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Papers of the Week

2022 Dec 23

J Neurotrauma

Racial differences in head pain and other pain-related outcomes following mild traumatic brain injury.


Naugle K M, Nguyen T, Smith JA, Saxe J, White F
J Neurotrauma. 2022 Dec 23.
PMID: 36565020.


Recent research suggests that mild traumatic brain injury (TBI) may exert deleterious effects on endogenous pain modulatory function, potentially underlying the elevated risk for persistent headaches following injury. Accumulating research also shows race differences in clinical and experimental pain, with African Americans (AA) generally reporting more severe pain, worse pain modulation, and greater pain sensitivity compared to Caucasians. However, race differences in pain-related outcomes following mild TBI have rarely been studied. The purpose of this study was to explore race differences in endogenous pain modulation, pain sensitivity, headache pain, and psychological factors among AA and Caucasian individuals with mild TBI in the first month following injury compared to healthy controls and across time. Patients with mild TBI were recruited from the local Emergency Department Trauma Centers. Sixty-three mild TBI participants (African Americans: n=23, Caucasians: n=40) enrolled in this study and completed study sessions at 1-2 weeks and 1-month post injury. Forty-one mild TBI-free control participants (African Americans: n=11, Caucasians: n=30), matched on age and sex, completed one study session. Assessments included a headache survey, Pain Catastrophizing Scale, CES-Depression Scale, and several quantitative sensory tests (QST) to measure endogenous pain modulatory function. The QST tests included conditioned pain modulation (CPM) to measure endogenous pain inhibitory function and temporal summation of pain and pressure pain thresholds (PPTs) of the head to measure pain sensitization and sensitivity. Two-way ANOVAs were used to determine whether the outcome measures differed as a function of race, mild TBI, and time. Mediation analysis was used to explore potential mediators for the race differences in headache pain intensity. The results showed that AA mild TBI participants reported significantly greater headache pain and pain catastrophizing and exhibited higher pain sensitivity and worse pain modulation on QST tests compared to Caucasian mild TBI participants. These same race differences were not observed among the healthy TBI-free control sample. The mediation analyses showed complete mediation for the relation between race and headache pain intensity by pain catastrophizing at 1-2 weeks and 1 month post injury. Overall, the results of this study suggest that African Americans compared to Caucasians are characterized by psychological and pain modulatory profiles following mild TBI that could increase the risk for the development of intense and persistent headaches following injury.