Does anxiety affect coping with chronic pain?

Abstract

OBJECTIVE: To evaluate whether symptoms of emotional distress related to pain affect patients' use of pain coping strategies. Relations between anxiety responses, as assessed by the Pain Anxiety Symptoms Scale, and coping strategies, as assessed by the Coping Strategies Questionnaire, were examined. DESIGN: Cross-sectional, retrospective, correlational. SETTING: A multidisciplinary pain management clinic in a university hospital. PARTICIPANTS: One hundred sixty-five patients (49.7% female) with chronic pain complaints. The most frequent complaint was low back pain (73%). Average age was 45.3 years (SD = 13.8). MAIN OUTCOME MEASURES: Pain coping strategy scores and ratings of ability to control and decrease pain. RESULTS: Generally, cognitive anxiety was associated with less overall coping with pain, whereas physiological anxiety was associated with a greater coping with pain. Escape and avoidance anxiety responses were associated with greater use of overt pain behaviors for coping. Regression analyses indicated that anxiety symptoms combined across cognitive, motoric, and physiological response types accounted for significant variance in seven of eight coping strategy scores. These analyses also revealed significant unique relations of separate anxiety modalities with coping variables. Relations between anxiety scores and the Catastrophizing subscale of the CSQ were much greater than the relations of anxiety scores with other coping variables, suggesting that catastrophizing may be better conceptualized as a distress response rather than a coping strategy. CONCLUSIONS: These results show that different types of anxiety symptoms have differing relations with pain coping responses. Cognitive anxiety symptoms may interfere with coping, whereas physiological anxiety symptoms may enhance coping. Possible mechanisms and implications are discussed.