(942) Post-operative pain experience in patients receiving lung surgery
(944) Coping with cerebral palsy pain: Adaptive and maladaptive strategies
Y. Lai, M. Wu; Graduate Institute of Nursing, Taipei Medical University, Taipei The purpose of this short-term longitudinal study was to investigate changes in pain intensity and patients’ pain coping during the 5 days after lung surgery (day 1, 3 and 5 post-surgery). The relationships among characteristics of pain control beliefs, cancer diagnosis, gender and patients’ use of pain coping strategies were also examined. Instruments used were a basic information form, a 0 to 10 Numerical Rating Scale for pain intensity, the Survey of Pain Attitudes(SOPA)-Control belief subscale, Brief Pain Coping Scale, and Demographic Information Form. Data were analyzed by descriptive statistics, repeated measures ANOVA, and regression. The results showed that: (1) the worst pain intensity and pain intensity on average were at medium to severe levels, with their peak on the first day after surgery; (2) patients perceived relatively low levels of pain control during the 5 days after surgery; (3) patients used relatively more non-pharmacological pain coping strategies than pharmacological strategies; (4) no significant correlation was observed between cancer diagnosis and pain characteristics, pain control beliefs or pain coping strategies; (5) no significant difference was observed between gender and pain characteristics, pain control beliefs or pain coping strategies; and (6) pain control beliefs and the worst pain intensity significantly influenced patients’ use of pharmacological pain coping. Overall, the findings suggest that pain is still not well controlled in patients receiving lung surgery. The results also support that both pain intensity and selected cognitive factors (control pain belief) can influence patients’ use of pharmacological pain coping strategies. Health care professionals should be aware of the importance of pain intensity and cognitive factor in influencing patients’ acute pain experience and to enhance a more effective pain coping for patients receiving lung surgery.
M. Jensen, J. Engel, L. Schwartz; University of Washington, Seattle, WA Previous research suggests that coping may play a role in adjustment to pain in persons with disabilities, but the association between coping and adjustment to CP-related pain is rarely examined. Forty-eight adults with cerebral palsy (CP) were interviewed on two occasions, separated by six months, to examine the association between changes in pain coping strategies and changes in adjustment to CP-related pain over time. As predicted, changes in coping strategy use were associated with changes in functioning. Specifically, decreased use of catastrophizing, rest, and reinterpreting pain, and increased use of task persistence were associated with decreases in depression over a six-month period. Increased use of task persistence was also associated with decreases in pain interference. The findings support the utility of a biopsychosocial model of CP-related pain, and indicate that some coping strategies (e.g., catastrophizing, task persistence) are more closely linked to functioning than others in the CP sample studied. These results provide preliminary empirical guidance for the coping strategies that may be most fruitfully targeted in the treatment of CP-related pain.
(943) Relationship between changes in coping and treatment outcome in patients with Fibromyalgia Syndrome: Support for the cognitive-behavioural model
(945) Educational achievement moderates catastrophizing‘s effects on pain in scleroderma
W. Nielson, M. Jensen; Arthritis Institute, St. Joseph‘s Health Care London, London, ON The present study utilized a sample of 198 individuals with Fibromyalgia Syndrome (FMS) to examine the association between treatment process variables (beliefs, coping strategies) and treatment outcomes (pain severity, activity level, emotional distress and life interference) related to a four-week multidisciplinary Fibromyalgia treatment program. Multiple regression analyses were utilized to evaluate these relationships pretreatment to post-treatment as well as from pre-treatment to 3- and 6-month follow-ups. The results indicated that outcomes were most closely related to: (1) an increased sense of control over pain, (2) a belief that one is not necessarily disabled by FM, (3) a belief that pain is not necessarily a sign of damage, (4) decreased guarding, (5) increased use of exercise, (6) seeking support from others, (7) activity pacing and (8) use of coping self-statements. These findings support a cognitive-behavioural model of fibromyalgia, and suggest targets for therapeutic change.
R. Edwards, I. Kudel, F. Wigley, J. Haythornthwaite; Johns Hopkins University, Baltimore, MD Across a variety of chronic illnesses, socioeconomic status (SES) is related to numerous health outcomes, including symptom severity and disability. Some studies have also indicated that psychosocial variables may mediate SES’ effects on health. Our group has examined these issues in the context of scleroderma, an autoimmune disorder associated with pain, affective disturbance, disruption of social relationships, and disability. Among our prior findings, pain-related catastrophizing, a negative cognitive and attitudinal response to pain, has emerged as particularly important in the association of SES and pain-related outcomes. Catastrophizing is negatively related to SES, and it mediates the adverse impact of low education on multiple pain-related outcomes. However, the relationship between maladaptive psychosocial states and healthrelated outcomes may also be moderated by SES, with low-SES individuals being more susceptible to the deleterious effects of catastrophizing. We investigated this question in a sample of 188 patients with scleroderma. After controlling for demographic factors, disease severity, and depressive symptomatology, catastrophizing was differentially associated with the affective dimension of pain and with social function across educational groups (p‘s⬍.01). Specifically, while catastrophizing was associated with greater pain among those with no college education (p⬍.01, 12% explained variance), it was not associated with pain in the college-educated group. Interestingly, catastrophizing also predicted better social functioning only among those with no college education (p⬍.01, 10% of variance accounted for). Collectively, study findings support the communal coping model of catastrophizing, whereby expressions of pain recruit solicitous social responses which then serve to positively reinforce pain. A novel finding in this study is that educational level may moderate catastrophizing‘s effects. Catastrophizing may be differentially reinforced by the social environment as a function of SES; moreover, this may partially account for the greater incidence of maladaptive coping and higher levels of pain in individuals of lower SES backgrounds.