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The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

Gordon, Jennifer L. PhD; Johnson, Jacqueline DrPH; Nau, Samantha BA; Mechlin, Beth PhD; Girdler, Susan S. PhD

doi: 10.1097/PSY.0000000000000385
Original Articles

Objective To examine the role of psychosocial factors in mediating the relationship between African American (AA) race and both increased pain sensitivity and blunted stress reactivity.

Methods Participants included 133 AA and non-Hispanic white (nHW) individuals (mean [SD] age, 37 [9]) matched for age, sex, and socioeconomic status. Participants underwent mental stress testing (Trier Social Stress Test) while cardiovascular, hemodynamic, and neuroendocrine reactivity were measured. Participants completed questionnaires assessing potential sources of psychosocial stress and were tested for pain responses to cold pain and the temporal summation of heat pulses. Mediation analyses were used to determine the extent to which exposure to psychosocial stress accounted for the observed racial differences in stress reactivity and pain.

Results Chronic stress exposure and reactivity to mental stress was largely similar among AAs and nHWs; however, AAs exhibited heightened pain to both cold (p = .012) and heat (p = .004). Racial differences in the relationship between stress reactivity and pain were also observed: while greater stress reactivity was associated with decreased pain among nHWs, reactivity was either unrelated to or even positively associated with pain among AAs (e.g., r = −.21 among nHWs and r = .41 among AAs for stroke volume reactivity and cold pressor intensity). Adjusting for minor racial differences in chronic psychosocial stress did not change these findings.

Conclusions Accounting for psychosocial factors eliminated racial differences in stress reactivity but not racial differences in sensitivity to experimental pain tasks. Increased exposure to chronic stress may not explain AAs' increased pain sensitivity in laboratory settings.

Supplemental digital content is available in the text.

From the Department of Psychiatry (Gordon, Johnson, Nau, Girdler), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Psychology (Mechlin), Earlham College, Richmond, Indiana.

Supplemental Content

Address correspondence and reprint requests to: Susan S. Girdler, PhD, Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, CB# 7160, 101 Manning Dr, Chapel Hill, NC 27599–3366, United States. E-mail:

Received for publication July 29, 2015; revision received June 13, 2016.

Copyright © 2017 by American Psychosomatic Society
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