Racial and ethnic differences in experimental pain sensitivity: systematic review and meta-analysis.
Our objective was to describe the racial and ethnic differences in experimental pain sensitivity. Four databases (PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and PsycINFO) were searched for studies examining racial/ethnic differences in experimental pain sensitivity. Thermal-heat, cold-pressor, pressure, ischemic, mechanical cutaneous, electrical, and chemical experimental pain modalities were assessed. Risk of bias was assessed using the Agency for Healthcare Research and Quality guideline. Meta-analysis was used to calculate standardized mean differences (SMDs) by pain sensitivity measures. Studies comparing African Americans (AAs) and non-Hispanic whites (NHWs) were included for meta-analyses because of high heterogeneity in other racial/ethnic group comparisons. Statistical heterogeneity was assessed by subgroup analyses by sex, sample size, sample characteristics, and pain modalities. A total of 41 studies met the review criteria. Overall, AAs, Asians, and Hispanics had higher pain sensitivity compared with NHWs, particularly lower pain tolerance, higher pain ratings, and greater temporal summation of pain. Meta-analyses revealed that AAs had lower pain tolerance (SMD: -0.90, 95% confidence intervals [CIs]: -1.10 to -0.70) and higher pain ratings (SMD: 0.50, 95% CI: 0.30-0.69) but no significant differences in pain threshold (SMD: -0.06, 95% CI: -0.23 to 0.10) compared with NHWs. Estimates did not vary by pain modalities, nor by other demographic factors; however, SMDs were significantly different based on the sample size. Racial/ethnic differences in experimental pain sensitivity were more pronounced with suprathreshold than with threshold stimuli, which is important in clinical pain treatment. Additional studies examining mechanisms to explain such differences in pain tolerance and pain ratings are needed.
Department of Pain and Translational Symptom Science, University of Maryland, Baltimore, MD.
Hee Jun
HJ
Kim
Department of Pain and Translational Symptom Science, University of Maryland, Baltimore, MD.
Gee Su
GS
Yang
Department of Neural and Pain Sciences, University of Maryland, Baltimore, MD.
Joel D
JD
Greenspan
Health Sciences and Human Services Library, University of Maryland, Baltimore, MD.
Katherine D
KD
Downton
Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD.
Kathleen A
KA
Griffith
Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD.
Cynthia L
CL
Renn
Department of Organizational Systems and Adult Health, School of Nursing, University of Maryland, Baltimore, MD.
Meg
M
Johantgen
Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD.
Susan G
SG
Dorsey
D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005006:Ethnicity; D006801:Humans; D010146:Pain / Q000453:epidemiology / Q000208:ethnology* / Q000503:physiopathology*; D017288:Pain Threshold / Q000208:ethnology* / Q000523:psychology*; D014481:United States / Q000453:epidemiology / Q000208:ethnology
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