Differences in Pain Coping Between Black and White Americans: A Meta-Analysis

Abstract

Compared to White individuals, Black individuals experience greater pain across clinical and experimental modalities. These race differences may be due to differences in pain-related coping. Several studies examined the relationship between race and pain coping; however, no meta-analytic review has summarized this relationship or attempted to account for differences across studies. The goal of this meta-analytic review was to quantify race differences in the overall use of pain coping strategies as well as specific coping strategies. Relevant studies were identified using electronic databases, an ancestry search, and by contacting authors for unpublished data. Of 150 studies identified, 19 met inclusion criteria, resulting in 6489 participants and 123 effect sizes. All of the included studies were conducted in the United States. Mean effect sizes were calculated using a random effects model. Compared to White individuals, Black individuals used pain coping strategies more frequently overall (d=0.25, p<0.01), with the largest differences observed for praying (d=0.70) and catastrophizing (d=0.40). White individuals engaged in task persistence more than Black individuals (d=−0.28). These results suggest that Black individuals use coping strategies more frequently, specifically strategies associated with poorer pain outcomes. Future research should examine the extent to which the use of these strategies mediates race differences in the pain experience. Perspective Results of this meta-analysis examining race differences in pain related coping indicate that, compared to White individuals, Black individuals use coping strategies more frequently, specifically those involving praying and catastrophizing. These differences in coping may help to explain race differences in the pain experience.

Race/Ethnicity Moderates the Association Between Psychosocial Resilience and Movement‐Evoked Pain in Knee Osteoarthritis

“…Corroborating the health care disparities literature, as well as our own work , NHBs with knee OA reported greater knee pain severity and disability, poorer functional performance, and greater knee pain with movement than did NHWs. However, there were no distinct group differences in measures of psychosocial resilience despite a vast literature reporting race/ethnic differences in pain coping . In fact, overall pain‐coping strategies are used more frequently among NHBs, particularly passive coping methods, such as catastrophizing, hoping, and praying .…”

“…To the best of our knowledge, no studies have yet examined these interrelationships among individuals with chronic pain. Given the extensive literature recognizing variations in social and economic stressors, as well as differential patterns of pain coping across racial/ethnic groups , it is reasonable to speculate that protective resilience factors known to mitigate the adverse effects of pain could also vary as a function of race/ethnicity. Understanding these differences may be particularly critical in terms of optimizing current pain treatments and reducing racial disparities in pain.…”

Pain-Related Rumination, But Not Magnification or Helplessness, Mediates Race and Sex Differences in Experimental Pain

“…Studies have also found that Black individuals and women engage in more frequent pain-related catastrophizing 10,22,25,29,36,46,47,72 , which partially accounts for the race and sex differences in pain tolerance 22,25,41,46,77 . However, it was unclear which specific components of catastrophizing were driving these mediation effects.…”

Individual differences in pain: understanding the mosaic that makes pain personal

“…In addition, considerable evidence suggests that minority patients are at greater risk for undertreatment of their pain, which could obviously contribute to the greater clinical pain severity observed among members of minority groups [2; 75]. Pain coping also differs significantly across racial/ethnic groups [48; 65], and it is possible that biological factors, such as genetic contributions, may play a role in racial/ethnic differences in pain responses [49; 79]. …”