# Psychological and brain mechanisms underlying disparities in opioid and non-opioid pain treatment decisions

> **NIH NIH K01** · UNIVERSITY OF MIAMI CORAL GABLES · 2021 · $170,560

## Abstract

Project Summary
Unequal prescribing of opioid and non-opioid analgesics among demographic groups contributes to two major
health disparities in the United States. Overprescribing of opioid analgesics to treat both acute and chronic
nonmalignant pain, especially in non-Hispanic whites, has fueled the opioid abuse epidemic. Underprescribing
of opioid and non-opioid analgesics in minorities and women, even when their use is medically indicated (e.g.,
acute and cancer pain), reduces the effectiveness of pain management in these groups. In order to mitigate
analgesic prescribing disparities and the associated risks of opioid abuse and poor pain management, we must
understand the mechanisms underlying these disparities. The current project will test two potential contributors
to these pain treatment disparities: 1) clinicians' inaccurate demographic stereotypes about pain sensitivity and
tendency to abuse opioids (i.e., the stereotype hypothesis), and 2) reduced activation of clinicians' pain-related
neural systems (e.g., anterior cingulate and anterior insula) in response to the pain of demographic outgroup
patients (i.e., the vicarious pain hypothesis). Prior studies of mechanisms underlying analgesic prescribing
disparities have been limited by the use of experimental paradigms that were low in ecological validity e.g.
asking participants to make prescribing decisions based solely on text-based medical vignettes or depictions of
individuals feigning pain. Additionally, although the robust fMRI literature on vicarious pain biases is related to
biases in pain assessment, vicarious pain biases have not been tested as a potential contributor to biases pain
treatment decisions. In the present proposal, these methodological limitations will be addressed and the
stereotype and vicarious pain hypotheses will be tested through 3 specific aims. Aim 1 involves the design and
production of a more ecologically valid video-based simulated pain assessment and treatment paradigm
depicting individuals experiencing genuine pain. Aim 2 includes an fMRI study of the effects of clinicians'
(medical students') vicarious pain responses and pain stereotypes on demographic biases in simulated pain
assessment and analgesic prescribing, using the video paradigm created in Aim 1. Finally, to determine the
clinical applicability of the findings from Aim 2, Aim 3 includes face-to-face pain assessments and treatment
recommendations during simulated clinical interactions with standardized patient actors. If the aims of this
proposal are achieved, these studies will yield new understanding of the relative contributions of pain-related
stereotypes and vicarious pain to analgesic prescribing disparities. These results could indicate whether pain
stereotype education, efforts to increase pain empathy, or both should be incorporated into clinician
interventions aimed at reducing analgesic prescribing disparities. Through this K01 career development award,
the candidate will gain facili...

## Key facts

- **NIH application ID:** 10102221
- **Project number:** 5K01DA045735-04
- **Recipient organization:** UNIVERSITY OF MIAMI CORAL GABLES
- **Principal Investigator:** Elizabeth R Losin
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $170,560
- **Award type:** 5
- **Project period:** 2018-03-01 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10102221

## Citation

> US National Institutes of Health, RePORTER application 10102221, Psychological and brain mechanisms underlying disparities in opioid and non-opioid pain treatment decisions (5K01DA045735-04). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10102221. Licensed CC0.

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