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Background Sex differences in pain sensitivity have been well documented, such that women often report greater sensitivity than men. However, clinical reports highlighting sex differences often equate gender and sex. This is a particularly critical oversight for those whose gender identity is different than their genetic sex. Methods This preliminary study sets to analyze differences in pain responses between cisgender and transgender individuals living with HIV and chronic pain. A total of 51 African-American participants (24 cisgender men, 20 cisgender women, 7 transgender women) with similar socioeconomic status were recruited. Genetic sex, gender identity, depression and anxiety, pain severity, pain interference and pain-related stigma were recorded. Participants also completed a quantitative sensory testing battery to assess pain in response to noxious heat and mechanical stimuli. Results Transgender women and cisgender women demonstrated a greater magnitude of temporal summation for heat pain stimuli or mechanical stimuli compared to cisgender men. Specifically, transgender women reported greater mechanical summation than either cisgender women or cisgender men. Transgender women and cisgender women similarly reported greater chronic pain severity compared to cisgender men. Conclusion These data support the notion that gender identity may play a more significant role in pain sensation than genetic sex. These results further maintain that not only gender identity and genetic sex are distinct variables but that treatment should be based on identity as opposed to genetic sex.

Background:Children with CHD are at risk for obesity and low levels of activity. These factors are associated with an increased risk of poor outcome. Participation in organised sports is an important avenue for children to maintain physical activity, though the relationship between sports participation and obesity has not been examined in the Fontan population.Methods:We performed a cross-sectional study of children aged 8–18 who had been evaluated between January 1, 2015 and October 1, 2019 at the Doernbecher Children’s Hospital outpatient paediatric cardiology clinic and had previously undergone a Fontan. Patients were excluded if they were unable to ambulate independently or if they had undergone a heart transplant. Patient characteristics were recorded from the electronic medical record. Parents were interviewed via a telephone survey and asked to describe their child’s activity levels and sports participation.Results:Our final cohort included 40 individuals, 74% were male. The overall prevalence of obesity (CDC BMI >95% for sex/age) in the cohort (23%) was significantly higher in non-athletes (33%) than athletes (0) (p = 0.02). There was no difference in cardiac complications or comorbidities between athletes and non-athletes. Athletes were more likely to meet daily activity recommendations (p = 0.05).Conclusion:Fontan patients who do not participate in sports are significantly more likely to be obese and less likely to be active than those who do. This is the first study to demonstrate the association between competitive sports participation and decreased likelihood of obesity in the Fontan population.

Background Sex differences in pain sensitivity have been well documented, such that women often report greater sensitivity than men. However, clinical reports highlighting sex differences often equate gender and sex. This is a particularly critical oversight for those whose gender identity is different than their genetic sex. Methods This preliminary study sets to analyze differences in pain responses between cisgender and transgender individuals living with HIV and chronic pain. A total of 51 African-American participants (24 cisgender men, 20 cisgender women, 7 transgender women) with similar socioeconomic status were recruited. Genetic sex, gender identity, depression and anxiety, pain severity, pain interference and pain-related stigma were recorded. Participants also completed a quantitative sensory testing battery to assess pain in response to noxious heat and mechanical stimuli. Results Transgender women and cisgender women demonstrated a greater magnitude of temporal summation for heat pain stimuli or mechanical stimuli compared to cisgender men. Specifically, transgender women reported greater mechanical summation than either cisgender women or cisgender men. Transgender women and cisgender women similarly reported greater chronic pain severity compared to cisgender men. Conclusion These data support the notion that gender identity may play a more significant role in pain sensation than genetic sex. These results further maintain that not only gender identity and genetic sex are distinct variables but that treatment should be based on identity as opposed to genetic sex.

Cognitive and behavioral factors are known to contribute to painful knee osteoarthritis (OA), including poor sleep quality and pain catastrophizing. The overall aim of this study was to further elucidate the relationships among knee pain, pain catastrophizing, and sleep quality in non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults with/at risk for knee OA. Our overall hypothesis is that pain catastrophizing disrupts sleep, which subsequently exacerbates knee pain severity. We also hypothesized that these associations would differ by ethnic/race group. We conducted a cross-sectional study of adults with/at risk for knee OA using community and clinic-based recruitment from two study sites both in the Southeastern United States. All participants (N = 171) provided sociodemographic data before completing the following validated measures: Western Ontario and McMaster Universities Osteoarthritis Index, Insomnia Severity Index, Coping Strategies Questionnaire (for pain catastrophizing), and PROMIS Depression items. Mean age was 58 years; 52% were NHB and 48% NWH. Controlling for age, BMI, education, gender, and depression, results revealed that ethnic/race group significantly moderated the association between pain catastrophizing and sleep quality (p = .025). Greater pain catastrophizing was associated with poorer sleep quality for NHW (p = .003), but not NHB (p = .684) participants. Accordingly, sleep quality was found to significantly mediate the association between pain catastrophizing and knee pain severity for NHW (confidence interval .0705 to .5988), but not NHB (confidence interval -.1526 to .2113). Findings suggest that pain catastrophizing promotes poor sleep, and poor sleep, in turn, promotes knee pain severity in NHW with/at risk for knee OA. Interestingly, pain catastrophizing may have a greater impact on the sleep quality of NHW compared to NHB peers. Future studies should evaluate protective factors in NHB populations that may explain the reduced impact of pain catastrophizing on sleep quality. R37AG033906-11.

Considerable evidence suggests that knee osteoarthritis (OA)-related clinical pain and disability significantly differs according to racial background. However, brain mechanisms underlying these differences are not well understood. We investigated altered central pain processing in a sample comprised of Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) adults with and without knee OA. NHB and NHW participants with knee OA (n = 123) and without knee OA (N = 41) were recruited to complete a brain imaging protocol using Arterial Spin Labeling (ASL) on a 3T fMRI scanner. Participant's regional cerebral blood flow (rCBF), a measure of brain activation, was examined at rest and during pressure pain stimulation. Aim 1 was to examine altered central processing in people with knee OA compared to people without knee OA. Aim 2 assessed racial group differences in central processing among NHB and NHW adults with knee OA. People with knee OA showed significant differences in rCBF at rest and during pain in the anterior cingulate cortex, sensory-motor cortex, para-hippocampal gyrus, and amygdala in comparison to people without knee OA. For people with knee OA, ethnic differences between NHWs (n = 52) and NHBs (n = 71) were present in the cingulate gyrus, amygdala, thalamus, sensory-motor cortex, and cerebellum. Comparing people with knee OA to people without knee OA at rest while controlling for race, we found a significant effect in the thalamus (p = .036) and amygdala (p = .046). For people with knee OA, NHBs vs NHWs showed a significant effect for the difference score (pain - rest) in the cerebellum (p = .012) when controlling for age and education. These results indicate that knee OA and racial background may be important contributors to altered central nervous system processing of pain. Supported in part by NIH/NIA grant AG033906 and the NIH/NCATS Clinical and Translational Science Awards to the University of Florida (UL1 TR000064) and the University of Alabama at Birmingham (ULITR000165).

Introduction:. A growing literature attests to the overwhelming prevalence of disabling chronic pain among people living with HIV (PLWH), yet very little is known about psychosocial contributors to poor chronic pain outcomes in this population. Pain-related perception of injustice may promote pain interference by hindering engagement in daily activities among individuals with chronic pain. Social support has been shown to buffer the negative impact of harmful beliefs on well-being and facilitate adjustment to chronic pain. Objective:. This cross-sectional study tested the buffering hypothesis of social support to determine whether increasing levels of social support mitigate the negative influence of perceived injustice on pain interference. Methods:. A total of 60 PLWH with chronic pain completed measures of perceived injustice, social support, pain severity, and interference, as well as depressive symptoms. Results:. In a regression-based model adjusted for age, sex, depressive symptoms, and pain severity, results indicated that social support significantly moderated (ie, buffered) the association between perceived injustice and pain interference (P = 0.028). Specifically, it was found that perceived injustice was significantly associated with greater pain interference among PLWH with low levels of social support (P = 0.047), but not those with intermediate (P = 0.422) or high levels of social support (P = 0.381). Conclusion:. Pain-related injustice perception reflects harmful beliefs regarding severity of loss consequent to chronic pain development, a sense of unfairness, and irreparability of loss. Access to a social support network may provide an adaptive means of mitigating the negative effects of perceived injustice.

Chronic pain in persons living with HIV (PLWH) may be related to alterations in endogenous pain modulatory processes (e.g., high facilitation and low inhibition of nociception) that promote exaggerated pain responses, known as hyperalgesia and central nervous system sensitization. This observational study examined differences in endogenous pain modulatory processes between 59 PLWH with chronic pain, 51 PLWH without chronic pain, and 50 controls without HIV or chronic pain. Quantitative sensory testing for temporal summation (TS) of mechanical and heat pain as well as conditioned pain modulation (CPM) were used to assess endogenous pain facilitatory and inhibitory processes, respectively. Associations among TS, CPM, and self-reported clinical pain severity (Brief Pain Inventory-Short Form) were also examined in PLWH with chronic pain. Findings demonstrated significantly greater TS of mechanical (p

Intersectional health-related stigma (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing reduced health-related quality of life (QOL). This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to mental QOL and physical QOL in a sample of PLWH and chronic pain. Participants (N = 66) were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Chronic Pain Stigma Scale, and the Short Form 36 Health Survey (SF-36). An intersectional HIV and chronic pain stigma composite variable was created and participants were categorized as either high (29%), moderate (35%), or low (36%). Results from two unadjusted ANOVAs revealed that intersectional HIV and chronic pain stigma was significantly associated with poor mental QOL (F2,65 = 3.09, p = .05) and poor physical health QOL (F2,65 = 8.74, p