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Multiple Levels of Suffering: Discrimination in Health-Care Settings is Associated With Enhanced Laboratory Pain Sensitivity in Sickle Cell Disease

key information

source: The Clinical Journal of Pain

year: 2016

authors: Mathur VA, Kiley KB, Haywood C Jr, Bediako SM, Lanzkron S, Carroll CP, Buenaver LF, Pejsa M, Edwards RR, Haythornthwaite JA, Campbell CM

summary/abstract:

OBJECTIVE:
People living with sickle cell disease (SCD) experience severe episodic and chronic pain and frequently report poor interpersonal treatment within health-care settings. In this particularly relevant context, we examined the relationship between perceived discrimination and both clinical and laboratory pain.

METHODS:
Seventy-one individuals with SCD provided self-reports of experiences with discrimination in health-care settings and clinical pain severity, and completed a psychophysical pain testing battery in the laboratory.

RESULTS:
Discrimination in health-care settings was correlated with greater clinical pain severity and enhanced sensitivity to multiple laboratory-induced pain measures, as well as stress, depression, and sleep. After controlling for relevant covariates, discrimination remained a significant predictor of mechanical temporal summation (a marker of central pain facilitation), but not clinical pain severity or suprathreshold heat pain response. Furthermore, a significant interaction between experience with discrimination and clinical pain severity was associated with mechanical temporal summation; increased experience with discrimination was associated with an increased correlation between clinical pain severity and temporal summation of pain.

DISCUSSION:
Perceived discrimination within health-care settings was associated with pain facilitation. These findings suggest that discrimination may be related to increased central sensitization among SCD patients, and more broadly that health-care social environments may interact with pain pathophysiology.

organization: Johns Hopkins University School of Medicine,Baltimore; Texas A&M University; Harvard Medical School; Brigham and Women's Hospital,Chestnut Hill, MA

DOI: 10.1097/AJP.0000000000000361

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