Coping With Chronic Pain: A Comparison of Two Measures.

Coping With Chronic Pain: A Comparison of Two Measures Tan G, Jensen MP, Robinson-Whelen S, et al (Department of Veterans Affairs, Medical Center, Houston, Tex), Pain. 2001;90:127-133.

According to the authors, recent studies using cognitive-behavioral models of chronic pain have demonstrated moderate to strong associations between coping responses and psychological well-being, physical functioning, and pain severity. Therefore, valid and reliable measures are necessary in order for clinicians and researchers to quantify the coping strategies used by patients with chronic pain. Based on these assumptions, the authors compared 2 widely used measurement tools: the Coping Strategies Questionnaire (CSQ) and the Chronic Pain Coping Inventory (CPCI). Their purpose was 2-fold: (1) to assess whether the CSQ and CPCI were complementary or redundant in predicting depression, disability, and pain severity and (2) to determine which specific scales of the CSQ and CPCI were associated with these same indicators.

The participant sample was drawn from an outpatient integrated pain management program at a large Veterans Administration hospital. Between 1995 and 1998, 1,265 patients received mailed packets that collected self-reported demographic information and included the 2 coping strategy measures (CSQ and CPCI) and 3 additional scales--the Center for Epidemiological Studies-Depression Scale (CES-D) to measure depression, the Sickness Impact Profile-Roland Scale (SIPR) to measure disability, and the pain severity subscale of the Multidimensional Pain Inventory (MPI) to measure pain. The return rate was 564 packets (44.6%).

The demographics of the respondents were as follows: the average age of the respondents was 50.8 years; 84.5% had a high school diploma and 12% were college graduates; 90.3% were male; 50.2% were married; 62.4% were white, 22.6% were black, and 4.6% were Hispanic; 48% were receiving disability compensation for pain; and 57.6% had been disabled by pain for more than 5 years. Descriptive statistics showed that this sample of respondents had a greater depressive symptomatology, greater disability, and greater pain severity than other samples of patients with chronic pain that were available for comparison.

A series of hierarchical multiple regression analyses were performed on the data from the CPCI and CSQ and the scales for depression (CES-D), disability (SIPR), and pain severity (MPI) in order to address the first goal of the study (ie, whether the CSQ and CPCI were complementary or redundant in predicting depression, disability, and pain severity). Results indicated that the CSQ was the better predictor of depression overall. Both the CPCI and CSQ contributed independently to the prediction of disability when controlling for the other tool, although the CPCI was the stronger of the 2 tools. Both the CPCI and CSQ modestly predicted pain severity.

Multiple regression analyses were performed on each of the CPCI scales (guarding, resting, asking for assistance, relaxation, task persistence, exercise/stretch, seeking social support, and coping self-statements) and the CSQ scales (diverting attention, reinterpreting pain, coping self-statements, ignoring pain sensations, praying/ hoping, catastrophizing, and increasing behavioral activities) with depression, disability, and pain while controlling for age, education, and sex. Concerning the second goal of the study (ie, which specific scales of the CSQ and CPCI were associated with depression, disability, and pain severity), the results showed the CSQ catastrophizing scale was the coping strategy that was most strongly correlated with depression, although other CSQ scales (coping self-statements, diverting attention, and increasing behavioral activities) also contributed. The CPCI guarding scale was most strongly correlated with disability. The CSQ catastrophizing scale was also the most strongly correlated coping strategy with pain severity.

The authors noted several limitations of the study, including its correlational design, its reliance on self-reported data, the low return rate, and a sample population dominated by older, male veterans with severe chronic pain. The authors suggested that future studies should do the following: (1) include women and participants with less severe pain symptoms, (2) gather data independent of self-reports, and (3) include positive outcomes such as employment status or functional ability along with the negative outcomes of depression, disability, and pain. More importantly, they recommended that future research should determine whether a causal link is present between coping strategies, particularly catastrophizing add guarding, and adjustment to pain. Finally, they suggested that a new measurement instrument should be constructed using individual scales from both the CPCI and CSQ to predict and measure outcomes.

The authors concluded that their findings were consistent with cognitive-behavioral models of pain, which hypothesize that how a person copes with pain reflects and possibly influences his or her adjustment to pain. They recommended that chronic pain treatment programs should focus on helping patients decrease their use of catastrophizing and guarding as part of their pain management plan.

Ann M York, PT, PhD Crawford Memorial Hospital Robinson, Ill