The social context of burning mouth syndrome: an exploratory pilot study of stigma, discrimination, and pain.

BACKGROUND: The social context of burning mouth syndrome (BMS) has received little attention in the scientific literature. However, social psychological theory and insights from those with lived experiences suggest that people living with BMS experience compounding effects of stigma related to their pain, diagnosis (or lack thereof), and intersectional identities. OBJECTIVE: Our aim is to provide initial evidence and to motivate new directions for research on BMS. Here, we present the results of an exploratory pilot study (n = 16) of women living with BMS in the United States. METHODS: Participants completed self-report measures of stigma, discrimination, and pain, as well as laboratory assessments of pain through quantitative sensory testing. RESULTS: Results indicate a high prevalence of internalized BMS stigma, experience of BMS-related discrimination from clinicians, and gender stigma consciousness in this population. Moreover, results provide initial evidence that these experiences are related to pain outcomes. The most robust pattern of findings is that internalized BMS stigma was related to greater clinical pain severity, interference, intensity, and unpleasantness. CONCLUSION: Given the prevalence and pain-relevance of intersectional stigma and discrimination identified in this pilot study, lived experience and social context should be incorporated into future research on BMS.

Estimation of microsatellite-based autozygosity and its correlation with pedigree inbreeding coefficient in crossbred cattle.

In countries where farming is largely subsistence, no pedigree records of farm animals are maintained at farmers' herd and scientific mating plans are not observed which leads to the accumulation of inbreeding and loss of production potential. Microsatellites have been widely used as reliable molecular markers to measure inbreeding. We attempted to correlate autozygosity estimated from microsatellite data with the inbreeding coefficient (F) calculated from pedigree data in Vrindavani crossbred cattle developed in India. The inbreeding coefficient was calculated from the pedigree of ninety-six Vrindavani cattle. Animals were further grouped into three groups viz. acceptable/low (F: 0-5%), moderate (F: 5-10%) and high (F: ≥10%), based on their inbreeding coefficients. The overall mean of the inbreeding coefficient was found to be 0.070 ± 0.007. A panel of twenty-five bovine-specific loci were chosen for the study according to ISAG/FAO. The mean FIS, FST, and FIT values were 0.0548 ± 0.025, 0.012 ± 0.001 and 0.0417 ± 0.025, respectively. There was no significant correlation between the FIS values obtained and the pedigree F values. The locus-wise individual autozygosity was estimated using the method-of-moments estimator (MME) formula for locus-specific autozygosity. The autozygosities ascribing to CSSM66 and TGLA53 were found to be significantly (p < .01 and p < .05, respectively) correlated with pedigree F values.

Exploration of allelic variants in short tandem repeats (STRs) flanking milk production QTLs and their association with milk production traits in Indian water buffaloes.

Short tandem repeats (STRs) are co-dominant, highly polymorphic marker loci, distributed throughout the genome and useful for identification and mapping of QTLs associated with variation in traits of economic significance. Allelic variants were identified in STRs located in close vicinity of cattle QTLs for milk production,, viz. BMS713, BM6404, BM4513, BM121, BM6105, TGLA245, BL1100, BMS1948, BMS711, BM1443, BM1706, BM6438, BM143, BM415, ETH131, ETH 2, and BM1329 in 109 water buffaloes of Murrah breed. All loci except TGLA245 exhibited polymorphism of varying degree. The observed number of alleles, effective number of alleles, PIC value, observed heterozygosity, and expected heterozygosity across all STR loci averaged 4.12 ± 0.22, 3.20 ± 0.22, 0.60 ± 0.04, 0.34 ± 0.05, and 0.66 ± 0.03, respectively. Goodness of fit (chi-square) and likelihood ratio (G square) test demonstrated that the population exhibited a deviation from HWE for all the loci. FIS was positive and ranged from 0.22 to 1.00. Least square analysis of variance exhibited significant effects of BM4513, ETH131, BM713, and BM6105 on first lactational total lactation milk yield, 305-day milk yield, lactation length, and dry period respectively. None of the STRs could exhibit significant effect on peak yield.

Motivational Salience Guides Attention to Valuable and Threatening Stimuli: Evidence from Behavior and Functional Magnetic Resonance Imaging.

Rewarding and aversive outcomes have opposing effects on behavior, facilitating approach and avoidance, although we need to accurately anticipate each type of outcome to behave effectively. Attention is biased toward stimuli that have been learned to predict either type of outcome, and it remains an open question whether such orienting is driven by separate systems for value- and threat-based orienting or whether there exists a common underlying mechanism of attentional control driven by motivational salience. Here, we provide a direct comparison of the neural correlates of value- and threat-based attentional capture after associative learning. Across multiple measures of behavior and brain activation, our findings overwhelmingly support a motivational salience account of the control of attention. We conclude that there exists a core mechanism of experience-dependent attentional control driven by motivational salience and that prior characterizations of attention as being value driven or supporting threat monitoring need to be revisited.

Establishment of a Patient-Centered Outcomes Research Network for Individuals with TBI and Neuropsychiatric Symptoms.

Aims: The overarching goal of this project was to establish a group comprised of a variety of TBI stakeholders for the purpose of: (1) determining facilitators and barriers in management of neuropsychiatric symptoms after TBI; (2) identifying strategies for maintaining a TBI PCOR network; (3) enumerating research topics related to TBI neuropsychiatry; and (4) highlighting policy changes related to TBI neuropsychiatry.Methods: Twenty-nine TBI stakeholders participated in focus group discussions. Qualitative analyses were conducted both manually and using Dedoose software.Results: Participant-identified barriers included stigma associated with experiencing neuropsychiatric symptoms and poor insurance coverage. Facilitators included treatment focused on education of neuropsychiatric symptoms after TBI and having a comprehensive caregiver plan. Best strategies for maintaining TBI PCOR network included having a well-defined project, continued regular meetings, and on-going education of network members. Pertinent research topics included TBI and aging, factors influencing outcomes after TBI, substance use disorders related to TBI, and effectiveness of telemental health services. Needed policy changes included making TBI neuropsychiatry education accessible to stakeholders and improving accessibility of TBI neuropsychiatric care.Conclusion: TBI stakeholders identified several facilitators of care for neuropsychiatric symptoms after TBI and suggested research topics and best practices for conducting PCOR in this area.

Characterization of pain, disability, and psychological burden in Marfan syndrome.

The clinical manifestations of Marfan syndrome frequently cause pain. This study aimed to characterize pain in a cohort of adults with Marfan syndrome and investigate demographic, physical, and psychological factors associated with pain and pain-related disability. Two hundred and forty-five participants (73% female, 89% non-Hispanic white, 90% North American) completed an online questionnaire assessing clinical features of Marfan syndrome, pain severity, pain-related disability, physical and mental health, depressive symptoms, pain catastrophizing, and insomnia. Eighty-nine percent of respondents reported having pain with 28% of individuals reporting pain as a presenting symptom of Marfan syndrome. Almost half of individuals reported that pain has spread from its initial site. Participants in our study reported poor physical and mental health functioning, moderate pain-related disability, and mild levels of depressive symptoms, sleep disturbances, and pain catastrophizing. Those who identified pain as an initial symptom of Marfan syndrome and those who reported that pain had spread from its initial site reported greater psychological burden compared with those without pain as an initial symptom or pain spreading. Physical health is the largest predictor of pain severity and pain-related disability. While pain catastrophizing and worse mental health functioning are significant correlates of pain severity and pain-related disability, respectively. Pain is a significant and persistent problem in Marfan syndrome and is associated with profound disability and psychological burden. Further studies are indicated to better characterize the directionality of pain, pain-related disability, and psychological burden in Marfan syndrome. © 2016 Wiley Periodicals, Inc.

A perspectives approach to suicide after traumatic brain injury: case and review.

BACKGROUND: Suicidal behavior after traumatic brain injury (TBI) is an increasingly recognized phenomenon. Both TBI and suicide are major public health problems and leading causes of death. The interaction between both of them is complex, and understanding it requires a multifaceted approach. Epidemiologic studies have shown a markedly higher incidence of suicide in individuals with TBI as compared with the general population, but imprecise definitions of suicide and suicidality as well as sample characteristics caution conclusive interpretation. Risk factors for suicide after TBI include male gender, presence of substance abuse or psychiatric disorders, and the severity of the injury. Evaluation of a suicidal patient with previous TBI currently relies on careful clinical examination. Established assessment tools can be useful but have not all been validated in this population. Intervention strategies should stress a multidimensional approach incorporating neurologic, behavioral, psychologic, pharmacotherapeutic, and psychosocial factors. OBJECTIVE: This article serves to review the currently available literature on suicidal behavioral after TBI. METHODS: It uses a case to illustrate how one might conceptualize this complex problem. CONCLUSION: It is hoped that this review stimulates further research in an area where there are still large gaps in our knowledge of this very important problem.

Bystander Acknowledgment Mitigates the Psychological and Physiological Pain of Racial Discrimination for Black Young Adults: A Randomized Controlled Trial.

Racism increases pain sensitization and contributes to racialized pain inequities; however, research has not tested interventions targeting racism to reduce pain. In this study, we examined whether White bystanders can act to mitigate racism's pain-sensitizing effects. To simulate racial exclusion in the laboratory, Black young adults (age 18-30; N = 92) were randomly assigned to be included or excluded by White players in a ball-tossing game (Cyberball). For half of the excluded participants, White bystanders acknowledged and apologized for the racial exclusion. Participants completed a cold pressor task to assess pain threshold, tolerance, and unpleasantness, and completed a survey assessing psychological needs (ie, belongingness, self-esteem, meaningful existence, and self-control). Participants who experienced racial exclusion reported significantly more threatened psychological needs and increased laboratory pain sensitization (ie, lower pain threshold and tolerance) than those who were included. However, when a White bystander acknowledged the racism, excluded participants reported higher levels of self-control, self-esteem, and decreased pain sensitization (pain threshold and tolerance) relative to excluded participants whose experience was not acknowledged. Our findings support that racism increased Black people's pain sensitivity and provide initial evidence for White bystander acknowledgment as a health intervention. PERSPECTIVE: Continual exposure to racism likely contributes to inequities in pain sensitization. We demonstrate that acute exposure to mild racism increases acute pain sensitization. Results suggest that a bystander acknowledging witnessed racism can buffer the acute sensitizing effects of racism on pain, pointing to the potential of interpersonal interventions targeting racism. TRIAL REGISTRATION: Clinicaltrials.gov NCT06113926.

Higher self-perceived stress reactivity is associated with increased chronic pain risk.

Introduction: Experiencing stress can contribute to unfavorable pain experiences, but outcomes vary across individuals. Evidence suggests that a person's specific reactivity to stressful events may influence pain responses. Previous studies measuring physiological stress reactivity have found associations with pain both clinically and in the laboratory. However, the time and cost required for testing physiological stress reactivity may limit clinical application. Objective: Self-reported perception of one's own stress reactivity has been shown to correlate with physiological stress reactivity in relation to health outcomes and may represent a valuable tool in clinical pain assessment. Methods: Using data from the Midlife in the US survey, we selected participants who did not have chronic pain at baseline (n = 1512) and who had data at follow-up 9 years later. Stress reactivity was assessed using a subscale of the Multidimensional Personality Questionnaire. We conducted a binary logistic regression to determine the odds of developing chronic pain, controlling for demographics and other health-related variables. Results: Results indicate that higher reported stress reactivity at baseline increased the odds of developing chronic pain at follow-up (odds ratio (OR) = 1.085, 95% confidence interval (CI) (1.021, 1.153), P = 0.008), with the only other significant predictor being the number of chronic conditions (OR = 1.118, 95% CI (1.045, 1.197), P = 0.001). Conclusion: Findings provide evidence for the predictive criterion validity of self-reported stress reactivity in the context of chronic pain risk. More generally, with increased need for virtual assessment and care, self-reported stress reactivity may be a useful, time-efficient, and cost-efficient tool for predicting pain outcomes in research and clinical contexts.

Experiencing Pain Invalidation is Associated with Under-Reporting of Pain: A Social Psychological Perspective on Acute Pain Communication.

Pain invalidation involves the dismissal or lack of understanding of another's pain, undermining their subjective experience. Frequent exposure to invalidation negatively impacts mental and physical health as well as pain-related behaviors, potentially leading people to conceal their pain from others in the future and/or withdraw from potential sources of support. It is therefore possible that experiencing pain invalidation may also impact pain-reporting behavior in clinical settings. Across 2 separate samples of emerging adults, we examined whether exposure to invalidation of one's pain was associated with cognizant modulation of one's subjective acute pain ratings within routine medical and dental settings. Drawing upon social psychological theories of impression management and self-presentation, we hypothesized that exposure to pain invalidation would be associated with the under-rating of one's pain. In Study 1, previous experiences of invalidation were associated with under-rating of one's pain when visiting the doctor and the dentist. Study 2 found that invalidation from family and medical professionals-but not from friends-was associated with under-rating pain in both settings. Findings provide further evidence for the harmful effects of pain invalidation, particularly for emerging adults, as the dismissal of one's subjective experience may sow self-doubt while reinforcing cultural stigmas against pain, leading to alterations in pain communication that ultimately creates barriers to efficacious clinical treatment and care and increase pain-related suffering. PERSPECTIVE: Pain invalidation imparts harm to those who already suffer from pain, be it mentally, physically, and/or behaviorally. We show that people who have encountered invalidation are more likely to under-rate their pain when seeking care, impeding assessment and treatment, and further highlighting the importance of clinical validation of pain experiences.

Traumatic Life Experience and Pain Sensitization: Meta-analysis of Laboratory Findings.

OBJECTIVES: Psychological trauma often co-occurs with pain. This relationship has been explored using laboratory pain measures; however, findings have been mixed. Previous studies have limited operationalization of trauma (eg, posttraumatic stress disorder) or pain (eg, pain thresholds), which may contribute to conflicting results. Further, prior reviews likely underrepresent trauma experiences among people who are not receiving clinical care, limiting generalizability. MATERIALS AND METHODS: We systematically reviewed the existing literature on the relationship between psychological trauma (eg, car accidents, sexual assault, childhood abuse, neglect) and laboratory pain (ie, quantitative sensory testing measures of pain threshold, intensity, summation, modulation), using inclusive criteria. The direction of the relationship between psychological trauma and pain sensitivity was evaluated, and moderation by purported pain mechanism (ie, pain detection, suprathreshold pain, central sensitization, inhibition) was explored. RESULTS: Analyses were conducted using 48 studies that provided 147 effect sizes. A multivariate random-effects model with robust variance estimation resulted in a small but statistically significant overall effect size of g=0.24 (P=0.0002), reflecting a positive association between psychological trauma and enhanced laboratory pain sensitivity. Upon examination of mechanistic moderators, this relationship appears driven by effects on pain detection (g=0.28, P=0.002) and central sensitization (g=0.22, P=0.04). While effect sizes were similar across all moderators, effects on suprathreshold pain and inhibition were not statistically significant. DISCUSSION: Findings demonstrate an overall pattern of trauma-related pain enhancement and point to central sensitization as a key underlying mechanism.

Racial identification modulates default network activity for same and other races.

Racial identification shapes self-concept and how people share in and respond to the emotional states of others around them. Prior neuroimaging studies have demonstrated the role of the neural default network in self-referential and empathic processing. However, how racial identification affects neural processing of social information remains unknown. Here, we examined the effect of racial identification on neural response related to social perception among African American and Caucasian American individuals using functional magnetic resonance imaging. Our results demonstrate that degree of racial identification predicts activity within cortical midline structures of the default network in response to viewing racial ingroup, relative to outgroup members, and activity within the medial temporal lobe subsystem of the default network in response to viewing racial outgroup, relative to ingroup members. Broadly, our findings suggest that the strength of racial identification is associated with differential recruitment of neural and cognitive processes to understand and respond to other people within and outside of one's racial group.

Over-Rating Pain is Overrated: A Fundamental Self-Other Bias in Pain Reporting Behavior.

Wide-spread cultural beliefs influence personal experiences and clinical treatment of pain, yet are often unexamined and unchallenged in the pain literature. The common cultural belief that people generally over-report or exaggerate pain is familiar, reflected in discordant patient-provider pain assessments, and compounded in the context of disparities in pain treatment. However, no studies have directly measured the prevalence of this belief among the general population, nor challenged the validity of this assumption by assessing normative pain reporting in clinical settings. Results of an initial and replication study suggest that reporting pain accurately "as-is" is the norm, yet most people still believe that others normatively over-report pain. We refer to the phenomenon by which most people report their pain as they experience it while paradoxically believing that others over-report their pain as the fundamental pain bias, and suggest this false perception may contribute to larger scale pain stigma and poor outcomes for people in pain. We also identify counter-stereotypical patterns of pain reporting among groups (ie, women, Latinx Americans) that face more disparate care. Results reinforce the need for respecting patient pain reports, and suggest that distrust surrounding others' pain experiences is prevalent in society. PERSPECTIVE: Most people claim to report their pain as accurately as possible, while simultaneously perpetuating common cultural beliefs that others over-report their pain. This fundamental pain bias highlights a pervasive misconception that likely contributes to patient-provider mistrust and broader cultural pain stigma.

Sociocultural Context and Pre-Clinical Pain Facilitation: Multiple Dimensions of Racialized Discrimination Experienced by Latinx Americans are Associated With Enhanced Temporal Summation of Pain.

The experiences of injustice and their impacts on pain among Latinx Americans are overlooked and understudied. Multidimensional and consequential experiences of racialized discrimination are common for Latinx Americans but have not been considered as factors relevant for enhanced pain experience or risk. In this study, we focused on the experiences of Latinx Americans living in Texas by assessing multiple dimensions of racialized discrimination (total lifetime discrimination, racialized exclusion, stigmatization, discrimination in the workplace or school, and racism-related threat and aggression) and a laboratory marker of central sensitization of pain (temporal summation of mechanical pain, MTS). Among 120 adults who did not have chronic pain, nearly all (94.2%) experienced racialized discrimination. Accumulated lifetime experience of racialized discrimination, as well as the frequency of each dimension of discrimination assessed, was associated with greater MTS. Results suggest that a process of discrimination-related central sensitization may start early, and may reflect enhanced pain experiences and pre-clinical chronic pain risk. Though replication is needed, results also indicate the discrimination and pain burden among Latinx Texans, and Latinx Americans broadly, are likely under-represented in the scientific literature. PERSPECTIVE: Racialized discrimination is multidimensional. Latinx Texans experience frequent discrimination that is associated with enhanced temporal summation of pain in the laboratory. Results indicate the importance of societal factors in pain processing and may reflect a mechanism of racism-related pre-clinical central sensitization observable before chronic pain onset.

Lifetime ostracism experiences and mechanisms of pain.

One social mechanism by which marginalization is enacted is via ostracism. Recent research has demonstrated ostracism's impact on physical health, but little is known about the relationship between accumulated lifetime experiences of ostracism and pain. Despite recent calls for added attention to social modulation of pain and social indicators of pain disparities, the impact of specific social factors on pain-including those of ostracism-are not well understood. Results of laboratory studies on the effects of acute ostracism experiences on pain sensitivity have been mixed. However, these studies have not considered lived and repeated experiences of ostracism, and primarily included single static measures of pain sensitivity. Additionally, inclusion and representation of the relationship between ostracism experiences and pain among people with minoritized identities are lacking in the current literature. In this study, we explored accumulated lifetime experiences of ostracism as a potential contributing factor to enhanced pain and one social mechanism by which societal inequity may create and maintain inequity in pain. We extracted measures of lifetime experiences of ostracism from six studies focused on social factors and (non-chronic) pain conducted between 2016 and 2020 (n = 505 adults). To retain and examine diversity within the sample, we used moderation and within-group analyses. Results indicate that greater experiences of lifetime ostracism are associated with lower cold pain tolerance, but not other pain measures, in the whole sample. Moderation and within-group analyses reveal opposing patterns of results between populations included in the extant literature (White participants, convenience samples) and those under-represented in the scientific literature (racialized groups, community samples). This study provides an example of a diversity science approach to examining social indicators of pain, illustrates the limited generalizability of previous studies on ostracism and pain, and highlights the need for increased representation and inclusion to understand mechanisms of pain and inequity.

Meaning in Life and Pain: The Differential Effects of Coherence, Purpose, and Mattering on Pain Severity, Frequency, and the Development of Chronic Pain.

OBJECTIVE: Meaning in life is consistently associated with better health outcomes across a range of mental and physical domains. However, meaning in life is a complex construct involving three distinct facets: coherence, purpose, and mattering. While these facets have been studied individually in relation to pain, they have not been assessed concurrently to parse out their potential distinct contributions to pain outcomes. We sought to identify the unique relationships of these individual facets of meaning with pain experiences and specify the components associated with pain-related resilience. METHODS: The associations of coherence, purpose, and mattering with pain outcomes were examined across three studies. Study 1 used data from the Midlife in the United States National Survey to determine associations between facets and the frequency of various recently experienced pains, and the development of chronic pain nine years later. Study 2 cross-sectionally observed the association between facets and recent pain severity in young adults. Using a diary-type approach, Study 3 captured fluctuations of pain severity in relation to the facets across the span of four weeks. RESULTS: Coherence was uniquely associated with less headache, backache, joint, and extremities pain frequency in Study 1, over and above purpose and mattering, controlling for other health variables. Coherence was also associated with lower odds of developing chronic pain. In Study 2, coherence was associated with less pain severity and fully mediated the relationship between global meaning in life and pain. Study 3 found that coherence predicted the most unique variance in weekly pain fluctuations. CONCLUSION: Across three studies and timescales, coherence was uniquely associated with fewer and less severe pain experiences over and above purpose and mattering. These findings provide support for the value of coherence as a resilience factor in the context of pain and suggest a potential benefit for coherence-specific interventions in clinical settings.

Making Pain Research More Inclusive: Why and How.

Current knowledge about mechanisms and interventions for pain has largely been derived from samples that are healthier, wealthier, younger, and more likely to be White than the general population. Failure to conduct inclusive pain research not only restricts generalizability and application of findings, but also hampers the discovery of mechanisms and the development of measures and interventions that are valid across population subgroups. Most of all, inclusive practices are critical to ensure that underrepresented groups derive equitable benefit from pain research. Here, we provide guidance for the pain research community on how to adopt inclusive research practices. We define "inclusion" to encompass a range of identities and characteristics, including racialized group/ethnicity, disability status, gender identity, sexual orientation, and age. We first describe principles relevant to promoting inclusion in pain research, including attention to: 1) stakeholder engagement; 2) structural factors underlying inequities; 3) the limitations of "disparity" research; 4) intersectionality; and 5) universal design. Next, we provide checklists with practical strategies for making studies more inclusive at each stage of the research process. We conclude by calling for system-level changes to ensure that the future of pain research is socially just, scientifically productive, and responsive to the needs of all people. PERSPECTIVE: This paper offers guidance on promoting inclusion of underrepresented groups in pain research. We describe principles relevant to conducting more inclusive research; eg, attention to stakeholder engagement, structural factors, and universal design. We provide checklists with practical strategies for inclusion at each stage of the research process.

Confronting Racism in All Forms of Pain Research: A Shared Commitment for Engagement, Diversity, and Dissemination.

This third paper in the "Confronting Racism in All Forms of Pain Research" series discusses adopting an antiracism framework across all pain research disciplines and highlights the significant benefits of doing so. We build upon the previous call to action and the proposed reframing of study designs articulated in the other papers in the series and seek to confront and eradicate racism through a shared commitment to change current research practices. Specifically, we emphasize the systematic disadvantage created by racialization (ie, the Eurocentric social and political process of ascribing racialized identities to a relationship, social practice, or group) and discuss how engaging communities in partnership can increase the participation of racialized groups in research studies and enrich the knowledge gained. Alongside this critical work, we indicate why diversifying the research environment (ie, research teams, labs, departments, and culture) enriches our scientific discovery and promotes recruitment and retention of participants from racialized groups. Finally, we recommend changes in reporting and dissemination practices so that we do not stigmatize or reproduce oppressive forms of power for racialized groups. Although this shift may be challenging in some cases, the increase in equity, generalizability, and credibility of the data produced will expand our knowledge and reflect the pain experiences of all communities more accurately. PERSPECTIVE: In this third paper in our series, we advocate for a shared commitment toward an antiracism framework in pain research. We identify community partnerships, diversification of research environments, and changes to our dissemination practices as areas where oppressive forms of power can be reduced.

Confronting Racism in Pain Research: A Call to Action.

Racism is an established health determinant across the world. In this 3-part series, we argue that a disregard of how racism manifests in pain research practices perpetuates pain inequities and slows the progression of the field. Our goal in part-1 is to provide a historical and theoretical background of racism as a foundation for understanding how an antiracism pain research framework - which focuses on the impact of racism, rather than "race," on pain outcomes - can be incorporated across the continuum of pain research. We also describe cultural humility as a lifelong self-awareness process critical to ending generalizations and successfully applying antiracism research practices through the pain research continuum. In part-2 of the series, we describe research designs that perpetuate racism and provide reframes. Finally, in part-3, we emphasize the implications of an antiracism framework for research dissemination, community-engagement practices and diversity in research teams. Through this series, we invite the pain research community to share our commitment to the active process of antiracism, which involves both self-examination and re-evaluation of research practices shifting our collective work towards eliminating racialized injustices in our approach to pain research. PERSPECTIVE: We call on the pain community to dismantle racism in our research practices. As the first paper of the 3-part series, we introduce dimensions of racism and its effect on pain inequities. We also describe the imperative role of cultural humility in adopting antiracism pain research practices.

Confronting Racism in All Forms of Pain Research: Reframing Study Designs.

This second paper in a 3-part series on antiracism in pain research across the translational spectrum focuses on study design factors. Although objectivity is a cornerstone value of science, subjectivity is embedded in every step of the research process as investigators make choices about who they collaborate with, which research questions they ask, how they recruit participants, which research tools they use, and how they analyze and interpret data. We present theory and evidence from disciplines such as sociology, medical anthropology, statistics, and public health to discuss 4 common study design factors, including 1) the dominant biomedical narrative of pain that restricts funding and exploration of social indicators of pain, 2) low diversity and inclusion in pain research enrollment that restricts generalizability to racialized groups, 3) the use of "race" or "ethnicity" as a statistical variable and proxy for lived experiences (eg, racism, resilience), and 4) limited modeling in preclinical research for the impact of social factors on pain physiology. The information presented in this article is intended to start conversations across stakeholders in the pain field to explore how we can come together to adopt antiracism practices in our work at large to achieve equity for racialized groups. PERSPECTIVE: This is the second paper in a 3-part series on antiracism in pain research. This part identifies common study design factors that risk hindering progress toward pain care equity. We suggest reframes using an antiracism framework for these factors to encourage all pain investigators to collectively make strides toward equity.