Coping, pain severity, interference, and disability: the potential mediating and moderating roles of race and education

Abstract

Researchers have demonstrated that certain types of pain coping are correlated with less pain severity and disability and that there are differences between Caucasians and African-American pain patients in their use of specific coping strategies. However, the extent to which racial group differences exist in the associations between pain coping strategies and pain severity, interference, and disability is unclear. Furthermore, the role of education in these associations is uncertain. We recruited a diverse community sample of individuals with chronic pain and their spouses to examine this issue (N = 105). Participants completed the Coping Strategies Questionnaire, Multidimensional Pain Inventory, and Sickness Impact Profile. Results showed that African-American participants reported significantly more pain severity, interference, and disability and reported using diverting attention and prayer and hoping pain-coping strategies significantly more often than Caucasian participants; however, only the racial group difference in prayer and hoping remained when controlling for education. We also examined whether race and education interacted with coping strategies in relating to pain and disability. Significant three-way interactions were found for physical and psychosocial disability, suggesting that educational level should be included in analyses exploring racial group differences. The results suggest the need for pain treatments that take into account the educational and cultural context of pain.

Perspective: This article demonstrates that demographic variables such as race and education should be considered together when evaluating the effectiveness of coping with pain. The findings have the potential to enhance research and clinical practice with diverse groups.

Figure 1

Expected physical disability scores based on race, education, and the use of reinterpreting pain sensations. Low and high education levels are represented by −1 SD and +1 SD from mean education, respectively. Expected disability scores were calculated on the basis of the regression results presented in Table 3.

Figure 2

Expected physical disability scores based on race, education, and the use of coping self-statements. Low and high education levels are represented by −1 SD and +1 SD from mean education, respectively. Expected disability scores were calculated on the basis of the regression results presented in Table 4.

Figure 3

Expected psychosocial disability scores based on race, education, and the use of coping self-statements. Low and high education levels are represented by −1 SD and +1 SD from mean education, respectively. Expected disability scores were calculated on the basis of the regression results presented in Table 5.