Pain Coping Style Research Articles

Factors associated with pain in children with hypermobility – a pilot study

Objectives To explore the relationships between the degree of musculoskeletal pain, pain associated with disability and quality of life are affected by having hypermobile joints. Methods Young people aged between 8-14 were recruited from the rheumatology based Non-Inflammatory Musculoskeletal Pain Clinic at Great Ormond Street Hospital over a 12 month period. They were assessed using biomechanical measures (muscle strength and degree of hypermobility), sensory processing using Quantitative Sensory Testing and psychological measures of anxiety, depression and pain coping styles using validated questions. Full Ethics approval was granted. Results 30 children were recruited (18 female: 12 male); mean age 11.08 with 77% being Caucasian. The mean Beighton score was 6.79/9. All patients reported pain mainly affecting lower limbs with an average score of 49/100 VAS. Degree of hypermobility did not have any impact. Reduced muscle strength was associated with increased pain and reduced quality of life. Other measures were compared to the norms for healthy children. Children with hypermobility appeared to demonstrate increased depression, negative mood, anhedonia and increased anxiety. They demonstrated reduced quality of life specifically with school, emotional well being, physical health and psychosocially. The subjects also had reduced sensitivity to touch including hot and cold. Conclusion The pain experienced by children with hypermobile joints is complex and includes biomechanical, sensory, psychological and social factors. This pilot study is planned to be expanded into a multi-centred project depending upon funding

The Role of Pain Coping and Kinesiophobia in Patients With Complex Regional Pain Syndrome Type 1 of the Legs

The aim of this cross-sectional study was to evaluate to what extent pain coping and kinesiophobia contribute to limitations in activity and participation in patients with complex regional pain syndrome type 1 (CRPS-1) of the lower limbs. A total of 238 patients with CRPS-1 of the legs from 4 pain clinics and 1 Department of Neurology of University Hospitals participated in this study. Pain and CRPS severity were assessed with the pain rating index of the McGill Pain Questionnaire and the CRPS Severity Score, respectively. Activity was measured with the Rising & Walking scale, and participation with the Social Functioning scale of the SF-36. In addition, the Tampa Scale for Kinesiophobia and Pain Coping Inventory were administered. Hierarchical linear regression was used to evaluate to what extent kinesiophobia and pain coping contributed to difficulties with Rising & Walking and Social Functioning. The analyses showed that the "resting" subscale of the Pain Coping Inventory-that is, 1 of the 3 scales evaluating passive pain coping strategies-contributed significantly to difficulties in rising and walking (explaining 12.5% of the variance) and to difficulties in social functioning (explaining 6.5%), whereas kinesiophobia was not associated with either of these measures. These findings indicate that making use of "resting" as a pain coping strategy contributes significantly to limitations in activity and participation in patients with CRPS-1 of the legs. Indications for a negative influence of kinesiophobia or a positive influence of an active pain coping style were not found.

Effect of Cryotherapy on Neuromuscular Electrical Stimulation: A Review of the Literature

Neuromuscular electrical stimulation (NMES) has been shown to be an eff ective technique to strengthen muscle following musculoskeletal injury or surgery. A limitation of NMES is the discomfort caused by the strong electrical contractions required for eff ective strength gains. This article explores whether the application of cryotherapy over muscle aff ects the ability of the muscle to contract in response to NMES and whether the reduction in discomfort of the stimulus enables greater force production. Eleven studies that met the inclusion criteria were reviewed. This review found that short-duration application of cryotherapy can improve tolerance to strong contractions elicited by NMES for muscle strengthening; however, longerduration applications may aff ect muscle force production. More studies are needed to determine the eff ect of cryotherapy on force production of muscle during NMES and whether greater increases in strength can be achieved. Neuromuscular electrical stimulation (NMES) is a widely used intervention for rehabilitation of weak or damaged muscle. Studies support the use of this technique for strengthening muscle following ligament repairs of the knee and total knee joint arthroplasties.1-4 The typical clinical approach is to place electrodes on the skin overlying the motor points of the muscle, which are usually defi ned as the location over the muscle where the motor nerve to the muscle is most accessible. The intensity of the stimulation depends on the amplitude, duration, and frequency of the electrical pulses, or bursts. A high-amplitude, longpulse duration stimulus is required to achieve a contraction that is at least 50% of maximal voluntary contraction (MVC). This stimulus may not be tolerated by the patient. Farquhar and Snyder-Mackler5 identifi ed patient discomfort as the limiting factor in using NMES in clinical settings, especially “when high contractile forces are sought for strength training regimens.” Most clinical uses of NMES are for strengthening of weak or injured muscle. The use of NMES for uninjured individuals is uncommon because strength gains can be achieved by exercise programs without the use of NMES. Patient tolerance to NMES for muscle strengthening depends primarily on the type of electrical current chosen for the treatment and the patient’s pain coping style.5 Some patients can tolerate burst mode alternating current (Russian stimulation) NMES, whereas other patients prefer biphasic pulsed NMES. Pain coping style varies from those patients who focus on the discomfort of NMES and those who focus on the benefi ts of the treatment and are willing to tolerate discomfort. Patients who focus on the discomfort of NMES require a blunting strategy to decrease their perception of pain. Strategies for blunting the perception of pain can include distraction by listening to music or interventions that interrupt nociception to the central nervous system. Modalities such as cryotherapy applied during or prior to NMES may be an effective blunting strategy; however, decreasing the temperature of tissues overlying a muscle or of the muscle itself may affect the ability of NMES to achieve a muscle contraction. The effect of Dr Nolan and Dr Galantino are from the Physical Therapy Program, School of Health Sciences, The Richard Stockton College of New Jersey, Galloway; and Dr Buccafurni is from Fox Rehabilitation, Northfi eld, New Jersey. Received: January 4, 2011 Accepted: June 12, 2012 Posted Online: January 2, 2013 The authors have no fi nancial or proprietary interest in the materials presented

Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control

BackgroundPain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes.Material/MethodsThe average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish versions of the Chronic Pain Coping Inventory-42 (PL-CPCI-42), Beck Depression Inventory (BDI-PL), Coping Strategies Questionnaire (CSQ-PL), Beliefs about Pain Control Questionnaire (BPCQ-PL), and Roland-Morris Disability Questionnaire (RMQ-PL).ResultsIn the PL-CPCI-42 results, resting, guarding and coping self-statements were frequently used as coping strategies (3.96 SD 1.97; 3.72 SD 1.72; 3.47 SD 2.02, respectively). In the CSQ-PL domains, catastrophizing and praying/hoping were frequently used as coping strategies (3.62 SD 1.19). The mean score obtained from the BDI-PL was 11.86 SD 7.23, and 12.70 SD 5.49 from the RMDQ-PL. BPCQ-PL results indicate that the highest score was in the subscale measuring beliefs that powerful others can control pain (4.36 SD 0.97). Exercise correlated significantly with beliefs about internal control of pain (rs=0.22). We identified associations between radiating pain and guarding (p=0.038) and between sports recreation and guarding (p=0.013) and task persistence (p=0.041).ConclusionsBack pain characteristics, depressive mood, disability, and beliefs about personal control of pain are related to chronic LBP coping styles. Most of the variables related to advancement of degenerative changes were not associated with coping efforts.

Assessment of pain experience and coping styles in children and adults with batten disease

Assessment of pain experience and coping styles in children and adults with batten disease

Painful Intercourse: Dyspareunia and Vaginismus

Dyspareunia and vaginismus are complex disorders involving a myriad of predisposing, precipitating and perpetuating factors that make painful intercourse a difficult symptom to relieve. A multidisciplinary, intersystems approach to etiology, assessment, and treatment is proposed as the optimal standard of care, with the collaboration of sex therapy, gynecology, and physical therapy. Etiology is reviewed as potentially involving physiological, psychological, couple, intergenerational, and sociocultural causes and influences. It is recommended that initial assessment focus on the properties of the pain, sexual function, and individual cognitive and coping styles. The assessment of relational, intergenerational, and sociocultural factors is best integrated throughout treatment. It is also recommended that treatment commence with education, goal setting, and anxiety reduction to then proceed to the systematic targeting of pain and physiological processes, sexual interactions, individual schema, and relationship dynamics. The challenges of treatment are identified as primarily consisting of multidisciplinary coordination, the tension between structure and spontaneity, the management of expectations, and definitions of treatment success. Finally, an appeal is made for future research to take a systems approach to the study of dyspareunia and vaginismus, as well as to increase the diversity of populations studied.

The factor structure and factorial invariance of the Pain-Coping Questionnaire across age: Evidence from community-based samples of children and adults

The Pain-Coping Questionnaire was developed for children to assess pain-coping strategies. It was originally suggested as a second-order factor measure: eight first-order factors and three higher-order factors. The main objective of this study was to investigate the psychometric properties of the PCQ when used with children and adults. Two samples of 702 children and 590 adults completed the measure. Confirmatory factor analytic procedures were used to examine the factor structure, and invariance across samples. The results provided good support for a second-order structural model of seven subscales for children, for a first-order structural model of seven subscales for adults, and for between-group invariance first-order structural model. These findings suggest that data obtained on the seven first-order factors from children are directly comparable to scores from adults. The internal consistency, criterion validity and convergent validity were also confirmed in both children and adult samples. This work also reports some preliminary findings related to sex and age differences on the use of pain-coping styles.

Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm

Alterations in neural activity due to pain and injury in early development may produce long-term effects on sensory processing and future responses to pain. To investigate persistent alterations in sensory perception, we performed quantitative sensory testing (QST) in extremely preterm (EP) children (n=43) recruited from the UK EPICure cohort (born less than 26 weeks gestation in 1995) and in age and sex matched term-born controls (TC; n=44). EP children had a generalized decreased sensitivity to all thermal modalities, but no difference in mechanical sensitivity at the thenar eminence. EP children who also required neonatal surgery had more marked thermal hypoalgesia, but did not differ from non-surgical EP children in the measures of neonatal brain injury or current cognitive ability. Adjacent to neonatal thoracotomy scars there was a localized decrease in both thermal and mechanical sensitivity that differed from EP children with scars relating to less invasive procedural interventions or from those without scars. No relationship was found between sensory perception thresholds and current pain experience or pain coping styles in EP or TC children. Neonatal care and surgery in EP children are associated with persistent modality-specific changes in sensory processing. Decreases in mechanical and thermal sensitivity adjacent to scars may be related to localized tissue injury, whereas generalized decreases in thermal sensitivity but not in mechanical sensitivity suggest centrally mediated alterations in the modulation of C-fibre nociceptor pathways, which may impact on responses to future pain or surgery.

Locus of control moderates the relationship between headache pain and depression.

The aim of the current study was to triangulate qualitative and quantitative data in order to examine in greater detail the relationship between self-reported headache pain severity, depression and coping styles. Psychosocial scales, headache characteristic scales and in-depth interviews were administered to 71 adults with the diagnosis of primary headache. Regression analyses with the scales showed that greater self-reported headache pain severity was associated with higher levels of depression. A high internal locus of control weakened the relationship between the headache severity and depression variables. The qualitative data supported the relationship between pain severity and internal locus of control and, in addition, revealed that perceived efficacy of pharmacologic intervention might be a related factor. The results suggested that stronger coping skills might reduce depression among headache sufferers.

Dancing in Pain: Pain Appraisal and Coping in Dancers

This study investigated the relationships between the type of pain experienced (performance pain andinjury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury.

Differential efficacy of written emotional disclosure for subgroups of fibromyalgia patients

To identify differential health benefits of written emotional disclosure (ED). Pain-coping style and demographic characteristics were examined as potential moderators of ED treatment efficacy in a randomized controlled trial with female fibromyalgia patients. Of three pain-coping styles, only patients classified as interpersonally distressed (ID) experienced significant treatment effects on psychological well-being, pain, and fatigue. Treatment effects on psychological well-being were also significantly greater for patients with a high level of education. Patients with an ID-coping style and/or high education appear to benefit most from ED.

Catastrophizing and Pain-Coping in Young Adults: Associations With Depressive Symptoms and Headache Pain

Cognitive and behavioral pain-coping strategies, particularly catastrophizing, are important determinants of the pain experience. Most studies of pain-coping are performed in samples of treatment-seeking patients with longstanding pain complaints. Individual differences in pain-coping styles may also significantly affect day-to-day pain and quality of life in nonclinical samples, though this has rarely been investigated. In particular, headache pain is common in the general population, and little is known about how pain-related coping affects pain and quality of life among headache sufferers from a nonclinical setting. In this study, 202 generally healthy subjects were divided into 2 groups, those who reported problem headaches and pain-free control subjects. Reports of pain-related catastrophizing and the use of active pain-coping strategies did not differ between the groups, but differential associations between pain-coping strategies and emotional functioning were observed. Specifically, within the headache group only, those reporting higher levels of pain catastrophizing and lower levels of active pain-coping showed the highest level of depressive symptoms. Further, higher catastrophizing was associated with greater headache pain and pain-related interference. These findings suggest that catastrophizing has little influence on emotional functioning in those without ongoing pain complaints and highlight the importance of coping in modulating the consequences of pain on day-to-day functioning, even in samples from nonclinical settings. Moreover, these findings indirectly suggest that interventions that increase adaptive coping and decrease catastrophizing may help to buffer some of the deleterious functional consequences of headache pain. This study adds to a growing literature that conceptualizes catastrophizing as a diathesis, or risk factor, for deleterious pain-related consequences. These data suggest that catastrophizing may require the presence of a pain condition before its detrimental effects are exerted.

A Prospective Clinical Evaluation of Treatment Effectiveness and Patient Satisfaction Following Usual Care Intervention at a Multidisciplinary Pain Centre

Purpose of the study: There is strong evidence obtained from controlled trials that supports the use of biopsychosocial multidisciplinary interventions for chronic pain. Yet, studies of the clinical effectiveness and routine application of these approaches in real world settings are rare. This clinical evaluation sought to prospectively track changes in physical (e.g., pain severity, pain-related disability) and psychological (e.g., pain anxiety, pain self-efficacy) outcomes following usual care intervention at a large pain medicine centre (PMC). The degree to which improvements in physical and psychological outcomes were related to patient satisfaction was also examined. Methods: One hundred and nine (M age = 56.32 years, 51.4% female, pain chronicity Mdn = 5 years) of 141 invited patients who attended the PMC for the first time over a 4-month period completed a pretreatment questionnaire comprised of standardised measures of pain, psychological function, and social background. Forty-three and 46 patients completed the 3- and 6-month follow-up assessments respectively, which also included measures of patient satisfaction. Results: Wiithin the initial 3 months of treatment there were no significant declines in reported pain intensity, yet patients reported significant improvements in pain relief (p < 0.05). Patients who completed the 3-month follow-up questionnaire reported significantly reduced levels of disability (p < 0.05), less frequent episodes of fearful appraisal and pain avoidance (p < 0.05), and a reduction in catastrophizing pain coping responses (p < 0.02). At 6 months, patients did not report any further improvements in physical and psychological function beyond what they had achieved within the first 3 months. Preliminary findings suggest that patient satisfaction with treatment is significantly related to perceived reductions in disability (p < 0.05) and improvements in self-efficacy for coping with pain (p < 0.01), yet not significantly related to changes in pain coping style. Conclusions: These findings highlight the importance of measuring treatment outcomes prospectively across different time points in view of the initial improvement in outcome and subsequent plateau observed here. Furthermore, these preliminary results suggest the centrality of patient beliefs pertaining to disability and confidence in their ability to cope when examining the effectiveness of pain interventions.

Sex and Age Differences in Coping Styles Among Children with Chronic Pain

The purpose of this study was to examine sex and age differences in coping strategies among pediatric patients with chronic pain. Sex differences are reported in the adult pain and coping literatures, but little attention has been given to possible distinctions in coping styles in the pediatric chronic pain population. Investigating pain coping skills at an early age may provide clinicians with a better understanding of the evolution of characteristic coping styles and identify areas for intervention. Pain intensity (Visual Analog Scale), pain coping strategies (Pain Coping Questionnaire), and coping efficacy were assessed in children (ages 8–12 years) and adolescents (ages 13–18 years), presenting to a pediatric chronic pain clinic ( n = 272). Significant sex differences in coping strategies were found. After controlling for pain intensity, girls used social support seeking more than boys, while boys used more behavioral distraction techniques. Adolescents engaged in more positive self-statements (a cognitive strategy) than children. Both boys and girls showed a trend toward pain coping efficacy being negatively correlated with average pain intensity. For girls, pain coping efficacy was also significantly negatively correlated with internalizing/catastrophizing. However, no sex or age differences in coping efficacy were found. This study demonstrates the early emergence of sex- and aged-based preferences in coping strategies among children and adolescents with chronic pain. The findings establish a basis for further research on early social influences in the development of pain coping styles in males and females. Implications for further clinical research in this area are discussed.

(336/965): Impact of pain coping on pain-relevant outcomes in adults with and without headaches

Cognitive and behavioral pain-coping strategies, particularly catastrophizing, are important determinants of the pain experience. However, most studies of pain- coping are performed in clinical samples with longstanding pain. Though rarely investigated, individual differences in pain-coping styles may also significantly impact daily pain and quality of life in non-clinical samples. In particular, headache pain is common in the general population, though little is known about how pain-related coping impacts pain and quality of life among headache sufferers.

Effects of attentional direction, age, and coping style on cold-pressor pain in children

This study assessed the relative efficacy of two imagery-based attentional strategies for modifying pain experience in children. Children aged 7–14 years (n=120) were randomly assigned to one of three conditions: distraction, sensory-focussing or control (no imagery). The distraction condition prompted children to focus their attention externally; the sensory-focussing condition prompted the child to focus internally on physical sensations. Self-report measures of pain coping style preferences and imagery ability were completed. Children's pain tolerance and perceptions of pain intensity were assessed using a 10 °C cold-pressor task. Results showed pain intensity ratings after 1min were lower for both intervention conditions than for the controls. Younger children (7–9 years) showed higher pain tolerance in the distraction condition than in the sensory-focussing condition, whereas both interventions were equally effective for older children (10–14 years). Among older children, coping style interacted with the intervention type: in the sensory-focussing condition, pain tolerance was negatively associated with self-reported distraction-based coping style, whereas in the distraction condition this association was positive. The results are interpreted with reference to current models of attention. The implications for use of attentional strategies in helping children to cope with clinical pain are discussed.

Birth settings and pain control trends among women in Finland

This paper aims to identify similarities and differences between the Finnish and UK systems of maternity care. Issues relating to maternity care policy emerge as crucial. Topics for comparison were identified during visits to Finnish hospital and community settings. These topics formed the basis of a selective review of the literature. Qualitative research by the co-author served to inform the comparison. The authors found that Finnish women are clear in their expectations of labour pain and the role of professional personnel. Because of these expectations the women adopt one of three coping styles. There is found to be a strong link between pain coping style and choice of place of birth. There may, however, be some dissonance between health care providers' and women's thinking about the place of birth. Midwives' positions are variable, but their thinking may not correspond with the woman's. It becomes clear that midwives' non-acceptance of women's knowledge base has serious implications. The conclusion is drawn that midwives should seek to understand women's thought processes.

Is Postoperative Pain a Self-Fulfilling Prophecy? Expectancy Effects on Postoperative Pain and Patient-Controlled Analgesia Use Among Adolescent Surgical Patients

To explore relationships among anxiety, anticipated pain, coping styles, postoperative pain, and patient-controlled analgesia (PCA) use among adolescent surgical patients and their parents. Sixty-five 12- to 18-year-old surgical patients undergoing surgery with postoperative PCA pain management were included. Before surgery, adolescents and parents reported anxiety and expected levels of postoperative pain. Pain catastrophizing and coping style were assessed within 48 hr after surgery, with pain scores and PCA use recorded through the end of the second postoperative day. Adolescents' preoperative psychological characteristics (anxiety and anticipated pain) predicted postoperative pain scores, number of PCA injections and demands, and the PCA injections:demands ratio, with reports of anticipated pain associating most closely with these postoperative pain outcomes. Parental anxiety and anticipated pain did not predict teens' postoperative pain. Coping style did not moderate the relationship between anticipated pain and pain outcomes. Findings are interpreted as suggesting a self-fulfilling prophecy in adolescents' postoperative pain experience wherein teens who expect to have high levels of postoperative pain ultimately report more pain and use more opioid PCA medication than those who report lower levels of pain.

Self-reported use of humor by hospitalized pre-adolescent children to cope with pain-related distress from a medical intervention

AbstractThis study addresses a measurement gap on the humor-pain interface in pre-adolescent children. 57 hospitalized children aged 6–12 years who had undergone a medical intervention completed measures of pain intensity and unpleasantness (Colored Analogue Scale), general pain coping style (Pain Coping Questionnaire), humor coping—creation, general, and painspecific (child version of the Multidimensional Sense of Humor Scale, and a new measure, the Sydney Children’s Hospital Humor Coping Scale for Children). The results supported predictions that (a) use of pain-specific humor-coping would be positively associated with an adaptive problemfocused coping style, and (b) an emotion-focused pain coping style would be inversely related to use of humor coping. Results also supported the hypothesis that humor coping would be more strongly (and inversely) related to ratings of pain unpleasantness rather than sensory intensity. The data provide preliminary evidence for the reliability and validity of the Sydney Children’s Hospital Humor Coping Scale for Children.

Testing a Model of Pain Appraisal and Coping in Children With Chronic Abdominal Pain.

This prospective study of children with recurrent abdominal pain (N=133; ages 8--15 years) used path analysis to examine relations among dispositional pain beliefs and coping styles, cognitions and behavior related to a specific pain episode, and short- and long-term outcomes. Children believing they could not reduce or accept pain appraised their episode-specific coping ability as low and reported passive coping behavior. Dispositional passive coping had direct effects on both episode-specific passive coping and long-term symptoms and disability. Accommodative coping (acceptance and self-encouragement) was associated with reduced episode-specific distress, which itself predicted reduced depressive symptoms 3 months later. Results suggest that coping-skill interventions for children with chronic pain should target reductions in passive coping and consider the potential benefits of accommodative coping strategies.