Background/Purpose: Studies have shown that African Americans with osteoarthritis (OA) have greater pain than Caucasians.   However, little is known about whether there are racial differences in patients’ perceived ability to cope with OA-related pain (coping efficacy).   This study examined relationships among race, pain coping efficacy, and pain severity in patients with hip and knee OA. 

Methods: We analyzed baseline data from 515 participants in a randomized controlled trial of a telephone-based OA self-management program (mean age = 60 years; 93% male; 46% non-white – 43% African American, 3% other racial / ethnic minorities).  Pain coping efficacy was assessed with two questions: “Based on all the things you did to cope, or deal, with your arthritis pain during the last week, 1.) how much control do you feel you had over it and 2.) how much were you able to decrease it?”  Responses used a 7-point Likert scale (0=no control / can’t decrease it at all to 6 = complete control / can decrease it completely).  Pain severity was assessed with the Arthritis Impact Measurement Scales-2 (AIMS2) pain subscale, which includes 5 items; total scores range from of 0 (least) to 10 (worst) pain.  We first fit simple linear regression models to examine the associations of pain severity (AIMS2) and race with the two pain coping efficacy questions.  We then used multiple linear regression modeling to examine associations of pain coping efficacy with race and pain severity, as well as whether the relationship between pain coping efficacy and pain severity differed by race (interaction term).  

Results: More severe pain was associated with lower pain coping efficacy (regression coefficient = -0.22, p <0.0001 for ability to decrease pain, regression coefficient = -0.28, p<0.0001 for perceived control over pain).  There was no racial difference in perceived ability to decrease pain (regression coefficient  = -0.13, p=0.37). However, mean perceived control over pain was 0.36 points lower for non-whites compared to whites (2.99 vs. 3.35, p = 0.01).  In the multiple linear regression model, perceived control over pain was 0.76 points lower for non-whites compared to whites (p = 0.09), and more severe pain was associated with lower perceived control (regression coefficient  = -0.21, p<0.001). In addition, there was some evidence that the relationship between perceived pain control and pain severity differed by race (interaction term p=0.05); specifically, the slope was steeper for non-whites, so that the racial difference in perceived pain control was greater at higher levels of pain (with non-whites perceiving less pain control at higher pain levels).

Conclusion: Non-white patients with OA perceived less control over their pain than whites, and this difference appears to be particularly accentuated at greater pain levels. These results highlight the importance of building our understanding of effective mechanisms to reduce racial differences in both pain severity and pain coping efficacy among individuals with OA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-differences-in-pain-coping-efficacy-in-patients-with-hip-and-knee-osteoarthritis/