Chronic pain affects 100 million people in the United States (U.S.) and produces annual costs up to $635 billion. While pain affects all segments of the population, racial and ethnic minorities in the U.S., particularly African Americans (AAs) experience more frequent, severe and disabling chronic pain compared to their non-Hispanic white (NHW) counterparts. While multiple factors inevitably contribute, ethnic group differences in central pain processing represent a potentially important determinant of greater clinical pain among AAs. During the previous funding cycle we found that African Americans (AA) with knee osteoarthritis (OA) reported significantly greater OA-related pain and disability than their non-Hispanic white (NHW) counterparts. Moreover, quantitative sensory testing indicated greater generalized pain facilitation and diminished pain inhibition among AA compared to NHW with and without knee OA. In addition, we observed ethnic differences in pain-related psychosocial and biological measures, which at least partially mediated ethnic group differences in pain sensitivity. However, our current findings provide indirect and cross-sectional evidence regarding ethnic group differences in central pain processing and their relationship to clinical pain. Moreover, ethnic group differences in the progression of both clinical symptoms and altered central pain processing over time, and the predictors thereof, have heretofore not been investigated. Therefore, the overarching goal of the proposed studies is to elucidate the mechanisms underlying ethnic group differences in knee OA-related pain by directly and prospectively assessing the progression and predictors of clinical pain and disability as well as altered central pain processing among middle-aged and older AA and NHW with symptomatic knee OA. Specifically, we propose to characterize ethnic group differences in clinical symptoms, systemic inflammation, psychosocial functioning and pain-related central nervous system (CNS) structure and function at baseline and over a two year follow-up period among older AA and NHW with symptomatic knee OA. We also propose to identify biopsychosocial predictors of ethnic group differences in the progression of both OA-related clinical symptoms as well as changes in pain- related CNS structure and function over the two-year follow-up period. This study will be the first to directly investigate ethnic group differences in central pain processing and to prospectively characterize the progression and biopsychosocial predictors of longitudinal changes in clinical symptoms and pain-related CNS structure and function in OA-related pain. The findings will provide novel and important information regarding the mechanisms underlying ethnic group differences in pain.

Public Health Relevance

Ethnic differences in clinical pain and pain-related disability in patients with knee osteoarthritis (OA) have been well documented, yet the mechanisms underlying these disparities remain poorly understood. Therefore, the goal of this project is to elucidate the mechanisms underlying ethnic group differences in knee OA-related pain by directly and prospectively assessing the nature and evolution of altered central pain processing and its relationship with progression of pain and disability among middle-aged and older African Americans and non-Hispanic whites with and without symptomatic knee OA.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Method to Extend Research in Time (MERIT) Award (R37)
Project #
Application #
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Nielsen, Lisbeth
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Florida
Schools of Dentistry/Oral Hygn
United States
Zip Code
Cardoso, Josue S; Riley 3rd, Joseph L; Glover, Toni et al. (2016) Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis. Pain 157:2104-14
Bartley, Emily J; King, Christopher D; Sibille, Kimberly T et al. (2016) Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization. Arthritis Care Res (Hoboken) 68:472-80
Fillingim, Roger B (2016) Individual Differences in Pain: Understanding the Mosaic that Makes Pain Personal. Pain :
Glover, Toni L; Goodin, Burel R; King, Christopher D et al. (2015) A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis. Clin J Pain 31:1060-7
Glover, Toni L; Horgas, Ann L; Fillingim, Roger B et al. (2015) Vitamin D status and pain sensitization in knee osteoarthritis: a critical review of the literature. Pain Manag 5:447-53
Petrov, Megan E; Goodin, Burel R; Cruz-Almeida, Yenisel et al. (2015) Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis. J Pain 16:478-90
Cruz-Almeida, Yenisel; Sibille, Kimberly T; Goodin, Burel R et al. (2014) Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis Rheumatol 66:1800-10
Cruz-Almeida, Yenisel; Fillingim, Roger B (2014) Can quantitative sensory testing move us closer to mechanism-based pain management? Pain Med 15:61-72
Cruz-Almeida, Yenisel; Riley 3rd, Joseph L; Fillingim, Roger B (2013) Experimental pain phenotype profiles in a racially and ethnically diverse sample of healthy adults. Pain Med 14:1708-18
King, Christopher D; Goodin, Burel; Kindler, Lindsay L et al. (2013) Reduction of conditioned pain modulation in humans by naltrexone: an exploratory study of the effects of pain catastrophizing. J Behav Med 36:315-27

Showing the most recent 10 out of 15 publications