The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621-630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment of emotional responses to pain. Innovations in clinical practice: a source book, 14, 309-321]. To assess this emotional reaction to pain in chronic pain patients, McCracken, Zayfert and Gross [McCracken, L., Zayfert, C., & Gross, R. (1992). The Pain Anxiety Symptom Scale: development and validation of a scale to measure fear of pain. Pain, 50, 67-73] developed the Pain Anxiety Symptom Scale (PASS) composed of four subscales: Cognitive Anxiety, Fearful Appraisal, Escape Avoidance and Physiological Anxiety. The present study extended previous work by examining the relationship among pain anxiety dimensions, use of active and passive coping strategies and arthritis self-efficacy as predictors of functional status in 154 rheumatoid arthritis (RA) patients. Functional status was assessed using the Five-Factor Model of the Arthritis Impact Scale, 2nd ed., (AIMS2): Physical Functioning, Affective Experience, Symptoms, Social Interaction and Role Function. Hierarchical multiple regression analysis on each of the AIMS2 criterion variables showed that pain anxiety, pain and symptom self-efficacy, health status and coping strategies were able to explain between 9 and 38% of the variance in the five AIMS2 variables. The present results support the hypothesized role of pain anxiety along with previously established contributions of self-efficacy and coping strategies, in affecting physical, social, emotional and role functioning in chronic RA patients.     

Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis

Pain-related avoidance factors and social resources, as assessed by pain coping and social support, are supposed to have lasting effects on functional disability and pain in chronic pain disorders. As a follow-up to a prospective study demonstrating short-term effects after one year (Behaviour Research and Therapy, 36, 179-193, 1998), the role of pain coping and social support at the time of diagnosis was investigated in relationship to the long-term course of functional disability and pain after three and five years in 78 patients with rheumatoid arthritis (RA), taking into account personality characteristics of neuroticism and extraversion, clinical status and use of medication. In line with findings at the one-year follow-up, results showed that more passive pain coping predicted functional disability at the three-year, but not the five-year follow-up. In addition, low levels of social support at the time of diagnosis consistently predicted both functional disability and pain at the three and five-year follow-ups. Results indicate that pain coping and social support, assessed very early in the disease process, can affect long-term functional disability and pain in RA, and suggest that early interventions focusing on pain-related avoidance factors and social resources for patients at risk may beneficially influence long-term outcomes in RA.     

Coping with neck and low back pain in the general population.

This study had 2 objectives: (a) to assess the psychometric properties of the Pain Management Inventory (PMI; G. K. Brown & P. M. Nicassio, 1987) with individuals in the general population with neck or low back pain, and (b) to assess the relationship between pain severity and coping. Data were taken from a mailed survey of a random sample of adults residing in Saskatchewan, Canada. Results validated the 2-factor structure of the PMI and provided evidence for the internal consistency of the coping subscales. Regression analyses revealed that passive coping was associated with being married, greater pain severity, depression, and poor health. Active coping was associated with female gender, higher education, less depression, good health, and frequent exercise. This study provides psychometric data to support the use of the PMI and information about factors associated with use of active and passive coping strategies in pain sufferers.     

The role of optimism and pessimism in chronic pain patients adjustment

This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test (LOT), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ), Hospital Anxiety and Depression Scale (HADS), and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model establishes positive relationships between optimism and the use of active coping strategies, whereas pessimism is related to the use of passive coping. Active coping is associated with low levels of pain, anxiety, depression and impairment and high levels of functioning. However, passive coping is related to high levels of pain, anxiety, depression and impairment and low levels of functioning. The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. The results support the hypotheses formulated regarding the relations among optimism, pessimism, coping and adjust of chronic pain patients. By analysing optimism among chronic pain patients, clinicians could make better predictions regarding coping and adjustment.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.     

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 degrees C cold-pressor task. Results showed pain intensity ratings after 1 min 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.     

Depression history and coping with chronic pain: a daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.     

Coping Styles,Pain Expressiveness,and Implicit Theories of Chronic Pain

Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain.     

Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a "part of the game," which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes' inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes' inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a “part of the game,” which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes’ inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes’ inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

the relationship between pain and coping styles among hiv-positive men and women

Abstract

Pain in HIV/AIDS patients is associated with compromised quality of life and emotional adjustment. Although previous findings support a relationship between coping styles and subjective pain for various groups of chronically-ill persons, little research has examined the associations between coping and pain in HIV-positive or AIDS patients. The purpose of this study was to explore the relationship between pain and coping styles among 105 HIV-positive participants (32 women and 73 men) in a randomized clinical trial designed to examine the effect of group psychotherapy on quality of life and health behavior. Participants completed the Brief COPE, the pain scale from the Medical Outcomes Study-HIV, and a demographic and medical questionnaire. Multiple regression analysis, with pain as the dependent variable, showed that participants who reported coping through denial reported greater pain severity (p < 0.0001). These results suggest that denial as a coping strategy appears to be signficantly associated with pain for persons with HIV/AIDS. However, further research is necessary to determine the causal relationship between pain and coping through denial. These findings also point to the possibility of psychological intervention in order to modify maladaptive coping styles and to ameliorate pain in this population.     

Playing it cool: Temperament, emotion regulation, and social behavior in preschoolers

The contributions of temperamental styles and emotional coping strategies to the development of preschoolers' social competence and behavior problems were investigated. The ability to cope with emotion was found to be more important than temperament alone in the development of prosocial behavior. Our results indicate that the use of passive coping strategies may play a significant role in the development of maladaptive behaviors in young children. Specifically, the use of passive coping strategies was found to moderate the relationship between temperament dimensions in predicting externalizing and internalizing maladaptive behaviors. When combined with extremely negative temperamental dispositions, just facing the problems was discovered to be beneficial for preschoolers, which encourages the use of preventative or interventional strategies in the classroom to develop constructive emotion regulation skills in young children.     

Effects of instructional set on attributions of nonvolition during hypnotic and nonhypnotic analgesia

Fifty highly hypnotizable subjects were assigned to four treatment groups or a no-treatment control group and then underwent two pain stimulation trials. Half the treated subjects were administered hypnotic analgesia, half waking analgesia. Within hypnotic and nonhypnotic treatments, half the subjects were given actively worded analgesia instructions, half passively worded instructions. Subjects in the four treated groups reported equivalent pain reduction and equivalent use of coping imagery, although hypnotic subjects rated themselves as more deeply hypnotized than did nonhypnotic subjects. Both hypnotic and nonhypnotic subjects given passive instructions rated their pain reduction as occurring involuntarily, whereas those given active instructions reported that their pain was reduced through their active use of coping strategies. These findings support sociocognitive formulations of hypnotic responding that view ratings of involuntariness as reflecting contextually guided interpretations of behavior.     

Passive coping response to depressive symptoms among low-income homebound older adults: Does it affect depression severity and treatment outcome?

Due to their homebound state, lack of financial resources, and/or other life demands, a significant proportion of depressed, low-income homebound older adults experience depression. Because of their limited access to psychotherapy, most of these older adults self-manage their depressive symptoms. The purposes of this study were to examine (1) the relationship between homebound older adults' coping responses to depressed mood and the severity of their depressive symptoms at baseline (n = 121), and (2) the moderating effect of passive coping responses on the relationship between participation in problem-solving therapy (PST: in-person or telehealth delivery) and depressive symptoms at 12- and 24-week follow-ups. Controlling for the effects of demographic and disability characteristics, cognitive passive coping was significantly associated with baseline depressive symptoms, while behavioral passive coping was not. The main effect of baseline cognitive passive coping response was also significant in mixed-effects regression analysis, but the interaction between coping pattern and group was not significant. The results point to a possibility that cognitive passive copers may have benefited as much from PST as the rest of the PST participants. Further research needs to examine the moderating effect of coping responses to depressive symptoms on treatment efficacy of PST and other psychosocial interventions for late-life depression.     

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions

This study sought to investigate cognitive-behavioural predictors of children's tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.     

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

In two experiments subjects rated their pain during baseline trials of cold pressor and finger pressure pain. After various instructional treatments, they were posttested with these same stimuli. As in previous studies, we found in both experiments that coping suggestions significantly reduced reported pain. Experiment 1, however, demonstrated that subjects often refrained from using available cognitive coping strategies to reduce pain unless they had been given explicit permission to do so. Experiment 2 replicated this finding and also showed that explicit permission to "do whatever you can to reduce pain" was as effective as a coping suggestion in decreasing reported pain. These findings indicate that subjects' interpretation of what is appropriate responding in the test situation determines how they choose to cope with the painful stimulation. Thus standard experimental procedures for assessing baseline levels of pain implicitly lead subjects to refrain from coping and thereby tend to underestimate their ability to control pain. Moreover, suggestions and other instructional techniques for coping with pain may produce much of their effect not by teaching subjects new coping skills but instead by giving them permission to use already available coping strategies.     

Experiential avoidance and self‐compassion in chronic pain

The present study investigates the role of coping, experiential avoidance, and self‐compassion on psychological distress prediction (i.e., depression, anxiety, and stress symptoms). A battery of self‐report questionnaires was used to assess coping, experiential avoidance, self‐compassion, and psychological distress in 103 adults with chronic pain from Portuguese primary health care units. Hierarchical regression analyses were performed and showed that experiential avoidance and self‐compassion are the factors that mostly explain psychological distress. Our results suggest that when people with chronic pain are willing to remain in contact with particular private experiences without attempting to control them, they reported less depression, anxiety, and stress. Implications for clinical practice were discussed, suggesting the importance of helping people with chronic pain to increase their willingness to pain rather than avoiding it.     

A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory

Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e. pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The nine-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.