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.”