Cognitions, Coping, and Social Environment Predict Adjustment to Pain in Spinal Cord Injury

Abstract

The current study examined the utility of a biopsychosocial model of chronic pain, and the associations between specific pain-related beliefs, coping, and social support and both mental health and pain interference, in persons with Spinal Cord Injury (SCI) and pain. A total of 157 patients completed surveys assessing physical and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Greater catastrophizing and pain-related beliefs (e.g., the belief that pain signals damage) were related with increased pain interference and poorer mental health, while coping styles (e.g., resting, asking for assistance) were related only with pain interference. Alternatively, greater perceived social support was related with better mental health. The findings are consistent with a biopsychosocial model, implicating the need to consider the impact of process and clinical variables on adjustment to chronic pain in persons with SCI.Perspective: This article identifies several psychosocial variables, including coping, catastrophizing, pain-related beliefs, and social support, that are related to adjustment in persons with SCI and pain. These results have implications for interventions designed to treat pain interference in persons with SCI.Keywords mental health; coping; spinal cord injury; pain Pain following spinal cord injury (SCI) is well-documented, with prevalence rates from 11% to 94%, and reports of 'current' pain problems between 67% to 79% 14. Pain in persons with SCI has been found to interfere with daily activities beyond the functional limitations related to the injury 47,52,60,69,70. A recent survey found that participants with SCI-related pain rated only a few pharmacological pain treatments as more than "somewhat" helpful 76.These issues highlight the importance of identifying psychosocial variables related to adjustment and pain interference in persons with SCI-related pain. Biopsychosocial models of pain recognize the likely impact of both biological and psychosocial components. The most common psychosocial categories within the biopsychosocial model (i.e., cognitions and appraisals, coping responses, and social environmental variables 50) have evidenced Correspondence to: Katherine A. Raichle, Ph.D., Department of Psychology, Seattle University, 901 12 th Ave, Box 222000, Seattle, WA 98122-1090. Tel.: 206-296-2815. Fax: 206-296-2141. E-mail: raichlek@seattleu.edu + Now at Department of Psychology, Seattle University, Seattle, WA;°N ow at Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and al...

Pain Catastrophizing and Beliefs Predict Changes in Pain Interference and Psychological Functioning in Persons With Spinal Cord Injury

“…These focus on the prevalence and course of pain problems and functioning in persons with SCI, 16 the utility of different pain treatments for persons with SCI, 4 the psychometric properties of paininterference measures in persons with SCI, 30 and the utility of a biopsychosocial model of adjustment to pain in SCI. 29 The longitudinal data assessed at 6 months following the initial survey have not yet been reported.…”

“…In one study, a belief in one's ability to have control over pain was associated with greater mental health, and a number of beliefs were associated with levels of pain interference, such as beliefs that pain signifies damage or that a medical cure exists for pain. 29 Regarding coping responses linked to pain in SCI, two studies in particular have demonstrated that particular coping responses are associated with better mental health, such as greater use of task persistence, 29 coping self-statements, and ignoring pain, 45 while other coping responses are associated with higher levels of pain interference, such as greater use of resting, guarding, and asking for assistance. 29 In addition, social environmental variables, such as perceived social support 29,31 and negative perceived partner responses to pain, 38 have been associated with adjustment.…”

Towards a science and practice of resilience in the face of pain

“…In an experimental setting with 101 healthy volunteers, both active and passive social support given by either a friend or stranger was associated with lower reported levels of pain following a cold pressor task (Brown, 2003). Cross-sectional studies indicated that social support plays a buffering role in the experience of pain, disability and impaired mental health (Kerns et al, 2002;Raichle et al, 2007). Further, Evers and colleagues investigated the predictive role of perceived social support at the time of diagnosis of rheumatoid arthritis.…”

Spinal cord injury, coping and psychological adjustment: a literature review

“…Coping and pain Raichle et al 18 looked at coping strategies, social support, pain beliefs and mental health when investigating biopsychosocial aspects of pain. In a sample of 157 patients, they found those with an external LOC and a tendency to catastrophize experienced more pain interference and decreased mental health well-being.…”