RESUMEN
OBJECTIVE: Racial/ethnic disparities in pain are well-recognized, with non-Hispanic blacks (NHBs) experiencing greater pain severity and pain-related disability than non-Hispanic whites (NHWs). Although numerous risk factors are posited as contributors to these disparities, there is limited research addressing how resilience differentially influences pain and functioning across race/ethnicity. Therefore, this study examined associations between measures of psychosocial resilience, clinical pain, and functional performance among adults with knee osteoarthritis (OA), and assessed the moderating role of race/ethnicity on these relationships. METHODS: In a secondary analysis of the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD-2) study, 201 individuals with knee OA (NHB = 105, NHW = 96) completed measures of resilience (ie, trait resilience, optimism, positive well-being, social support, positive affect) and clinical pain, as well as a performance-based measure assessing lower-extremity function and movement-evoked pain. RESULTS: Bivariate analyses showed that higher levels of psychosocial resilience were associated with lower clinical pain and disability and more optimal physical functioning. NHBs reported greater pain and disability, poorer lower-extremity function, and higher movement-evoked pain compared with NHWs; however, measures of psychosocial resilience were similar across race/ethnicity. In moderation analyses, higher optimism and positive well-being were protective against movement-evoked pain in NHBs, whereas higher levels of positive affect were associated with greater movement-evoked pain in NHWs. CONCLUSION: Our findings underscore the importance of psychosocial resilience on OA-related pain and function and highlight the influence of race/ethnicity on the resilience-pain relationship. Treatments aimed at targeting resilience may help mitigate racial/ethnic disparities in pain.
RESUMEN
Temporomandibular disorder (TMD) is an orofacial pain condition often resulting in functional impairment and pain-related disability. Given the relationship between stress and pain in TMD, it has been suggested that dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis (e.g., cortisol responsivity) could contribute to the onset and maintenance of the condition. Research has shown that therapies to control pain and stress can improve quality of life in patients with persistent pain, with recent evidence supporting resilience as a potential target of intervention. However, no studies have systematically examined whether a resilience intervention has efficacy in modulating neuroendocrine functioning in TMD. Therefore, the primary objective of this pilot study was to investigate the effects of a resilience-based hope intervention on pain-evoked cortisol levels in individuals with TMD. Twenty-nine participants were randomized to a 3-session intervention intended to increase hope or a control intervention targeting pain and stress education. Prior to and after the intervention, participants attended two experimental sessions whereby salivary cortisol was obtained after the induction of a painful, cold-water procedure. While there were no intervention group differences in pain-evoked cortisol response, greater situational and dispositional hope were associated with lower levels of cortisol. Overall, findings suggest that positive emotional resources may attenuate heightened neuroendocrine activity; however, further research is needed to determine the physiological benefits of resilience-oriented therapies.