OBJECTIVE: To investigate possible differences in coping mechanisms in the painful crisis between Jamaican and London patients with homozygous sickle cell disease. DESIGN: Patients recruited from two London hospitals and the MRC Laboratories (Jamaica) at the University of the West Indies, Kingston, Jamaica were assessed using a questionnaire design. Patients with homozygous sickle cell disease were included, 30 in London and 30 in Jamaica. RESULTS: Jamaican patients in Jamaica had less general anxiety, a lower emotional response to pain, lower levels of perceived pain, and felt better able to decrease their pain. London patients believed that the disease had a more marked effect on their quality of life. CONCLUSION: Understanding the differences between patients' response to pain and their coping ability between Jamaican and UK patients may have important lessons for evolving effective management in the UK.