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Whether you鈥檝e dreaded the bite of the dentist鈥檚 drill, the viselike contractions of childbirth or the crushing pressure of a heart attack, one thing鈥檚 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 factors such as 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.

鈥淲e鈥檙e trying to get a handle on what some of the reasons for those differences might be,鈥� said psychologist David Sheffield, a research assistant professor at UF鈥檚 College of Medicine who also is affiliated with Gainesville鈥檚 Malcom Randall Veterans Affairs Medical Center. He presented the results in March at the annual meeting of the American Psychosomatic Society in Monterey, Calif. 鈥淭here 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鈥檙e 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). And we don鈥檛 yet know why that is.

鈥淭he second thing is we know within health-care settings it makes a difference to whom you are reporting your pain,鈥� he added. 鈥淲e 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 also might make a difference in terms of what people say about their pain.鈥�

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 measured participants鈥� blood pressure and heart rate while they were resting and while the ice water was applied, in an effort to explore possible physical explanations for the way they rated pain. Although blacks in the study had a higher systolic blood pressure than whites, the finding did not account for differences in pain reporting. Instead, cultural traditions might well be at work.

Even at that, 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.

鈥淧eople have different beliefs regarding whether it鈥檚 good or not good to be experiencing pain,鈥� Sheffield said. 鈥淪ome cultures are much more accepting of pain as a good thing versus pain as not a good thing. They may use different coping strategies or styles when they encounter painful situations. And of course we鈥檝e also been very crude in how we group individuals. At the moment we鈥檙e saying one group is very different from another group, but what might really matter are subgroups of the population. For example, I鈥檓 white. But I鈥檓 also English, and there鈥檚 a whole load of cultural beliefs and traditions that go along with that. So the 鈥榮tiff upper lip鈥� thing might affect what I say in response to pain.鈥�

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.

鈥淚t is not at all apparent, however, that these arise from genetic influences. There are numerous studies of cultural differences among white subjects,鈥� Rollman said. 鈥淭he stereotypical findings are that southern Europeans complain about pain more than northern Europeans.

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.

鈥淔urthermore, it鈥檚 not a given that stoicism is good and expressiveness is bad, although that is often taken away from pain studies such as these,鈥� he added. 鈥淥ne can easily argue the opposite. Cultural differences, again to the extent that they exist, are not limited to expressions of pain. There may also be differences, which we would view quite differently, in expressions of joy or happiness, on the one hand, and unhappiness or anger, on the other.鈥�

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

鈥淪tereotypes have no place in medicine or psychology,鈥� he wrote in the book 鈥淐ultural Clinical Psychology: Theory, Research, and Practice.鈥� 鈥淧ain is experienced by individuals, not by groups.鈥�