F02 - Coping with Pain (791) Wellness-focused and illness-focused coping in chronic pain: Predicting affective distress and pain-related disability M. Davidson, D. Tripp, P. Davidson, Y. Borshch; Queen’s University, Kingston, ON Over the past two decades, coping has emerged as an important factor in the adaptation to chronic pain. Recently Jensen et al. (Pain, 1995) have differentiated between wellness-focused and illness-focused coping strategies. Wellness-focused (WF) strategies are those that are encouraged in chronic pain treatment, (e.g., relaxation, exercising), and illness-focused (IF) strategies are those that tend to be discouraged (e.g., guarding, resting). While this is an important distinction, little research has examined the relationship of WF and IF strategies to chronic pain outcome. The present study examines the relationship of wellness-focused and illness-focused coping strategies to pain disability and to associated affective distress. A group of 52 patients referred to our chronic pain clinic completed the Beck Depression Inventory (BDI), the Multidimensional Pain Inventory (MPI; pain severity), the Pain Disability Index (PDI), the Chronic Pain Coping Inventory (CPCI; WF and IF coping), and the Pain Catastrophizing Scale (PCS). Multiple regression analysis was used to predict depressive symptoms from WF and IF coping, with the effect of pain severity, disability, and catastrophizing statistically controlled. The overall equation was significant (F(5,46)⫽ 9.31, p⫽.00). WF coping emerged as a significant predictor of affective distress (t(1, 46)⫽ ⫺2.23, p⬍.03), and IF coping did not predict affective distress. A second multiple regression analysis predicted pain-related disability from WF and IF coping, controlling for pain severity, catastrophizing, and depressive symptoms. The overall equation was significant (F(5,46)⫽11.55, p⫽.00). IF coping emerged as a significant predictor of disability (t(1,46)⫽3.10, p⬍.01), and WF did not predict disability. Results suggest that the use of wellness-focused coping is associated with less affective distress, and the use of illness-focused coping is associated with greater disability. Implications for coping skills based treatment are discussed
Abstracts (793) Coping with pain in cancer patients H. Knotkova, P. Homel, R. Portenoy, S. Malamud, C. Clark, R. Wharton; Beth Israel Medical Center, Dept of Pain Medicine and Palliative Care, New York, NY The main purpose of the study was to evaluate the relationship between pain and coping strategies in oncology patients. Forty five patients (16M,29F, mean age 52 years) with advanced cancer (stage II-IV) participate in the study. Health care professionals rated patients’ level of disability using Karnofsky Performance Status scale (KPS), and identified patients’ stage of illness and location of primary cancer. Patients responded to Multidimensional Affect and Pain Survey (MAPS) and Coping Strategy Questionnaire (CSQ). MAPS contains 101 pain and emotion descriptors grouped into 30 clusters and 3 Superclusters (SC): I. Somatosensory Pain SC, II. Emotional Pain SC, and III. Well-being SC. CSQ evaluates 7 strategies how to cope with pain: Diverting Attention, Reinterpreting Pain Sensations, Coping Self Statements, Ignoring Sensations, Praying/Hoping, Catastrophizing, and Increase Behavioral Activities. Descriptive statistics, t-test for independent samples, and Spearman’s correlations were used to evaluate the data. Results: Patients’ scores on MAPS Somatosensory Pain SC correlated positively with Praying/Hoping strategy (p⬍.003), MAPS Emotional Pain SC correlated positively with Catastrophizing strategy (p⬍.006), while MAPS Well-being SC correlated positively with following CSQ strategies: Diverting Attention (p⬍.0001), Reinterpreting Pain Sensations (p⬍.004), Coping Self Statements (p⬍.0001), Ignoring Sensations (p⬍.002), and Increase Behavioral Activities (p⬍.001). No significant gender differences were found, and KPS did not correlate significantly with any of CSQ strategies. There are substantial differences in coping styles that are used by patients with high scores on somatosensory vs emotional dimension of pain. Patients with high scores on somatosensory dimension of pain tend to use Praying/Hoping as their strategy how to cope with pain, while patients who suffer emotional pain tend to use Catastrophizing strategy, and patients who feel positive emotions and high level of well-being tend to use Diverting Attention, Reinterpreting Pain Sensations, Coping Self Statements, Ignoring Sensations, and Increase Behavioral Activities to cope with their cancer-related pain.
(792) Pain catastrophizing and the underestimation of impending acute pain
(794) Does coping with stress facilitate coping with acute pain?
S. Waxman, D. Tripp, M. Davidson, K. Smith, A. Hsieh; Queen’s University, Kingston, ON The purpose of the present study was to examine the possible under- or over-estimation of pain experience across high and low levels of pain catastrophizing in an experimental and clinical setting where acute pain is anticipated. It has been hypothesized that pain catastrophizing may play an essential role in participants’ inaccurate estimates of pain, specifically the under-prediction of impending pain.1 In the experimental study, 61 undergraduates participated in a cold presser task (Females ⫽ 54; M age ⫽ 22.39, SD ⫽ 4.47), while 54 athletic adults undergoing Anterior Cruciate Ligament (knee) surgery following a sports injury were assessed in the clinical study (Females ⫽ 25; M age ⫽ 25.4, SD ⫽ 8.08). Mixed results were found indicating that high catastrophizers in the experimental study significantly underestimated imminent cold presser pain (t ⫽ ⫺1.96, p ⬍ .05), whereas high vs low catastrophizers in the clinical sample did not significantly differ in their underestimation of pain. These discrepant findings are discussed in light of current literature and follow up research is suggested. (1. Sullivan et al., Pain, 2001).
H. Hekmat, P. Staats, A. Staats; University of Wisconsin, Stevens Point, WI This study explores the effects of managing stress with relaxation on the experience of acute pain. Sixty participants, who experienced acute cold water pain, were randomly assigned to one of the following interventions: (a) Stress desensitization (b) neutral imagery control (NI), and (c) non-treatment control. Prior to and after treatment, participants were given measures of stress, anxiety, and pain. Measures included: Depression Anxiety Stress Scale (DASS), Pain Anxiety Symptoms Scale (PASS), Daily Stress Inventory, Stress-arousal Checklist, and the revised Multiple Affect Adjective Checklist (MAACL-R). A cold pressor task was used to induce acute pain. Participants submerged their hand in ice water before and after therapy to gather pain data. The stress desensitization participants visualized recent stress-evoking events, coped with them while relaxed on pleasant imagery. Univariate and Multivariate statistics were used to analyze data. Results indicated that desensitization of current emotional stressors significantly reduced stress, pain anxiety, and improved participants’ mood states (p⬍ .01). Treating stress with desensitization significantly improved pain threshold and tolerance (p⬍ .01). Results are supportive of psychological behaviorism theory of pain and suggest that behavioral management of patients’ daily stresses have beneficial effects on pain.