“When compared with white patients, black individuals tend to report higher levels of pain for a number of conditions,” explains Adam T. Hirsh, PhD. “Black patients also tend to have a lower pain tolerance and report higher pain intensity and unpleasantness. Coping with pain is an important aspect of care for clinicians managing patients with pain.”

A Meta-Analysis

Several studies show that ignoring strategies are associated with less pain whereas praying, hoping, and catastrophizing have been linked to higher pain levels. To date, many of the investigations exploring the relationship between race and pain coping have come with inconsistent results. To gain further insights on this connection, Dr. Hirsh and colleagues published a meta-analytic review in the Journal of Pain to quantify race differences (black versus white) in the use of pain coping strategies.  “Our goal was to better understand one possible mechanism of race differences in the pain experience,” says Dr. Hirsh.

For the study, investigators identified relevant studies using electronic databases, an ancestry search, and by contacting authors for unpublished data. The analysis had 19 studies that met inclusion criteria, resulting in nearly 6,500 participants, all from the United States. “This information may help clinicians identify strategies to improve their management of chronic pain and offer more support for patients,” says Dr. Hirsh.

Assessing Key Findings

According to the results, black individuals used pain-coping strategies more frequently overall than white patients. Most notably, blacks engaged in hoping, praying, and catastrophizing more frequently. The study noted that the catastrophizing response of blacks may be related to a more general sense of learned helplessness. “Although catastrophizing is often associated with worse pain and functioning, it may also serve as a way to solicit assistance or empathic responses from others, including family, friends, and medical providers,” Dr. Hirsh says.

The passive coping strategies that were more often used by blacks have been associated with poorer pain outcomes, according to Dr. Hirsh. “These differences in coping may help to explain race differences in the pain experience,” he says. “Because blacks use pain-coping strategies more often, they are also more likely to engage in maladaptive strategies, which may partly account for their increased pain and impairment when compared with white individuals.”

Looking Into the Future

More research is needed to determine the extent to which use of these coping strategies mediates race differences in the pain experience. “Throughout medicine, to assess is to intervene, such that merely asking patients about their pain coping may actually change their coping behavior for the better,” says Dr. Hirsh. “Studies are needed to clarify how differences in hopes, prayers, and catastrophizing are related to race differences in pain. We also need to further examine race differences in intra- and inter-personal values and goals within the context of pain. With this data, we may be able to better understand race differences in pain coping and improve patient-centered, culturally-sensitive care for all patients in pain.”

Adam T. Hirsh, PhD, has indicated to Physician’s Weekly that he has received grants/research aid from the NIH, the American Pain Society, the Walther Cancer Foundation, the American Psychological Association, Indiana University, and the Purdue Research Foundation.

References

Meints SM, Miller MM, Hirsh AT. Differences in pain coping between Black and White Americans: a meta-analysis. J Pain. 2016 Jan 16 [Epub ahead of print]. Available at: http://www.jpain.org/article/S1526-5900(16)00019-5/fulltext.

Hirsh AT, George SZ, Bialosky JE, Robinson ME. Fear of pain, pain catastrophizing, and acute pain perception: relative prediction and timing of assessment. Pain. 2008;9:806-812.

Campbell CM, Witmer K, Simango M, et al. Catastrophizing delays the analgesic effect of distraction. Pain. 2010;149:202-207.

Dunn KS, Horgas AL. Religious and nonreligious coping in older adults experiencing chronic pain. Pain Manage Nurs. 2004;5:19-28.

Hastie BA, Riley JL, Fillingim RB. Ethnic differences and responses to pain in healthy young adults. Pain Med. 2005; 6:61-71.