Highlights
- •We meta-analyzed differences in pain coping between white and black Americans.
- •Overall, black individuals use coping strategies more frequently.
- •Race differences in pain coping are largest for praying and catastrophizing.
- •Research is needed to better understand the influence of culture in this context.
Abstract
Perspective
Key words
The Current Study
Methods
Search Methods
Pain | Coping | Race |
---|---|---|
Nociception | CSQ | African American |
Catastrophizing | Black | |
Chronic Pain Coping Inventory | Ethnicity | |
Coping self statements | ||
Distraction | ||
Diverting attention | ||
Guarding | ||
Hoping | ||
Ignoring | ||
PCS | ||
Pain Coping Inventory | ||
Pain Coping Questionnaire | ||
Praying | ||
Reinterpreting pain | ||
Relaxation | ||
Seeking social support | ||
Stone and Neale Daily Coping Inventory | ||
Transformation | ||
Vanderbilt Multidimensional Pain Coping Inventory | ||
Wishful Thinking |
Eligibility Criteria

Screening, Coding, and Requests for Missing Data
Data Analytic Approach
Moderator Analyses
Cognitive Versus Behavior | Active Versus Passive | Problem- Versus Emotion-Focused | |||
---|---|---|---|---|---|
Cognitive | Behavioral | Active | Passive | Problem-Focused | Emotion-Focused |
Catastrophizing | Asking for assistance | Coping self statements | Catastrophizing | Asking for assistance | Catastrophizing |
Coping self Statements | Depending on others | Diverting attention | Depending on others | Depending on others | Coping self statements |
Diverting attention | Exercise and stretching | Exercise and stretching | Hoping/praying | Diverting attention | Hoping/praying |
Hoping/praying | Functioning despite pain | Functioning despite pain | Passive techniques | Exercise and stretching | Reinterpreting pain |
Ignoring pain | Guarding | Ignoring pain | Restricting functioning | Functioning despite pain | Seeking support |
Reinterpreting pain | Increasing behavioral activity | Increasing behavioral activity | Retreating | Guarding | Transformation |
Transformation | Reducing demands | Reinterpreting pain | Using medication | Increasing behavioral activity | Wishful thinking |
Wishful thinking | Restricting functioning | Self-care | Wishful thinking | Reducing demands | Worrying |
Worrying | Retreating | Task persistence | Worrying | Relaxation | |
Seeking support | Transformation | Restricting functioning | |||
Self-care | Retreating | ||||
Standard health care | Self-care | ||||
Task persistence | Standard health care | ||||
Using medication | Task persistence | ||||
Using medication |
Statistical Software
Wilson DB: Meta-analysis macros for SAS, SPSS, and Stata. Available at: http://mason.gmu.edu/∼dwilsonb/ma.html. Accessed May 3, 2014
Results
Study Sample
Study | Sample Size (Black Participants), n | Mean Age, Years | Percent Female Sex | Sample | Coping Questionnaire |
---|---|---|---|---|---|
Allen et al 2 | 491 (221) | 60.12 | 6.74 | Clinical | SNDCI adapted for pain |
Campbell et al 11 | 120 (62) | 21.07 | 57.69 | Nonclinical | CSQ |
Cano et al 13 | 105 (43) | 53.64 | 59 | Clinical | CSQ-Revised |
Chibnall and Tait 17 | 1475 (580) | N/A | 37.7 | Clinical-low back injury | PCS |
Cruz-Almeida et al 21 | 194 (95) | 24.34 | 48.15 | Nonclinical | PCS |
Dun et al 22 | 197 (38) | 76.36 | 77 | Nonclinical | Modified version of the CSQ; modified version of the Religious Problem-Solving Scale |
Edwards et al 26 | 194 (97) | 45.7 | 52.6 | Clinical | CSQ |
Fabian et al 28 | 37 (11) | 21.5 | 61.29 | Nonclinical | PCS |
Forsythe et al 31 | 155 (60) | 19.47 | 53.5 | Nonclinical | PCS |
Golightly et al 35 | 153 (59) | 61.8 | 51.6 | Clinical-arthritis | SNDCI adapted for pain; CSQ |
Goodin et al 36 | 114 (28) | 19.9 | 50 | Nonclinical | PCS |
Goodin et al (unpublished) | 114 (28) | 19.9 | 50 | Nonclinical | CSQ |
Hastie et al 39 | 650 (287) | 21 | 64 | Nonclinical | CSQ-Revised |
Hastie et al 38 | 372 (185) | 24.63 | 58.2 | Nonclinical | List of pain reducing behaviors |
Jones et al 49 | 939 (459) | 59.35 | 3.2 | Clinical-arthritis | CSQ |
Jordan et al 50 | 100 (48) | 54.72 | 100 | Clinical-arthritis | CSQ |
McIlvane 63 | 175 (77) | 66.74 | 100 | Clinical-unspecified | VMPCI; Emotional Approach Coping Scale; catastrophizing subscale of the CSQ; 2 religious items from the SNDCI |
Ruehlman et al 77 | 428 (214) | 53.5 | 58.4 | Clinical -unspecified | Profile of Chronic Pain: Screen and Extended Assessment |
Tan et al 91 | 479 (127) | 51.2 | 9.6 | Clinical -unspecified | CSQ |
Study | Study SMD | 95% CI | Effect |
---|---|---|---|
Allen et al 2 | .26 | .17 to .34 | B > W |
Campbell et al 11 | .62 | −.24 to 1.47 | B = W |
Cano et al 13 | .38 | −.16 to .93 | B = W |
Chibnall and Tait 17 | .28 | .14 to .35 | B > W |
Cruz-Almeida et al 21 | .17 | −.11 to .45 | B = W |
Dunn et al 22 | .22 | .12 to .31 | B > W |
Edwards et al 26 | .10 | −.10 to .31 | B = W |
Fabian et al 28 | .89 | .14 to 1.64 | B > W |
Forsythe et al 31 | .68 | .34 to 1.01 | B > W |
Golightly et al 35 | .33 | .14 to .53 | B > W |
Goodin et al 36 | .70 | −1.20 to 1.60 | B = W |
Goodin et al (unpublished) | .47 | .29 to .64 | B > W |
Hastie et al 39 | .26 | −.11 to .62 | B = W |
Hastie et al 38 | .17 | −.02 to .36 | B = W |
Jones et al 49 | .07 | .03 to .11 | B > W |
Jordan et al 50 | .06 | −.52 to .64 | B = W |
McIlvane 63 | .18 | .05 to .31 | B > W |
Ruehlman et al 77 | .10 | −.18 to .38 | B = W |
Tan et al 91 | .12 | .02 to .21 | B > W |
Relationship Between Race and Overall Coping Strategies
Coping Strategy | k | N | Effect | SMD | 95% CI | Z | I2 | FSN |
---|---|---|---|---|---|---|---|---|
Overall | 19 | 6,489 | B > W | .25 | .17 to .32 | 6.35* | 46.86 | 29 |
Hoping/praying | 12 | 3,595 | B > W | .70 | .48 to .92 | 6.34* | 88.89 | 72 |
Catastrophizing | 17 | 5,307 | B > W | .40 | .26 to .53 | 5.81* | 79.58 | 51 |
Diverting attention | 11 | 2,781 | B > W | .20 | .13 to .27 | 5.32* | 0 | 11 |
Coping self-statements | 11 | 3,384 | B = W | .08 | −.01 to .17 | 1.8 | 34.97 | 0 |
Reinterpreting pain | 11 | 2,956 | B > W | .10 | .03 to .18 | 2.8† | 0 | 0 |
Ignoring pain sensations | 10 | 3,209 | B = W | −.09 | −.26 to .08 | −1.07 | 81.05 | 0 |
Increasing behavioral activity | 5 | 1,729 | B = W | .00 | −.11 to .11 | −.02 | 34.78 | 0 |
Exercising and stretching | 2 | 679 | B > W | .33 | .01 to .65 | 2.02† | 85.16 | 7 |
Task persistence | 2 | 910 | W > B | −.28 | −.41 to −.14 | −3.99* | 0 | 4 |
Guarding | 2 | 679 | B = W | .28 | −.04 to .60 | 1.72 | 80.99 | 4 |
Relaxation | 2 | 679 | B = W | .23 | −.04 to .50 | 1.68 | 46.24 | 3 |
Seeking social support | 3 | 1,029 | B = W | .23 | −.04 to .51 | 1.66 | 47.92 | 4 |
Relationship Between Race and Specific Coping Strategies
Moderation
Variable | R2 | β | Z |
---|---|---|---|
Overall | |||
Age | .18 | −.42 | −1.58 |
% Female sex | .03 | .16 | .72 |
Hoping/praying | |||
Age | .16 | −.40 | −1.13 |
% Female sex | .22 | .47 | 1.75 |
Catastrophizing | |||
Age | .41 | −.64 | −3.14* |
% Female sex | .01 | .10 | .47 |
Diverting attention | |||
Age | .01 | −.11 | −.23 |
% Female sex | .29 | .54 | 1.62 |
Coping self-statements | |||
Age | .23 | .48 | 1.07 |
% Female sex | .00 | .02 | .08 |
Reinterpreting pain | |||
Age | .02 | .13 | .21 |
% Female sex | .17 | .41 | 1.05 |
Ignoring | |||
Age | .01 | −.10 | −.19 |
% Female sex | .25 | −.50 | −1.84 |
Increasing behavioral activity | |||
Age | 1.00 | −1.00 | −1.80 |
% Female sex | .01 | −.09 | .17 |
Exercising and stretching | |||
Age | .07 | −.26 | −.41 |
% Female sex | .91 | .96 | 2.48* |
Coping Strategy | k | Effect | SMD | 95% CI | Z |
---|---|---|---|---|---|
Active | 12 | B = W | .03 | −.34 to .10 | .95 |
Passive | 18 | B > W | .53 | .39 to .68 | 7.28* |
Problem-focused | 12 | B > W | .14 | .07 to .21 | 3.86* |
Emotion-focused | 18 | B > W | .32 | .22 to .40 | 6.70* |
Cognitive | 17 | B > W | .29 | .20 to .38 | 6.19* |
Behavioral | 8 | B = W | .05 | −.03 to .12 | 1.30 |
Conclusions
Acknowledgments
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Article info
Publication history
Footnotes
All authors have read and approved the manuscript, and all have contributed substantially to data analysis and manuscript preparation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Preliminary results from this study were presented in a poster session at the 2015 meeting of the American Pain Society.
This work was supported by a grant from the National Institutes of Health awarded to A.T.H. (R01MD008931).
The authors have no conflicts of interest to declare.