This thesis describes coping in pacients with chronic musculoskeletal pain. It focuses especially on the cognitive evaluation of pain and coping strategies. Furthermore it deals with the emotional changes in chronic pain. The theoretical part consists of the development of access to pain and the overview of some current knowledge of biological and psychosocial determinant of pain. Emphasis is placed on a holistic, biopsychosocial approach to the issue. Empirical part consists of research aimed at assesing the important factors that contribute to cope life with pain, as in terms of personal dispositions of an individual, so in terms of environmental influence. The main aim of the research is to identity the most used coping strategies and to assess their effectiveness. Keywords: chronic disease, chronic pain, coping resources, coping strategies

This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS? The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region. Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation. These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.

Objective. To assess the use of active and passive pain coping strategies in persons with hip disability before participating in hip school and analyse differences between and correlations with gender and other different background factors and further to analyse the test-retest reliability of the Swedish version of Pain Coping Inventory (PCI-S). Methods. A descriptive cross sectional study among 52 persons (41 women, 11 men, mean age 63±8.6) was conducted. The PCI-S was filled in together with a background form and Hip disability and Osteoarthritis Outcome Score (HOOS).   10 persons also filled on PCI-Stwice a week apart to test the reliability. Results. The participants showed big variety in use of pain coping strategies, slightly more active than passive strategies , with women using significant more active pain coping strategies compared to men (p=0.003). The most common used strategies were distraction (active) and resting (passive). The PCI-S showed good test-retest reliability (ICC 0.95 for active strategies in total and 0.88 for passive). Conclusion. Pain coping strategies vary a lot with no strategy in general used very often. PCI-S can be a reliable instrument for assessing pain coping strategies in order to learn more about how patients cope with pain.

Chronic pain affects nearly 48 million Americans (Haggard, Stowell, Bernstein, & Gatchel, 2008). Established guidelines for pain management encourage the use of personality assessment in chronic pain evaluation (Karlin, Creech, Grimes, Clark, Meagher, & Morey, 2005). In relation to the Big Five personality factors, low Openness relates negatively to treatment success, (Hopwood, Creech, Clark, Meagher, & Morey, 2008), and elevated Neuroticism scores also correlate with increased pain levels among individuals in hospital or rehab settings (Ashgari & Nicholas, 2006; Nitch & Boon, 2004). In contrast to these prior studies, this study identifies correlates in a relatively high-functioning population (college students) to further elucidate the connection between chronic pain and personality. This study compares scores on the NEO-FFI (Costa & McCrae, 1992), the West Haven-Yale Multidimensional Pain Inventory (WHYMPI, Kerns, Turk, & Rudy, 1985), and the Pain Catastrophizing Scale (PCS, American Academy of Orthopaedic Manual Physical Therapists, 2010). Significant correlations were found between Neuroticism, Extraversion, and Agreeableness and select subscales of both the WHYMPI and the PCS. A linear regression of scores showed that Neuroticism was very strongly related to WHYMPI scores. In fact, the WHYMPI scores accounted for 67.9% of variance in Neuroticism. Scores on the WHYMPI also correlated with PCS scores. Helplessness and Overall scores significantly correlated to Life Control and certain positive social support scores. The findings of this study emphasize the need for pain clinicians to incorporate psychological assessments, especially concerning Neuroticism, into their evaluations of chronic pain patients.

Tyrimo tikslas – nustatyti, pacientų, patiriančių lėtinį veido skausmą, pykčio išgyvenimo, skausmo įveikos strategijų ir skausmo intensyvumo sąsajas. Tyrime dalyvavo LSMUL Kauno Klinikose gydomi pacientai, sergantys trišakio nervo neuralgija. Tyrime dalyvavo 15 vyrų, 27 moterų, tiriamųjų amžiaus vidurkis – 64,9 metai (SD=12,13). Tyriamieji buvo apklausiami anketavimo būdu. Tiriamų reiškinių įvertinimui naudoti: Skausmo intensyvumo klausimynas (Von Korff ir kt., 1992); Įveikos strategijų klausimynas (Rosenstiel ir Keefe, 1983); Asmenybinio ir būsenos pykčio klausimynas (Spielberger, 1999). Rezultatai parodė, kad padidėjusio aktyvumo strategijos taikymas yra susijęs moterų skausmo intensyvumu. Meldimosi ir tikėjimo bei katastrofizavimo naudojimas yra susijęs su vyrų skausmo intensyvumu. Nenustatytos pykčio sąsajos su pykčio išgyvenimo aspektais: asmenybiniu pykčiu, situaciniu pykčiu bei pykčio išraiškos ir kontrolės indeksu. Vyrų, pykčio išraiškos ir kontrolės indekas yra susijęs su aktyviomis įveikos strategijomis. Moterų, situacinis ir asmenybinis pyktis susijęs su pasyviomis skausmo įveikos strategijomis. Lytis nuspėja pasyvias skausmo įveikos strategijas. Skausmo intensyvumas nuspėja aktyvias skausmo įveikos strategijas. Pacientų patiriamą skausmo intensyvumą nuspėja aktyvių ir pasyvių skausmo įveikos strategijų naudojimas. Vyrams mažesnė tikimybė rinktis pasyvias įveikos strategijas nei moterims. Esant stipriam skausmo intensyvumui, tikimybė naudoti aktyvias skausmo... [toliau žr. visą tekstą] / The aim of the study was to assess relationships between pain coping strategies, anger and pain intensity among patients suffering from trigeminal neuralgia. The subjects of the study were 15 men and 28 women undergoing treatment in Hospital of Lithuanian University of Health Sciences Kaunas Clinics. General age mean equal to 64,9 (SD=12,13) years. Participants were asked to complete Grading the Severity of Chronic Pain Questionnaire (Von Korff ir kt., 1992), The Coping Strategies Questionnaire (Rosenstiel ir Keefe, 1983) and State-Trait Anger Expression Inventory-2 (Spielberger, 1999). Results indicated that increased activity is related to woman pain intensity. Prayer and faith and catastrofizing are associated with man pain intensity. Findings didn’t provide evidence to support relationships between trait anger, state anger and anger expression and control index. Nevertheless, anger expression and control index of man is associated with active coping strategies. State and trait anger of woman is associated with passive pain coping strategies. Furthermore, there evidence to support that sex predicts passive pain coping strategies. Pain intensity predicts active pain coping strategies. Active and passive pain coping strategies predicts pain intensity. Men are less likely to choose passive coping strategies than woman. With the strong pain intensity probability of the use of active pain coping strategies decreases. With the increasing use of passive coping strategies... [to full text]

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Migraine - with or without aura - is an enervating primary headache disorder that represents a heavy economic and social burden. The health-related quality of life of migraineurs is poor. The aim of this research was to investigate the health-related quality of life of migraine without aura sufferers. As the thesis was approached from a biopsychosocial perspective, potential determinants were chosen for investigation from the molecular, individual, interpersonal and wider societal levels. The research was executed in two phases: Phase 1 data (N = 341) were gathered using a survey of health-related quality of life (Short Form 6), temperament (the Tridimensional Personality Questionnaire), catastrophizing as a pain coping strategy (the four-item Pain Coping Scale) and the amount of perceived social support (the six-item Social Support Questionnaire). For phase 2, participants were requested to provide blood specimens for ELISA serum quantification of glutamate (n = 66) and gene expression analysis of the main glutamate transporter gene SLC1A2 on real-time reverse-transcription polymerase chain reaction (n = 20). Of the 341 adult residents of Gauteng Province, South Africa that participated in the survey, 94 (28%) met the criteria for migraine without aura and a further 60 (18%) suffer from possible migraine without aura, using the International Classification of Headache Diagnosis (2nd edition) criteria. This indicates that migraine without aura is a significant burden for South Africa. Health-related quality of life was significantly poorer for migraineurs versus those without migraine (p < .001), and is in fact comparable to that of liver transplant, cardiac bypass and elderly populations. This raises concerns about the severe burden of the disease on the mental and physical well-being of South African sufferers. Investigation of the predictors of health-related quality of life yielded two significant variables when controlling for sex, head and neck injury and language - Harm Avoidance and vii Catastrophizing. The regression model accounts for 29% of the variance in health-related quality of life. A reciprocal relationship likely exists between Harm Avoidance and Catastrophizing, in which a harm avoidant migraineur interprets the headache pain as a catastrophic event to be avoided – even at high cost to the self. Though there have been calls for more biopsychosocial studies of migraine, this thesis did not find added understanding of health-related quality of life through the combination of biological and psychosocial data. The implication is that the role of glutamate in migraine without aura still requires further investigation. Further study is also required with regard to which biological factors may influence the sufferer’s quality of life. The thesis indicates a key role for psychological intervention in aiding migraineurs to live a life of quality. The inclusion of interventions for the psychological aspects of migraine may yield improved outcomes for patients. However, Gauteng residents suffering from MO are potentially unaware of their diagnosis and therefore of potential management for their disorder. Awareness around migraine needs to be the first step in limiting this disorder’s devastating impact on individuals, their relationships and their potential to contribute meaningfully to society. / Psychology / D.Litt. et Phil. (Psychology)