Coping strategies and their associations with levels of disability or pain, among older veterans receiving primary care

Abstract

Little information is available regarding the types of coping strategies used by older persons with chronic non-cancer pain, or whether specific methods of coping are associated with reduced levels of disability or pain. Our objectives were to (1) identify the types of strategies used by older persons to cope with chronic pain, and (2) determine whether specific strategies are associated with lower levels of disability or pain. Potential participants were drawn from a random (20%) sample of all patients aged 65 years or above receiving primary care at the West Haven VA, and were screened via telephone to determine eligibility status (i.e., pain for ⩾3 consecutive months due to a non-cancer cause). We conducted telephone interviews using an open-ended question to ascertain the types of coping strategies used by participants and inquired about the effectiveness of each method (0 to 5 Likert scale with responses ranging from not at all to extremely effective). We obtained data on participants' levels of disability (days of activity restriction due to pain in past month) and pain (0–10 numeric rating scale), as well as sociodemographics, comorbid conditions, and psychological status using validated instruments. Two reviewers independently coded all open-ended responses and disagreements were resolved by consensus. Similar coping strategies were assembled into discrete categories (e.g., “prays” and “attends church, etc.” for religious activities). Of 938 patients screened for chronic pain, 258 met eligibility criteria, and 210 (81%) participated. Respondents had a mean age of 75 (standard deviation = 5.1) years; most were Caucasian (96%), and male (99%). Commonly reported coping strategies used in the month prior to the interview included medication use in 153/210 (73%), exercise (33%), cognitive strategies such as distraction (31%), religious activities (18%), pacing, i.e., alternating periods of activity with rest (15%), and hot/cold modalities (13%). None of these six coping strategies was associated with lower levels of disability or pain intensity in either bivariate or multivariate analyses. Self-reported effectiveness of the six coping strategies was relatively high, however, with 57% using religious activities and 46% of those using medications rating them as “quite a bit” or “extremely” effective. We identified a broad spectrum of coping strategies used by older veterans with chronic non-cancer pain. Although positive associations were not observed between specific coping strategies and decreased levels of disability or pain, self-reported effectiveness of the coping strategies was high. Future research is planned to determine whether the coping strategies identified in this study are associated with beneficial outcomes in specific domains of health (e.g., emotional well-being) among older persons with chronic pain.