Monday, March 27, 2023

New Study Examines Impact of Race on Chronic Pain Disparities

Andrea Dilworth authored the following post for UMMC. 

As a postdoctoral researcher, Dr. Matthew Morris studied pain and sensitivity in otherwise healthy black and white children.

He was shocked by the vast differences along racial lines, and curious to learn why.

A decade later, the associate professor of psychiatry and human behavior is principal investigator of a five-year, $3.3 million study he hopes will explain how social and biobehavioral factors contribute to a greater risk of transitioning from acute to chronic pain following a traumatic orthopedic injury in black patients compared to white patients.

While acute pain ends after an injury heals, chronic pain, which continues long after treatment, can last months or years, according to the U.S. Department of Health and Human Services. Chronic pain is linked to depression and one of the top reasons people seek medical attention.

“There is a long history of false beliefs regarding non-Hispanic black individuals exhibiting greater pain tolerance than non-Hispanic white individuals, and therefore having less need for medications that could manage their pain,” Morris said. “These historically-rooted beliefs are still held by some medical students and physicians, and likely contribute to racial disparities in pain management. The research we are conducting seeks to dispel those false beliefs.

“In fact, evidence suggests that the lived experiences of non-Hispanic black individuals, which includes greater exposure to stressful and traumatic events across the lifespan, are actually associated with greater – rather than less – pain sensitivity.” 

The Acute to Chronic pain Transition and Race study (ACTR) study, funded by the National Institute for Minority Health and Health Disparities, will recruit 300 patients – half black, half white – with traumatic orthopedic injuries and assess pain outcomes during hospitalization and monthly follow-up visits. 

“It is well documented that black patients have more chronic pain and more disability due to chronic pain,” said Dr. Cindy Karlson, associate professor of psychiatry and human behavior and co-investigator. “This study will be an important step toward understanding why these disparities exists.”

In the United States, traumatic injuries cause more than 30 million trips to emergency rooms and 2.5 million hospitalizations every year, according to the National Hospital Ambulatory Medical Care Survey.

With a multidisciplinary research team from the University of Mississippi Medical Center, Vanderbilt University Medical Center, and University of Alabama at Birmingham, ACTR has begun recruiting patients.

Dr. Patrick Bergin, associate professor of orthopedic surgery and rehabilitation, said his role as co-investigator is to help identify eligible patients and determine those at high risk of chronic pain.

“The injuries we’ve chosen have been reviewed in other large prospective studies because of their propensity to cause chronic pain,” said Bergin. “Chronic pain, apart from the intrinsic suffering, can make it difficult to remain employed or enter the work force and can damage interpersonal relationships.

“If we can identify risk factors for chronic pain development and come up with solutions to prevent it, we can help improve people's lives.”

During phase one, researchers will identify similarities and differences in how biobehavioral factors including depression, posttraumatic stress, inflammatory biomarkers, and treatment expectations affect chronic pain in both groups. Phase two will focus on the impact of social factors like greater life and neighborhood stress and lower socioeconomic status.

Before patients undergo surgery, researchers will collect blood samples, which Dr. Gailen Marshall, R. Faser Triplett Sr. MD Chair of Allergy and Immunology, and his lab will use to examine levels of inflammatory biomarkers responsive to both acute stressors and injury that are elevated among people with chronic pain.

“There is a spectrum of immune/inflammatory effects to the same stressor – such as acute trauma and chronic pain – among different people just as there are different psychological responses,” Marshall explained. “Predicting who responds in a specific way to chronic stressors has tremendous therapeutic potential for patients with inflammatory dysfunction.”

As executive director of the UMMC Human Immunology and Inflammation Biomarker Core Laboratory, Marshall has extensive experience analyzing samples.

“The relationship between psychological stress and pain is a ‘two-way street,’ that is, the greater the stress, the higher the perception of pain and vice versa,” said Marshall.

Still, the role inflammation plays is unclear. Marshall believes this study will help establish the relationship between chronic pain and stress and identify an immune/inflammatory biomarker profile related to the risk for developing chronic pain.

“If so, future studies may be able to use these profiles in predicting patients at greatest risk for developing chronic pain with the ultimate goal of intervening to prevent rather than just treat the chronic pain syndrome,” said Marshall.

Karlson, also director of Inpatient Pediatric Psychology Services in the Department of Pediatrics, Division of Hematology/Oncology, said while ACTR focuses on adults, it may also help pediatric patients, many of whom spend years trying to get a medical diagnosis and “fix” their pain.

Because chronic pain is so complicated, treatment for both children and adults often involves a multidisciplinary specialty pain clinic. 

“Childhood pain often continues into adulthood,” said Karlson, “so, it is extremely important to get comprehensive treatment as soon as possible.” 

The multifaceted study will also use quantitative sensory testing to evaluate how patients respond to sensations. For example, using a type of pinprick stimulator, they will apply different amounts of pressure to the skin to examine pain sensitivity to provide insight into the patients’ pain experiences.

“We hope that improved understanding of these disparities in pain experiences, including emphasis that they emerge from lived experiences and not innate biological differences, can promote more equitable management of pain in health care settings,” said Morris.

Kingfish note: The original UMMC press release capitalized "black" while leaving "white" in lower-case.  JJ considers such a practice to be racist and edited the press release to leave both races non-capitalized. 



Anonymous said...

3.3 million for a study - if you don’t feel like reading.

Anonymous said...

So if I am reading this right, the hypothesis is not that the prescription to manage chronic pain is different, it's the biological response to pain??

If so, thats not a health disparity....

Anonymous said...

I always heard it was red heads who have the highest tolerance to pain and that it was a high correlation to their lack of possessing a soul.

Anonymous said...

Lord, wait 'til the US government gets wind of this! This will bring on more entitlements up to and including, the BIG R.

Anonymous said...

All of that money and time spent to try to find out something that almost anyone could have explained in just a few minutes. The government is very good at scattering money around just to come back on their favorite saying. It is racist. That is always the spring loaded answer to everything.

Anonymous said...


We have been studying health disparities for many years. The federal government "got wind" of it a long time ago.

Disparities do exist and they do adversely affect the health of minority populations, but as I said in 10:11......

If this is a within population biological response to pain, that isn't a disparity. Disparities are things like differences in treatment, differences in resources, differences in provider availability.....this just doesn't seem like that to me

Anonymous said...

Why race? Why whites and African Americans? Disparities can be found at any number of societal groupings. If there is one thing modern genetic/DNA analysis has taught it is that our classification of many people according to a certain "race" is often not the most significant or accurate way to identify that person. Some Chinese people have more in common physically with an individual from Africa than a person identified as African-American. This study like many whose object is to justify a social policy is probably more political science than medical science.

Anonymous said...

This is not a research study; it is a confirmation piece to “dispel” the false beliefs that White doctors have about Black people’s pain tolerance, according to the principal “researcher” himself. So, they already have their conclusion, and simply need to spend 3.5 mil on research to validate their pre-conceived, lived experiences truth. And to continually emphasize that Black and Hispanic people deserve the reverence of upper case letters, while whitey is a mere lower case sub-group. Just return the money and write “systemic racism practiced by whitey doctors denies non-Hispanic Black people proper medical treatment. The end.”

Anonymous said...

Pain is a subjective measure and cannot be independently verified by labs, radiology, etc. In fact, pain as a "fifth vital sign" was largely created by opioid-producing pharma companies ( You know that graphic you sometimes see on the wall in a doctor's office that shows a 1-10 scale from "No Pain" to "Worst Possible" or "Very Severe" - pharma.

This proposed study is dubious at best. CMS is now pushing hard the concept of "health equity" (whatever that means). Sounds like someone is trying to catch that tailwind.

Anonymous said...

The study looks at " social and biobehavioral factors ." In other words,enviornmental variables.There is no accounting for genetic factors.Like so many studies this study will probably conclude that structural racism is at least in part to blame. Poor health outcomes often have a genetic basis.

Wokeness? said...

Why is "black" capitalized and "white" is not? Hmmm.

Anonymous said...

So we are all equal....but we aren't. How about white's who have experienced bio-behavioral trauma? Does the same hypothesis apply? If so, the hypothesis really has nothing to do with race and this is just some woke mumbo-jumbo put out by those who despise categorizing people by race, while at the same time perpetuating it.

Anonymous said...

I quit reading when I saw the word “black” capitalized and the word “White” not capitalized .

Anonymous said...

Reading this article is giving me chronic pain

Anonymous said...

If you look at the literature on health and healthcare disparities (two different things), you start noticing big numbers like 75 percent vs 25 percent, on and on. This stuff isn't some social policy agenda hit piece, these are real researchers, trying to solve real problems that exist within our very real healthcare system........ and you bet if you get a 3.5 million dollar grant your research proposal made sense to some extremely intelligent people.

And yes, I am typing in a hurry so I am sure there are typos all in that paragraph y'all will be happy to ding me on.

And I don't like Gailen Marshall personally but he is pretty much a legend

Anonymous said...

Both my maternal and paternal families have a high threshold of pain.
My spouse's families do not.
There is no difference in effort, determination or the ability to obtain or treatment or correctly co-operate.
I'm always amazed by all kinds of baseless assumptions and intolerance!

Anonymous said...

"Reading this article is giving me chronic pain".

Bet it's in your ass like mine is.

Anonymous said...

Isn't this entire study superfluous? C'mon, we've got medical maryjane!

Anonymous said...

Written with a big dose of "confirmation bias."

Don Drane said...

10:47 - You're having trouble with the word 'disparity'. I'm sure you've probably heard the term 'disparate impact'.

For at least 50 years that's been the label federal government agencies have hung on everything related to myths associated with minorities.

And to address disparate impact, it takes, guess what? Federal government intervention into the private sector, control of business and industry and the granting of preference in all aspects of our lives.

Pro tip said...

"Andrea Dilworth authored the following post for UMMC."

All I got to say is IF you wind up in the UMMC ER with pain that you think is a heart attack, you better go FULL ON FRED SANFORD so you will be seen sooner than the 10 1/2 hours I waited to be seen.

Krusatyr said...

I've had excellent surgeries at St D's, the old Hinds Central and Baptist, for twenty-five+ years, incredible doctors and surgeons also. Just had pacemaker replaced at Baptist and surgeon, attending staff, anesthesiologists were all top drawer. I avoid UMC, maybe I just think their buildings are ugly, so bad luck?

Anonymous said...

Krusadist: Hinds Central, or whatever it's called now, has, over the past 25 years, changed names as often as it has changed bed linens. Good luck keeping pace now with your new alternator.

Anonymous said...

"The study looks at " social and biobehavioral factors ." In other words,enviornmental variables.There is no accounting for genetic factors.Like so many studies this study will probably conclude that structural racism is at least in part to blame. Poor health outcomes often have a genetic basis."
March 27, 2023 at 11:33 AM

I noticed that. A century of Communists' having worked to limit what one is allowed to say, means that one is only ALLOWED to conclude that something like Structural Racism is behind the difference in outcomes.

Meanwhile, a Communist nation which has been mapping the world's genome, has STATED that it is working on race-specific diseases - as in creating pathogens to target specific racial groups (in other words, they are free to acknowledge things which we are forbidden to acknowledge).

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