Neural and sociocultural mediators of ethnic differences in pain


Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity- and gender-balanced sample of African Americans, Hispanics and non-Hispanic Whites using functional magnetic resonance imaging during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased frontostriatal circuit activations associated with pain rating, discrimination, experimenter trust and extranociceptive aspects of pain elsewhere. In contrast, the neurologic pain signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extranociceptive central pain mechanisms and suggest that nociceptive pain processing may be similar across ethnicities.

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Fig. 1: fMRI thermal stimulation task design.
Fig. 2: Differences in pain rating across ethnic groups and mediation by discrimination.
Fig. 3: Results of whole-brain voxel-wise GLM analysis showing brain regions exhibiting a stronger dose–response effect of painful heat in AA participants.
Fig. 4: Mediation analyses showing that brain regions exhibiting a stronger dose–response effect of painful heat in AA participants in the whole-brain analysis mediate the relationship between painful stimulus intensity and pain rating differently in the AA group compared to the HA and WA groups.
Fig. 5: Relationship between NAc activity and discrimination frequency.
Fig. 6: NPS responses to painful heat and relationship with pain rating across ethnic groups.

Data availability

The data that support the findings of this study are available from the corresponding author on request.

Code Availability

The Mediation Toolbox used to conduct the mediation analyses can be freely accessed at

Change history

  • 03 March 2020

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.


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This work was supported by the National Institutes of Health (grant nos. 2R01MH076136 and R01DA035484 to T.D.W. and 5K01DA045735 to E.A.R.L.) and start-up funds from the University of Miami College of Arts and Sciences (to E.A.R.L.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We thank the IBG and J. Hewitt and S. A. Rhea for their help and support in recruiting from the IBG participant pools. We thank E. Delk for her help with data analysis and A. Ledbetter and D. Ryan for their help with recruitment and data collection.

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E.A.R.L. and T.D.W. designed the study. E.A.R.L., J.R.A-H. and H.E. collected the data. E.A.R.L., C-W.W., T.D.W. and N.A.M. analysed the data. E.A.R.L. wrote the manuscript and E.A.R.L and C-W.W. created the figures, both with substantial input from the other authors.

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Correspondence to Elizabeth A. Reynolds Losin or Tor D. Wager.

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Extended data

Extended Data Fig. 1 Average continuous pain intensity ratings for the three stimulus intensity levels by heat condition.

Error bands are between-participant standard error.

Extended Data Fig. 2 Path diagrams and statistics for three-path, multi-level mediation analysis between painful stimulus intensity, connectivity between the vmPFC and NAc clusters from the GLM, and trial-by-trial pain rating across all participants.

Connectivity between the vmPFC and NAc regions from the GLM exhibited a trend (p <0.1) towards mediating the relationship between painful stimulus intensity and pain rating. Path coefficients are listed for each path with standard errors in parentheses.

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Losin, E.A.R., Woo, C., Medina, N.A. et al. Neural and sociocultural mediators of ethnic differences in pain. Nat Hum Behav 4, 517–530 (2020).

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