Passive Pain Coping Strategies Research Articles

Development and Validation of the Scale for Pain Self-Efficacy (SPaSE) in German and English Languages for Children and Adolescents

No validated measure for pain self-efficacy in children and adolescents is currently available in the German language, and existing English versions have limitations. This study used a thorough development process to create the Scale for Pain Self-Efficacy (SPaSE) in both German and English languages. Scale development was based on self-efficacy theory, adapting items from existing self-efficacy measures, and review of patients’ perspectives. The final version of the 11-item SPaSE was created with expert discussions and testing of content validity, comprehensibility, and construct validity. The validation process consisted of exploratory factor analysis, testing of item characteristics, internal consistency, and sensitivity to change in 2 German samples of children and adolescents with chronic pain (study 1: outpatient sample N = 150, inpatient sample N = 31). Cross-validation in a U.S. sample (study 2: N = 98) confirmed the 1-factor structure, the sound psychometric properties and reliability of the SPaSE. Sum scores of the SPaSE were negatively correlated with pain-related disability, pain intensity, passive pain coping strategies, and emotional distress, in line with previous research. The valid and reliable SPaSE can be used in clinical practice to monitor pain treatment progress, advances the field of pain self-efficacy research in Germany, and opens the door to comparative research in German and English samples. PerspectiveThis article presents psychometric properties of a newly developed measure of pain self-efficacy in children and adolescents that is available in both German and English language. This measure could be used in both research and clinical practice to measure treatment progress and outcome.

Preliminary Outcomes of an Older Peer and Clinician co-Facilitated Pain Rehabilitation Intervention among Adults Aged 50Years and Older with Comorbid Chronic Pain and Mental Health Conditions.

The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with eight participants aged 55 to 62years old with mental health conditions including schizophrenia spectrum disorder, bipolar disorder, major depressive disorder, personality disorder, and adjustment disorder. The quantitative data were assessed from observational methods, a pain rating scale and related measures. We used semi-structured interviews for qualitative feedback on experiences with the BA-PR intervention after participation. Overall, the participants had positive experiences following receipt of the BA-PR intervention. The recruitment and adherence rates for participants were 72.7% and 100%, respectively. Approximately 75% of the participants remained enrolled in the study. Findings from a paired t-test showed the BA-PR intervention was linked to significantly reduced prescription opioid misuse risk, t (7) = 2.42, p < 0.05. There were also non-significant reductions in pain intensity and depression severity, in addition to improvements in active and passive pain coping strategies and behavioral activation.The BA-PR intervention is the first pain rehabilitation intervention specifically designed for middle-aged and older adults with comorbid chronic pain and mental health conditions. Our findings indicate promise for the BA-PR intervention to potentially reduce prescription opioid misuse risk, pain, and depressive symptoms. However, a quasi-experimental study is needed before rigorous effectiveness testing.

Sex matters in complex regional pain syndrome.

BackgroundComplex regional pain syndrome (CRPS) is much more prevalent in women than men but potential differences in clinical phenotype have not been thoroughly explored to date. Differences in the clinical presentation between sexes may point at new avenues for a more tailored management approach of CRPS. We therefore explored if in CRPS, the patient's sex is associated with differences in clinical and psychological characteristics.MethodsIn this cross‐sectional study of 698 CRPS patients (599 females) fulfilling the Budapest clinical or research criteria, CRPS signs and symptoms, CRPS severity, pain (average pain intensity in the previous week and McGill pain rating index), pain coping (Pain Coping Inventory), physical limitations (Radboud Skills Questionnaire (upper limb), Walking and Rising questionnaire (lower limb)), anxiety and depression (Hospital Anxiety and Depression scale) and kinesiophobia (Tampa scale for kinesiophobia) were evaluated.ResultsMale CRPS patients used more often extreme words to describe the affective qualities of pain, used more passive pain coping strategies, and were more likely to suffer from depression and kinesiophobia.ConclusionSex‐related differences are present in CRPS, but the effect is generally small and mainly concerns psychological functioning. A greater awareness of sex‐specific factors in the management of CRPS may contribute to achieving better outcomes.SignificanceWhat is known? Nonsex‐specific clinical data of CRPS patients. What is new? Male CRPS patients used more often extreme words to describe the affective qualities of pain, used more passive pain coping strategies, and were more likely to suffer from depression and kinesiophobia.

Feelings of Usefulness to Others Predict Active Coping With Osteoarthritis Knee Pain.

To investigate associations of perceived usefulness to other people with active versus passive coping strategies among adults with knee osteoarthritis (OA). Additional aims explored contributions of personality variables to this dynamic. 199 persons (70.3 years ± 10.4) with knee OA reported personality, coping, and psychosocial data using the Big Five Inventory, subscales from the Social Provisions Scale, and the Coping With Illness measure. Regression analyses identified predictors of perceived usefulness and its independent and interactive associations with active versus passive coping and personality variables. Better subjective health predicted perceived usefulness. Older adults with higher reported perceived usefulness employed more active than passive pain coping strategies. Passive coping was associated with neuroticism and greater functional disability. Usefulness predicted active OA pain coping, suggesting that it may promote well-being among persons with chronic pain. Further study investigating perceived usefulness in promoting positive health behaviors is needed.

Psychological Factors and Pain Exacerbation in Knee Osteoarthritis: A Web Based Case-Crossover Study

Objectives: The pain experienced by osteoarthritis (OA) patients is neither constant nor unchanging and patients experience episodes of pain exacerbations. Using an innovative web based case-crossover design, we evaluated whether psychological factors are risk factors for pain exacerbations in patients with knee OA. Methods: In a 3-months internet-based case-crossover study, participants with symptomatic knee OA were recruited and followed at 10-day intervals (control periods). Participants were also instructed to log on to the study website if they experienced a knee pain exacerbation (case periods). Pain exacerbation was defined as an increase of ≥ 2 on a participant’s numerical rating scale (0-10) from his/her usual background pain score reported at baseline visit. The periods were 10 days for affect measures and 30 days for pain coping/perceived stress measures. The relation of psychological factors to the risk of pain exacerbation was examined using conditional logistic regression. Results: Of 298 participants recruited, 149 and 54 provided both case and control periods with no overlap for examining affect and pain coping/perceived stress factors respectively. Higher negative affect (negative affect score ≥ 18: odds ratio (OR) 6.49; 95% CI 3.45-12.2) and passive coping strategies (OR 1.26; 95% CI 1.05-1.50) were associated with increased risk of pain exacerbations; while higher active coping strategies (OR 0.81; 95% CI 0.66-0.98) had a protective effect. Conclusion: The findings emphasize the need for avoidance of negative affect and passive pain coping strategies and conversely reinforce the benefit of active pain coping strategies in prevention and management of OA pain exacerbations.

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.

Active or passive pain coping strategies in hip and knee osteoarthritis? results of a national survey of 4,719 patients in a primary care setting

To study pain coping strategies in patients with hip and knee osteoarthritis (OA), and to assess the psychometric qualities of the French version of the Pain Coping Inventory (PCI). We conducted a national, cross-sectional survey in a primary care setting in France. A total of 1,811 general practitioners included 5,324 patients with hip and knee OA who completed several questionnaires, including the PCI, which assesses ability to cope with pain. The records of 4,719 (86.4%) patients were analyzed (knee 2,781; hip 1,553; hip and knee 385). Supporting the structure of the original questionnaire, we found that the 33 PCI questionnaire items could be grouped into 3 domains defining active coping strategies and 3 defining passive coping strategies. Acceptable convergent validity was found for the PCI (Cronbach's alpha coefficient for each domain >0.68). Coping strategy scores were significantly higher in patients with both knee and hip involvement (mean +/- SD 2.3 +/- 0.4) than for patients with OA at 1 site (mean +/- SD 2.1 +/- 0.4), and in women compared with men (P < 0.001). The use of passive pain coping strategies increased with OA duration, and was greater in older and overweight patients, in patients with no current physical activity or major impairment, in retired and nonworking patients, and in patients who were not married, and to a lesser extent in patients with higher pain intensity. Compared with previous data, patients with OA demonstrated lower active and higher passive strategies than patients with rheumatoid arthritis and other chronic painful conditions. The PCI has good structural validity and is highly suitable for analyzing active and passive pain coping strategies in OA. In OA, active and passive coping strategies differ significantly as a function of age, body mass index, OA involvement, professional and marital status, sport activities, and OA duration, with pain intensity having a weaker effect.

Perceived Social Support and Coping Responses Are Independent Variables Explaining Pain Adjustment Among Chronic Pain Patients

The purpose of the present study was to test a hypothetical model of the relationships between perceived social support, coping responses to pain, pain intensity, depressed mood, and functional disability (functional status and functional impairment) in a population of patients with chronic pain in a Spanish Clinical Pain Unit. It was postulated that social support and pain coping responses both independently influence reported pain intensity, depressed mood, and functional disability. Analyses were performed by Structural Equation Modelling. The results indicated that satisfaction with social support is significantly associated with a depressed mood and pain intensity, but not with functional disability. Although this effect is independent of the use of active coping responses by patients, there is a modest but significant relationship between social support and passive coping strategies, indicating that higher levels of perceived social support are related to less passive pain coping strategies. The findings underscore the potential importance of psychosocial factors in adjustment to chronic pain and provide support for a biopsychosocial model of pain. This article tested a hypothetical model of the relationships between social support, pain coping, and chronic pain adjustment by using Structural Equation Modelling. The results indicate that perceived social support and pain coping are independent predictors of chronic pain adjustment, providing support for a biopsychosocial model of pain.

Continued disability and pain after lumbar disc surgery: The role of cognitive-behavioral factors

Cognitive-behavioral factors are considered important in the development of chronic disability and pain in patients with low back pain. In a prospective cohort study of 277 patients undergoing surgery for lumbosacral radicular syndrome, the predictive value of preoperatively measured cognitive-behavioral factors (fear of movement/(re)injury, passive pain coping, and negative outcome expectancies) for disability and pain intensity at 6 weeks and 6 months after surgery was investigated, taking into account the effect of possible confounding variables. Higher levels of cognitive-behavioral factors were found to be associated with a worse outcome at both 6 weeks and 6 months. These associations remained significant after controlling for possible confounding variables (preoperative disability and pain intensity, age, gender, educational level, duration of complaints, neurological deficits, and intake of analgesics) and pain intensity 3 days postoperatively. In multiple regression analyses, the cognitive-behavioral factors independently predicted different outcomes. Fear of movement/(re)injury predicted more disability and more severe pain at 6 weeks and more severe pain at 6 months; passive pain-coping strategies predicted more disability at 6 months; and negative outcome expectancies predicted more disability and more severe pain at both 6 weeks and 6 months. The findings support the potential utility of preoperative screening measures that include cognitive-behavioral factors for predicting surgical outcome, as well as studies to examine the potential benefits of cognitive-behavioral treatment to improve surgical outcome.

The Role of Helplessness, Fear of Pain, and Passive Pain-Coping in Chronic Pain Patients

The goal of this study was to examine the relative contribution of helplessness, fear of pain, and passive pain-coping to pain level, disability, and depression in chronic pain patients attending an interdisciplinary pain center. One hundred sixty-nine chronic pain patients who had entered treatment at an interdisciplinary pain center completed various questionnaires and a pain diary. Helplessness, fear of pain, and passive pain-coping strategies were all related to the pain level, disability, and depression. When comparing the contribution of the predictors in multiple regression analyses, helplessness was the only significant predictor for pain level. Helplessness and the passive behavioral pain-coping strategies of resting significantly predicted disability. The passive cognitive pain-coping strategy of worrying significantly predicted depression. These findings indicate a role for helplessness and passive pain-coping in chronic pain patients and suggest that both may be relevant in the treatment of pain level, disability, and/or depression.

Ethnic differences in responses to multiple experimental pain stimuli

A growing body of literature suggests that the experience of clinical pain differs across ethnocultural groups. Additionally, some evidence indicates greater sensitivity to experimentally induced pain among African Americans; however, most studies have included only one pain modality. This study examined ethnic differences in responses to multiple experimental pain stimuli, including heat pain, cold pressor pain, and ischemic pain. Heat pain threshold and tolerance, ratings of repetitive suprathreshold heat, and ischemic and cold pressor pain threshold and tolerance were assessed in 120 (62 African American, 58 white) healthy young adults. Also, several psychological instruments were administered. No ethnic group differences emerged for threshold measures, but African Americans had lower tolerances for heat pain, cold pressor pain and ischemic pain compared to whites. Ratings of intensity and unpleasantness for suprathreshold heat stimuli were significantly higher among African Americans. African Americans reported greater use of passive pain coping strategies and higher levels of hypervigilance. Controlling for passive pain coping did not account for group differences in pain responses, while controlling for hypervigilance rendered group differences in heat pain tolerance and ischemic pain tolerance non-significant. These findings demonstrate differences in laboratory pain responses between African Americans and whites across multiple stimulus modalities, and effect sizes for these differences in pain tolerance were moderate to large for suprathreshold measures. Hypervigilance partly accounted for group differences. Additional research to determine the mechanisms underlying these effects is warranted.

Contrasting emotional approach coping with passive coping for chronic myofascial pain.

Passive or emotion-focused coping strategies are typically related to worse pain and adjustment among chronic pain patients. Emotional approach coping (EAC), however, is a type of emotion-focused coping that appears to be adaptive in some nonpain populations but has not yet been examined in a chronic pain population. In a sample of 80 patients (75% women, M = 48.67 years of age) with chronic myofascial pain, we contrasted how EAC (assessed with the Emotional Approach Coping Scale) and 5 passive pain-coping strategies (assessed with the Vanderbilt Multidimensional Pain Coping Inventory (VMPCI)) were related to sensory and affective pain, physical impairment, and depression. Passive coping strategies were positively correlated with one another, but EAC was inversely correlated with most of them. The VMPCI passive strategies were substantially positively related to negative affect, whereas EAC was inversely related to negative affect. Controlling for potentially confounding demographics, higher EAC was related to less affective pain and depression, even after controlling for negative affect. Using passive coping strategies, in contrast, was associated with more pain, impairment, and depression, although these relations were greatly attenuated after controlling for negative affect. When considered simultaneously, EAC, but not passive coping, was related to affective pain, and both EAC and passive coping were significant correlates of depression, although in opposite directions. In secondary analyses, we found that EAC was related to less pain (particularly sensory) among men and to less depression among women. Unlike the use of passive pain-coping strategies, which are associated with worse pain and adjustment, the use of EAC (emotional processing and emotional expression) with chronic pain is associated with less pain and depression. This suggests that some emotion-focused types of pain coping may be adaptive, and it highlights the need to assess emotional coping processes that are not confounded with distress or dysfunction.

The Effect of Intensive Group Exercise in Patients with Chronic Low Back Pain

The purpose of the present study was to evaluate the effect of 15 weeks of intensive bi-weekly group exercise in sedentary subjects with long-lasting chronic low back pain (CLBP). Twenty-nine sedentary subjects with long-lasting CLBP were successively assigned to an exercise group (EG, n=16) or a control group (CG, n=13). Patients in the EG exercised for 75 min bi-weekly for 15 weeks. The CG followed traditional medical care. Cardiovascular fitness, back and abdominal muscle strength, and flexibility of hip muscles and the spine were measured before and after treatment. Outcome measures were low back pain (visual analogue scale, VAS), functional disability (the revised Oswestry LBP Disability Index), anxiety and depression (Hospital Anxiety and Depression Scale, HAD), and active and passive pain coping strategies (Vanderbilt Pain Management Inventory, VPMI). The results showed statistically significant differences between the groups in advantage of the EG in all physical capacity tests, except for cardiov...

Psychosocial predictors of functional change in recently diagnosed rheumatoid arthritis patients

In order to examine the influence of active and passive pain-coping strategies and social support characteristics on the change in functional status in the first stage of the disease in rheumatoid arthritis patients, self-report data and clinical and laboratory measures were collected from 91 patients (70% female, mean age 57 yr) shortly after diagnosis and 1 yr later. Multiple regression analyses indicated that, after taking the influence of demographic variables, disease activity and pain into account, a decrease in functional status (mobility, self-care, grip strength) after 1 yr could be predicted by an initially more frequent use of the passive pain-coping strategies of worrying and resting. A decrease in mobility could be additionally predicted by an initially smaller social network. Results indicate the impact of passive pain-coping strategies and social network characteristics for the prognosis of functional outcome in the first stage of the disease and suggest the early manifestation of avoidance mechanisms, including behavioral, cognitive-emotional and social components, in face of a chronic stressor.

Psychosocial and psychophysical assessments of patients with unexplained chest pain

It is imperative to assess the psychosocial factors that may influence the subjective experiences and pain behavior of persons with chronic unexplained chest pain. Both psychologists and physicians tend to rely on self-report measures of psychological distress, which provide little unique information about patients with chronic chest pain to differentiate them from patients with other painful disorders such as irritable bowel syndrome, gastroesophageal reflux disease, or coronary artery disease. However, assessment of pain-coping strategies, spouse responses to the patient's pain behaviors, and pain thresholds for esophageal balloon distention do differentiate patients with chronic chest pain from healthy controls and patients with various other chronic pain disorders. Specifically, chronic chest pain patients tend to use relatively passive pain-coping strategies such as praying and hoping, and to report relatively high levels of spouse reinforcement of pain behaviors. Finally, in response to esophageal balloon distention, chronic chest pain patients display low pain thresholds that do not generalize to stimulation by mechanical finger pressure. Preliminary evidence suggests these low thresholds are due primarily to a tendency to set low standards for making pain judgments regarding esophageal stimuli of moderate-to-high intensity levels.

Pain coping strategies and depression in rheumatoid arthritis.

A study was conducted to examine the role of pain episodes and the role of active and passive pain coping strategies in predicting depression in 287 patients with rheumatoid arthritis (RA). The independent effects of pain and pain coping strategies, as well as the interaction effects between pain and pain coping strategies on depression, were evaluated cross-sectionally and prospectively over a 6-month interval. The cross-sectional findings revealed that pain, passive coping, and the interaction between pain and passive coping contributed independent variance, all accounting for higher depression. Of principal interest was the finding that the frequent use of passive pain coping strategies in the face of high pain contributed to the most severe level of depression over time. These results were obtained after controlling for the potentially confounding effects of prior depression, functional disability, and medication status. These data imply that there may be a potential benefit of developing techniques to reduce the use of passive pain coping strategies to deal with chronic arthritis pain in cognitive-behavioral pain management programs.