# Relationships among discrimination, cognitive-affective pain amplifiers, and identification with Native American culture: results from the Oklahoma Study of Native American Pain Risk

## TL;DR

The study explores how discrimination and cultural identification affect pain-related anxiety and catastrophizing in Native Americans.

## Contribution

It reveals that stronger cultural identification correlates with increased pain catastrophizing due to higher discrimination exposure.

## Key findings

- Higher identification with Native American culture strengthens the link between discrimination and pain catastrophizing.
- Discrimination is associated with increased pain-related anxiety, but cultural identification does not moderate this effect.
- Those with stronger cultural identification reported experiencing more discrimination.

## Abstract

Native Americans (NAs) experience higher rates of chronic pain than other U.S. ethnic/racial groups. This may be partly caused by stress from interpersonal discrimination, which promotes pain-related catastrophizing and anxiety, cognitive-emotional processes that amplify pain. Greater identification with NA culture has been shown to buffer against negative health outcomes for NA communities, therefore the present study examined whether greater identification with NA culture buffers against the harmful effects of discrimination on pain-related anxiety and catastrophizing.

Participants were 153 healthy, chronic pain-free NAs enrolled in the Oklahoma Study of Native American Pain Risk (OK-SNAP). Identification with NA culture was assessed by the Native American Acculturation Scale (NAAS), which was reversed scored so that higher scores=greater identification. Interpersonal discrimination was assessed by the Everyday Discrimination Scale. Following laboratory pain tasks, situational pain catastrophizing was assessed with the Pain Catastrophizing Scale and pain-related anxiety was assessed with a visual analogue scale (VAS).

A significant interaction was found between discrimination and identification with NA culture when predicting pain catastrophizing (ΔR2 = 0.034, p = 0.017). Greater identification with NA culture was associated with a significant positive relationship between discrimination and pain catastrophizing (p < 0.001), whereas less identification was associated with a non-significant relationship (p = 0.32). Although discrimination was associated with higher pain-related anxiety (p = 0.015), this was not moderated by identification with NA culture (ΔR2 = 0.009, p = 0.23), nor did identification with NA culture predict pain-related anxiety. An additional analysis found that NAs who identified more with NA culture experienced more discrimination (p = 0.012).

These findings suggest that the relationship between discrimination and pain catastrophizing is stronger for NAs who identify more strongly with NA culture, an effect that is likely due to these individuals having greater overall exposure to discrimination. Alternatively, the NAAS may not capture the full range of cultural processes that buffer against negative health outcomes for NAs. Future research should examine other facets of cultural resilience.