Background & Aims

Living with persisting pain can take a significant toll on patients and requires the use of different coping strategies to manage pain in everyday life. Yet how individuals cope with chronic pain at a given moment and why some lead to better outcomes is not clearly understood. Previous literature on coping has focused on describing different coping strategies and their comparative effectiveness, implying that some ways of coping are superior. Moreover, pain experiences are influenced by contextual factors that dynamically change over time, a feature that is not sufficiently addressed in current theoretical models of coping. The efficacy of different coping approaches therefore depends on the momentary process and how the context is appraised. Here, we present a systematic review of current theoretical frameworks of coping relevant for chronic pain, and based on this literature, propose a new dynamic model of coping in chronic pain.

Methods

A systematic search was conducted in three databases (Medline, Embase, Web of Science) on October 4th 2023. We included original peer-reviewed articles written in English that described human research. Articles were excluded if they did not contain a novel theory/framework/model, if the presented model or framework was not theoretical, if it was not focused on health-related stress or pain, or if it was not sufficiently focused on coping. In addition, articles that described dyadic or communal models of coping were excluded, as the focus of the search was to inform a model of individual coping. A total of 1381 articles were identified, before duplicates were removed. After screening, a total of 14 articles were included for analysis.

Results

The systematic search revealed 14 models and frameworks that aimed to explain coping with health-related stress or pain. Common factors related to the coping process included appraisal (of threat or coping abilities), personal resources, social context and support, locus of control, self-efficacy, physiological and psychological state, and previous experiences. Some of the models categorised coping as either adaptive or maladaptive, in which some strategies were associated with better outcomes. Based on these results and existing research, we developed a new dynamic model to better understand how coping processes unfold dynamically in chronic pain conditions. We discuss how the five factors of controllability, predictability, salience, personal resources, and motivation interact over time to impact coping. This model also integrates elements of predictive coding to show how previous experiences and expectations influence future coping.

Conclusions

This systematic review shows how previous models of coping with health-related stress or pain have conceptualised the coping process. Several common factors were identified across models and integrated with literature on stress and coping to produce a new model of coping in the context of chronic pain. This model shows how coping outcomes are contingent on the interplay between momentary factors and previous experiences. Instead of categorising methods of coping as adaptive or maladaptive, the model aims to explain how decisions arise momentarily and are appraised in relation to short-term and long-term goals. Our review also discusses how interventions may target different factors in the coping model and how personalised approaches could support chronic pain patients in their coping efforts.

References

Brown, G. K., & Nicassio, P. M. (1987). Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. PAIN, 31(1), 53. https://doi.org/10.1016/0304-3959(87)90006-6

DeLongis, A., & Holtzman, S. (2005). Coping in Context: The Role of Stress, Social Support, and Personality in Coping. Journal of Personality, 73(6), 1633–1656. https://doi.org/10.1111/j.1467-6494.2005.00361.x

Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer Publishing Company.

Lynn Snow-Turek, A., Norris, M. P., & Tan, G. (1996). Active and passive coping strategies in chronic pain patients. Pain, 64(3), 455–462. https://doi.org/10.1016/0304-3959(95)00190-5

Peres, M. F. P., & Lucchetti, G. (2010). Coping Strategies in Chronic Pain. Current Pain and Headache Reports, 14(5), 331–338. https://doi.org/10.1007/s11916-010-0137-3

Tan, G., Teo, I., Anderson, K. O., & Jensen, M. P. (2011). Adaptive Versus Maladaptive Coping and Beliefs and Their Relation to Chronic Pain Adjustment. The Clinical Journal of Pain, 27(9), 769–774. https://doi.org/10.1097/AJP.0b013e31821d8f5a

Presenting Author

Merethe Blandhol

Poster Authors

Merethe Blandhol

MSc

University of Oslo

Lead Author

Seoyoung Lee

MSc

University of Oslo

Lead Author

Topics

  • Systematic Reviews/Meta-Analysis