Do Blacks and Whites Cope with Pain Differently?

Do Blacks and Whites Cope with Pain Differently?

Researchers from the School of Science at Indiana University-Purdue University Indianapolis (IUPUI) conducted an analysis of clinical and experimental studies that found blacks employ pain-coping strategies differently and more frequently than whites.

“Coping” is broadly defined as the use of behavioral and cognitive techniques to manage pain.

Their analysis was based on 19 studies that included a total of 2,719 black adults and 3,770 white adults, and was published in The Journal Pain.

They found that blacks were significantly more likely to use “praying” and “hoping” as pain-coping strategies compared to whites. Blacks were also more likely to think about their pain in a catastrophic manner compared to whites.

“Our findings suggest that blacks frequently use coping strategies that are associated with worse pain and functioning,” said lead author Adam T. Hirsh, a clinical psychologist at IUPUI. “They view themselves as helpless in the face of pain. They see the pain as magnified — the worst pain ever. They ruminate, think about the pain all the time, and it occupies a lot of their mind space.”

“This catastrophic manner of coping is frequently labeled by health providers as a negative or maladaptive approach to pain and has been associated with poor functioning,” Hirsh added. “But it may also be a potent communication strategy — it tells others in a culture with a strong communal component that the person is really suffering and needs help. Thus, it may be helpful in some ways, such as eliciting support from other people, and unhelpful in other ways. In future studies, we will give this more nuanced investigation.”

The one coping strategy whites used more than blacks was ignoring pain.

“Numerous investigations have found that differences in coping strategies are associated with differences in pain intensity, adjustment to chronic pain, and psychological and physical functioning,” an IUPUI release about the study stated. “For example, several of the studies reviewed by the IUPUI researchers found that ignoring strategies are associated with less pain, whereas praying and hoping and catastrophizing are associated with higher pain levels.”

The analyzed studies also showed that blacks experience greater pain, they report less-effective pain care, are unable to return to work for a longer periods of time, and have worse functional outcomes. Hirsh said these race differences may be partly due to differences in pain-related coping.

Hirsh and his colleagues note that understanding these racial differences in coping with pain may be clinically useful in tailoring individual treatment, support and care.

“Clinicians see patients who are becoming more and more diverse over time,” Hirsh continued. “It behooves us to ask about these things and to make good use of what the patient tells us. This study speaks to the need to provide such patient-centered and culturally sensitive medical care.”

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Jean Price

Something I happened to think about…several years ago, my physician started me on a new diabetic med, (and I’m so sorry I don’t know what it was because it was a sample and I’ve since thrown the bottle away, but I’ll try to check). Within just a short while of taking this medication, my pain drastically increased. I wouldn’t be due for any further pain medication for quite a while so I was miserable, and more than a little confused since it was like someone flipped a switch and my pain escalated. After about two days of this type of concurrence, it dawned on me that the medications could be reacting oddly. I called the pharmaceutical company and explained, and the pharmacest said although it wasn’t in their prescribing information, it was highly likely since they both used the same receptors and the new diabetic medication took precedence over the pain meds in attaching to those receptors! ! After checking with my endocrinologist, I stopped the new med and resumed my usual response from my pain medications. I thought this might be of interest to anyone who may have had a sudden loss of effectiveness from their pain meds, especially if another new medication for another condition was introduced recently. Often effects aren’t listed as interactions but they still interfere with some aspects. Check with your doctor if you think this is happening on any meds, especially before you stop anything!

For Michael Wagner and others: I am highly visible as a chronic facial pain patient advocate and information miner, from my own website and others. I don’t wish to divert traffic from the National Pain Report, but any who wish to correspond separately may do so via If there is a site guideline on the use of email addresses in comments, I would appreciate a tip from Admin please. Otherwise, anyone interested can find me by running a google search on Richard A. Lawhern or Red Lawhern.

Regards and best,

michael wagner

Dear DR Lawhern:
Last year I went to CA. twice to see a pain specialist DR Forest Tennant, He done a check swab for genetic test, the results came back from a Seattle based company, Genelex.
The CYP2D6 poor metabolizer *3/*4
The CYP2C19 intermediate Metabolizer *1/*2
The CYP2C9 ” ”

I have called this company at least 20 times and no one there could ever give me a answer to there results, I asked 5 doctors and many pharmacist, one said he had a week of it in college but don’t remember anything.
so this test cost Medicare $2500.00 and a total waist of time and money.
it would be nice if I could find out something that would work for pain.
I looked a long time trying to find a way to email DR Lawhern but I need to start this way and hope he reads this post.
It would be nice if there was a way to find a way to help with pain problems.
I heard that the CYP450 has a lot to do with this, why it wasn’t ordered I don’t know.


Below is a link to an article in Modern Healthcare regarding race and pain med prescriptions and race and addiction, The racial divide in the opioid crisis. If you have to signup to read the article and anyone here wants to read it. let me know and I’ll be glad to copy and paste it here. I have also posted a link to a JAMA Jan 2, 2008 article, “Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments”

The racial divide in the opioid crisis-

JAMA Jan 2, 2008 Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments-

Jean Price

Dr. Lawyers…interesting comment about the genetic factors. It would make sense since metabolism is so individual. I wonder if genetics can also influence long term use effectiveness, or play a part in tolerance. I have another possible thought to throw out for some people….one thing I’ve just realized has to do with joint injections for pain…which some Rheumatoligists, Orthopedists, and even internist and family practice doctors do… pain clinic doctor does all joint injections under fluoroscopy and it has made a world of difference in the effectiveness and the length of relief I’ve had when compared to multiple other times with different physicians who didn’t use this technique. It has to do with visualizing the area of medication placement and usually extends the treated area because of this. So if joint injections haven’t helped in the past, you still might have relief from this method with some one who does fluoroscopy. I haven’t been well enough with other health issues to have the knee replacement I’ve needed for the last six plus years, and the last several injections were not effective at all. These were done both by my orthopedic surgeon and my Rheumatologist. In talking about still not being up to surgery with my pain doctor, he asked about trying it with fluoroscopy. I don’t think I’ll ever have another injection without it after my improved response. He had done a shoulder injection for me years ago with equally good results when I was trying to avoid a shoulder surgery to correct a clavicle issues that was trapping the muscles…and the pain resolved within a few weeks, with only minor flare ups since. I didn’t know it would also be so effective for knees! So I give this option to any of you with RA or other degenerative issues. I think helping one body part takes just that much off the whole pain picture…and some days that’s a lifesaver!

A thought for Michael Wagner and others who share his pain experience, if I may. There is an emerging field of medical science which addresses the variability in response to medications, between individual patients. The evidence points toward genetic factors which mediate the absorption and metabolism of both anti-seizure medications (often used off-label against neurological pain) and opiods. Some patients do not receive relief even from acute pain, with one or both classes of medications. If you’ve had difficulty finding an appropriate medication plan for chronic pain, it may be worth asking your primary care providers if you should have genetic testing done for the factors known to limit their effectiveness.


michael wagner

A little off the subject, but I think it fits in,
I will explain a little about how opiates and alcohol has worked on my body and mind. I quit drinking 30 years ago, but I worked 12 hours a day and drank 4 hours after work, never got drunk it didn’t have much effect on me, why I never figured it out, and accident came one after another and the worst was a in surgery accident a surgeon got a screw rapped around the L-5 nerve root and the tip of the screw well into the spinal canal and sewed me up and then had to leave town to finish some schooling, there were 6 Dr’s in the Seattle firm and none of them would do anything till he got back , well 6 weeks to the day a oil based 5th time mylogram showed , then right into surgery, in time adhesive arachnoiditis set in. Then the oxycontin came out and a pain specialist was prescribing me 120 mgs every 6 hrs for the pain that kept me working 12 hours a day , 4 days a week, at the start they made me feel talkative and had a feel good about them. but shortly It kept the pain down , I could miss a dose and that never bothered me, sometimes I was so busy I didn’t even think about taking them. I am going to be 75 years old next month, and I find nothing that will help with pain what so ever. I have been all over the US and Asia trying to find pain help, if there was any help there was no doctors that knew what to do. So my thoughts as like Krissys and Jeans comment’s just told in a different way. I do know this being self employed all my life had made things different in every way you can think of.
I do know this the past years I have been a genie pig for a bunch of pain doctors.
and there will never be any help for me. Are DNA make ups are all different. medicare paid $2500.00 for there share of that test a CA. DR wanted yet I had made 20 calls to the company that did the testing and noe of them could tell me what the medications and there make up or interactions were.

Thanks Jean Price, for the acknowledgement. I have for 20 years supported chronic face pain patients (of whom my spouse is one) as a website designer, online research analyst and information miner. From years of professional practice as a technology futurist, I am generally familiar with the requirements of proper meta-analysis and trials design. And I am often appalled by the word noise I see published by people who should have known better. A great deal of medical and psychological research simply doesn’t replicate when repeated by independent investigators. I suspect the subject of this thread might fall into that category.

Jean Price

Krissy…I do realize the content of the show was directed at heroin addiction, and I definitely agree it is an incredibly devastating and sad problem which needs to be addressed. So many young vibrant lives are consumed, and families shattered. Truly they are patients too, and even have pain….untreated emotional pain. Yet the statements they made about the “crisis” being because of excess OxyContin prescribing for pain and how “an opioid is an opioid”…so heroin AND OxyContin are the foes we need to squelch, was another way of confusing the two issues of addiction and chronic pain. I totally agree a person in physical pain speaking up would be unnecessary for this kind of show…what I said when I made my comment was not one person (meaning the presenters, doctors, etc.) spoke up about opioids being a viable treatment option for chronic pain, and safe also… when people have a healthy respect for it (like any medication!) and use it to increase function and as prescribed. If they were talking purely of heroin, I agree wholeheartedly there would have been no need for this even. But when THEY bring in pain medication (and compare it to heroin) I think it’s important they hold up the truth about legally obtained prescription medication for people with chronic pain being appropriate and not something that needs to be stopped. They didn’t do this. And that’s my concern. It wouldn’t have taken anything away from the addiction problem at all, but it would have helped clarified that opioids are not evil when used for pain. Thanks for your insight. (I also think Richard, as usual, has valid points!)

Kristine (Krissy)

Of course it does, but it is not researched properly. See Richard Lawhern’s comment.

Kristine (Krissy)

I agree with Dr. Richard completely.

Jean Price, last night’s PBS Frontline show wasn’t about the pain patient at all, but a very real and sad story of addiction in young people. I don’t think it would have been necessary to even mention a pain patient like us; I think this side of the story is very important and we have to realize that addicts are patients too, but in a different kind of pain. (I know you realize that.)


I wonder if the lack of quality health care and lack of adequate pain management for blacks as oppossed to whites has any bearing in this ?

Jean Price

Well, I can’t buy this…I don’t think prayer is ever responsible for making a person feel worse. It is usually empowering and helps a person feel hopeful…and also helps them let go of uncontrollable goals…as in “Let go and let God.” I think this coping strategy helps minimize a person’s pain, not make them feel their pain is worse…regardless of their color! Maybe this is simplistic, but I believe if there was a pain meter to show pain, black and white would show the same readings, given similar conditions for chronic pain. And if coping differs at all it would be more likely to differ in regard to access to health care and the stress it can bring when it’s harder to come by and varies in quality. As for ignoring pain, I think this is usually the result of distraction therapy more than a mindset, and the same types of distractions would be used by each group. I’m not at all sure why anyone would consider this worthy of an article or a study…and worthy of posting on their site to their followers! To me it would be better filed away where no one would ever see it and think it matters…isn’t this just another way to separate instead of unify? And aren’t there so many other issues with chronic pain that could be studied that would actually help people? Perhaps I’m a little jaded tonight since I just watched Frontline’s television show about the “dangerous heroin epidemic brought on by over prescribing opioids” with all their skewed statistics. It leaves the viewer thinking opioids are the devil! And there was not even one statement, not one one person who said they were highly regarded as helpful for chronic pain. Bigger battles need waged more than comparisons of black white coping, I say


I have mixed feelings. Prayer surely can be a positive coping mechanism in that it connects a patient with something larger than themselves. Prayer should be able to elicit positive feelings, and it might be a way to socially connect with others (“Please pray for me – I’m in pain.”) I don’t know if some folks get deep into prayer as they do for meditation, but it seems to me that prayer and meditation are fairly similar in some ways.

Praying out of hopelessness and despair can be ruminating and worsen conditions, but praying out of hope or for a “connection” or as an enrichment of spiritual life sounds beneficial to me.

Disclaimer: I actually don’t really pray with regard to my pain. I tend to pray with gratitude and pray for others, but I don’t really see myself as very religious/spiritual.

Veronica Clark

I’ve known both black and white people in pain, and I don’t agree with this ‘study’. It’s a very small biased study of a tiny group of people. I know some white people that think a paper cut is horrendous. I’m in pain 24/7, but don’t think of it unless I have to. I’m white. I also don’t think people should be separated according to race when it comes to pain. It’s part of what is wrong with this country today. This study most certainly should not be published, as it will cause even more controversy between the races – as if we need that!!

michael Wagner

I hate to say this but I have black neighbors and both of them have nice cars and nice houses, one has been on L&I for 7 years, and social security to make up the one third that they don’t pay so he is living much better that when they were taking all the taxes out, all this money is tax free. S and the other neighbor only 52 slim but hates to do any work he has to get someone to do everything, I have known him for 20 years and he is 50 and trying as hard as he can to get a retirement, I know they all talk about getting uncle sam for all they can get. This might be part of that subject

Mark Ibsen

It would be good to link this kind of study with objective data:
DNA screening in the CYP and COMT systems.
An objective measurement of pain
Data about chronic pain:
Are more blacks or whites in chronic pain?
The entire cultural tapestry contributes, does it not?
We may have discovered the source of the music referred to as the Blues.

A meta-analysis of this kind should be taken with a serious grain of salt, so that we do not impute cause and effect improperly. The investigators were at least one step removed from contact with the patients themselves, or with the investigators whose studies they read. It is an objective reality that minorities are under-served by the medical profession, and that they tend to present in emergency care venues with more severe disability and dysfunction as a consequence. Thus not only do they “use” strategies associated with greater levels of pain, it is entirely plausible that they actually HAVE greater levels of pain because of delayed or inconsistent treatment for acute conditions.

Poverty is generally associated with poorer health and poorer healthcare outcomes. It would be interesting to isolate for the impact of poverty on coping strategies, apart from race. One suspects that if this were done, the impact of coping strategies might be lost in the noise.