In Vivo Praying and Catastrophizing Mediate the Race Differences in Experimental Pain Sensitivity

Abstract

Black individuals have a lower tolerance for experimental pain than White individuals. Black and White individuals also differ in their use of pain coping strategies, which may explain the race differences in pain sensitivity. We examined the extent to which situation-specific pain coping mediated Black-White differences in pain sensitivity. We hypothesized that: (1) Black participants would demonstrate lower pain tolerance than White participants, (2) Black participants would use different pain coping strategies than White participants, and (3) the differential use of these strategies would mediate the relationship between race and pain tolerance. Healthy college undergraduates (N=190) participated in a cold pressor task and then completed the CSQ-R to assess their situation-specific pain coping. Compared to White participants, Black participants demonstrated lower pain tolerance, engaged in more situationspecific catastrophizing and praying, and ignored pain less frequently. Catastrophizing and praying were inversely related to pain tolerance and were significant mediators of the relationship between race and pain tolerance. The indirect effect of praying was stronger than that of catastrophizing. Race differences in pain sensitivity may be due, in part, to differences in the use of catastrophizing and praying as coping strategies. These results may help guide treatments addressing maladaptive pain coping. Perspective:This study suggests that race differences in pain sensitivity may be due, in part, to the differential use of catastrophizing and praying strategies. Psychosocial treatments for pain should encourage patients to take an active role in their pain management.

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

“…The finding that Black individuals catastrophized more frequently to experimental pain was consistent with our hypothesis and with previous experimental studies 22,25,46 . Our results also align with those from clinical studies.…”

“…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.…”

“…Furthermore, research has found that Black individuals and women more frequently catastrophize about pain than do White individuals and men, respectively 25,36,46,72 . Given the relationship between catastrophizing and pain, along with evidence of race and sex differences in pain and catastrophizing, catastrophizing may contribute to race and sex differences in the pain experience. Indeed, studies have found that catastrophizing mediates race differences in pain intensity, pain tolerance, and affective responses to pain 22,25,46 .…”

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

“…The communal model of coping is consistent with the collectivistic orientation that is characteristic of many Black cultures [20], wherein members place a higher importance on interpersonal than on intrapersonal outcomes. Consequently, although pain catastrophizing might lead to increased pain at the intrapersonal level – indeed, catastrophizing has been shown to mediate race differences in pain tolerance [31,64] – it may also confer significant advantages at the interpersonal level. This communal coping model interpretation would also be consistent with findings that Black individuals seek social support more than White individuals.…”

Culturally Responsive Pain Management for Black Older Adults

“…It seems like you aren’t very comfortable right now and I would like to get you some medication that will work along with your prayers to relieve your pain.” Although, many older Black Americans find prayer to be a helpful and important part of their care and recovery, it is important to communicate with them, in a respectful way, that prayer alone may not sufficiently control high levels of pain. In fact, engagement in more prayer has been associated with lower pain tolerance in Black Americans (Meints & Hirsh, 2015). Despite the noted contrast in the cultural belief and the expected clinical outcome, showing appreciation means recognizing the importance of this practice for many and making reasonable accommodation to integrate it into care.…”