25-30 Orig research

Background: Research on coping with chronic pain has focused on exploring the impact of different coping responses on various aspects of living with chronic pain. The aim of this study is to determine whether certain coping responses can be identified as predictors of the level of pain intensity reported by the chronic pain patient, as well as predictors of these individuals’ psychosocial functioning. Methods: One hundred and seventy-two individuals suffering from chronic pain completed both the West Haven-Yale Multidimensional Pain Inventory and the Coping Responses Inventory – Adult Form. The prevalence of the use of Avoidance and Approach Coping, and the relationship between these responses and psychosocial functioning (Pain Severity, Interference, Support, Life Control, and Affective Distress) were explored. Hierarchical regression analyses were performed in order to determine the amount of variance explained by the specific predictor variables. Results: The findings of this research suggest that coping responses do impact upon the psychosocial functioning of individuals with chronic pain, and more specifically, on the level of interference, severity of pain, perceived amount of control over life and the amount of emotional distress experienced by these patients. Conclusion: The outcomes of this study appear to contradict the general consensus in literature that regards Approach Coping responses as being associated with decreased pain severity and improved psychosocial functioning. The manner in which specific components of each type of coping response relates to specific aspects of psychosocial functioning was investigated; an aspect that was found to be lacking in most research regarding coping and chronic pain. Peer reviewed (Submitted: 2009-02-03, Accepted: 2009-09-29) Introduction The experience of chronic pain can be viewed from a biopsychosocial perspective, where chronic pain is regarded as emanating from multidirectional interactions between biological, psychological and social factors, with the contribution of each domain regarded as equally important. An individual’s emotional status, the particular nature of their attention to nociceptive stimuli, their beliefs and expectations with regard to pain, the degree of control they perceive to have over their pain, their individual background and past experiences with pain, as well as their general physical and psychological health, may affect their perception of pain. Furthermore, the value of psychosocial functioning as a prognostic indicator in chronic pain should not be underestimated. In one study 59% of the variance in the disability experienced by the participating chronic pain patients could be attributed to their psychosocial functioning. The physiological experience of pain is associated with many comorbid stressors such as interpersonal, emotional and other psychosocial problems. Thirty per cent to 54% of individuals treated for chronic pain in the USA are diagnosed with comorbid depression, while anxiety and anger are also commonly reported by these patients. Not only has the experience of chronic pain been found to influence patients’ emotional wellbeing, but the process and outcome of their pain treatment also influences their emotional state. Consequently, chronic pain could be regarded as a psycho-physiological disorder most often presenting primarily as psychosocial impairment. Deficient social support is associated with both the incidence and severity of depression among chronic pain patients. This may be indicative of the possible predisposing role that low levels of social support (including marital conflict and lack of family support) play in the development of depression in patients with chronic pain. However, the relationship between social support and depression may best be conceptualised as interactive, rather than causal, in nature. Coping refers to the cognitive and behavioural attempts at dealing with internal or external demands perceived as threatening to overwhelm the individual’s resources and entails adapting cognitive and behavioural attempts to deal with these internal or external demands. Coping is a dynamic process and the type of coping response used depends upon the changing psychosocial environment and context. Higher levels of perceived social support have been associated with the use of approach coping responses. Hence the conclusion can generally be drawn that active or approach coping responses, where the stressor is acted upon or action is taken to improve resistance to stress, are associated with reduced pain severity and improved psychosocial functioning. Patients who present with elevated levels of pain severity, life interference and affective distress, while displaying low levels of life control and activity, tend to present with less adaptive psychosocial functioning. These patients are also more prone to using avoidance coping responses. In contrast, individuals who utilise adaptive coping strategies tend to display lower levels of pain severity, life interference and affective distress, and higher levels of life control and activity.