Dr. Adams' Alabama Headache Blog

Coping strategies are self generated cognitive maneuvers used by chronic pain patients to deal with their stress. In this study, the pain level, duration and coping strategies of 49 female TMD patients as measured by the Coping Strategies Questionnaire-Revised (CSQ-R) were compared with psychological status (SCL-90 scores) and degree of disability (SF-36 Health Status.) High intensity reported pain was found to be associated with more frequent use of Catastrophizing Coping Self Statements, Distraction and Praying than low intensity pain. While individual dimensions of the SCL-90 (Anxiety, Depression, Somatization, and General Stress Index) showed no statistical difference, all dimensions were higher in the high pain patients. High pain were more disabled than low pain patients (Mann-Whitney U analysis of SF-36, z -3.26, p=0.001). When long term pain (2-50 yrs) was compared with short term pain responses (1 month-1.5 yrs), long term patients used Distancing and Ignoring more than short term patients. Degree of disability was the same between long and short-term pain. When patients used three coping strategies (Catastrophizing, Distraction, and Praying), significantly higher levels of anxiety, depression, somatization and general stress were reported. Patients who used Distancing more often reported higher levels of anxiety and general stress. Patients using a wide variety of coping strategies (flexibilty) reported higher levels of pain, more psychological distress and greater disability. Using a diversity of coping strategies was not related to long duration of pain. The use of the combination of three strategies, Catastrophizing, Distraction, and Praying are associated with elevated psychological scores abd greater disability. Intensity, not duration of pain appears to determine which coping strategies are used by patients. Some of these strategies may be maladaptive.