The relationship of locus of control to pain coping strategies and psychological distress in chronic pain patients

Although behavioral scientists have long been interested in how an individual's locus of control relates to coping and adjustment, basic information remains to be gathered on the relevance of locus of control to adaptation to persistent pain. This study examined the relationship of locus of control orientation to pain coping strategies and psychological distress in chronic pain patients. Subjects were 62 chronic pain patients. All patients were administered: (1) the Multidimensional Health Locus of Control Scales to assess locus of control, (2) the Coping Strategies Questionnaire to evaluate pain coping strategies, and (3) the Symptom Checklist-90 Revised to assess psychological distress. Correlational analyses revealed that patients who viewed outcomes as controlled by chance factors such as fate or luck tended to rely on maladaptive pain coping strategies and rated their abilities to control and decrease pain as poor. They also exhibited greater psychological distress. Regression analyses indicated that patients having a chance orientation toward locus of control were more likely to report depression, anxiety, and obsessive-compulsive symptoms and to have higher overall levels of psychological distress. Chance locus of control also predicted greater reliance on diverting attention and praying/hoping in dealing with their pain. In addition, patients high on chance locus of control reported feeling helpless to deal effectively with their pain problem. Clinicians evaluating chronic pain patients need to be aware that patients who view outcomes as controlled by external factors such as chance may have deficits in pain coping strategies and may report greater psychological distress than patients who do not have this locus of control orientation.     

The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment

Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.     

原发性青光眼患者人格特征和应对方式相关性的研究

目的 探讨原发性青光眼患者的人格特征和应对方式的相关性.方法 运用艾森克个性问卷(EPQ)和医学应对问卷(MCMQ),对100例原发性青光眼患者进行问卷调查,采用描述性及Spearman等级相关的研究方法对数据进行分析.结果 原发性青光眼患者人格特征中的掩饰性因子(L)得分为(57.83±4.13)分;在应对方式中,面对得分为(16.91±2.21)分,回避得分为(15.69±2.01)分,屈服得分为(11.54±2.03)分,与常模相应得分相比均有显著差异;采用Spearman等级相关统计方法显示掩饰性因子与面对呈显著负相关,与回避方式呈显著正相关.结论 原发性青光眼患者人格特征异于正常人群,常采用回避和屈服的应对方式,而较少采用面对的应对方法.外向的、与人容易沟通的患者比较易于采用积极的应对方式,而在情绪和掩饰性相同的患者中,可以采取完全不同的应对方式.     

The effect of psychological intervention on personality change, coping, and psychological distress of Japanese primary breast cancer patients

The purpose of this study is to estimate the effectiveness of psychological intervention on personality change, enhancing perceived emotional support, and, ultimately, assisting in the adaptive coping and psychological well-being of Japanese primary breast cancer patients. The intervention consists of 3 sessions that include providing medical and psychological information and counseling using the structured association technique. The participants were 28 primary breast cancer patients (14 for the experimental group and 14 for the control group). Participants were assessed at 3 to 4 days after surgery (preintervention) and 3 months (postintervention) and 6 months (follow-up) after discharge using 5 scales: the self-repression scale, the Japanese version of the self-esteem scale, the emotional support scale, the Japanese version of the Mental Adjustment to Cancer Scale, and the Japanese version of the Hospital Anxiety and Depression Scale. The intervention seemed to have enhanced the short-term personality change, adaptive coping, and psychological well-being of primary breast cancer patients. However, further trials will be needed with larger samples to corroborate the findings.     

Predictors of psychological distress in chronic pain patients

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self-report assessment questionnaire which included a 12-item, 5-point semantic differential measure of psychological well-being/distress, together with a range of single-item measures of pain and psychosocial factors measured using 5-point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.     

Posttraumatic growth, coping strategies, and psychological distress in adolescent survivors of cancer

Only recently have researchers begun to empirically examine positive outcomes such as posttraumatic growth in adolescent cancer. This article examines associations between posttraumatic growth, coping strategies, and psychological distress in adolescent cancer survivors. Adolescents who finished cancer treatment 2 to 10 years prior (N = 31) completed self-report measures of posttraumatic growth, coping, symptomatology, and disease-related characteristics. Younger age at diagnosis and less use of avoidant coping strategies predicted lower levels of psychological distress. Adolescents' beliefs that they were more likely to relapse and the use of more acceptance coping strategies predicted higher levels of posttraumatic growth. Adolescent cancer survivors may be capable of experiencing posttraumatic growth. Those who believe they are more prone to relapse and use more acceptance coping strategies are likely to have higher levels of posttraumatic growth. As health care professionals encourage adolescent cancer survivors to use fewer avoidant coping strategies, they can also encourage survivors to use more acceptance coping strategies.     

Identification of patients with headache at risk of psychological distress

OBJECTIVE: To test the hypothesis that anxiety and depression are associated with headache frequency, severity, and disability. BACKGROUND: There is significant comorbidity between chronic headache and psychological distress. Headache associated with anxiety or depression tends to be more severe and often requires supplementary psychological treatment in addition to headache therapy. Therefore, the identification of patients with headache who are at risk of psychological distress is important. METHODS: One hundred twenty-seven consecutive patients with headache attending a university headache clinic were evaluated. Questionnaires about headache symptoms and psychological distress were completed. Comparisons were made between psychological distress and headache frequency, severity, and disability. RESULTS: Depression and anxiety were significantly greater in the subjects of this study who had frequent headache (>4 days per week) and frequent headache-associated disability (activities reduced or prohibited because of headache >3 days per week). Subjects who reported their headache severity as typically severe were no more likely to report depression or anxiety than those with mild or moderate headache severity. Quality-of-life measures of physical and social functioning, emotional distress, and general health and vitality were reduced in subjects with frequent episodes of headache-associated disability. All areas, with the exception of general health perception, were reduced in subjects with frequent headache. Severe headache was associated with reductions in role and social functioning. CONCLUSIONS: Frequent headache and frequent disability are associated with depression, anxiety, and impaired quality of life. Reports of typical headache severity are less likely to correlate with psychological distress. Therefore, patients with headache who report frequent headache or frequent periods of headache-related disability should be further evaluated for the presence of psychological disturbance.     

Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment

Recent studies suggest that coping strategies play an important role in adjustment to chronic pain. Identification of factors that influence coping could potentially help clinicians facilitate the use of adaptive coping strategies by pain patients. According to social learning theory, self-efficacy beliefs (judgments regarding one's capabilities) and outcome expectancies (judgments regarding the consequences of behaviors) are significant determinants of coping behavior. This study tested hypotheses derived from social learning theory by examining the contributions of these beliefs to the prediction of coping behavior in chronic pain patients. One hundred and fourteen chronic pain patients completed measures of health-related dysfunction, pain severity, use of 8 coping strategies, and outcome and self-efficacy expectancies regarding these coping strategies. In support of social learning theory, and consistent with research in other areas, the patients' beliefs regarding their capabilities were strongly related to reported coping efforts. Beliefs about the consequences of coping efforts and their interaction with beliefs about capabilities were generally unrelated to coping. These results suggest that treatment should emphasize the actual practice and use of adaptive coping strategies over education about their outcome.     

Use of the chronic pain coping inventory to assess older adults' pain coping strategies.

Little is known about the strategies that older adults use to cope with persistent pain. The purpose of this study was to describe strategies used by older, retirement community-dwelling adults to cope with persistent, noncancer pain, as assessed by the Chronic Pain Coping Inventory (CPCI), to examine the associations of these strategies with disability and depression, and to compare the 65-item and 42-item versions of the CPCI in this population. Two hundred fifty residents of 43 retirement communities in the Pacific Northwest completed baseline measures for a randomized controlled trial of a pain self-management intervention, including the CPCI and measures of demographics, comorbidity, pain-related disability, and depression. The most frequently reported strategies, as assessed by the CPCI, were Task Persistence, Pacing, and Coping Self-Statements. The least frequently used strategies were Asking for Assistance and Relaxation. Regression analyses demonstrated that coping strategies explained 26%, 19%, and 18% additional variance in physical disability, depression, and pain-related interference, respectively, after controlling for age, gender, comorbidity, and pain intensity. Internal consistency for most CPCI-65 and CPCI-42 subscales was adequate. This study clarifies strategies used by older adults to cope with persistent pain and provides preliminary validation of the CPCI in this population. PERSPECTIVE: Findings from this study on pain coping strategies in older adults might suggest potentially useful coping strategies clinicians could explore with individual patients. Investigators can use study findings to design trials of interventions to help older adults cope more effectively with pain.     

Examining pain-related distress in relation to pain intensity and psychological distress

Despite frequent use of the term symptom distress in the pain literature, symptom distress is often confused with symptom intensity and psychological distress, contributing to inadequate assessment of symptoms and less than ideal symptom management. In this article we address these issues and propose a hybrid model, combining Price's interaction of pain sensation, pain unpleasantness, and secondary pain affect model with an information processing model. Recommendations on methods and techniques to reduce this confusion would assist healthcare professionals and researchers to better distinguish among these terms as they manage patient symptoms and design symptom management studies. Thus, the purpose of this article is to examine the terms symptom distress, symptom intensity, and psychological distress using pain as the example symptom.     

Ethnic differences in pain coping: factor structure of the coping strategies questionnaire and coping strategies questionnaire-revised.

Coping has been examined extensively in the pain literature, although coping instruments have been typically validated in clinical populations with little ethnic diversity. This study examined the factor structure of the Coping Strategies Questionnaire (CSQ) and the CSQ-Revised (CSQ-R) in 650 healthy male and female African American (44%) and white (56%) subjects and explored associations of coping to health and pain-related measures. Factor analyses revealed 6 components for each ethnic group, accounting for comparable amounts of variance and resembling previously reported CSQ subscales. Internal consistency for both ethnic groups was acceptable (0.72-0.91). There were significant main effects for ethnicity on 4 of the CSQ-R scales (P < .05). No ethnic differences in pain or health variables emerged, although when split into high-pain versus minimal-pain groups, differences were revealed on catastrophizing. Results indicate that the factor structure of the CSQ-R in healthy adults is similar to clinical populations and is comparable across African American and white subjects. Group differences on CSQ-R scales suggest potentially important ethnic influences on pain coping. These findings support the use of the CSQ-R to assess coping in African Americans and in healthy young adults. Additional clinical research is needed to determine the practical importance of group differences in pain coping. PERSPECTIVE: Coping has been examined extensively in the pain literature, although coping instruments typically have been validated in clinical populations with little ethnic diversity. This study examines the factor structure of the CSQ-Revised in an ethnically diverse population and supports the use of the CSQ-R to assess coping in African Americans and in healthy young adults.     

Postoperative pain syndrome and its relationship with individual psychological features of personality

A total of 120 patients subjected to planned operations for diseases of thoracic and abdominal organs and main vessels were examined for an objective evaluation of the postoperative pain syndrome. The psychological status of patients and its relationship with the painful syndrome and narcotic doses needed for pain arrest were studied. In the control (100 pts) the initial depression and postoperative pain were in direct correlation. Tetracycline antidepressant lerivone was used to confirm the results. Depression and the severity of postoperative pain decreased significantly in 20 patients.     

The relationship between PTSD and chronic pain: Mediating role of coping strategies and depression

People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into 2 groups, those with (n = 65) and those without (n = 136) concurrent PTSD. All participants completed measures of pain severity, interference, emotional functioning, and coping strategies. Those with current PTSD reported significantly greater pain severity and pain interference, had more symptoms of depression, and were more likely to meet diagnostic criteria for a current alcohol or substance use disorder (all p-values <.01). Participants with PTSD reported more use of several coping strategies, including guarding, resting, relaxation, exercise/stretching, and coping self-statements. Illness-focused pain coping (i.e., guarding, resting, and asking for assistance) and depressive symptoms jointly mediated the relationship between PTSD and both pain interference (total indirect effect = 0.194, p < .001) and pain severity (total indirect effect = 0.153, p = .004). Illness-focused pain coping also evidenced specific mediating effects, independent of depression. In summary, specific pain coping strategies and depressive symptoms partially mediated the relationship between PTSD and both pain interference and severity. Future research should examine whether changes in types of coping strategies after targeted treatments predict improvements in pain-related function for chronic pain patients with concurrent PTSD.     

Five-year outcomes in TMD: relationship of changes in pain to changes in physical and psychological variables

Factors influencing natural history and clinical course of pain in temporomandibular disorders (TMD) are largely unknown. Physical, psychological and behavioral data from a population-based epidemiologic study of TMD were examined in 234 cases of persons reporting TMD pain. The cases were assigned to one of five pain pattern groups based on changes in average TMD pain from baseline to 5-year follow-up: (i) remitted (49% of the sample), (ii) high-improvement (14%), (iii) low-improvement (9%), (iv) same (13%), and (v) worse (16%). For each pain change group, an ANOVA-derived pattern analysis was performed to assess whether the pattern of change in each of seven physical and three psychological variables was congruent or dissimilar to the pattern of change in average pain intensity. For none of the physical or psychological variables was the change over time completely congruent with the changes in pain. Changes in ambient average TMD pain were most closely related to those clinical variables whose assessment is influenced by pain or other self-reported symptoms (e.g., number of muscle sites painful to examiner palpation), while the amount of pain change was less closely related to changes in clinical variables, such as joint sounds, where assessment is not dependent on subjective report. The three psychological variables, anxiety, depression, and somatization, displayed similar change patterns, but these patterns were distinctly different from those of the physical variables in that the remitted pain group was at the population mean at baseline for these psychological variables and remained there; significant improvement in psychological status was observed only in the pain group showing high improvement. The other three pain change groups exhibited elevated psychological distress scores at both baseline and 5 years. These results indicate that although the relationships among the course of pain, of physical variables, and of psychological variables are complicated, the 5-year outcome in pain is largely independent of readily discernible changes in clinical signs.     

A typology of pain coping strategies in pediatric patients with chronic abdominal pain

This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n=699) were pediatric patients (ages 8-18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children's pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n=311) that replicated in Sample 2 (n=388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients' pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications.     

The relationship between psychological distress and free-living physical activity in individuals with chronic low back pain

The aim of this cross-sectional pilot-study was to investigate the relationship between psychological distress and free-living physical activity (PA) in individuals with chronic low back pain (CLBP). Thirty-eight participants with non-specific CLBP (29 = distressed; 9 = non-distressed) were recruited. PA levels were measured using an accelerometer (activPAL? activity monitor) over a one week period. The following parameters of physical activity were recorded: time upright (standing or walking), time standing, time walking, and step count. Psychological distress was assessed using a modified version of the distress risk assessment method (DRAM) which is a combination of somatic anxiety and depressive symptoms. The Distressed group spent significantly less time upright over a mean 24 h day (?1.47 h, 95% CI ?2.70 to ?0.23 h, p < 0.05), attributable to 1.01 h less standing and 0.46 h less walking. Depressive symptoms were a statistically significant independent predictor of time upright (β = ?0.49, p < 0.05). This pilot-study found that individuals with CLBP and elevated levels of distress spend less time upright than their non-distressed counterparts. Clinically, when treating individuals with CLBP and elevated distress levels, free-living PA may be low and interventions aimed at increasing upright activity may be appropriate.     

Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients

Pain behavior and pain coping strategies were systematically measured in a group of 32 chronic low back pain (LBP) and 32 myofascial pain dysfunction (MPD) syndrome patients. Both groups reported high levels of psychological distress on the SCL-90R. The LBP patients were significantly less active, took more narcotic and sedative-hypnotic medications, and showed higher levels of motor pain behavior (guarding, rubbing, and bracing) than the MPD patients. The LBP patients used attention diversion, and praying or hoping as pain coping skills to a much greater extent than the MPD patients. The relationship of these findings to prior research is described, and future research needs in this area are identified.     

Perceived social support and coping responses are independent variables explaining pain adjustment among chronic pain patients.

The purpose of the present study was to test a hypothetical model of the relationships between perceived social support, coping responses to pain, pain intensity, depressed mood, and functional disability (functional status and functional impairment) in a population of patients with chronic pain in a Spanish Clinical Pain Unit. It was postulated that social support and pain coping responses both independently influence reported pain intensity, depressed mood, and functional disability. Analyses were performed by Structural Equation Modelling. The results indicated that satisfaction with social support is significantly associated with a depressed mood and pain intensity, but not with functional disability. Although this effect is independent of the use of active coping responses by patients, there is a modest but significant relationship between social support and passive coping strategies, indicating that higher levels of perceived social support are related to less passive pain coping strategies. The findings underscore the potential importance of psychosocial factors in adjustment to chronic pain and provide support for a biopsychosocial model of pain. PERSPECTIVE: This article tested a hypothetical model of the relationships between social support, pain coping, and chronic pain adjustment by using Structural Equation Modelling. The results indicate that perceived social support and pain coping are independent predictors of chronic pain adjustment, providing support for a biopsychosocial model of pain.