Pain Coping Strategies: Potential predictors of chronic pain adjustment and treatment outcome

Jennifer L. Y. Lee

The present study investigated the potential of coping strategies as assessed by the Coping Strategy Questionnaire, CSQ (Rosenstiel & Keefe, 1983) in predicting chronic pain patients' level of adjustment and response to a multidisciplinary treatment programme. Coping efforts of patients presenting with chronic pain were examined in relation to measures of adjustment comprising measures of pain, psychological distress, functional disability and impairments. These measures were derived using standardised instruments with satisfactory psychometric properties. Subjects were sixteen patients who completed a 6-week pain management programme, PUMP, at the Fremantle Hospital, and fifteen patients who were wait-listed for treatment of chronic pain at the Sir Charles Gairdner Hospital. The results showed that several coping strategies are potentially useful in making predictions about adjustment level and response to treatment efforts. The use of coping self-statement strategies, high ratings of personal control and efficacy in dealing with pain were found to be related to lower pain levels, lower distress and functional disability, and high activity. Consistent with literature on pain coping strategies, this study found that catastrophizing is associated with poorer adjustment and the use of diverting attention strategy is associated with greater pain intensity. Treatment related improvements in functional disability were associated with improvements in effective coping. Patients who completed the programme made significant improvements on functional disability measures as compared with pre-test measures and with patients on the wait-list. There was an associated increase in use of reinterpreting pain sensation, praying and hoping, and coping self-statement strategies and a significant improvement in ratings of personal control and efficacy. The chronic pain management programme, PUMP, was most effective for those who were initially coping badly, but had little effects for those who were coping well. There was an inverse relationship between improvements and pre-test measures of diverting attention, praying and hoping and coping self-statement strategies, and a positive relation with personal control ratings. The results indicate that patients improved significantly in adaptive functioning i.e., increase in activity levels and reduction in functional disability, in spite of pain and distress, which remained unchanged. Patients on the wait list showed no significant changes at post-test.

Pain Coping Strategies: Potential predictors of chronic pain adjustment and treatment outcome

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