# Mechanisms Linking Adversity and Pain in African American Adults

> **NIH NIH U54** · MEHARRY MEDICAL COLLEGE · 2020 · $297,681

## Abstract

Chronic pain is a major public health challenge, affecting 100 million adults in the United States and 
resulting in over $600 billion annually in treatment costs and lost productivity. African-American (AA) adults are 
disproportionately affected by daily and chronic pain and report higher pain severity and greater pain-related 
disability across a variety of conditions. Compared to non-minorities with similar pain conditions, AA adults 
have poorer physical functioning, greater impairment at work and home, and lower quality of life. Daily bodily 
pain is common and often a precursor to chronic pain. Understanding the mechanisms that contribute to daily 
pain in AA adults is critical for prevention efforts targeting vulnerable adults before they develop debilitating 
and difficult to treat chronic pain conditions. Daily pain is more likely to become chronic in adults who have 
experienced adversity. Compared to non-minorities, AA adults report greater exposure to childhood trauma, 
family adversity, interpersonal violence, and racial discrimination. Thus, AA adults are impacted by disparities 
in risk factors for pain (adversity) and by chronic pain itself. Although the mechanisms linking adversity to daily 
pain in AA adults have not been clearly delineated, two promising pathways involve alterations of stress 
response systems (i.e., hypothalamic-pituitary-adrenal [HPA] axis) and pain sensitivity. The HPA axis plays an 
important role in stress-induced analgesia and may account, in part, for the relation between adversity and 
pain. Chronic and traumatic stressors are associated with diminished cortisol secretion. In turn, lower cortisol 
levels predict higher subsequent pain severity. Preliminary data suggest that prolonged HPA hypo-activity, 
indexed by hair cortisol concentration (HCC), is associated with greater pain intensity and pain-related 
disability. Despite theoretical models implicating HPA hypo-activity as a consequence of adversity and a risk 
factor for chronic pain, no studies have investigated HPA function as a mechanism linking adversity to daily 
pain in AA adults. Experimental pain responses correlate with pain intensity and predict risk for developing 
pain. Adversity is associated with altered evoked pain sensitivity. In turn, experimental pain responses predict 
daily and chronic pain. Although racial differences in experimental pain responses are well-established, no 
studies have tested altered pain sensitivity as a mechanism linking adversity to pain in AA adults. We will 
recruit 160 participants (~50% female), 18-45 years of age, without chronic pain, who self-identify as AA. 
Assessments at baseline, 6- and 12 months will determine exposure to adversity (self-report, geocoded crime 
report data), daily pain (intensity/disability), HCC (hair samples), and experimental pain facilitation and 
inhibition. Anticipated findings will highlight two novel mechanistic pathways linking cumulative adversity, which 
is more com...

## Key facts

- **NIH application ID:** 9974585
- **Project number:** 5U54MD007586-34
- **Recipient organization:** MEHARRY MEDICAL COLLEGE
- **Principal Investigator:** Subodh Nag
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $297,681
- **Award type:** 5
- **Project period:** 1997-09-30 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9974585

## Citation

> US National Institutes of Health, RePORTER application 9974585, Mechanisms Linking Adversity and Pain in African American Adults (5U54MD007586-34). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9974585. Licensed CC0.

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