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Edwin N Aroke,1,* Jai Ganesh Nagidi,2 Vinodh Srinivasasainagendra,3 Tammie L Quinn,4 Fiona BAT Agbor,1 Kiari R Kinnie,1 Hemant K Tiwari,3 Burel R Goodin5,* 1Department of Acute, Chronic, and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Computer Science, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; 3Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; 5Department of Anesthesiology, School of Medicine, Washington University, St Louis, MO, USA*These authors contributed equally to this workCorrespondence: Edwin N Aroke, School of Nursing, University of Alabama at Birmingham, 1701 2nd Avenue S, NB 470G, Birmingham, AL, 35294-1210, USA, Tel +1205-975-75700, Email earoke@uab.eduIntroduction: Having a lower socioeconomic status (SES) is a predictor of age-related chronic conditions, including chronic low back pain (cLBP). We aimed to examine whether the pace of biological aging mediates the relationship between SES and cLBP outcomes – pain intensity, pain interference, and physical performance.Methods: We used the Dunedin Pace of Aging Calculated from the Epigenome (DunedinPACE) software to determine the pace of biological aging in adults ages 18 to 85 years with no cLBP (n = 74), low-impact pain (n = 56), and high-impact pain (n = 77).Results: The mean chronological age of the participants was 40.9 years (SD= 15.1); 107 (51.7%) were female, and 108 (52.2%) were Black. On average, the pace of biological aging was 5% faster [DunedinPACE = 1.05 (SD = 0.14)] in the sample (DunedinPACE value of 1 = normal pace of aging). Individuals with higher levels of education had a significantly slower pace of biological aging than those with lower education levels (F = 5.546, p = 0.001). After adjusting for sex and race, household income level significantly correlated with the pace of biological aging (r = − 0.17, p = 0.02), pain intensity (r = − 0.21, p = 0.003), pain interference (r = − 0.21, p = 0.003), and physical performance (r = 0.20, p = 0.005). In mediation analyses adjusting for sex, race, and body mass index (BMI), the pace of biological aging mediates the relationship between household income (but not education) level and cLBP intensity, interference, as well as physical performance.Discussion: Results indicate that lower SES contributes to faster biological aging, possibly contributing to greater pain intensity and interference, as well as lower physical performance. Future interventions slowing the pace of biological aging may improve cLBP outcomes.Pain language summary: Individuals of lower socioeconomic status (SES) experience worse outcomes from age-related chronic conditions, including chronic low back pain (cLBP). This work examines the relationship between SES, pace of biological aging, and cLBP intensity, interference with daily activities, and physical function. Lower SES correlates with a faster pace of biological aging, as well as cLBP pain intensity, pain interference, and physical performance. The pace of biological aging helps explain the relationship between household income and cLBP intensity, interference, as well as physical performance. Interventions targeting SES disparities may slow biological aging and improve cLBP outcomes.Keywords: socioeconomic status, health disparities, DunedinPACE, pace of biological aging, chronic low back pain, epigenetic clock

Jun Y Byun,1 Crystal Chapman Lambert,1 Pariya L Fazeli,1 Burel R Goodin,2 Anand S Iyer,1,3 Mirjam-Colette Kempf,1 Jenni M Wise,1 Yookyong Lee,4 David Scott Batey,5 David E Vance1 1School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 2School of Medicine, Washington University in St. Louis, St. Louis, MO, USA; 3Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; 5School of Social Work, Tulane University, New Orleans, LA, USACorrespondence: Jun Y Byun, School of Nursing, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL, 35294-4410, USA, Tel +1 205 427 5878, Email junbyun@uab.eduAbstract: Chronic obstructive pulmonary disease (COPD) is a fatal chronic disease experienced by 10% of people living with HIV (PLWH). As the population of older PLWH continues to increase, the prevalence of COPD is anticipated to grow as well. Despite this concerning trend, there is a lack of theoretical models to guide clinical practice and research on aging with HIV and COPD. To address this gap, this article describes the Baltes and Baltes’ SOC (Selective Optimization with Compensation) Model as a guiding framework for understanding successful aging of PLWH with COPD. The article highlights eight areas of aging (eg, length of life, biological health, mental health, cognitive efficiency, social competence, productivity, personal control, and life satisfaction) with HIV and with COPD and the potential synergetic effects of having two critical chronic diseases. Drawing from a synthesis of literature, we adapted the SOC model to include dedicated areas specifically tailored for HIV, COPD, and the intersectional areas impacted by both conditions. Furthermore, we integrated bidirectional relationships within the eight areas of aging into the model, aiming to enhance the practical application of the modified model. Based on the identified gaps in the literature, implications for clinical practice, research, and future theoretical developments are provided.Keywords: COPD, HIV, cognitive efficiency, length of life, successful aging

Demario S Overstreet,1,&ast; Larissa J Strath,1,&ast; Fariha N Hasan,2 Robert E Sorge,1 Terence Penn,1 Deanna D Rumble,1 Edwin N Aroke,3 Asia M WIggins,1 Jonas G Dembowski,1 Eeshaan K Bajaj,1 Tammie L Quinn,1 D Leann Long,4 Burel R Goodin1 1Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA; 2School of Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA; 3School of Nursing, Nurse Anesthesia Program, Department of Acute, Chronic, & Continuing Care, University of Alabama at Birmingham, Birmingham, AL, USA; 4School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA&ast;These authors contributed equally to this workCorrespondence: Demario S Overstreet, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 45 Francis Street, MRB 6-11, Boston, MA, 02115, USA, Email doverstreet@bwh.harvard.eduIntroduction: Considerable evidence suggests that there are significant ethnic/racial differences in the experience of pain among individuals suffering from chronic musculoskeletal conditions. Additionally, low levels of vitamin D have been associated with pain severity. Further, vitamin D deficiency is more prevalent in Non-Hispanic Black (NHB) individuals compared to Non-Hispanic Whites (NHW).Objective: The aim of this study was to investigate the associations among race, pain severity, and serum levels of vitamin D in a sample of patients with chronic low back pain (cLBP).Methods: All study participants (n = 155) self-identified their race/ethnicity as either NHB or NHW. Blood samples were collected to assess circulating levels of serum 25- hydroxy vitamin D. Vitamin D levels were categorized as optimal (≥ 20 ng/mL), insufficient (12– 19 ng/mL) or deficient (< 12 ng/mL). Participants then self-reported their pain severity using the Brief Pain Inventory – Short Form.Results: Results showed that a greater proportion of NHB versus NHW participants were categorized as Vitamin D deficient (χ2 (2, N = 155) = 16.79, p < 0.001). An analysis of covariance (ANCOVA) revealed that NHBs reported significantly greater pain severity relative to NHWs (F(1150) = 6.45) p = 0.012. Further, self-reported pain severity significantly differed according to Vitamin D clinical categories (F(2150) = 4.19, p = 0.013). Participants with deficient vitamin D reported significantly greater pain severity in comparison to participants with optimal vitamin D (F(1101) = 7.28, p = 0.008).Conclusion: The findings suggest that Vitamin D deficiency may be linked to greater pain severity in a sample of individuals with cLBP, especially for those who identify as NHB.Keywords: race, pain, vitamin D, disparities

Ellen L Terry,1 M Dottington Fullwood,2 Staja Q Booker,1 Josue S Cardoso,3 Kimberly T Sibille,2 Toni L Glover,4 Kathryn A Thompson,5 Adriana S Addison,6 Burel R Goodin,5 Roland Staud,7 Laura B Hughes,6 Laurence A Bradley,6 David T Redden,8 Emily J Bartley,9 Roger B Fillingim3,9 1Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States; 2Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States; 3Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States; 4Oakland University, School of Nursing, Rochester, MI, United States; 5Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States; 6University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States; 7Department of Medicine, University of Florida, Gainesville, Florida, United States; 8Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States; 9University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United StatesCorrespondence: Ellen L TerryDepartment of Biobehavioral Nursing Science, University of Florida, PO Box 100197, Gainesville FL 32610-0197 Tel ( +352) 273-6441Email elterry@ufl.eduPurpose: Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only.Patients and Methods: Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB).Results: As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination (F(1, 175)=26.660, p< 0.001), greater levels of pain catastrophizing (F(1, 180)=12.919, p< 0.001), higher levels of clinical pain and disability, and lower levels of physical function (ps< 0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p< 0.01; NHW males: r=0.37, p< 0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index).Conclusion: These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.Keywords: experiences of discrimination, Perceived Stress Scale, pain catastrophizing, knee osteoarthritis, pain, disability, physical function

Larissa J Strath,1 Robert E Sorge,1 Michael A Owens,1 Cesar E Gonzalez,1 Jennifer I Okunbor,1 Dyan M White,1 Jessica S Merlin,2 Burel R Goodin1 1University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA; 2University of Pittsburgh, Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Pittsburgh, PA, USACorrespondence: Robert E Sorge Tel +1205-934-8563Fax +1205-975-6110Email rsorge@uab.eduBackground: 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.Keywords: transgender, gender identity, sex differences, pain, quantitative sensory testing

Edwin N Aroke,1 Paule V Joseph,2 Abhrarup Roy,2 Demario S Overstreet,3 Trygve O Tollefsbol,4 David E Vance,1 Burel R Goodin3 1School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 2Sensory Science and Metabolism Unit (SenSMet), Division of Intramural Research, National Institute of Nursing Research, National Institute of Health, DHHS, Bethesda, MD, USA; 3Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Biology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: African Americans disproportionately suffer more severe and debilitating morbidity from chronic pain than do non-Hispanic Whites. These differences may arise from differential exposure to psychosocial and environmental factors such as adverse childhood experiences, racial discrimination, low socioeconomic status, and depression, all of which have been associated with chronic stress and chronic pain. Race, as a social construct, makes it such that African Americans are more likely to experience different early life conditions, which may induce epigenetic changes that sustain racial differences in chronic pain. Epigenetics is one mechanism by which environmental factors such as childhood stress, racial discrimination, economic hardship, and depression can affect gene expression without altering the underlying genetic sequence. This article provides a narrative review of the literature on epigenetics as a mechanism by which differential environmental exposure could explain racial differences in chronic pain. Most studies of epigenetic changes in chronic pain examine DNA methylation. DNA methylation is altered in the glucocorticoid (stress response) receptor gene, NR3C1, which has been associated with depression, childhood stress, low socioeconomic status, and chronic pain. Similarly, DNA methylation patterns of immune cytokine genes have been associated with chronic stress states. Thus, DNA methylation changes may play an essential role in the epigenetic modulation of chronic pain in different races with a higher incidence of epigenetic alterations contributing to more severe and disabling chronic pain in African Americans. Keywords: chronic pain, epigenetics, racial health disparities, epigenomics, DNA methylation, stress

Hailey W Bulls,1 Emily L Freeman,1 Austen JB Anderson,2 Meredith T Robbins,3 Timothy J Ness,3 Burel R Goodin1,3 1Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Biology, Samford University, Birmingham, AL, USA; 3Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: It has been suggested that increased pain sensitivity and disruption of endogenous pain inhibitory processes may account, at least in part, for the greater prevalence and severity of chronic pain in women compared to men. However, previous studies addressing this topic have produced mixed findings. This study examined sex differences in pain sensitivity and inhibition using quantitative sensory testing (QST), while also considering the influence of other important factors such as depressive symptoms and sleep quality. Healthy men (n=24) and women (n=24) each completed a QST battery. This battery included an ischemic pain task (IPT) that used a submaximal effort tourniquet procedure as well as a conditioned pain modulation (CPM) procedure for the assessment of endogenous pain inhibition. Prior to QST, participants completed the Center for Epidemiologic Studies Depression Scale and the Pittsburgh Sleep Quality Index. Analyses revealed significant sex differences for the ischemic pain task and the conditioned pain modulation procedure, such that women tolerated the ischemic pain for a shorter amount of time and demonstrated less pain inhibition compared with men. This remained true even when accounting for sex differences in depressive symptoms and sleep quality. The results of this study suggest that women may be more pain sensitive and possess less-efficient endogenous pain inhibitory capacity compared with men. Whether interventions that decrease pain sensitivity and enhance pain inhibition in women ultimately improve their clinical pain outcomes is an area of research that deserves additional attention in the future. Keywords: sex differences, pain sensitivity, inhibition, depressive symptoms, sleep