Chronic low back pain: Toward an integrated psychosocial assessment model.

Reports on the integration of 6 dimensions of chronic low back pain to provide a multidimensional profile of the patient. These dimensions were pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, and illness behavior. Cluster analysis of the data obtained from 100 patients with chronic low back pain revealed the presence of 3 distinct patient groups: patients who were in control, patients who were depressed and disabled, and patients who were active copers with high denial. The validity of these clusters was supported by significance testing on several external variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 depicting 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of MMPI-2 profiles in chronic back pain patients: differences in path models of coping and somatization

OBJECTIVE: To show clinical utility and empirical validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) chronic pain patient subgroups by identification of differential multivariate relationships across groups. METHOD: This study used structural equation modeling to test cognitive coping strategies and somatization as mediator variables in path models with pain severity and depression used as exogenous (independent) variables and patient's activity level as the final endogenous (dependent) variable, across MMPI-2 profiles. RESULTS: Hierarchical cluster analysis, performed on a sample of 569 chronic low back patients, resulted in four cluster profiles identifiable as those found in previous work with the MMPI-2 (within normal limits, V-type, neurotic triad, and depressed-pathological). Somatization mediated the relationship between depression and activity level for the neurotic triad group but not the other three groups. A positive linear relationship was found between somatization and depression for the within normal limits, neurotic triad, and depressed-pathological groups, whereas their linear association was negative for the V-type group. Cognitive coping strategies mediated the relationship between depression and activity level for the within normal limits group. In addition, cognitive coping was predictive of activity level for the within normal limits, V-type, and neurotic triad groups but not for the depressed-pathological group. CONCLUSION: Consistent with previous cluster analytic studies, this study replicated four MMPI-2 cluster profile groups in chronic pain patients. These results have also shown that several multivariate relationships between variables are different across MMPI-2 groups, providing evidence for the validity for these MMPI-2 subgroups.     

Effects of cognitive coping skills training on coping strategies and experimental pain sensitivity in African American adults with sickle cell disease.

The present study examined whether training in cognitive coping skills would enhance pain coping strategies and alter pain perception in adults with sickle cell disease (SCD). Sixty-four African Americans with SCD were randomly assigned to either a cognitive coping skills condition (three 45-min sessions in which patients were trained to use 6 cognitive coping strategies) or a disease-education control condition (three 45-min didactic-discussion sessions about SCD). Pain sensitivity to calibrated noxious stimulation was measured at pre- and posttesting, as were cognitive coping strategies, clinical pain, and health behaviors. Results indicated that, compared with the randomly assigned control condition, brief training in cognitive coping skills resulted in increased coping attempts, decreased negative thinking, and lower tendency to report pain during laboratory-induced noxious stimulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of the pain response inventory for children.

The Pain Response Inventory (PRI) was developed as a multidimensional instrument to assess children's coping responses to recurrent pain. The PRI assesses 3 broad coping factors—Active, Passive, and Accommodative—each with subscales representing specific strategies for coping with pain. Confirmatory factor analysis was used to derive and cross-validate the factor structure of the PRI in 3 different samples of children and adolescents: 688 9–16 yr olds in general population, 120 8–18 yr old abdominal pain patients who also completed followup interviews 2-wks and 6 mo after initial interview, and 224 11–23 yr old former abdominal pain and well patients. The subscales were found to be internally consistent and reasonably stable. Validity of the subscales was assessed by examining the relations of particular coping strategies to various outcome indicators, including functional disability, somatization symptoms, and depressive symptoms. Results indicated that different types of health outcome were predicted by different patterns of PRI coping strategies, thus supporting the utility of a multidimensional approach to the assessment of coping responses to pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-Related Differences Among Adults Coping With Pain: Evaluation of a Developmental Life-Context Model.

The pain and coping literature is limited because of its almost exclusive focus on young adults. Our goal was to develop and evaluate a theoretically sound model of age-related differences in coping. Age-related increases in emotion-focused and avoidance-oriented coping and decreases in problem-focused coping were expected to arise from age-related differences in life-context (e.g., health status, stress levels) and in the pain experience. Questionnaire data were collected from 280 older and younger adults with pain. Increasing age was associated with lower pain severity/interference and greater perceived control over pain. Life-context partially mediated this relationship. As hypothesized, there were age-related declines in problem-focused coping. Contrary to expectations, however, older adults also used fewer emotion-focused coping strategies. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Active and passive coping strategies in chronic pain patients

This study assessed the validity of active and passive coping dimensions in chronic pain patients (n = 76) using the Coping Strategies Questionnaire and the Vanderbilt Pain Management Inventory. The validity of active and passive coping dimensions was supported; passive coping was strongly related to general psychological distress and depression, and active coping was associated with activity level and was inversely related to psychological distress. In addition, the Coping Strategies Questionnaire was found to be a more psychometrically sound measure of active and passive coping than the Vanderbilt Pain Management Inventory.     

Sickle cell disease pain in children and adolescents: change in pain frequency and coping strategies over time

Examined 9-month follow-up data obtained from children and adolescents with sickle cell disease (SCD) and their parents participating in a longitudinal study of pain coping strategies. Of 87 subjects completing the baseline assessment of pain coping strategies, 70 (80%) of their parents completed a structured pain interview assessing their child's health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for age and pain frequency revealed that baseline Coping Attempts were associated with higher levels of school, household, and social activity during painful episodes. Baseline Passive Adherence was associated with more frequent health care contacts during the subsequent 9 months. Increases in Negative Thinking over time were associated with further increases in health care contacts during the follow-up period. Comparing pain coping strategies assessed at baseline to pain coping strategies measured at follow-up revealed that pain coping strategies were relatively stable over time for younger children but changed more for adolescents.     

Correlates of improvement in multidisciplinary treatment of chronic pain.

Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients (aged 21–64 yrs) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 mo after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suffering for science: The effects of implicit social demands on response to experimentally induced pain.

144 undergraduates rated their pain during baseline trials of cold-pressor and finger-pressure pain in 2 experiments. After various instructional treatments, they were posttested with the same stimuli. Results show that coping suggestions significantly reduced reported pain. In Exp I (80 Ss), however, Ss often refrained from using available cognitive coping strategies to reduce pain unless they had been given explicit permission to do so. Exp II (64 Ss) replicated this finding and showed that explicit permission to "do whatever you can to reduce pain" was as effective as a coping suggestion in decreasing reported pain. Findings show that Ss' interpretation of what was appropriate responding in the test situation determined how they chose to cope with the painful stimulation. It is suggested that standard experimental procedures for assessing baseline levels of pain implicitly lead Ss to refrain from coping and thereby tend to underestimate their ability to control pain. It is further suggested that instructional techniques for coping with pain may produce much of their effect by giving Ss permission to use already available coping strategies. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with health problems: Developing a reliable and valid multidimensional measure.

Current conceptions relating psychological variables to health recognize the key role of coping processes as mediating variables between stress and illness, yet few reliable and valid instruments exist for the assessment of coping with physical health problems. A self-report instrument, the Coping With Health Injuries and Problems Scale (CHIP) was developed identifying 4 basic coping dimensions for responding to health problems: distraction, palliative, instrumental, and emotional preoccupation coping. The CHIP's factor structure, established with a large derivation sample of adults, is cross-validated in a heterogenous group of general medical patients and a homogeneous group of patients being treated for lower back pain. Preliminary construct validity data are presented by comparing the coping behaviors of patients with chronic and acute illnesses and by comparing CHIP scores with basic coping styles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial predictors of children's postoperative pain

The purpose of this study was to investigate the influence of psychosocial variables in the prediction of children's pain intensity following surgery. Forty-two children, ages 7 to 17 years (M = 12.26, SD = 3.06), completed an interview 1 week prior to surgery assessing anticipatory distress related to their forthcoming surgery and history of coping strategy use. Following surgery, children reported the intensity of their pain using visual analog scales. Findings demonstrated that the majority of children experienced moderate to severe postoperative pain. Hierarchical multiple regression analyses revealed that psychosocial variables added to the prediction of children's postoperative pain after controlling for the influence of surgery-related and demographic variables. These findings lend initial support for the inclusion of psychosocial assessment measures (e.g., anticipatory surgery distress) in the preoperative assessment of pediatric patients who may be at risk for excessive postsurgical pain.     

Age, ego level, and the life-span development of coping and defense processes.

Developmental variation in coping and defense strategy use was examined in a sample of 100 male and female participants ranging in age from 10 to 77 years. Each participant was administered Loevinger's ego development task, the Ways of Coping measure, and the Defense Mechanism Inventory. In addition, a brief narrative of a stressful experience was assessed for the developmental level of the response and for its content. The results suggest that, in addition to age, the developmental measures of ego level and source of stress predict the use of particular coping and defense strategies. In keeping with other research, sex differences in coping and defense strategies were also found. These findings are discussed in light of the need for tasks that are able to assess both developmental and individual differences in the maturity of coping and defense strategy use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being.

The effect of dispositional optimism on recovery from coronary artery bypass surgery was examined in a group of 51 middle-aged men. Patients provided information at three points in time—(a) on the day before surgery, (b) 6–8 days postoperatively, and (c) 6 months postoperatively. Information was obtained relating to the patient's rate of physical recovery, mood, and postsurgical quality of life. Information was also gathered regarding the manner in which the patients attempted to cope with the stress of the surgery and its aftermath. As expected, dispositional optimism proved to be an important predictor of coping efforts and of surgical outcomes. More specifically, dispositional optimism (as assessed prior to surgery) correlated positively with manifestations of problem-focused coping and negatively with the use of denial. Dispositional optimism was also associated with a faster rate of physical recovery during the period of hospitalization and with a faster rate of return to normal life activities subsequent to discharge. Finally, there was a strong positive association between level of optimism and postsurgical quality of life at 6 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking screening and management in primary care practices

This study examined how pain coping efficacy and pain coping strategies were related to reports of pain during mammography. Subjects were 125 women over the age of 50 undergoing screening mammograms. Prior to their mammogram, all subjects completed the Coping Strategies Questionnaire (CSQ) to assess how they cope with day-to-day pain experiences. Ratings of pain during the mammogram were collected using a 6-point pain/discomfort scale, a 100-mm Visual Analog Scale, the adjective checklist of the McGill Pain Questionnaire, and the Brief Pain Inventory. Up to 93% of the women reported the mammogram examination was painful. On average, women rated the mammography pain in the low to moderate range. Considerable variability in pain ratings was found, however, with some women reporting severe pain and others reporting little or no pain. Correlational analyses were conducted to examine how coping efficacy (CSQ ratings of ability to decrease pain and ability to control pain) and coping strategies (CSQ pain coping strategy subscales) related to variations in pain report. There was a pattern for ratings of ability to decrease pain to be related to lower ratings of current mammography pain. Women who rated their ability to decrease pain as high reported lower average levels of mammography pain, lower ratings on the mammography pain/discomfort scale, and were much more likely to report having had lower levels of pain during their last mammogram. These findings suggest that women who rate their coping efficacy in decreasing day-to-day pain as low may be at higher risk for having a painful mammogram. Individual pain coping strategies were not generally correlated with pain ratings. Behavioral interventions (e.g., patient controlled breast compression) and cognitive therapy interventions (e.g., training in the use of calming self-statements or distraction techniques) designed to increase coping efficacy potentially could be useful in reducing pain in women who are at risk for pain during mammography.     

Latent structure of strategies used to cope with nociceptive stimulation.

Investigated the latent cognitive structure of 32 undergraduates' perceptions of coping strategies used by 50 college students exposed to a cold pressor test or a muscle ischemia task, using multidimensional scaling (MDS). The resulting strategy clusters (e.g., behavioral activity, pleasant imaginings) were grouped into sensation acknowledging, coping relevance, and cognitive/behavioral dimensions. Using different methodology and MDS analysis, 22 undergraduates' perceptions of the 3 coping strategies were examined. There was close correspondence between the resulting dimensions and those of the 1st sample. Results show that Ss preferred strategies that ignored pain sensations and suggest a method for assessing relative efficiency of coping strategies for pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's spontaneous strategies for coping with pain: A review of the literature.

Reviews the literature on strategies children use for coping with pain before professional intervention. The development of direct methods of assessing children's behavioral and cognitive coping strategies is traced; and evidence for developmental differences in the types of strategies children employ is presented. Initial evidence regarding the effectiveness of spontaneous coping strategies is presented. Future research directions to be taken may include extension to pediatric chronic pain populations, outcome studies, and investigation of parents' roles in children's development and application of coping strategies. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sickle cell disease pain: Relation of coping strategies to adjustment.

This study examines pain coping strategies in a relatively neglected pain population, sickle cell disease (SCD) patients. Seventy-nine patients diagnosed with SCD were given a structured interview to assess pain, activity level, and health care use during painful episodes. Patients also completed the SCL-90—R as an index of psychological distress and the Coping Strategies Questionnaire. Regression analyses controlled for age, sex, and disease severity measures. Results indicated that the coping strategies factors were important predictors of pain and adjustment. Individuals high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health care services. Individuals high on Coping Attempts were more active during painful episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postoperative pain in children: Developmental and family influences on spontaneous coping strategies.

Examined children's and parents' reactions to postoperative pain, including stress appraisal and cognitive-behavioral coping processes from a developmental perspective. 30 younger children (aged 7–9 yrs) and 30 older children (aged 10–16 yrs) and their parents provided interview and psychometric data about pain and coping on the day following surgery. Observational data also was provided by nurses. All children described a variety of self-control strategies found to be helpful in managing postoperative pain. Older children were more likely to report using cognitive coping strategies, yet they reported lower overall self-efficacy. Coping strategy use, perceived self-efficacy, and frequency of catastrophizing thoughts were significantly predictive of children's pain, affective distress, and physical recovery. Parental anxiety was positively related to child anxiety, and inversely related to child self-efficacy and frequency of cognitive coping. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)