The effects of socioeconomic position on endogenous pain modulation: A quasi-experimental approach

作     者：Raghuraman, Nandini Akintola, Titilola Rassu, Fenan S. Chen, Shuo Gruber-Baldini, Ann Colloca, Luana 

作者机构：Department of Pain and Translational Symptom Science School of Nursing University of Maryland Baltimore United States Graduate Program in Life Sciences Program in Epidemiology and Human Genetics University of Maryland School of Medicine Baltimore United States Center to Advance Chronic Pain Research University of Maryland Baltimore United States Department of Anesthesiology and Psychiatry University of Maryland School of Medicine Baltimore United States Placebo Beyond Opinions Center University of Maryland School of Nursing Baltimore United States Institute for Genome Sciences School of Medicine University of Maryland Baltimore United States Program in Health Equity and Population Health School of Medicine University of Baltimore United States Program in Personalized and Genomic Medicine School of Medicine University of Maryland Baltimore United States Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore United States Department of Physical Medicine and Rehabilitation School of Medicine The Johns Hopkins University Baltimore United States 

出 版 物：《Journal of Pain》 (J. Pain)

年 卷 期：2025年

页      面：104778页

学科分类：1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 1009[医学-特种医学] 10[医学] 

基　　金：National Center for Integrative Health National Center for Complementary and Integrative Health, NCCIH National Institutes of Health, NIH National Institute of Dental and Craniofacial Research, NIDCR, (R01 DE025946, R01AT011347, R21 DE032532 Colloca/Dorsey) National Institute of Dental and Craniofacial Research, NIDCR 

主　　题：Ancestry informative markers Conditioning Expectations Latent class analysis Pain severity Placebo Social disparities 

摘      要：Socioeconomic Position (SEP) is a multidimensional construct encompassing education, income, occupation, and neighborhood distress, influencing chronic pain severity, interference, and duration. However, its impact on placebo analgesia, where reduced pain perception occurs due to treatment belief, remains understudied. Using a quasi-experimental approach, we investigated SEP s influence on placebo analgesia in 401 participants with temporomandibular disorder (TMD) and 400 pain-free individuals. Using latent class analysis, we grouped participants into two SEP groups based on self-reported education, income, occupation, and neighborhood distress indices, including the area deprivation and distressed community indexes. Ancestry Informative Markers (AIMs) and self-reported race were included to account for genetic and demographic influences. Placebo analgesia was elicited using verbal suggestion and classical conditioning. Linear mixed models were employed to analyze SEP s impact, while multiple regression and ANCOVA assessed AIMs’ and race s effects. Comparable placebo effects were observed between participants with TMD and pain-free individuals (F(1,4765.73) = 0.49, p = 0.48). A trend was noted in the main effect of SEP (F(1,4764.5) = 3.64, p = 0.056). Among TMD participants, those with distressed SEP exhibited lower placebo analgesia (F(1,4765.73) = 7.9, p = 0.005), while placebo response did not differ by SEP in pain-free participants (F(1,4765.73) = 0.27, p = 0.59). East Asian ancestry (β = 5.71, 95% CI [1.50, 9.92]) and self-reported Asian (mean = 24.20, sem = 1.52, p = 0.020) were associated with greater placebo analgesia. This study highlights the interplay of SEP, AIMs, and race in placebo analgesia and calls for tailored pain management interventions. Perspective: SEP significantly contributes to pain disparities. This quasi-experimental study demonstrates analogous placebo analgesia between chronic pain and pain-free individuals but finds lower placebo analg