Neural and Sociocultural Mediators of Ethnic Differences in Pain

Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity/gender-balanced sample of African Americans, Hispanics, and non-Hispanic Whites using fMRI during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased fronto-striatal circuit activations associated with pain rating, discrimination, experimenter trust, and extra-nociceptive aspects of pain elsewhere. In contrast, the Neurologic Pain Signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extra-nociceptive central pain mechanisms, and suggest that nociceptive pain processing may be similar across ethnicities.