Susan ayers cambridge handbook of psychology he

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Coping with chronic pain
Naomi Lester 1 , Francis J. Keefe 2 , Meredith E. Rumble 2 and Jeffrey D. Labban 2
1 Bastyr University
2 Duke University Medical Center
Chronic pain is a problem that affects millions of individuals
every year. Much of chronic pain is associated with significant
progressive degenerative disease. Such diseases include arthritis
and cancer, and involve prolonged severe pain which may be only
partially ameliorated through the use of analgesic medication.
This chapter examines the ways in which individuals cope with
chronic pain. We describe how pain coping is conceptualized
and measured and discuss what has been learned about
adaptive and maladaptive methods for coping with chronic pain.
We conclude with an exploration of new directions for research in
this area.
Coping with chronic pain
Coping has been defined as the process of managing stressful
situations, either external or internal, that are viewed as taxing
an individual’s adaptive resources (Lazarus & Folkman, 1984).
The ways in which individuals view or appraise potentially
stressful situations is an important component of this process
definition of coping. In chronic pain, the ways in which a patient
views pain are particularly important in their reactions to
pain. Individuals may view pain as unpredictable and feel
very little control over pain flares. Conversely, they may view pain
as a constant irritation but one that can often be dealt with
successfully.
Coping with pain can be thought of as cognitions and behaviours
that serve to manage or decrease the sensation of pain and
distress caused by pain. Within this basic framework, researchers
have formulated several models of pain-coping. We will discuss
five such models – the problem/emotion-focused coping model;
the active/passive coping model; the cognitive/behavioural coping
model; the fear avoidance model; and the acceptance model.
The problem- and emotion-focused coping model
Using the Ways of Coping Checklist (WCCL; Folkman & Lazarus,
1980), Folkman and Lazarus have created a coping model that categorizes
coping strategies as either problem-focused or emotionfocused.
Table 1 lists sample items from the WCCL. Problemfocused
efforts seek to alter the individual’s relationship to a stressor.
Emotion-focused coping serves to alter one’s internal reactions
to a stressor. For example, the chronic pain patient faced with the
choice of engaging in an activity known to cause pain (say sitting in
a cinema for a back pain patient) may use a problem-focused coping
strategy such as having a friend pick up a video instead and/or an
Table 1. Items from the Ways of Coping Checklist
Problem-focused coping:
Concentrated on something good that could come out of the
whole thing
Made a plan of action and followed it
Seeking social support:
Talked to someone to find out about the situation
Asked someone for advice and followed it
Wishful-thinking:
Hoped a miracle would happen
Wished I could change what happened
Self-blame:
Realized that I brought the problem on myself
Blamed myself
Avoidance:
Went on as if nothing had happened
Tried to forget the whole thing
emotion-focused strategy such as controlling their disappointment
by thinking about some other pleasant activity.
The WCCL is a 42-item pencil and paper questionnaire.
Individuals are asked to indicate a recent stressful experience
and then answer each question. When this questionnaire is
used in studies of chronic pain, respondents are usually asked to
indicate a stressor associated with their pain condition. Some
forms of the WCCL use a ‘Yes/No’ response format while others
employ a scale on which respondents indicate the extent to
which they use each coping strategy. There are several scoring
methods for the WCCL. One which is frequently used (Vitaliano
et al., 1985) adds questionnaire responses to form one problemfocused
and four emotion-focused sub-scales. The emotion-focused
sub-scales measure seeking social support, wishful thinking,
self-blame and avoidance. The problem-focused scale contains
items such as ‘just took things one step at a time’. The emotionfocused
scales are composed of such items as ‘asked someone
I respected for advice and took it’, ‘hoped a miracle would
happen’, ‘blamed myself’ and ‘kept others from knowing how bad
things were’.
Research examining the relationships between problem- and
emotion-focused coping, and adjustment to chronic pain has
been carried out in several groups of arthritis patients (Manne &
Zautra, 1990; Parker et al., 1988; Regan et al., 1988). This research
suggests that arthritis patients who rely on wishful thinking, and
to a lesser extent, on blame and avoidance-coping strategies
may experience more depression and greater physical disability