THE COPING STRATEGIES QUESTIONNAIRE AND CHRONIC PAIN ADJUSTMENT - A CONCEPTUAL AND EMPIRICAL REANALYSIS

Objective: Some studies have found significant relations between both the factor scores and subscales of the Coping Strategies Questionnaire (CSQ) and various measures of adjustment to chronic pain. In their review of the literature on coping with chronic pain, Jensen et al. (Pain 1991;47:249-83) suggest that conceptual overlap between the subscales may inflate these observed correlations. In the present study, we examine the factor structure of the CSQ subscales which reflect coping, excluding the CSQ subscales which measure appraisal or activity. We then examine the relationship between the CSQ factors and subscales and pain adjustment, while controlling for selected variables. Design and Subjects: One hundred fifty-two chronic pain patients were administered the CSQ. Seventy-three were also administered the Multidimensional Pain Inventory (MPI). Adjustment to chronic pain was defined based on patients' cluster membership on the MPI and responses to the Interference, Pain Severity, and Negative Affect subscales. Setting: Tertiary care center. Results: Multiple regression analyses revealed that the Pain Avoidance factor was positively related to pain severity, interference, and MPI cluster membership. In addition, the catastrophizing subscale was positively related to negative affect and MPI cluster membership even when controlling for level of depression, ability to decrease pain was related to lower levels of pain severity, and ability to control pain was related to MPI cluster membership. Neither the Conscious Cognitive Coping factor nor the Increasing Activities subscale was related to the adjustment measures. Follow-up analyses revealed that the Praying/Hoping subscale appeared to account for the relationship between pain avoidance and adjustment. Conclusion: The results suggest that praying/hoping and catastrophizing are related to poorer adjustment to chronic pain, that ability to control and decrease pain are related to better adjustment, and that catastrophizing appears to be a separate construct from depression. The results also suggest that the individual CSQ subscales may have greater utility in terms of examining coping, appraisals, and pain adjustment compared to the composite scores.