Sociocultural & biobehavioral influences on pain expression and assessment

National Center For Complementary & Integrative Health

Investigators

Linked publications, trials & patents

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 completed data collection for our first sub-study on the protocol (which was halted for one year in light of the COVID-19 pandemic) and completed the second sub-study using remote data collection tools. 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 resumed data collection on the first sub-study, but accrual is quite slow in light of the pandemic, and we finally collected our 100th participant in July of 2022 after much work from the entire study team. Although our final enrollment did not achieve equal numbers across our key racial and gender demographics (i.e. 20 participants per group for Black male, Black female, White male, White female), difficulties in recruiting individuals from minoritized groups are well documented, and we will be explicit about our recruitment efforts and restricted eligibility and enrollment when we submit the manuscript. We will 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 anticipate data analyses and manuscript preparation will be complete this fall as the PhD student leading the study will be starting a postdoc shortly. Following completion, sub-study 1 participants were asked whether they want their images to be included in a database that will be shown to other participants. Images of a subset of participants who opted into this database were used as stimuli for a subsequent sub-study (sub-study 2), which measure how individuals view and judge pain in others that they perceive to be similar or different from them. 54 participants (perceivers) viewed 96 videos of people (targets) undergoing painful stimulation and provided ratings of whether the target was in pain or not and how intense the sensation was. These ratings were compared with targets actual pain ratings to allow us to measure not only pain assessment but also its accuracy. There were 12 targets from 4 sociodemographic groups: Black male, Black female, White male, White female (3 targets per group, 2 innocuous and 2 painful videos per participant). This allowed us to measure whether sociodemographic factors influenced pain assessment. We found that perceivers attributed less pain to Black individuals relative to White individuals, and were less accurate in rating pain in Black individuals. This finding mimics the well documented health disparities in pain that are observed in clinical settings and previous research. Participants also over-estimated pain in female individuals relative to males, in contrast to disparities observed in the clinic. We also found that racial differences in pain assessment were stronger for individuals who reported higher values in the modern racism scale, and that group membership (i.e. whether an individual self-reported the same racial or gender identity as the person in the video) did not impact assessment. A manuscript reporting these findings is currently in preparation (Dildine, Antkiewicz, Brookes, Olssen, and Atlas) and will be submitted within the next month.