Pain Coping in Racially Diverse American Patients

Dr. Edwards and a team of researchers explored the relationships between ethnic differences in pain and pain coping. Their 2012 review, published in Pain Management, showed that African Americans were more likely to rely on passive pain coping strategies, such as praying, hoping, and seeking social support, possibly leading to more depression and disability. 2

“The findings of this new review did not surprise me. They are nice and consistent and include both clinical and non-clinical studies. The review supports differences in person-to-person coping strategies as well as in racial group strategies. The challenge now is to explain why. We can only speculate about religious, cultural, and community differences,” Dr Edwards told Clinical Pain Advisor.

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Although there is some evidence for a neurophysiologic explanation of racial pain differences, the evidence is weak, Dr. Edwards pointed out. “There are plenty of controlled laboratory studies showing that African Americans have a lower pain threshold and higher pain intensity, but these rely on self-reporting of pain. The studies are consistent and they show up in minorities across countries. But until we have brain imaging that shows a difference in racial response to pain, it is too early to say there is a physiologic explanation.”

Identifying Negative Coping Strategies

Identifying negative coping strategies is important because these strategies can be changed to improve outcomes. Primary care providers should consider assessing pain coping in patients with chronic pain.

“Two questionnaires that could help identify poor coping are the Coping Strategies Questionnaire and the Pain Catastrophizing Scale. These are the most frequently used tools for assessing pain-related coping,” Dr Hirsh noted.

For patients who could benefit from better coping strategies, therapies such as acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR) have been shown to improve pain outcomes and reduce depression and pain-related anxiety.

“There is good evidence for ACT and MBSR. These therapies are usually available for patients with access to university-based pain clinics, [but] not so much for patients in places like rural South Dakota,” Dr Edwards said.