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Coping with Chronic Pain

Some Patients Suffer More

Published online by Cambridge University Press:  02 January 2018

Naomi H. Elton*
Affiliation:
Great Ormond Street Hospital for Sick Children, London
Magdi M. H. Hanna
Affiliation:
Pain Relief Unit, Kings College Hospital, London
Janet Treasure
Affiliation:
Institute of Psychiatry, London
*
Dr Elton, Department of Psychological Medicine, Great Ormond Street Hospital for Sick Children, London WC1 3JH

Abstract

Background

A multi-dimensional approach was used to examine coping in chronic pain. The following hypotheses were tested: (a) patients who cope maladaptively also cope generally in a similar way; (b) patients' maladaptive coping is associated with childhood adversity.

Method

Cross-sectional and retrospective data were collected from 68 consecutive patients (aged 18–70) at a pain clinic where their disease was non-systemic and the pain had lasted for at least three months. Sixty-one patients were interviewed using the Structured Clinical Interview for DSM–III–R, and the Measure of Parental Care in Childhood. All patients completed questionnaires on their pain and personality.

Results

Two coping styles emerged from factor analysis. One was associated with chronicity, psychiatric morbidity, harm avoidance, immature defence style and reporting parental indifference.

Conclusion

Patients may be predisposed to cope maladaptively after the experience of parental indifference in early life. Such coping is likely to reflect more general patterns.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

Andrews, G., Pollock, C. & Stewart, G. (1989) The determination of defence style by questionnaire. Archives of General Psychiatry, 46, 455460.CrossRefGoogle ScholarPubMed
Barsky, A. J., Wyshak, G. & Klerman, G. L. (1986) Hypochondriasis. An evaluation of the DSM–III criteria in medical outpatients. Archives of General Psychiatry, 43, 493501.CrossRefGoogle ScholarPubMed
Benjamin, S., Barnes, D., Berger, S., et al (1988) The relationship of chronic pain, mental illness and organic disorders. Pain, 32, 185195.Google Scholar
Block, A. R., Kremer, E. F. & Gaylor, M. (1980) Behaviour therapy of chronic pain. The spouse as a discriminant cue for pain behaviour. Pain, 9, 243252.Google Scholar
Boston, K., Peace, S. & Richardson, P. H. (1990) The pain cognitions questionnaire. Journal of Psychosomatic Research, 34, 103109.Google Scholar
Bowlby, J. (1988) A Secure Base: Clinical Applications of Attachment Theory. London: Routledge.Google Scholar
Breuer, J. & Freud, S. (1955) Studies on Hysteria. In Standard Edition, Vol. 2 (ed. & trans. Strachey, J.). London: Hogarth Press.Google Scholar
Brown, G. K., Nicassio, P. M. & Wallston, K. A. (1989) Pain coping strategies and depression in rheumatoid arthritis. Journal of Consulting and Clinical Psychology, 57, 652657.Google Scholar
Cassidy, J. & Kobak, R. R. (1988) Ambivalence and its relation to other defensive processes. In Clinical Implications of Attachment (eds Belsky, J. & Nezworski, T.), pp. 300326. Hove: Lawrence Erlbaum.Google Scholar
Cloninger, C. R. (1987) A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 44, 573588.Google Scholar
Dean, C. & Surtees, P. G. (1989) Do psychological factors predict survival in breast cancer? Journal of Psychosomatic Research, 33, 561569.Google Scholar
Edwin, D. H., Pearlson, G. D. & Long, D. M. (1984) Psychiatric symptoms and diagnosis in chronic pain patients. Pain, (Suppl. 2), S180.Google Scholar
Engel, G. L. (1959) “Psychogenic” pain and the pain-prone patient. American Journal of Medicine, 26, 899918.Google Scholar
Fishbain, D. A., Goldberg, M., Meagher, B. R., et al (1986) Male and female chronic pain patients categorised by DSM–III psychiatric diagnostic criteria. Pain, 26, 181197.Google Scholar
Flor, H., Turk, D. C. & Scholz, O. B. (1987) Impact of chronic pain on chronic pain patients and spouses: marital, emotional and physical consequences. Journal of Psychosomatic Research, 31, 6371.Google Scholar
Fordyce, W. E. (1974) Pain viewed as learned behaviour. In Advances in Neurology, Vol. 4 (ed. Bonica, A. J.), pp. 415422. New York: Raven Press.Google Scholar
Fordyce, W. E. (1978) Learning processes in pain. In The Psychology of Pain (ed. Sternbach, R. A.), pp. 4972. New York: Raven Press.Google Scholar
Fordyce, W. E., Fowler, R. A., Lehman, J. R., et al (1973) Operant conditioning in the treatment of chronic pain. Archives of Physical and Medical Rehabilitation, 53, 399408.Google Scholar
Frymoyer, J. W. (1988) Back pain and sciatica. New England Journal of Medicine, 318, 291300.Google Scholar
Gamsa, A. (1990) Is emotional disturbance a precipitator or a consequence of chronic pain? Pain, 42, 183195.CrossRefGoogle ScholarPubMed
Gamsa, A. & Vikis-Freibergs, V. (1991) Psychological events are both risk factors in, and consequences of, chronic pain. Pain, 44, 271277.CrossRefGoogle ScholarPubMed
Goldthorpe, J. H. & Hope, K. (1974) The Social Grading of Occupations: a New Approach and Scale. Oxford: Oxford University Press.Google Scholar
Gottlieb, H., Strite, L., Roller, R., et al (1977) Comprehensive rehabilitation of patients having chronic low back pain. Archives of Physical Medicine and Rehabilitation, 58, 101108.Google ScholarPubMed
Gross, R., Doerr, H., Caldirola, G., et al (1980) Borderline syndrome and incest in chronic pelvic pain patients, International Journal of Psychiatry in Medicine, 10, 7996.CrossRefGoogle ScholarPubMed
Harkapaa, K., Jarvikoski, A., Mellin, G., et al (1991) Health locus of control beliefs and psychological distress as predictors for treatment outcome in low back pain patients: results of a three month follow up of a controlled intervention study. Pain, 46, 3541.Google Scholar
Harris, T., Brown, G. W. & Bifulco, A. (1986) Loss of parent in childhood and adult psychiatric disorder: the role of lack of adequate parental care. Psychological Medicine, 16, 641659.Google Scholar
Hudgens, A. (1979) Family-orientated treatment of chronic pain. Journal of Marital and Family Therapy, 5 (4), 6778.Google Scholar
International Association for the Study of Pain, Subcommittee on Taxonomy (1986) Classification of chronic pain: description of chronic pain syndromes and definitions of pain terms. Pain, (Suppl. 3), S1S225.Google Scholar
Jensen, M. P., Turner, J. A. & Romano, J. M. (1991) Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment. Pain, 44, 263269.Google Scholar
Krishnan, R. R. K., France, R. D., Pelton, S., et al (1985) Chronic pain and depression: I. Classification of depression in chronic low back pain patients. Pain, 22, 279287.Google Scholar
Lindsay, P. & Wyckoff, M. (1981) The depression-pain syndrome and its response to antidepressants. Psychosomatics, 22, 571577.Google Scholar
Main, M. (1982) Avoidance in the service of attachment: a working paper. In Behavioural Development: the Bielefeld Interdisciplinary Project (eds Immelmann, K., Barlow, G. W., Petrinovich, I., et at), pp. 651693. Cambridge: Cambridge University Press.Google Scholar
Melzack, R. (1975) The McGill pain questionnaire: major properties and scoring methods. Pain, 1, 275299.Google Scholar
Melzack, R. (1987) The short-form McGill pain questionnaire. Pain, 30, 191197.Google Scholar
Parker, G. B. & Barnett, B. (1988) Perceptions of parenting in childhood and social support in adulthood. American Journal of Psychiatry, 145, 479482.Google Scholar
Melzack, R., Barrett, E. A. & Hickie, I. E. (1992) From nurture to network: examining links between perceptions of parenting received in childhood and social bonds in adulthood. American Journal of Psychiatry, 149, 877885.Google Scholar
Philips, H. C. & Hunter, M. (1982) A psychophysiological investigation of tension headache. Headache, 22, 173181.CrossRefGoogle ScholarPubMed
Philips, H. C. & Jahanshahi, M. (1985) The effects of persistent pain: the chronic headache sufferer. Pain, 21, 163176.Google Scholar
Pilowsky, I. (1967) Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 8993.Google Scholar
Romano, J. M. & Turner, J. A. (1985) Chronic pain and depression: does the evidence support a relationship? Psychological Bulletin, 97, 1834.Google Scholar
Roy, R. (1982) The pain-prone patient. A revisit. Psychotherapy and Psychosomatics, 37, 202213.CrossRefGoogle Scholar
Spitzer, R. L., Williams, J. B. W., Gibbon, M., et al (1989) Structured Clinical Interview for DSM–III–R: Patient Edition. New York: New York State Psychiatric Institute.Google Scholar
Swanson, D. W., Swenson, W. M., Maruta, T., et al (1978) The dissatisfied patient with chronic pain. Pain, 4, 367378.Google Scholar
Trieschmann, R. B. (1973) Operant conditioning in the treatment of chronic pain. Archives of Physical and Medical Rehabilitation, 53, 399408.Google Scholar
Violin, A. (1980) The onset of facial pain – a psychological study. Psychotherapy and Psychosomatics, 34, 1116.Google Scholar
Walker, E., Katon, W., Harrop-Griffiths, J., et al (1988) Relationship of chronic pelvic pain to psychiatric diagnosis and childhood sexual abuse. American Journal of Psychiatry, 145, 7580.Google Scholar
Watson, M., Greer, S., Blake, S., et al (1984) Reaction to diagnosis of breast cancer. Relationship between denial, delay and rates of psychological morbidity. Cancer, 53, 20082012.Google Scholar
Williams, D. A. & Keefe, F. J. (1991) Pain beliefs and the use of cognitive-behavioural coping strategies. Pain, 46, 185199.Google Scholar
Zarkowska, E. (1981) The relationship between subjective and behavioural aspects of pain in people suffering from lower back pain. MPhil. Thesis, University of London.Google Scholar
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