mood disorders than whites. SEM showed blacks lived in a lower SES neighborhood, with a stronger association for those over age 65. Living in a lower SES neighborhood was associated with increased pain severity, pain-related disability and mood disorders. Race was independently associated with affective pain as well as indirectly associated through nSES. Racial disparities in pain-related disability were mediated by nSES. Black race was not associated with more mood disorders, but with living in a lower SES neighborhood which was in turn associated with more mood disorders. Neither race nor nSES are singularly important factors in the chronic pain experience. Both race and nSES are important when examining chronic pain patients. Interventions designed to improve nSES would likely reduce racial disparities in the chronic pain experience for older black and white Americans.
R Gibson, R Harris, B Rahim-Williams, D Herrera, C Campbell, K Virtusio, J Riley III, B Hastie, R Fillingim; University of Florida, Gainesville, FL A recent study of experimental pain suggests expectations of pain experiences contribute to differences in response to painful stimuli in experimental settings. In addition, factors such as gender and ethnicity/ culture have also been found to have an impact on the perception of pain experiences. These expectations can be confounding factors in experimental pain research. It is therefore important to understand and relate participant expectations to experimental pain situations. As part of a larger study of healthy volunteers that examines gender and ethnic difference in response to experimental pain participants responded to a structured, open-ended interview. The participants were asked to describe past physical pain experiences and to compare their responses to those of other genders and ethnicities. Participants in the study selfidentified as belonging to one of three ethnic groups: Non-Hispanic White (n⫽23), African American (n⫽22) or Hispanic (n⫽20). Each ethnic group contained both male and female participants. Interviews were coded using Atlas-ti and analysis included a comparison of responses, themes and narratives between and among gender and ethnic groups. Differences were observed in the type of pain experiences recalled with men reporting more sports or trauma injuries and women generally reporting menstrual or somatic pain. Expectations of pain tolerance also varied by gender and ethnicity. Participant responses reflected the belief that men were expected to tolerated pain better than women, however many women in the study reported having a higher pain tolerance than their male peers. This belief was also expressed for various ethnicities. Participants often described their pain experiences in a narrative context. The unique aspects of the acute pain narratives are discussed within the context of the chronic pain narrative literature. The results of this study suggest that a qualitative research approach provides a unique understanding of cultural values and expectations that can affect experimental pain responses.