Sick and Tired: Understanding and Managing Sleep Difficulties in ...

the mediational role of coping in the relationship between illness representation and
health outcomes is weak (Carlisle, John, Fife-Schaw, & Lloyd, 2005).
Due to the unique demands of different medical conditions, the effectiveness of coping
strategies may be dependent on their appropriateness for the situation or illness. Indeed,
research focusing on coping and FMS specifically, has revealed that higher use of active
coping strategies is associated with increased disability, pain and poor physical
functioning. Nicassio et al (1995) explored the use of coping at baseline and 3 months
later using the Pain Coping Strategies Questionnaire (CSQ, Rosenstiel & Keefe, 1983)
to explore the effect of coping on pain in FMS. In the regression analysis they revealed
that higher use of active coping strategies were associated with higher levels of pain and
lower quality of well-being. Their study also found that higher use of passive coping
strategies was associated with increased levels of depression. This was partially
supported by a study conducted by Martin et al (1996) looking at the use of coping
attempts (rather than active or passive coping). Martin et al (1996) revealed that coping
attempts and catastrophizing were both related to higher disability, and coping attempts
were associated with psychosocial disability. Therefore, it appears that in contrast to
other chronic pain conditions, such as arthritis, active coping may be detrimental in
FMS (Nicassio et al., 1995).
Although both of the aforementioned studies used the CSQ, different underlying factors
of the CSQ were revealed. In the Nicassio et al (1995) study there were two underlying
factors: „coping attempts‟ and „pain control and rational thinking‟; whereas Martin et al
(1996) also found two factors but these were: „coping attempts‟ and „catastrophizing‟.
Differences in the underlying factors of the CSQ may reflect differences in the methods
of the two studies, a longitudinal study by Nicassio et al (1995) and a cross-sectional
study by Martin et al (1996) and differences between the two study populations (one
recruiting through rheumatology clinics, the other recruiting through the community and
patient support groups.) The inconsistent findings may also reflect that coping is a more
complex phenomenon than these measures suggest. There is evidence that the use of
coping strategies is not stable and may change over time. For example, in a review of
the literature on coping and chronic pain, Jensen et al (1991) stated that “some coping
strategies in the CSQ are related to adjustment, only in patients reporting low levels of
pain severity” (p. 277). It should also be noted that these studies by Martin et al (1996)
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