Secondary analysis: heat and self-report pain sensitivity associate with biological sex and racialized sociocultural group but may not be mediated by anxiety or pain catastrophizing

Supplemental Digital Content is Available in the Text.We evaluate associations of minoritized racial group and female sex with heat and self-report pain sensitivity and find problems with pain sensitivity questionnaire validity. Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination.8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment. 23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination.9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score.5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination.8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain. 5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination.9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score.5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination.8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination. 9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score.5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination. 8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination.9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score. 5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination.8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men. 16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination.9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score.5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population. Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination.8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background. 54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination.9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score.5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3. 28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination.8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination. 9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score.5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54Introduction:Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population.Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity.Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 x 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 x 10-8) limited PSQ face validity in racialized minorities.Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.In the United States, racialized minority groups, such as Black and Asian people, experience a greater severity of and disability from chronic pain.2,3,5,13,35,37 Interestingly, enhanced pain perception in minoritized groups appears to precede development of chronic pain. This enhanced sensitivity is possibly a result of the persistent stress caused by structural racism and systemic discrimination. 8 Although racism against Black Americans is endemic and well recognized, the association of enhanced pain sensitivity in racially minoritized groups exists in other groups subject to racial discrimination. For example, the association of enhanced pain sensitivity in an ethnically minoritized group exists in China where people from the Uygur minority demonstrate enhanced pain sensitivity compared with the Han Chinese majority.63 Previous research indicates that Hispanic, Asian, and Black people have greater pain sensitivity, and above threshold painful stimuli is rated as more painful in these minoritized groups compared with White people. In addition, individuals from these minoritized racial or ethnic groups demonstrate lower tolerance, especially to stressful and thermal stimuli.12,31,36,38,39,43,50,51,53 Sex differences are well known in pain. Women tend to be more sensitive to pain, report higher pain intensity to fixed painful stimuli, and demonstrate lower tolerance compared with men.16-18,20,34,50 Minoritized group differences in pain sensitivity may limit patient-reported effectiveness of multidimensional pain treatment.23,33Previous mixed reports of minoritized group differences in pain-related psychological traits (eg, depression, anxiety, pain catastrophizing) may indicate greater depression, anxiety, and pain catastrophizing in racialized minorities compared with White people.4,10,36,60 Differences in somatization across racialized groups were also reported, indicating that Black people and women with temporomandibular disorders had higher level of somatization compared with White people and men.19The pain sensitivity questionnaire (PSQ) has been used to measure self-rated pain sensitivity, predominantly in populations predominantly composed of European sociocultural background.54-56 Studies have shown that the PSQ detects minoritized group differences in between Black and White people in pain sensitivity and clinical pain for both healthy participants and patients with chronic pain.5,40 The original validation study found no sex difference in PSQ, while finding differences in experimental pain sensitivity between men and women.54 Currently, limited information regarding validity of the PSQ is available in Asian and Black people.Overall enhanced pain sensitivity is often present in minoritized groups that experience discrimination. This led us to the hypothesis that no matter the identity of the group, anxiety experienced by racialized minority groups and women would lead to enhanced pain sensitivity. Based on prior research, we predicted that enhanced pain sensitivity in minoritized groups would be mediated by greater anxiety, which is often the result of the experience of stress and discrimination.9,40,48 The primary predictions of this secondary analysis study were as follows: (1) people from racialized minority groups would be more sensitive to painful stimuli and rate painful stimuli greater than White people, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing11,12,38,50; (2) women would be more sensitive to painful stimuli and rate painful stimuli greater than men, and this enhanced sensitivity would be mediated by anxiety or pain catastrophizing50; (3) there would be a positive correlation between PSQ scores and pain intensity ratings to suprathreshold painful mechanical stimuli54; (4) there would be an effect of racialized minority group on self-report pain sensitivity in terms of the PSQ score and somatization in terms of the Pennebaker Inventory of Limbic Languidness (PILL) score. 5 Finally, considering the Eurocentric sociocultural development of the pain sensitivity questionnaire, we predicted that racially minoritized individuals' lack of experience with some of the items on the PSQ would lead to a different estimation of PSQ item rating compared with those items that had been experienced.54