title: Multiple Levels of Suffering: Discrimination in Health-Care Settings is Associated With Enhanced Laboratory Pain Sensitivity in Sickle Cell Disease.
abstract: 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.
authors.affiliation: *Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD †Texas A&M University, Department of Psychology, College Station, TX ‡Johns Hopkins University School of Medicine, Division of Hematology §University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD ∥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.
authors.forename: Vani A
authors.initials: VA
authors.lastname: Mathur
authors.forename: Kasey B
authors.initials: KB
authors.lastname: Kiley
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Bediako
authors.forename: Sophie
authors.initials: S
authors.lastname: Lanzkron
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Carroll
authors.forename: Luis F
authors.initials: LF
authors.lastname: Buenaver
authors.forename: Megan
authors.initials: M
authors.lastname: Pejsa
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000503:physiopathology / Q000523:psychology*; D001291:Attitude of Health Personnel; D059333:Central Nervous System Sensitization; D004192:Discrimination, Psychological; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement; D017288:Pain Threshold; D011601:Psychophysics; D057566:Self Report; D055815:Young Adult