Coping with chronic pain: sources of intrinsic and contextual variability

Intra- and interindividual differences in the within-person coupling between daily pain and affect of older adults

The bidirectional interplay between chronic pain and negative affect is well-established in patient samples. However, less is known about the day-to-day relationship between pain and affect of older adults without severe illnesses and to what extent this association differs within and between individuals. A total of 224 participants (M_age = 77.6, SD_age = 6.2) reported their daily experience of pain, impairment by their pain and affect during 21 consecutive days. Multilevel modeling results showed that on days with increased pain individuals also reported less positive affect and more negative affect. Time-lagged results indicated a temporal carry-over from yesterday's pain to today's negative affect but not to today's positive affect. Moreover, on days when individuals reported stronger impairment by their pain, they showed a stronger within-person coupling between daily pain and affect in contrast to days with a weaker experience of daily impairment. Yesterday's pain and today's negative affect were more strongly associated within individuals who reported higher levels of impairment. Interindividual differences in the within-person coupling between daily pain and affect were found with regard to general physical health conditions and general satisfaction with health. This study demonstrated the importance of focusing on within-person couplings between daily pain and affect beyond patient samples in order to better understand the maintenance of emotional stability despite daily hassles in older adults' everyday lives.

Racial and ethnic differences in the experience and treatment of noncancer pain

The burden of pain is unequal across racial and ethnic groups. In addition to racial and ethnic differences in the experience of pain, there are racial and ethnic disparities in the assessment and treatment of pain. In this article, we provide a nonexhaustive review of the biopsychosocial mechanistic factors contributing to racial and ethnic differences in both the experience and treatment of pain. Using a modified version of the Socioecological Model, we focus on patient-, provider- and system-level factors including coping, perceived bias and discrimination, patient preferences, expectations, patient/provider communication, treatment outcomes and healthcare access. In conclusion, we provide psychosocial factors influencing racial and ethnic differences in pain and highlight future research targets and possible solutions to reduce these disparities.

Evaluating psychosocial contributions to chronic pain outcomes

The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.

Dispositional Optimism and Coping: A Meta-Analytic Review

The relation between dispositional optimism and better adjustment to diverse stressors may be attributable to optimism's effects on coping strategies. A meta-analytic review ( K = 50, N = 11,629) examined the impact of dispositional optimism on coping. Dispositional optimism was found to be positively associated with approach coping strategies aiming to eliminate, reduce, or manage stressors or emotions ( r = .17), and negatively associated with avoidance coping strategies seeking to ignore, avoid, or withdraw from stressors or emotions ( r = -.21). Effect sizes were larger for the distinction between approach and avoidance coping strategies than for that between problem and emotion-focused coping. Meta-analytic findings also indicate that optimists may adjust their coping strategies to meet the demands of the stressors at hand, and that the optimism-coping relationship is strongest in English-speaking samples.

The Psychological Evaluation of Patients with Chronic Pain: a Review of BHI 2 Clinical and Forensic Interpretive Considerations

Pain is the most common reason why patients see a physician. Within the USA, it has been estimated that at least 116 million US adults suffer from chronic pain, with an estimated annual national economic cost of $560-635 billion. While pain is in part a sensory process, like sight, touch, or smell, pain is also in part an emotional experience, like depression, anxiety, or anger. Thus, chronic pain is arguably the quintessential biopsychosocial condition. Due to the overwhelming evidence of the biopsychosocial nature of pain and the value of psychological assessments, the majority of chronic pain guidelines recommend a psychological evaluation as an integral part of the diagnostic workup. One biopsychosocial inventory designed for the assessment of patients with chronic pain is the Battery for Health Improvement 2 (BHI 2). The BHI 2 is a standardized psychometric measure, with three validity measures, 16 clinical scales, and a multidimensional assessment of pain. This article will review how the BHI 2 was developed, BHI 2 concepts, validation research, and an overview of the description and interpretation of its scales. Like all measures, the BHI 2 has strengths and weaknesses of which the forensic psychologist should be aware, and particular purposes for which it is best suited. Guided by that knowledge, the BHI 2 can play a useful role in the forensic psychologist's toolbox.

Optimism and the experience of pain: benefits of seeing the glass as half full

There is a strong body of literature that lends support to the health-promoting effects of an optimistic personality disposition, observed across various physical and psychological dimensions. In accordance with this evidence base, it has been suggested that optimism may positively influence the course and experience of pain. Although the associations among optimism and pain outcomes have only recently begun to be studied adequately, emerging experimental and clinical research links optimism to lower pain sensitivity and better adjustment to chronic pain. This review highlights recent studies that have examined the effects of optimism on the pain experience using samples of individuals with clinically painful conditions, as well as healthy samples in laboratory settings. Furthermore, factors such as catastrophizing, hope, acceptance and coping strategies, which are thought to play a role in how optimism exerts its beneficial effects on pain, are also addressed.

More optimism, less pain! The influence of generalized and pain-specific expectations on experienced cold-pressor pain

Accumulating evidence suggests that dispositional optimism might be a protective factor against experiencing pain. The current paper presents two studies investigating the association between dispositional optimism and experimental pain. Moreover, the influence of pain-specific expectations on this association is investigated. In Study 1, mediation of pain-specific expectations in the relation between dispositional optimism and pain was hypothesized. Expected and experienced pain ratings were obtained from 66 healthy participants undergoing a cold pressor tolerance task. In Study 2, the moderating effect of dispositional optimism on the association between induced pain expectations and pain reports was studied in 60 healthy participants undergoing a 1-min cold pressor task. Both studies controlled for individual differences in fear of pain. Significant associations between dispositional optimism and pain ratings were found in both studies, although the exact time point of these associations differed. Subscale analyses revealed that only the pessimism subscale contributed significantly to these findings. We found no evidence for hypothesized mediation and moderation effects. Alternative explanations for the optimism-pain association are discussed.

Optimism lowers pain: evidence of the causal status and underlying mechanisms

Previous studies have demonstrated a relation between dispositional optimism and lower pain sensitivity, but the causal status of this link remains unclear. This study sought to test the causal status by experimentally inducing a temporary optimistic state by means of writing about and visualizing a future best possible self. In addition, we explored pain expectations and (situational) pain catastrophizing as possible underlying mechanisms of the link between optimism and pain. Seventy-nine university students participated in a cold pressor task (CPT). Before the CPT, half of them received the optimism manipulation and the other half a control manipulation. Induced optimism was related to lower pain intensity ratings during the CPT compared to the control group, thereby experimentally confirming causality. This effect was not explained by pain-related expectations about the task. Situational pain catastrophizing, however, did seem to mediate the relation between optimism and pain. This study is novel in that it confirms the causal status of optimism towards pain. Additionally, the results reveal that positive interventions might provide a useful alternative in reducing pain catastrophizing as an extremely relevant target in pain treatment.

Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis

OBJECTIVE

To systematically review the associations between different approaches to activity (ie, activity pacing, avoidance, or endurance) and indicators of patient functioning in chronic pain samples.

DATA SOURCES

A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed up to March 2011.

STUDY SELECTION

To be included, studies had to (1) be written in English, (2) report on an adult chronic pain sample, and (3) report a correlation coefficient between at least 1 measure of 1 of the 3 "approach to activity" variables and an indicator of patient functioning.

DATA EXTRACTION

Two reviewers independently screened abstracts and full-text articles for eligibility and extracted the data. Results of correlation analyses were grouped on the basis of measure of approach to activity (pacing/avoidance/endurance) and the criterion variable measured (pain/physical functioning/psychological functioning), resulting in 9 categories. Random-effects modeling was then used to pool data across studies in each category.

DATA SYNTHESIS

Forty-one studies were eligible for inclusion. Results demonstrated that avoidance of activity was consistently associated with more pain, poorer psychological functioning, and more physical disability. While enduring with activity was associated with enhanced physical and psychological functioning, these relationships appeared to be dependent on the measure used, with measures more reflective of persisting with activities to the point of severe pain aggravation (overactivity) linked to poorer outcomes. Pacing was generally linked to better psychological functioning but more pain and disability.

CONCLUSIONS

Although causation cannot be determined, results of this study suggest that both avoidance of activity and overactivity are associated with poorer patient outcomes. Unexpected results relating to pacing may reflect either the ineffectiveness of pacing if not used to gradually increase an individual's activity level or the notion that individuals with better psychological functioning but more pain and disability are more inclined to pace activity.

Dispositional optimism: a psychological resource for Mexican-origin mothers experiencing economic stress

Dispositional optimism is believed to be an important psychological resource that buffers families against the deleterious consequences of economic adversity. Using data from a longitudinal study of Mexican-origin families (N = 674), we tested a family stress model specifying that maternal dispositional optimism and economic pressure affect maternal internalizing symptoms, which, in turn, affects parenting behaviors and children's social adjustment. As predicted, maternal optimism and economic pressure had both independent and interactive effects on maternal internalizing symptoms, and the effects of these variables on changes over time in child social adjustment were mediated by nurturant and involved parenting. The findings replicate and extend previous research on single-parent African American families (Taylor, Larsen-Rife, Conger, Widaman, & Cutrona, 2010), and demonstrate the generalizability of the positive benefits of dispositional optimism in another ethnic group and type of family structure.

Catastrophizing, depression and pain-related disability

OBJECTIVE

The objective of the study was to examine catastrophizing, depression and their interactive effects in predicting disability in patients with chronic pain.

METHOD

A battery of questionnaires was mailed to primary care patients in a large integrated health care delivery system. The Patient Health Questionnaire was used to assess major depression, the Coping Strategies Questionnaire assessed catastrophizing and the Graded Chronic Pain Scale was used to assess pain intensity and two measures of disability, including self-report of pain interference and days missed from usual activities. Patient medical records were used to assess severe medical illness. Of the 5808 respondents, 2618 met criteria for chronic pain. Multiple regression analyses, covarying for age, gender, severe medical illness and pain intensity, estimated the main and interactive effects of catastrophic thinking and depression on two measures of pain-related disability.

RESULTS

Both catastrophic thinking and depression were statistically significant predictors of both measures of pain-related disability, with larger effect sizes observed for catastrophic thinking.

CONCLUSIONS

Routine assessment of both catastrophic thinking and depression is important in the treatment of chronic pain patients, and modification of these factors may reduce disability and increase the ability of chronic pain patients to participate in daily life activity.

Pain catastrophizing and pain coping among methadone-maintained patients

OBJECTIVE

The aim of this study was to examine the association of pain catastrophizing and pain coping strategies with characteristic pain intensity (an average of worst, least, and typical pain intensity in the past week) and recent pain-related disability (an average of three measures of past week pain interference) in opioid-dependent patients enrolled in a methadone maintenance treatment program (MMTP) who reported recent pain.

DESIGN

Cross-sectional survey.

PATIENTS

One hundred and eight MMTP patients who reported recent pain.

MEASURES

Participants completed measures of demographics, pain status (i.e., "chronic severe pain" [pain lasting at least 6 months with at least moderate pain intensity or significant pain interference in the past week] vs "some pain" [pain in the past week not meeting the threshold of chronic severe pain]), characteristic pain intensity, recent pain-related disability, somatization, depression, catastrophizing, and pain coping strategies.

RESULTS

  Catastrophizing explained a significant proportion of the variance in characteristic pain intensity (14%) and recent pain-related disability (11%) after controlling for demographics, pain status, somatization, and depression. Mirroring the findings of studies of non-opioid-dependent chronic pain patients, greater catastrophizing was associated with greater pain intensity and increases in recent pain-related disability. On average, the "chronic severe pain" group reported higher levels of catastrophizing than the "some pain" group.

CONCLUSION

Consistent with studies of patients with chronic pain who are not opioid dependent, our findings emphasize the importance of assessing and addressing catastrophizing in MMTP patients with pain.

Association between optimism and self-reported facial pain

OBJECTIVE

The objective of this study was to assess the association between optimism and self-reported facial pain.

MATERIAL AND METHODS

Data were obtained for 5,696 subjects born in 1966 in Northern Finland and included in the study of the Northern Finland Birth Cohort. Data on facial pain were collected using a questionnaire. Optimism was measured using the revised version of the Life Orientation Test.

RESULTS

The data showed that optimism was inversely associated with facial pain. Associations were found only among non-depressive subjects.

CONCLUSIONS

It can be concluded that optimism is an independent psychosocial determinant of pain experience that should be taken into account in assessing the prognosis of facial pain and its treatment.

The relationships among coping styles and fatigue in an ethnically diverse sample

The present study focused on coping strategies among African Americans, Latinos, and European Americans with chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). The coping strategies examined were measured by using the COPE Scales, which assess Seeking Emotional Social Support, Positive Reinterpretation and Growth, Acceptance, Denial, Turning to Religion, Behavioral Disengagement, and Focusing on and Venting Emotions. In addition, the four coping strategies specifically designed for people with CFS, including maintaining activity, accommodating to the illness, focusing on symptoms, and information-seeking, were used in this study. It was hypothesized that African Americans and Latinos in comparison to European Americans would be more likely to use religious coping, behavioral disengagement, and denial. As predicted, African Americans were significantly more likely to turn to religion than European Americans, and Latinos and African Americans used denial significantly more often than European Americans. An additional finding was that focusing on symptoms was associated with greater fatigue and more physical disability among African Americans. Within the Latino sample, acceptance was related to greater fatigue and less physical disability, and greater optimism predicted less mental disability. Among European American participants, maintaining activity was related to less mental disability, whereas accommodating to the illness predicted more physical disability. These results indicate that coping varies among various ethnic groups with CFS and ICF; however, denial is consistently related to less adaptive outcomes. Therefore, healthcare professionals should find ways to reduce patient use of denial and promote alternative strategies for managing life events.

Ethnic similarities and differences in the chronic pain experience: a comparison of african american, Hispanic, and white patients

OBJECTIVE

Ethnic differences in the perception, experience, and impact of pain have received growing attention in recent years. Although studies comparing pain among African Americans, Hispanics, and whites have yielded mixed findings, increasing evidence suggests an enhancement of the pain experience for African American and Hispanic patients. Mechanisms proposed to account for this effect include systematic differences in psychological distress and in pain-coping strategies, or differential relationships between these factors and pain. However, few studies have evaluated all of these variables, or matched ethnic groups precisely on potential confounds.

DESIGN

The present study compares African American, Hispanic, and white chronic pain patients across multiple dimensions of pain, emotional distress, pain-related disability, and pain coping after matching patients on a variety of potentially confounding variables.

RESULTS

Results indicated no significant ethnic differences on measures of pain, depression, psychopathology, or pain-related disability. While most coping variables did not differ by ethnicity, substantive group differences were evident on the praying and hoping subscale of the Coping Strategies Questionnaire, with African Americans and Hispanics reporting higher scores relative to whites on items relating to prayer. Inter-relationships among pain, coping, and distress were generally quite similar across ethnic groups, although active coping showed some variation in its relationship with pain-related outcomes. Catastrophizing was generally associated with greater pain and distress, and use of prayer/hope as a coping strategy was associated with greater disability across ethnic groups.

CONCLUSIONS

These results suggest that ethnic differences in pain, pain-related sequelae, and affective factors may be small when ethnic groups are closely matched on confounding variables. Moreover, interventions designed to facilitate adaptive coping are likely to be effective across ethnic groups.

Ethnic differences and responses to pain in healthy young adults

Ethnic disparities in pain have recently gained increasing attention; however, relatively few studies have examined ethnic differences in pain prevalence, and even fewer have addressed whether ethnic groups differ in their pain-reducing behaviors. Thus, this study investigated ethnic differences in pain prevalence and impact among healthy young African Americans, Hispanics, and non-Hispanic whites.(1) Also, ethnic differences in pain-reducing behaviors were explored. Undergraduate students (N = 1,037) from three ethnic groups completed a telephone survey of recent pain experiences. Groups did not differ in overall pain frequency or severity; however, more African Americans reported chest and stomach region pain, whereas more Hispanics reported pain in the legs/feet. Significant group differences regarding pain-reducing behaviors emerged. More whites utilized self-care behaviors, compared to Hispanics and African Americans. Conversely, greater numbers of African Americans and Hispanics than whites reported having prayed to relieve pain. The predictors of the total number of pain-reducing behaviors used differed across ethnic groups. For whites, pain intensity and interference were the strongest predictors of pain-reducing behaviors. For African Americans, total pain sites, as well as interference and frustration, were significantly associated with pain-reducing behaviors, while among Hispanics, worry and frustration were the strongest predictors for total pain-reducing behaviors. These results suggest potentially important ethnic differences in patterns and predictors of pain-reducing actions, and their emergence in a healthy sample suggest that ethnic differences in pain-related responses predate the development of chronic pain. These findings may have important implications for understanding ethnic differences in responses to clinical pain and for tailoring treatment approaches to eliminate disparities.

Ethnicity, control appraisal, coping, and adjustment to chronic pain among black and white Americans

OBJECTIVE

To identify similarities and differences among non-Hispanic black and white patients in pain appraisal, beliefs about pain, and ways of coping with pain. We also examined the association between these factors (i.e., appraisals, beliefs, coping) and patient perception or subjective experience of their functioning in each ethnic group.

DESIGN

Cross-sectional survey of patients with chronic pain at pretreatment assessment.

SETTING

Integrated pain management program at a Veterans Affairs Medical Center in Texas.

PATIENTS

A total of 128 non-Hispanic black Americans and 354 non-Hispanic white Americans completed self-report measures of pain appraisal, coping, and adjustment that included the Multidimensional Pain Inventory, Survey of Pain Attitudes, Coping Strategies Questionnaire, and Chronic Pain Coping Inventory.

RESULTS

Although the analyses indicated many similarities between the two groups concerning pain-related beliefs and coping, the black patients reported lower perceived control over pain, more external pain-coping strategies, and a stronger belief that others should be solicitous when they experience pain. The black patients also reported significantly higher levels of depression and disability, even after controlling for pain severity. Regression analyses revealed that the coping and appraisal factors predicting physical and psychological functioning were the same for both white and black patients, with ethnicity accounting for a nonsignificant amount of the total variance.

CONCLUSIONS

The current findings suggest similarities as well as differences between non-Hispanic black and white patients in the ways they view and cope with pain. However, the association between psychological factors (attitudes and beliefs, coping responses) and adjustment to chronic pain was comparable for both ethnic groups. If replicated, the findings suggest that specific tailoring of cognitive behavioral therapies to different racial/ethnic groups may not be needed to maximize treatment outcome.

Ethnic differences in pain coping: factor structure of the coping strategies questionnaire and coping strategies questionnaire-revised

Coping has been examined extensively in the pain literature, although coping instruments have been typically validated in clinical populations with little ethnic diversity. This study examined the factor structure of the Coping Strategies Questionnaire (CSQ) and the CSQ-Revised (CSQ-R) in 650 healthy male and female African American (44%) and white (56%) subjects and explored associations of coping to health and pain-related measures. Factor analyses revealed 6 components for each ethnic group, accounting for comparable amounts of variance and resembling previously reported CSQ subscales. Internal consistency for both ethnic groups was acceptable (0.72-0.91). There were significant main effects for ethnicity on 4 of the CSQ-R scales (P < .05). No ethnic differences in pain or health variables emerged, although when split into high-pain versus minimal-pain groups, differences were revealed on catastrophizing. Results indicate that the factor structure of the CSQ-R in healthy adults is similar to clinical populations and is comparable across African American and white subjects. Group differences on CSQ-R scales suggest potentially important ethnic influences on pain coping. These findings support the use of the CSQ-R to assess coping in African Americans and in healthy young adults. Additional clinical research is needed to determine the practical importance of group differences in pain coping.

PERSPECTIVE

Coping has been examined extensively in the pain literature, although coping instruments typically have been validated in clinical populations with little ethnic diversity. This study examines the factor structure of the CSQ-Revised in an ethnically diverse population and supports the use of the CSQ-R to assess coping in African Americans and in healthy young adults.

Thermal thresholds predict painfulness of diabetic neuropathies

OBJECTIVE

Pathophysiology explaining pain in diabetic neuropathy (DN) is still unknown.

RESEARCH DESIGN AND METHODS

Thirty patients with peripheral DN (17 men and 13 women; mean age 52.4 +/- 2.5 years) were investigated. Fifteen patients had neuropathic pain, and 15 patients were free of pain. Patients were followed over 2 years and examined at the beginning and thereafter every 6 months. Clinical severity and painfulness of the DN were assessed by the neuropathy impairment score and visual analog scales (VASs). Cold and warm perception thresholds as well as heat pain thresholds were obtained for evaluation of Adelta- and C-fibers. Nerve conduction velocities (NCVs) and vibratory thresholds were recorded for analysis of thickly myelinated fibers. Moreover, for assessment of cardiac vagal function, heart rate variability (HRV) was evaluated. In order to reduce day-to-day variability of pain, mean values of the five time points over 2 years were calculated and used for further analysis. Data were compared with an age- and sex-matched control group of healthy volunteers.

RESULTS

There were significant differences regarding electrophysiological studies, HRV and quantitative sensory testing (QST) between patients and healthy control subjects (P < 0.001). Generally, patients with neuropathic pain were indistinguishable from pain-free patients. In the pain group, however, VAS pain ratings were correlated to the impairment of small-fiber function (cold detection thresholds, P = 0.02; warm detection thresholds, P = 0.056).

CONCLUSIONS

Intensity of pain in painful DN seems to depend on small nerve fiber damage and deafferentation.

The Psychological Assessment of Candidates for Spinal Cord Stimulation for Chronic Pain Management

It is known that, in spite of meeting appropriate clinical criteria for spinal cord stimulation (SCS) and having undergone flawless procedures, a significant number of patients who fail the therapy continues to exist. It is the purpose of this article to focus on the development of psychosocial indicators of success for SCS, if any. Referring to specialist literature authors present a review of what is known, what is not known, and what remains controversial on this topic. After reading this article we hope the reader will understand the importance of a psychological evaluation as part of the development of standards for identifying appropriate patients for this therapy. To improve treatment outcomes of SCS, seems to be essential to perform psychosocial evaluations on all persons clinically indicated for SCS to exclude those patients, who most probably, on a psychosocial level, will fail the procedure. To maximize treatment efficacy, authors believe spinal cord stimulation for chronic pain control must be part of a comprehensive program. An accurate preoperative psychosocial assessment and a course of psychological assistance both before and after therapy seems to be crucial for improving outcomes.

Models of adjustment to chronic illness: Using the example of rheumatoid arthritis

There are a number of theoretical frameworks that attempt to explain how individuals may adjust to threats to health and serious physical illness. The three major paradigms that attempt to organize key components of health and adaptation to illness include the following: the biomedical model which emphasizes disease; psychological models of adaptation to illness; and biopsychosocial models with the latter two emphasizing health, functioning, and well-being. Each of these three major paradigms, including biomedical, psychosocial, and biopsychosocial frameworks, is discussed and critiqued in turn, and contributions and theoretical issues in terms of adjustment to chronic illness, particularly rheumatoid arthritis (RA), are highlighted. Furthermore, a biopsychosocial framework for conceptualizing adjustment to physical illness is proposed that incorporates elements from key existing biomedical and psychosocial models of adaptation to chronic physical health issues.

Refractory chronic pain

Refractory chronic pain is a significant public health problem and frustrating to everyone affected by it. All physicians can participate in the care of these patients, but psychiatrists should take a leading role in their care. A comprehensive approach offers hope and increases the opportunities for successful treatment. Each perspective of an interdisciplinary formulation has a unique logic that defines specific methods for designing treatment for the patient with refractory chronic pain. The patient does not have to fit into one theoretic approach or model to receive and accept treatment. The patient's diagnoses are based on the formulation, which then directs treatment along rational directions. The linkages and interactions of a patient's diagnoses can then be investigated within a framework that includes the entire person and not just his or her biochemistry. If a patient's suffering persists, other factors must be considered that may have been overlooked before the treatment plan is abandoned or modified. Usually these factors are within one of the perspectives initially thought to be less important. A new combination of approaches is then required to treat the patient successfully. The perspectives appreciate not only that the patient is struggling through important life events but also that he is a person composed of vulnerabilities and strengths, having made many choices and afflicted by diseases.

Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?

Physical and psychosocial disability in patients with chronic pain have been shown to be associated with patients' pain-related beliefs, tendency to catastrophize, and pain coping strategy use. However, little is known about whether beliefs, catastrophizing, and coping strategies are independently associated with patient adjustment. Identification of specific beliefs, cognitive responses, and coping strategies strongly and independently associated with physical and psychosocial functioning would suggest the importance of targeting those variables for modification in treatment. One hundred sixty-nine patients entering a multidisciplinary pain treatment program completed measures of pain, beliefs, coping, catastrophizing, physical disability, and depression. Principal components analyses were used to create belief and coping components, which were then entered in multiple regression analyses predicting physical disability and depression. Belief scores significantly and independently predicted both physical disability and depression, after controlling for age, sex, pain intensity, catastrophizing, and coping. Coping scores significantly and independently predicted physical disability, but not depression, whereas catastrophizing independently predicted depression, but not physical disability. These findings suggest the importance of targeting specific pain-related beliefs and coping strategies, as well as catastrophizing, for modification in the treatment of patients with chronic pain.