Sensitivities to Thermal and Mechanical Stimuli: Adults With Sickle Cell Disease Compared to Healthy, Pain-Free African American Controls.

Evidence supports, but is inconclusive that sensitization contributes to chronic pain in some adults with sickle cell disease (SCD). We determined the prevalence of pain sensitization among adults with SCD pain compared with pain-free healthy adults. In a cross sectional, single session study of 186 African American outpatients with SCD pain (age 18-74 years, 59% female) and 124 healthy age, gender, and race matched control subjects (age 18-69 years, 49% female), we compared responses to standard thermal (Medoc TSA II) and mechanical stimuli (von Frey filaments). Although we observed no significant differences in thermal thresholds between controls and patients, patients with SCD had lower pain thresholds to mechanical stimuli and reported higher pain intensity scores to all thermal and mechanical stimuli at a non-painful body site. Compared with controls, about twice as many patients with SCD showed sensitization: 12% versus 23% at the anterior forearm site (P = .02), and 16% versus 32% across 3 tested sites (P = .004). Among patients with SCD, 18% exhibited some element of central sensitization. Findings indicate that persistent allodynia and hyperalgesia can be part of the SCD pain experience and should be considered when selecting therapies for SCD pain. PERSPECTIVE: Compared with matched healthy controls, quantitative sensory testing in adults with pain and sickle cell disease (SCD) demonstrates higher prevalence of sensitization, including central sensitization. The findings of allodynia and hyperalgesia may indicate neuropathic pain and could contribute to a paradigm shift in assessment and treatment of SCD pain.

Demographic Predictors of Pain Sensitivity: Results From the OPPERA Study.

The demographic factors of sex, age, and race/ethnicity are well recognized as relevant to pain sensitivity and clinical pain expression. Of these, sex differences have been the most frequently studied, and most of the literature describes greater pain sensitivity for women. The other 2 factors have been less frequently evaluated, and current literature is not definitive. Taking advantage of the large Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study cohort, we evaluated the association of sex, age, and self-reported race with 34 measures of pressure, mechanical, and thermal pain sensitivity encompassing threshold and suprathreshold perception. Women were significantly more pain-sensitive than men for 29 of 34 measures. Age effects were small, and only significant for 7 of 34 measures, however, the age range was limited (18-44 years of age). Race/ethnicity differences varied across groups and pain assessment type. Non-Hispanic white individuals were less pain-sensitive than African-American (for 21 of 34 measures), Hispanic (19 of 34), and Asian (6 of 34) individuals. No pain threshold measure showed significant racial differences, whereas several suprathreshold pain measures did. This suggests that racial differences are not related to tissue characteristics or inherent nociceptor sensitivity. Rather, the differences observed for suprathreshold pain ratings or tolerance are more likely related to differences in central nociceptive processing, including modulation imposed by cognitive, psychological, and/or affective factors. PERSPECTIVE: The influence of sex, age, and race/ethnicity on various aspects of pain sensitivity, encompassing threshold and suprathreshold measures and multiple stimulus modalities, allows for a more complete evaluation of the relevance of these demographic factors to acute pain perception.

Vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis.

OBJECTIVE: Low circulating serum levels of 25-hydroxyvitamin D (referred to hereafter as vitamin D) have been correlated with many health conditions, including chronic pain. Recent clinical practice guidelines define vitamin D levels <20 ng/ml as deficient and levels of 21-29 ng/ml as insufficient. Vitamin D insufficiency, including the most severe levels of deficiency, is more prevalent in black Americans. Ethnic and race group differences have been reported in both clinical and experimental pain, with black Americans reporting increased pain. The purpose of this study was to examine whether variations in vitamin D levels contribute to race differences in knee osteoarthritis pain. METHODS: The sample consisted of 94 participants (74% women), including 45 blacks and 49 whites with symptomatic knee osteoarthritis. Their average age was 55.8 years (range 45-71 years). Participants completed a questionnaire on knee osteoarthritis symptoms and underwent quantitative sensory testing, including measures of sensitivity to heat-induced and mechanically induced pain. RESULTS: Blacks had significantly lower levels of vitamin D compared to whites, demonstrated greater clinical pain, and showed greater sensitivity to heat-induced and mechanically induced pain. Low levels of vitamin D predicted increased experimental pain sensitivity, but did not predict self-reported clinical pain. Group differences in vitamin D levels significantly predicted group differences in heat pain and pressure pain thresholds at the index knee and ipsilateral forearm. CONCLUSION: These data demonstrate that race differences in experimental pain are mediated by differences in the vitamin D level. Vitamin D deficiency may be a risk factor for increased knee osteoarthritis pain in black Americans.

Ethnic differences in pain, itch and thermal detection in response to topical capsaicin: African Americans display a notably limited hyperalgesia and neurogenic inflammation.

BACKGROUND: Topical application of capsaicin commonly produces burning, stinging and itching as well as hyperalgesia to heat stimuli via activation of transient receptor potential vanilloid subtype 1. OBJECTIVES: To investigate whether there are differences in sensory response and neurogenic inflammation to topical capsaicin in four different ethnic populations with different skin types. METHODS: The study was performed in 40 healthy subjects consisting of 10 African Americans, 10 East Asians, 10 Hispanics and 10 Caucasians. Warmth sensation and heat pain detection thresholds, as well as pain intensity, were measured before and after application of capsaicin or placebo on forearms along with skin blood flow and the extent of the flare reaction. RESULTS: In African Americans the heat pain detection threshold, pain intensity and skin blood flow did not change significantly after capsaicin application, while in the other three ethnic groups a significant change occurred characterized by hyperalgesia and vasodilatation. The postcapsaicin warmth sensation threshold increased in African Americans and decreased in Hispanics, the latter also uniquely experiencing postcapsaicin itch. CONCLUSIONS: Our observations indicate that African Americans display a limited hypersensitivity following topical capsaicin, compared with the three other ethnic groups.

Ethnic variations in facial skin neurosensitivity assessed by capsaicin detection thresholds.

BACKGROUND: Ethnic variations in sensitive skin have not been thoroughly explored and remain controversial. OBJECTIVE: To objectively assess ethnic variations in facial skin neurosensitivity through individual detection thresholds of topically applied capsaicin. PATIENTS/METHODS: The single-blind, controlled study was performed in 144 women from three ethnicities: Asian, African, and Caucasian. Five solutions with increasing capsaicin concentration were successively applied to one side of nasolabial folds, while the other side simultaneously received the vehicle as control. The test was discontinued when the volunteer reported on the capsaicin side a sensation whatever its nature. Otherwise the experimenter continued the test, using the next solution with higher capsaicin content and so on, until the subject experienced a sensation on the capsaicin side. RESULTS: Each ethnic group was divided into six sub-groups according to the level of sensitivity to capsaicin, i.e. from detection of the lowest concentration up to no detection of the highest concentration, 100-fold higher. Asian women tended to have higher capsaicin detection thresholds than Caucasians, but lower thresholds than Africans. Nevertheless, the distribution did not greatly differ between the three ethnicities. CONCLUSIONS: The capsaicin skin neurosensitivity test is painless and the changes across individuals of different ethnic backgrounds appear minimal.

The impact of ethnic differences in response to capsaicin-induced trigeminal sensitization.

Ethnic differences in the experience of pain, pain-related health care utilization and pain-reducing activities have been reported. Thus, evaluating of such variations is important in clinical and experimental pain. Since clinical pain is greatly influenced by disease-specific factors (severity, duration, type and treatment), evaluating ethnic differences in experimental pain models may not only provide some information about underlying mechanisms but also may predict or explain group differences in clinical pain. Migraine prevalence within ethnic populations is varied. Capsaicin injection to the forehead of healthy volunteers induces the state of an experimental trigeminal sensitization, which is one of the proposed mechanisms of migraine. The aim of the present study was to investigate ethnic differences between Caucasians and South Indians in this model of trigeminal sensitization. Thirty-two healthy male volunteers (16 South Indians and 16 Danish Caucasians) were included. Capsaicin (100 microg/0.1 ml) was injected intradermally to the right forehead skin. Pain sensitivity, secondary hyperalgesic area, and pressure pain threshold were assessed. Overall, the model showed significant greater pain responses in South Indians (8.75+/-1.25 cm pain intensity and 9.33+/-2.32 cm2 hyperalgesic area) compared to Caucasians (6.25+/-1.95 cm pain intensity and 6.25+/-1.41 cm2 hyperalgesic area). The model may provide important information for further clinical research, e.g. migraine or differences in mechanisms underlying trigeminal sensitization.