Skip to main content
SpringerLink
Log in

The role of self-evaluated pain sensitivity as a mediator of objectively measured pain tolerance in Native Americans: findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP)

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Native Americans (NAs) are at increased risk for chronic pain. One mechanism contributing to this pain disparity could be personal pain beliefs, which may influence actual pain sensitivity. Thus, we examined whether self-evaluated pain sensitivity (SEPS) mediates the relationship between ethnicity [NAs vs. non-Hispanic Whites (NHWs)] and objectively-measured pain tolerance, and whether catastrophic thinking and pain-related anxiety influence these pain beliefs. 232 healthy, pain-free NAs and NHWs completed questionnaires measuring SEPS, catastrophizing, and anxiety. Objective pain tolerance was also assessed. Results suggested: (1) NAs reported higher levels of SEPS, catastrophizing, and anxiety, (2) catastrophizing may have enhanced anxiety and both catastrophizing and anxiety were associated with higher SEPS, and (3) anxiety and SEPS were associated with lower pain tolerance. A significant bootstrapped mediation analysis suggested NAs experienced higher pain-related anxiety, which may have promoted higher SEPS, that in turn reduced pain tolerance. Longitudinal research is needed to confirm this.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Anderson, S. R., & Losin, E. A. R. (2017). A sociocultural neuroscience approach to pain. Culture and Brain, 5, 14–35

    Google Scholar 

  • Azimi, P., Azhari, S., Shahzadi, S., Nayeb Aghaei, H., Mohammadi, H. R., & Montazeri, A. (2016). Outcome measure of pain in patients with lumbar disc herniation: Validation study of the Iranian version of Pain Sensitivity Questionnaire. Asian Spine Journal, 10, 480–487

    PubMed  PubMed Central  Google Scholar 

  • Bartley, E. J., & Fillingim, R. B. (2013). Sex differences in pain: A brief review of clinical and experimental findings. BJA: British Journal of Anaesthesia, 111, 52–58

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bell, B. A., Ruscheweyh, R., Kelley, B. J., Ness, T. J., Vetter, T. R., & Sellers, A. B. (2018). Ethnic differences identified by Pain Sensitivity Questionnaire correlate with clinical pain responses. Regional Anesthesia & Pain Medicine, 43, 200–204.

    Google Scholar 

  • Bishop, K. L., Holm, J. E., Borowiak, D. M., & Wilson, B. A. (2001). Perceptions of pain in women with headache: A laboratory investigation of the influence of pain-related anxiety and fear. Headache: The Journal of Head and Face Pain, 41, 494–499

    CAS  Google Scholar 

  • Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213

    CAS  PubMed  Google Scholar 

  • Callister, L. C. (2003). Cultural influences on pain perceptions and behaviors. Home Health Care Management & Practice, 15, 207–211

    Google Scholar 

  • Campbell, C. M., Edwards, R. R., & Fillingim, R. B. (2005). Ethnic differences in responses to multiple experimental pain stimuli. Pain, 113, 20–26

    PubMed  Google Scholar 

  • Campbell, C. M., France, C. R., Robinson, M. E., Logan, H. L., Geffken, G. R., & Fillingim, R. B. (2008a). Ethnic differences in the nociceptive flexion reflex (NFR). Pain, 134, 91–96

    PubMed  Google Scholar 

  • Campbell, C. M., France, C. R., Robinson, M. E., Logan, H. L., Geffken, G. R., & Fillingim, R. B. (2008b). Ethnic differences in diffuse noxious inhibitory controls (DNIC). The Journal of Pain : Official Journal of the American Pain Society, 9, 759–766

    Google Scholar 

  • Campbell, C. M., Kronfli, T., Buenaver, L. F., Smith, M. T., Berna, C., Haythornthwaite, J. A., & Edwards, R. R. (2010). Situational vs. dispositional measurement of catastrophizing: Associations with pain responses in multiple samples. The Journal of Pain: Official Journal of the American Pain Society, 11, 443–453

    Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396

    CAS  PubMed  Google Scholar 

  • Coronado, R., Mackie, L., Simon, C., & George, S. (2014). (180) Pain sensitivity questionnaire differentiates individuals with shoulder pain who demonstrate widespread sensitivity with quantitative sensory testing. The Journal of Pain, 15(4), S21.

  • Derogatis, L. R. (1994). SCL-90-R: Administration, scoring and procedures manual (3rd ed.). NCS Pearson.

  • Gedney, J. J., & Logan, H. (2004). Memory for stress-associated acute pain. The Journal of Pain, 5, 83–91

    PubMed  Google Scholar 

  • Gedney, J. J., & Logan, H. (2006). Pain related recall predicts future pain report. Pain, 121, 69–76

    PubMed  Google Scholar 

  • Gedney, J. J., Logan, H., & Baron, R. S. (2003). Predictors of short-term and long-term memory of sensory and affective dimensions of pain. The Journal of Pain, 4, 47–55

    PubMed  Google Scholar 

  • Goffaux, P., Michaud, K., Gaudreau, J., Chalaye, P., Rainville, P., & Marchand, S. (2011). Sex differences in perceived pain are affected by an anxious brain. Pain, 152, 2065–2073

    PubMed  Google Scholar 

  • Gracely, R. H., Geisser, M. E., Giesecke, T., Grant, M. A. B., Petzke, F., Williams, D. A., & Clauw, D. J. (2004). Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain, 127, 835–843

    CAS  Google Scholar 

  • Granot, M., & Ferber, S. G. (2005). The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study. The Clinical Journal of Pain, 21, 439–445

    PubMed  Google Scholar 

  • Green, C. R., Baker, T. A., Smith, E. M., & Sato, Y. (2003). The effect of race in older adults presenting for chronic pain management: A comparative study of black and white Americans. The Journal of Pain, 4, 82–90

    PubMed  Google Scholar 

  • Grosen, K., Drewes, A. M., Pilegaard, H. K., Pfeiffer-Jensen, M., Brock, B., & Vase, L. (2016). Situational but not dispositional pain catastrophizing correlates with early postoperative pain in pain-free patients before surgery. The Journal of Pain, 17, 549–560

    PubMed  Google Scholar 

  • Hansen, G. R., & Streltzer, J. (2005). The psychology of pain. Emergency Medicine Clinics, 23(2), 339–348.

  • Hardt, J., Jacobsen, C., Goldberg, J., Nickel, R., & Buchwald, D. (2008). Prevalence of chronic pain in a representative sample in the United States. Pain Medicine, 9, 803–812

    PubMed  Google Scholar 

  • Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications.

  • Hechler, T., Endres, D., & Thorwart, A. (2016). Why harmless sensations might hurt in individuals with chronic pain: About heightened prediction and perception of pain in the mind. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2016.01638

    Article  PubMed  PubMed Central  Google Scholar 

  • Jimenez, N., Garroutte, E., Kundu, A., Morales, L., & Buchwald, D. (2011). A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples. The Journal of Pain : Official Journal of the American Pain Society, 12, 511–522

    Google Scholar 

  • Jöreskog, K. G., & Sörbom, D. (2006). LISREL 8.80. Chicago: Scientific Software International.

  • Kim, H. J., Yang, G. S., Greenspan, J. D., Downton, K. D., Griffith, K. A., Renn, C. L., Johantgen, M., & Dorsey, S. G. (2017). Racial and ethnic differences in experimental pain sensitivity: Systematic review and meta-analysis. Pain, 158, 194–211

    PubMed  Google Scholar 

  • Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L. S., Schubiner, H., & Keefe, F. J. (2011). Pain and emotion: A biopsychosocial review of recent research. Journal of Clinical Psychology, 67, 942–968

    PubMed  PubMed Central  Google Scholar 

  • Mauldin, J., Cameron, H. D., Jeanotte, D., Solomon, G., & Jarvis, J. N. (2004). Chronic arthritis in children and adolescents in two Indian health service user populations. BMC Musculoskeletal Disorders, 5, 30

    PubMed  PubMed Central  Google Scholar 

  • McCracken, L. M., Faber, S. D., & Janeck, A. S. (1998). Pain-related anxiety predicts non-specific physical complaints in persons with chronic pain. Behaviour Research and Therapy, 36, 621–630

    CAS  PubMed  Google Scholar 

  • Meagher, M. W., Arnau, R. C., & Rhudy, J. L. (2001). Pain and emotion: Effects of affective picture modulation. Psychosomatic Medicine, 63, 79–90

    CAS  PubMed  Google Scholar 

  • Meghani, S. H., Byun, E., & Gallagher, R. M. (2012). Time to take stock: A meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Medicine, 13, 150–174

    PubMed  Google Scholar 

  • Nielsen, C. S., Staud, R., & Price, D. D. (2009). Individual differences in pain sensitivity: Measurement, causation, and consequences. The Journal of Pain, 10, 231–237

    PubMed  Google Scholar 

  • Noel, M., Palermo, T. M., Chambers, C. T., Taddio, A., & Hermann, C. (2015). Remembering the pain of childhood: Applying a developmental perspective to the study of pain memories. Pain, 156, 31–34

    PubMed  Google Scholar 

  • Osman, A., Barrios, F. X., Kopper, B. A., Hauptmann, W., Jones, J., & O’Neill, E. (1997). Factor structure, reliability, and validity of the Pain Catastrophizing Scale. Journal of Behavioral Medicine, 20, 589–605

    CAS  PubMed  Google Scholar 

  • Ostrom, C., Bair, E., Maixner, W., Dubner, R., Fillingim, R. B., Ohrbach, R., Slade, G. D., & Greenspan, J. D. (2017). Demographic predictors of pain sensitivity: Results from the OPPERA Study. The Journal of Pain : Official Journal of the American Pain Society, 18, 295–307

    Google Scholar 

  • Palit, S., Kerr, K. L., Kuhn, B. L., Terry, E. L., DelVentura, J. L., Bartley, E. J., Shadlow, J. O., & Rhudy, J. L. (2013). Exploring pain processing differences in Native Americans. Health Psychology, 32, 1127–1136

    PubMed  Google Scholar 

  • Petzke, F., Clauw, D. J., Ambrose, K., Khine, A., & Gracely, R. H. (2003). Increased pain sensitivity in fibromyalgia: Effects of stimulus type and mode of presentation. Pain, 105, 403–413.

    PubMed  Google Scholar 

  • Picavet, H. S. J., Vlaeyen, J. W. S., & Schouten, J. S. A. G. (2002). Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156, 1028–1034

    PubMed  Google Scholar 

  • Pleis, J. R., Ward, B. W., & Lucas, J. W. (2010). Summary health statistics for U.S. adults: National Health Interview Survey, 2009. Vital and Health Statistics. Series 10 Data from the National Health Survey, 249, 1–207

    Google Scholar 

  • Quan, X., Fong, D. Y. T., Leung, A. Y. M., Liao, Q., Ruscheweyh, R., & Chau, P. H. (2018). Validation of the Mandarin Chinese version of the Pain Sensitivity Questionnaire. Pain Practice, 18, 180–193

    PubMed  Google Scholar 

  • Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9, 745–758

    PubMed  PubMed Central  Google Scholar 

  • Rahim-Williams, B., Riley, J. L., Williams, A. K. K., & Fillingim, R. B. (2012). A quantitative review of ethnic group differences in experimental pain response: Do biology, psychology, and culture matter? Pain Medicine, 13, 522–540

    PubMed  Google Scholar 

  • Rahim-Williams, F. B., Riley, J. L., Herrera, D., Campbell, C. M., Hastie, B. A., & Fillingim, R. B. (2007). Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics. Pain, 129, 177–184

    PubMed  PubMed Central  Google Scholar 

  • Rehberg, B., Mathivon, S., Combescure, C., Mercier, Y., & Savoldelli, G. L. (2017). Prediction of acute postoperative pain following breast cancer surgery using the pain sensitivity questionnaire. The Clinical Journal of Pain, 33(1), 57–66.

  • Rhee, H. (2000). Prevalence and predictors of headaches in US adolescents. Headache: The Journal of Head and Face Pain, 40, 528–538

    CAS  Google Scholar 

  • Rhudy, J. L., Dubbert, P. M., Parker, J. D., Burke, R. S., & Williams, A. E. (2006). Affective modulation of pain in substance-dependent veterans. Pain Medicine, 7, 483–500

    PubMed  Google Scholar 

  • Rhudy, J. L., Huber, F., Kuhn, B. L., Lannon, E. W., Palit, S., Payne, M. F., Hellman, N., Sturycz, C. A., Güereca, Y. M., Toledo, T. A., Demuth, M. J., Hahn, B. J., & Shadlow, J. O. (2020). Pain-related anxiety promotes pronociceptive processes in Native Americans: Bootstrapped mediation analyses from the Oklahoma Study of Native American Pain Risk. Pain Reports, 5, e808

    PubMed  PubMed Central  Google Scholar 

  • Rhudy, J. L., Lannon, E. W., Kuhn, B. L., Palit, S., Payne, M. F., Sturycz, C. A., Hellman, N., Güereca, Y. M., Toledo, T. A., Huber, F., Demuth, M. J., Hahn, B. J., Chaney, J. M., & Shadlow, J. O. (2020b). Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: Main findings from the Oklahoma Study of Native American Pain Risk. Pain, 161, 388–404

    PubMed  PubMed Central  Google Scholar 

  • Robinson, M. E., Bialosky, J. E., Bishop, M. D., Price, D. D., & George, S. Z. (2010). Supra-threshold scaling, temporal summation, and after-sensation: Relationships to each other and anxiety/fear. Journal of Pain Research, 3, 25–32

    PubMed  PubMed Central  Google Scholar 

  • Ross, E., Huber, F., Kuhn, B., Lannon, E., Sturycz, C., Payne, M., Hellman, N., Toledo, T., Güereca, Y., Palit, S., Demuth, M., Shadlow, J., & Rhudy, J. (2019). (232) Assessing chronic pain onset in Native Americans: Follow-up results from the Oklahoma Study of Native American Pain Risk (OK-SNAP. The Journal of Pain, 20, S33

    Google Scholar 

  • Rowell, L. N., Mechlin, B., Ji, E., Addamo, M., & Girdler, S. S. (2011). Asians differ from non-Hispanic Whites in experimental pain sensitivity. European Journal of Pain (london, England), 15, 764–771

    Google Scholar 

  • Ruscheweyh, R., Marziniak, M., Stumpenhorst, F., Reinholz, J., & Knecht, S. (2009). Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire. Pain, 146, 65–74

    PubMed  Google Scholar 

  • Rutchick, A. M., & Slepian, M. L. (2013). Handling ibuprofen increases pain tolerance and decreases perceived pain intensity in a cold pressor test. PLoS ONE, 8, e56175

    CAS  PubMed  PubMed Central  Google Scholar 

  • Sandrini, G., Serrao, M., Rossi, P., Romaniello, A., Cruccu, G., & Willer, J. C. (2005). The lower limb flexion reflex in humans. Progress in Neurobiology, 77, 353–395

    PubMed  Google Scholar 

  • Sellers, A. B., Ruscheweyh, R., Kelley, B. J., Ness, T. J., & Vetter, T. R. (2013). Validation of the english language pain sensitivity questionnaire. Regional Anesthesia and Pain Medicine, 38, 508–514

    PubMed  Google Scholar 

  • Shavers, V., Bakos, A., & Sheppard, V. (2010). Race, ethnicity, and pain among the U.S. adult population. Journal of Health Care for the Poor and Underserved, 21, 177–220.

    PubMed  Google Scholar 

  • Shimo, K., Ueno, T., Younger, J., Nishihara, M., Inoue, S., Ikemoto, T., Taniguchi, S., & Ushida, T. (2011). Visualization of painful experiences believed to trigger the activation of affective and emotional brain regions in subjects with low back pain. PLoS ONE, 6, e26681

    CAS  PubMed  PubMed Central  Google Scholar 

  • Somers, T. J., Keefe, F. J., Pells, J. J., Dixon, K. E., Waters, S. J., Riordan, P. A., Blumenthal, J. A., McKee, D. C., LaCaille, L., Tucker, J. M., Schmitt, D., Caldwell, D. S., Kraus, V. B., Sims, E. L., Shelby, R. A., & Rice, J. R. (2009). Pain catastrophizing and pain-related fear in osteoarthritis patients: Relationships to pain and disability. Journal of Pain and Symptom Management, 37, 863–872

    PubMed  Google Scholar 

  • Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7, 524

    Google Scholar 

  • Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17, 52–64

    CAS  PubMed  Google Scholar 

  • Thorn, B. E., & Williams, G. A. (1989). Goal specification alters perceived pain intensity and tolerance latency. Cognitive Therapy and Research, 13, 171–183

    Google Scholar 

  • Toledo, T. A., Kuhn, B. L., Payne, M. F., Lannon, E. W., Palit, S., Sturycz, C. A., Hellman, N., Güereca, Y. M., Demuth, M. J., Huber, F., Shadlow, J. O., & Rhudy, J. L. (2020). The effect of pain catastrophizing on endogenous inhibition of pain and spinal nociception in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. Annals of Behavioral Medicine, 54, 575–594

    PubMed  PubMed Central  Google Scholar 

  • Vaegter, H. B., & Graven-Nielsen, T. (2016). Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity. Pain, 157, 1480–1488

    PubMed  Google Scholar 

  • Valeberg, B. T., Pedersen, L. M., Girotto, V., Christensen, V. L., & Stubhaug, A. (2017). Validation of the Norwegian Pain Sensitivity Questionnaire. Journal of Pain Research, 10, 1137–1142

    PubMed  PubMed Central  Google Scholar 

  • Wilcox, R. R. (2016). Understanding and applying basic statistical methods using R. Wiley.

    Google Scholar 

  • Zborowski, M. (1952). Cultural components in responses to pain. Journal of Social Issues, 8, 16–30

    Google Scholar 

Download references

Acknowledgements

The authors would like to thank Bethany Kuhn, Yvette Guereca, Edward Lannon, Shreela Palit, Cassandra Sturycz, Mara Demuth, Burkhart Hahn, Heather B. Coleman, Kathryn A. Thompson, Jessica M. Fisher, Samuel P. Herbig, Ky’Lee B. Barnoski, Garrett Newsom, and Lucinda Chee for their help with data collection, as well as Dr. John M. Chaney for his consultation on the project. This research was supported by the National Institute on Minority Health and Health Disparities of the National Institute of Health under Award Number R01MD007807. The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health, National Science Foundation, Indian Health Service, or the Cherokee Nation. The authors report no conflicts of interest.

Funding

This research was supported by the National Institute on Minority Health and Health Disparities of the National Institute of Health under Award Number R01MD007807. The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health, Indian Health Service, or the Cherokee Nation.

Author information

Authors and Affiliations

  1. Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA

    Erin N. Ross, Tyler A. Toledo, Felicitas Huber, Parker A. Kell, Natalie Hellman, Joanna O. Shadlow & Jamie L. Rhudy

Authors
  1. Erin N. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tyler A. Toledo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Felicitas Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Parker A. Kell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Natalie Hellman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joanna O. Shadlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jamie L. Rhudy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jamie L. Rhudy.

Ethics declarations

Conflict of interest

Erin N. Ross, Tyler A. Toledo, Felicitas Huber, Parker A. Kell, Natalie Hellman, Joanna O. Shadlow, Jamie L. Rhudy declares they do not have any conflict of interest.

Ethical approval

Study procedures were approved by the Institutional Review Boards of the University of Tulsa, Cherokee Nation, and Indian Health Service Oklahoma City Area Office.

Human and animal consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

Both verbal and written consent were obtained prior to initiation of study procedures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ross, E.N., Toledo, T.A., Huber, F. et al. The role of self-evaluated pain sensitivity as a mediator of objectively measured pain tolerance in Native Americans: findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP). J Behav Med 45, 272–284 (2022). https://doi.org/10.1007/s10865-021-00257-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-021-00257-3

Keywords

Search

Navigation