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Multiple Levels of Suffering

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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.


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.


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.


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.
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Keywords: clinical pain; patient-provider interaction; quantitative sensory testing; racial discrimination; temporal summation

Document Type: Research Article

Affiliations: 1: Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD, Texas A&M University, Department of Psychology, College Station, TX 2: Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD 3: Johns Hopkins University School of Medicine, Division of Hematology 4: University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD 5: Harvard Medical School, Departments of Anesthesiology, Perioperative, Pain Medicine, and Psychiatry; Brigham and Women's Hospital, Pain Management Center, Harvard Medical School, Chestnut Hill, MA

Publication date: December 1, 2016

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