Ethnicity, control appraisal, coping, and adjustment to chronic pain among black and white Americans

Objective. To identify similarities and differences among non-Hispanic black and white patients in pain appraisal, beliefs about pain, and ways of coping with pain. We also examined the association between these factors (i.e., appraisals, beliefs, coping) and patient perception or subjective experience of their functioning in each ethnic group. Design. Cross-sectional survey of patients with chronic pain at pretreatment assessment. Setting. Integrated pain management program at a Veterans Affairs Medical Center in Texas. Patients. A total of 128 non-Hispanic black Americans and 354 non-Hispanic white Americans completed self-report measures of pain appraisal, coping, and adjustment that included the Multidimensional Pain Inventory, Survey of Pain Attitudes, Coping Strategies Questionnaire, and Chronic Pain Coping Inventory. Results. Although the analyses indicated many similarities between the two groups concerning pain-related beliefs and coping, the black patients reported lower perceived control over pain, more external pain-coping strategies, and a stronger belief that others should be solicitous when they experience pain. The black patients also reported significantly higher levels of depression and disability, even after controlling for pain severity. Regression analyses revealed that the coping and appraisal factors predicting physical and psychological functioning were the same for both white and black patients, with ethnicity accounting for a nonsignificant amount of the total variance. Conclusions. The current findings suggest similarities as well as differences between non-Hispanic black and white patients in the ways they view and cope with pain. However, the association between psychological factors (attitudes and beliefs, coping responses) and adjustment to chronic pain was comparable for both ethnic groups. If replicated, the findings suggest that specific tailoring of cognitive behavioral therapies to different racial/ethnic groups may not be needed to maximize treatment outcome.