Secondary analysis: heat and self-report pain sensitivity associate with biological sex and racialized sociocultural group but may not be mediated by anxiety or pain catastrophizing

Timothy J Meeker; Hee Jun Kim; Ingrid K Tulloch; Michael L Keaser; David A Seminowicz; Susan G Dorsey

doi:10.1097/PR9.0000000000001133

Secondary analysis: heat and self-report pain sensitivity associate with biological sex and racialized sociocultural group but may not be mediated by anxiety or pain catastrophizing

Pain Rep. 2024 Jan 24;9(1):e1133. doi: 10.1097/PR9.0000000000001133. eCollection 2024 Jan.

Authors

Timothy J Meeker^{1

2}, Hee Jun Kim³, Ingrid K Tulloch⁴, Michael L Keaser², David A Seminowicz⁵, Susan G Dorsey^{2

6}

Affiliations

¹ Department of Biology, Morgan State University, Baltimore, MD, USA.
² Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.
³ Community of Acute and Chronic Care, The George Washington University, Washington, DC, USA.
⁴ Department of Psychology, Morgan State University, Baltimore, MD, USA.
⁵ Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
⁶ Department of Pain and Translational Symptom Sciences, University of Maryland School of Nursing, Baltimore, MD, USA.

Abstract

Introduction: Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.

Methods: Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.

Results: Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 × 10^-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 × 10^-8) limited PSQ face validity in racialized minorities.

Conclusion: Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.

Keywords: Asian people; Black people; Cultural bias; Pain sensitivity; Somatization.

Abstract

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