Sociocultural & biobehavioral influences on pain expression and assessment

National Center For Complementary & Integrative Health

Investigators

Linked publications & trials

Abstract

This protocol measures pain-related facial responses in a diverse population to measure whether nonverbal responses to pain vary as a function of biological and sociocultural factors. We will then measure whether individuals (both healthy volunteers and medical providers) pay attention to different features of pain or assess pain differently in in-group relative to out-group individuals, and whether we can develop interventions to reduce any biases in attention or pain assessment. This year, we resumed data collection for our first sub-study on the protocol (which was halted for one year in light of the COVID-19 pandemic), and modified our protocol to be able to use remote data collection tools to complete sub-studies 2 and 3. We made numerous adjustments to be able to resume data collection on our first sub-study, which measures the association between noxious stimuli, pain, and facial responses. Of course measuring facial responses would not be possible if participants wore masks, and therefore we made physical modifications to our testing room in order to safely administer pain with the participant in one room and the experimenter in another adjacent room. The study was on hold from March through September of 2020, then we spent two months adjusting procedures and implementing telehealth and e-screening to reduce in person testing time. We collected two participants in November of 2020, then were required to halt healthy volunteer research again until April 2021. We have since resumed data collection on the first sub-study, but accrual is quite slow in light of the pandemic. We now have 77 participants who completed sub-study 1 (we had 64 at the end of last year). Data collection will be complete when we have at least 100 participants (20 participants per group for Black male, Black female, White male, White female). We will then use specialized software to measure facial responses via video and to avoid implicit biases that could affect results if we used human coders. We will measure whether sex differences are observed in facial responses that are similar to sex differences in pain, as well as whether we see differences in facial responses or sex differences as a function of race, ethnicity, or identity centrality of race or sex. We have begun analyzing facial and autonomic data from the study to establish our data processing pipeline. Following completion, sub-study 1 participants are asked whether they want their images to be included in a database that will be shown to other participants. Images of participants who opt into this database are used as stimuli for our subsequent sub-studies 2 and 3, which measure how individuals view and judge pain in others that they perceive to be similar or different from them. Through this, we hope to gain insight on behavioral mediators of health disparities in pain. We originally planned to record eye position during pain assessment and measure responses in both healthy volunteers and medical providers. However, in light of the pandemic, we modified the study to remove eye tracking so that the study could be completed remotely. We also removed the medical provider group to facilitate simpler accrual. We are now collecting data for sub-study 2 concurrently with substudy 1 and have 14 participants who have completed the task. Data collection will be complete when we have 54 participants.