Use Of Pain Coping Strategies Research Articles

Differences in the Use of Pain Coping Strategies Between Oncology Inpatients with Mild vs. Moderate to Severe Pain

The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of ≤4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain ( n = 224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores ( P = 0.04) and significantly lower ratings of overall health ( P < 0.0001). No differences were found between the two pain groups on any of the subscales of the CSQ, except catastrophizing ( P < 0.0001). Compared with the mild pain group, patients in the moderate to severe group scored significantly higher on this subscale. In addition, patients in the moderate to severe group used more passive coping strategies ( P = 0.02). Except for catastrophizing, the number and types of pain coping strategies used by this sample of hospitalized patients do not appear to be influenced by their pain intensity scores. Finally, when the CSQ scores of these hospitalized oncology patients were compared with those found in previous studies of oncology outpatients and patients with chronic noncancer pain, the scores were similar.

Coping With Chronic Pain Among Younger, Middle-Aged, and Older Adults Living With Neurological Injury and Disease

Objective. This article compares use of pain coping strategies among older, middle-aged, and younger adults living with chronic pain and seeks to determine whether the relationship between pain severity and coping is moderated by age. Method. Participants were 464 adults reporting chronic pain secondary to multiple sclerosis, spinal cord injury, or neuromuscular disease. Participants completed a survey including measures of pain severity and the Chronic Pain Coping Inventory. Results. After controlling for clinical and demographic variables, older adults (older than 60) reported a wider range of frequently used strategies and significantly more frequent engagement in activity pacing, seeking social support, and use of coping self-statements than did younger or middle-aged adults. Moderation analyses suggest that, for younger adults, efforts at coping generally increased with greater pain severity, whereas this relationship did not exist for older adults. Discussion. These data suggest differences in the quantity and quality of pain coping among age groups.

Effects of work ability and health promoting interventions for women with musculoskeletal symptoms: A 9-month prospective study

BackgroundWomen working in the public human service sector in 'overstrained' situations run the risk of musculoskeletal symptoms and long-term sick leave. In order to maintain the level of health and work ability and strengthen the potential resources for health, it is important that employees gain greater control over decisions and actions affecting their health – a process associated with the concept of self-efficacy. The aim of this study was to describe the effects of a self-efficacy intervention and an ergonomic education intervention for women with musculoskeletal symptoms, employed in the public sector.MethodsThe design of the study was a 9-month prospective study describing the effects of two interventions, a comprehensive self-efficacy intervention (n = 21) and an ergonomic education intervention (n = 21). Data were obtained by a self-report questionnaire on health- and work ability-related factors at baseline, and at ten weeks and nine months follow-up. Within-group differences over time were analysed.ResultsOver the time period studied there were small magnitudes of improvements within each group. Within the self-efficacy intervention group positive effects in perceived work ability were shown. The ergonomic education group showed increased positive beliefs about future work ability and a more frequent use of pain coping strategies.ConclusionBoth interventions showed positive effects on women with musculoskeletal symptoms, but in different ways. Future research in this area should tailor interventions to participants' motivation and readiness to change.

Validation of the Chinese Version of Pain Self-Efficacy Questionnaire

Self-efficacy is a person's belief in his or her ability to perform a certain behavior that achieves a desired outcome. Belief in self-efficacy influences the use of pain-coping strategies, physical and psychological function, and rehabilitation outcome in chronic pain patients. We conducted this prospective study to validate the psychometric properties of a Chinese version of the Pain Self-Efficacy Questionnaire (PSEQ-HK). A previously translated PSEQ-HK was evaluated with the author's consent. Forward-backward translation was conducted, followed by critical appraisal by an expert panel. Reliability was examined by completing the PSEQ-HK twice over a 1-wk interval. One-hundred-twenty Chinese patients with chronic nonmalignant pain were asked to self-complete a set of health-related instruments in Chinese: Numeric Pain Rating Scale, Hospital Anxiety and Depression Scale, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, and Medical Outcome Study Short-Form 36 (SF36) Health Survey. PSEQ-HK had good retest reliability (intraclass correlation coefficient 0.75) and high internal consistency (Cronbach's alpha 0.93). Exploratory factor analysis showed a one-factor model that accounted for 61% of the total variance, with minimal factor loading of 0.69. It was significantly correlated with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and five domains of SF36 (bodily pain, vitality, social functioning, role emotion, and mental health). Moderate correlations were observed with Roland-Morris Disability Questionnaire and two domains of SF36 (role physical, general health). It had no correlation with pain score and medication use. PSEQ-HK is a reliable Chinese clinical assessment tool with satisfactory psychometric properties. Our results provided preliminary support for the construct validity of PSEQ-HK in a heterogeneous Chinese population with chronic nonmalignant pain.

The relationship between health-related quality of life, pain, and coping strategies in juvenile arthritis – A one year prospective study

The aim of this 12-month prospective study was to compare reports describing the health-related quality of life (HRQL) of children with Juvenile idiopathic arthritis (JIA) obtained from parents and children, to investigate the extent to which the children's HRQL changed over a 12-month period, and to describe the relationship between children's HRQL, and their experience of pain and use of pain coping strategies. Fifty-four children aged 8-18 years with JIA and their parents completed standard questionnaires assessing children's HRQL, pain intensity, and pain coping strategies at baseline, 6 months, and 12 months. In general, children reported that their HRQL was better than was reported by parents. Both informants described children's HRQL as being very stable over the 12 months of the study. Consistent with the Biobehavioural Model of Pain, there was a significant negative relationship between children's HRQL and their experience of pain. However, there was little evidence that pain coping strategies mediated the relationship between children's experience of pain and their HRQL.

Self-Efficacy for Managing Pain Is Associated With Disability, Depression, and Pain Coping Among Retirement Community Residents With Chronic Pain

Little is known about cognitive and behavioral factors that influence older adults’ adjustment to chronic pain. The objective of this study was to investigate the relationship of self-efficacy for managing pain to reports of pain intensity, pain-related disability, depressive symptoms, and pain coping strategy use among 140 retirement community residents (88% female; age mean = 81.7, range 66–99 years) with chronic pain. The 8-item Arthritis Self-Efficacy Scale, modified to specify pain rather than arthritis, demonstrated good psychometric characteristics (Cronbach alpha = .89, minimal floor and ceiling effects, and validity) in this sample. Controlling for age, gender, and pain intensity, self-efficacy was associated significantly and negatively with pain-related disability and depressive symptoms ( P values < .001), and positively with use of pain coping strategies previously found to be associated with better outcomes (task persistence, exercise/stretch, coping self-statements, activity pacing; P values < .05). Self-efficacy for managing pain appears to be important in the adjustment of older adults with pain. Research is needed to determine whether interventions designed to increase self-efficacy improve quality of life and prevent functional declines in this population. Perspective Among retirement community residents (mean age of 82 years) with chronic pain, higher self-efficacy for managing pain is associated with less disability and depression and with the use of pain coping strategies related to better adjustment. This suggests the potential value of interventions to increase self-efficacy in this population.

Relationship of pain‐coping strategies and pain‐specific beliefs to pain experience in children with juvenile idiopathic arthritis

To examine whether pain-specific beliefs and coping strategies of patients with juvenile idiopathic arthritis (JIA) independently predict their reported pain, while controlling for relevant demographic variables, disease activity, and parent-rated disability. To compare use of pain-coping strategies and pain-related beliefs of a selected subgroup of patients with high pain and low disease activity (high pain group) with the remaining patients. Children with JIA (n = 56) completed the Pain Coping Questionnaire, a revised version of the Survey of Pain Attitudes, and a 3-week pain diary. The parents completed the Childhood Health Assessment Questionnaire (CHAQ). Second order principal component analyses were conducted in order to reduce the number of independent variables. Regression analyses of the dependent measure were performed. The use of coping strategies and health beliefs were compared using t-tests for independent samples. Pearson's correlation coefficients were calculated to examine the direct associations between each individual coping and belief scale, and the pain measure. Only the CHAQ and the cognitive belief composite factor score made statistically significant contribution to the prediction of pain after controlling for other variables. Significant differences were found between the scores of high pain patients and the rest of the group for the health belief subscale of disability (mean +/- SD 2.0 +/- 0.6 and 1.2 +/- 0.7, respectively), and for the health belief subscale of harm (mean +/- SD 2.7 +/- 0.6 and 1.8 +/- 0.7, respectively). Significant correlations were obtained between the pain measure and the pain-coping subscale of catastrophizing, the pain belief subscales of disability, harm, solicitude (inverse), control, and medical cure. These results support a model of pain experience in patients with JIA where psychological factors are strongly influential. It may be efficient to focus behavioral interventions on a subgroup of children where the pain experience seems to be in discordance with the disease activity.

Can high optimism and high pessimism co-exist? Findings from arthritis patients coping with pain

Data from 120 elderly osteoarthritis patients showed that dispositional optimism and pessimism interacted in their associations with the frequency of use of pain-coping strategies: participants higher on both dispositions reported more intense coping. Controlling for age, pain level, history of prior serious disease, or negative and positive affectivity did not affect the results. Possible explanations for the co-existence of high optimism and pessimism under certain conditions are proposed.

Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping

A patient's readiness to adopt a self-management approach to pain has been hypothesized to increase during multidisciplinary pain treatment and to impact pain coping responses. The Pain Stages of Change Questionnaire (PSOCQ; [J Pain (1997) 227]) was designed to assess four components of readiness to self-manage pain: pre-contemplation, contemplation, action, and maintenance. We tested three hypotheses concerning this construct in two different samples of patients with chronic pain: (1) readiness to self-manage pain, as assessed by the PSOCQ, would increase from pre-multidisciplinary pain treatment to post-treatment and follow-up; (2) changes in readiness to self-manage pain measured pre-treatment to post-treatment and follow-up would be associated with changes in the use of pain coping strategies; and (3) increases in readiness to self-manage pain would be associated with improvement in multidisciplinary pain treatment. The findings supported all three hypotheses. We discuss the implications of the findings for understanding motivational issues in the self-management of pain.

A Randomized, Controlled Comparison of Educational and Behavioural Interventions for Women with Fibromyalgia

We evaluated the effects of educational (EI) and behavioural interventions (BI) across a 10-week treatment period and at 6-month follow-up on various variables (e.g. coping with pain) for female patients with fibromyalgia (FM). The effects of EI and BI vs. the waiting-list control (WLC) group were also analysed. The EI did not lead to any significant changes. The BI led to benefits on the patients' use of pain coping strategies, functional disability, perceptions of pain and quality of sleep. With the exception of quality of sleep, these effects disappeared at follow-up. The WLC deteriorated in some of the Coping Strategies Questionnaire (CSQ) and the McGill Pain Questionnaire (MPQ) subscales. The BI did somewhat better than the EI, in particular, but only the improvement in sleep-quality remained over time. We concluded that improvements were few after treatment and all, but one, disappeared at follow-up. Essentially, there were no differences between the three conditions in terms of effectiveness. More research is needed to clarify further the value of behaviourally oriented interventions for FM patients, particularly their value over time.

The DSM-IV nosology of chronic pain: a comparison of pain disorder and multiple somatization syndrome

This study evaluates the classification of pain from the perspective of the DSM-IV system. Of 60 in-patients with long-standing and disabling pain syndromes, 29 with pain disorder (PD) and 31 with pain as part of a multiple somatization syndrome (MSS) were compared before and after a structured cognitive-behavioral treatment. It was hypothesized that MSS patients show more psychological distress, are more severely disabled, and respond less to the treatment. Both groups were similar with respect to sociodemographic status, history of pain symptomatology and comorbidity with DSM-IV mental disorders. The results show that MSS patients had higher levels of affective and sensoric pain sensations as well as more pain-related disabilities. They were also less successful during treatment to reduce their pain-related depression and anxiety. Psychosocial functioning was improved only by PD patients, but remained almost unchanged in the MSS group. However, there were no group differences concerning general depression and hypochondriasis, dysfunctional attitudes towards body and health, and use of pain coping strategies. It is concluded that the DSM-IV distinction between ‘pure’ pain disorder and syndromes involving pain plus multiple somatoform symptoms cannot generally be confirmed, but further studies of validation are needed. Copyright 2000 European Federation of Chapters of the International Association for the Study of PainKEYWORDS: pain, somatization disorder, somatoform disorder, ceognitive-behavioral treatment, DSM-IV, ICD-10.

Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?

Physical and psychosocial disability in patients with chronic pain have been shown to be associated with patients’ pain-related beliefs, tendency to catastrophize, and pain coping strategy use. However, little is known about whether beliefs, catastrophizing, and coping strategies are independently associated with patient adjustment. Identification of specific beliefs, cognitive responses, and coping strategies strongly and independently associated with physical and psychosocial functioning would suggest the importance of targeting those variables for modification in treatment. One hundred sixty-nine patients entering a multidisciplinary pain treatment program completed measures of pain, beliefs, coping, catastrophizing, physical disability, and depression. Principal components analyses were used to create belief and coping components, which were then entered in multiple regression analyses predicting physical disability and depression. Belief scores significantly and independently predicted both physical disability and depression, after controlling for age, sex, pain intensity, catastrophizing, and coping. Coping scores significantly and independently predicted physical disability, but not depression, whereas catastrophizing independently predicted depression, but not physical disability. These findings suggest the importance of targeting specific pain-related beliefs and coping strategies, as well as catastrophizing, for modification in the treatment of patients with chronic pain.

ARE PAIN TOLERANCE OF FEMALE RUNNERS AND USE OF PAIN COPING STRATEGIES RELATED TO THE EXPERIENCE OF CHILDBIRTH?

Experimental ischaemic pain tolerances were compared for 10 female runners who had given birth and 10 female runners who had not given birth. In both groups pain tolerances were positively correlated with the spontaneous use of pain-coping strategies. No differences were found between the groups in pain tolerances, use of coping strategies, or estimates of pain intensity at tolerance; however, athletes who had experienced childbirth reported tolerating greater pain during their normal training sessions.

The relationship of arthritis self-efficacy to daily pain, daily mood, and daily pain coping in rheumatoid arthritis patients

There is an increasing awareness in the medical community that psychosocial variables such as beliefs in self-efficacy are important determinants of treatment outcome. However, before measures of self-efficacy are widely incorporated into clinical practice, there needs to be a better understanding of how they relate to daily pain, mood and coping. In the present study 128 rheumatoid arthritis patients completed diaries for 30 days in which they provided daily ratings of joint pain, negative and positive mood, the use of pain coping strategies, and coping efficacy. The patients then participated in an evaluation session during which measures of self-efficacy (the Arthritis Self Efficacy Scale (ASES)), demographic variables, and medical status were collected. A series of hierarchical regression analyses was conducted to determine the degree to which self-efficacy measures collected at the time of the evaluation session were related to daily diary measures collected during the 30 preceding days. The results revealed that self-efficacy was significantly related to daily ratings of pain, mood, coping and coping efficacy. Interestingly, the findings regarding self-efficacy were obtained even after taking into account the effects of important demographic and medical status variables. Taken together, these results suggest that self-efficacy ratings collected from arthritis patients at the time of an evaluation session may well be related to recent experiences of daily pain and mood, as well as the daily use and perceived effectiveness of pain coping strategies.

Coping with pain in the hip or knee in relation to physical disability in community-living elderly people.

To investigate the use of pain coping strategies by community-living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability. A group of 157 people with pain "in the last month" was identified. Coping with pain was assessed with the Pain Coping Inventory, physical disability with the Sickness Impact Profile, and household and sport activities with a validated structured interview method. People with chronic pain used relatively more "resting," and "reducing demands" as pain coping strategies. Pain chronicity made a significant contribution to physical disability; however, when corrected for other variables in a regression model, no significant partial correlation was found. We conclude that pain coping has a mediating role in the relationship between pain chronicity and physical disability. Less use of "resting" and a physically active lifestyle are independently associated with less physical disability.

Pain in young adults--III: Relationships of three pain-coping measures to pain and activity interference.

The study had two purposes: (a) to examine the relationships among coping strategies measured by the Coping Strategies Questionnaire (CSQ) (1), the Vanderbilt Pain Management Inventory (VPMI) (2), and the Ways of Coping Inventory (WOC) (3) and identify the higher-order composite factors representing these relationships; and (b) to determine the degree to which individual coping scale scores and composite coping factor scores could explain variability in the pain intensity and pain-related activity interference reported by young adults. Measures of pain coping were collected from 206 young adults using the CSQ, VPMI, and WOC, along with measures of pain intensity, pain location, and the extent to which pain interfered with daily activities. Results indicated considerable variability in the reported frequency of use of pain-coping strategies and in pain intensity, location, and activity interference. Principal components factor analysis identified three higher-order coping factors (Emotional and Other-Directed Coping, Active Cognitive Coping, and Self-Efficacy for Pain Control) that explained 87% of the variance in individual coping scale scores. The degree to which individual scale scores and composite factor scores explained variability in pain intensity and activity interference variables was determined through a series of multiple regression analyses. The results revealed that individual scale scores, particularly the CSQ scales of catastrophizing and praying or hoping, were best able to explain the variance in measures of pain and activity interference. Taken together, these findings provide further support for the importance of coping variables in explaining the experience of pain and adjustment in young adults.

Coping with labor pain

This exploratory study aimed to examine the nature, origin, and effectiveness of pain coping strategies used during childbirth. The labor pain of 51 British women was assessed around the time of birth by visual analogue scales and the McGill Pain Questionnaire. The use of pain coping strategies and their origins was established through the analysis of data obtained in an extended semi-structured interview. Subjects were found to use a range of strategies during labor, many of which they had previously used to cope with pain. The nature of these strategies was, in essence, similar to that described in the empirical literature on pain coping, though it appeared that strategies had often been acquired informally as well as through structured training. The total number of strategies used in labor was negatively correlated with levels of labor pain.

The effect of cognitive behavior therapy in patients with rheumatoid arthritis

In order to examine the effectiveness of cognitive behavioral therapy for patients with rheumatoid arthritis (RA) three patients groups were studied: a cognitive behavioral therapy group (CBT), an occupational therapy group (OT), and a waiting-list control group. The CBT received a comprehensive, 10-session treatment package that taught progressive relaxation, rational thinking and the differential use of pain coping strategies. CBT resulted in minor changes in pain coping behavior at posttreatment, while CBT and OT showed an increase of knowledge of RA. No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up. Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study. It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied, as well as to the rather small changes in coping behavior.

Pain in Young Adults. II

The first goal of the study was to determine the internal reliability of the Coping Strategies Questionnaire (CSQ) in young adults. The second goal was to examine the relation of the CSQ to reported pain levels. The third goal was to investigate the relationship between the CSQ and concomitant pain problems. The fourth goal was to compare young adults and different chronic pain samples in terms of the frequency of coping strategy use and perceived effectiveness of coping strategies. The study included 252 undergraduate students who were given the CSQ, a demographic and pain level questionnaire, and a concomitant pain problem survey. The results indicated that the CSQ was internally reliable when used to assess pain coping strategy use among young adults. Catastrophizing was found to be associated with both pain level and concomitant pain problems, with subjects reporting higher levels of catastrophizing having higher levels of pain and a higher frequency of both migraine headaches and low back pain. Finally, differences were found when comparing the perceived effectiveness in controlling and decreasing pain, and in the use of specific coping strategies in the young adult and chronic pain samples. The young adult sample reported a greater perceived efficacy in controlling and decreasing pain, compared to a sample of low back pain patients and a sample of myofacial pain patients. The results indicate that the CSQ is a reliable measure for the study of pain-coping strategies used in this population, and one that relates to differences reported in the experience of pain.

The Use of Pain Coping Strategies by Patients with Phantom Limb Pain

Previous research has demonstrated a relationship between the use of pain coping strategies and the level of pain and psychological distress experienced by patients suffering from a variety of chronic pain syndromes. The present study assessed coping strategy use in patients suffering from phantom limb pain by means of the Coping Strategies Questionnaire (CSQ). Sixty phantom limb pain patients completed the CSQ and measures of pain and psychological distress. The factor structure of the CSQ was found to be broadly similar to that obtained in other studies of chronic pain. Three factors reflecting 'Cognitive Coping', 'Helplessness' and 'Pain Denial' were found. Both pain report and psychological distress were found to be related to use of strategies within factor 2 (Helplessness), the number of different drugs patients used, and the time they had experienced phantom limb pain. Twenty percent of the variance in pain scores and 19% of the variance in psychological distress were significantly explained by coping strategies included in the 3 factors on the CSQ. Patient history variables significantly explained a further 14% of the variance in pain scores and 14% of the variance in psychological distress. Examination of regression analyses of the subscales of the CSQ revealed that catastrophising explained the largest proportion of the variance in pain report and psychological distress.