• Melissa A Day, L Charles Ward, Michelle P Grover, Dawn M Ehde, Oliver R Illingworth, and Mark P Jensen.
• School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
• Eur J Pain. 2020 Jul 1; 24 (6): 1072-1083.

BackgroundThis study reports a multivariate test of sex and race differences in experimental pain, and the degree to which these differences could be uniquely attributable to three levels of cognition: primary appraisals (threat, challenge), secondary appraisals (pain catastrophizing) and/or cognitive processes (mindful observing, non-reactivity). Both the predictive and mediator role of the cognitive variables was of interest.MethodsThe study employed a cross-sectional experimental design, with the cold pressor task employed as the pain stimulus. The total sample included N = 355 healthy adults (67% female, 33% male; 70% Caucasian, 30% Asian).ResultsSignificant sex and race differences on pain tolerance were found, with females and racial minorities reporting less pain tolerance (ps < 0.001). Males reported significantly higher challenge appraisals and non-reactivity, and lower pain catastrophizing than females; Asians reported significantly higher threat appraisals and pain catastrophizing than Caucasians. In multivariate analyses, challenge appraisals and non-reactivity emerged as the strongest predictors of pain tolerance. Furthermore, challenge appraisals mediated the sex-pain tolerance association (p = .017).ConclusionsThis study showed that race and sex differences, at least in part, may be accounted for by differences in pain-related cognitions.SignificanceThe three levels of cognition investigated in this research represent changeable, important processes for potentially mitigating the impact of pain in vulnerable groups.© 2020 European Pain Federation - EFIC®.

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