UF researchers find ethnic differences in reports of pain perception

May 2, 2001

GAINESVILLE, Fla. — Whether you’ve dreaded the bite of the dentist’s drill, the viselike contractions of childbirth or the crushing pressure of a heart attack, one thing’s certain: Pain is commonly feared yet in many ways poorly understood.

The sensation may be universal, but the intensity with which it is felt varies widely, colored by past experience, insomnia, cultural conditioning, and fundamental biologic or psychological makeup. Now findings from a University of Florida study add credence to the dawning realization that ethnicity also appears to play an important role in how patients report pain.

In a study of more than 200 student athletes, UF researchers found that on average the 55 black participants reported a greater sensitivity to pain than their 159 white counterparts during an uncomfortable laboratory test. Blacks rated their discomfort at an average of 8.2 on a 13-point scale. Whites reported less pain, scoring 6.9. Participants, who included men and women age 17 to 24, rated the intensity and unpleasantness of the pain they experienced when a bag of ice water was placed on their foreheads for two minutes.

The study also indicated the athletes rated their pain as more intense when the experiment was conducted by whites rather than Asians.

“We’re trying to get a handle on what some of the reasons for those differences might be,” said psychologist David Sheffield, a research assistant professor at UF’s College of Medicine who also is affiliated with Gainesville’s Malcom Randall Veterans Affairs Medical Center. He presented the results in March at the annual meeting of the American Psychosomatic Society in Monterey, Calif. “There might be differences that translate into treatment issues as well, in terms of what individuals will say in response to painful stimuli. African Americans seem to report more pain, yet we know studies have shown they’re not receiving more treatment. Indeed, if anything, they are less likely to receive certain diagnostic tests, and they may receive less-aggressive treatment (to alleviate their pain).

“The second thing is we know within health-care settings it makes a difference to whom you are reporting your pain,” he added. “We know it makes a difference whether you are reporting to a doctor or a nurse or a psychologist; now it seems from these data that we can infer that ethnicity might also make a difference.”

In the health-care arena, such discrepancies in pain perception or cultural attitudes about discomfort take on added import, because they may influence whether a person seeks prompt medical attention. For example, physicians have long known that blacks wait longer to leave for the hospital when they have chest pain that might indicate a heart attack.

So if many blacks report being more sensitive to pain, why have some studies shown it takes them longer to seek help? Researchers speculate that educational level, cultural or socioeconomic differences, psychological state and other factors could all be at play.

Experts say the issue is complex but important because properly assessing and treating pain is such a huge challenge for patients, their families and physicians. The American Pain Society reports that chronic pain is a major public health problem that afflicts more than 50 million Americans. The price tag is hefty: Medical bills, lost income and productivity, workers’ compensation and legal expenses associated with chronic pain are estimated at $50 billion.

UF researchers concede it would be foolish to generalize too much from a single study; after all, even within groups individuals harbor many differences. They are conducting additional studies to investigate whether these differences apply in a health-care setting.

“People have different beliefs regarding whether it’s good or not good to be experiencing pain,” Sheffield said. “They may use different coping strategies or styles when they encounter painful situations. And of course we’ve also been very crude in how we group individuals. At the moment we’re saying one group is very different from another group, but what might really matter are subgroups of the population. For example, I’m white. But I’m also English, and there’s a whole load of cultural beliefs and traditions that go along with that. So the ‘stiff upper lip’ thing might affect what I say in response to pain.”

Most studies on racial differences have found that blacks report a lower tolerance to pain, said Gary B. Rollman, a professor of psychology at the University of Western Ontario.

“It is no at all apparent, however, that these arise from genetic influences. There are numerous studies of cultural differences among white subjects,” Rollman said. “Nobody suggests these are genetic differences. Rather, differences in pain behaviors among groups are much more likely due to such factors as role models, education, economic status, and access to medical and social support than to racial or ethnic composition.

“Furthermore, it’s not a given that stoicism is good and expressiveness is bad, although that is often taken away from pain studies such as these,” he added. “One can easily argue the opposite.”

Rollman said ultimately physicians have a responsibility to treat each individual as unique.

“Stereotypes have no place in medicine or psychology,” he wrote in the book “Cultural Clinical Psychology: Theory, Research, and Practice.” “Pain is experienced by individuals, not by groups.”