The Role of Coping Flexibility and Its Underlying Mechanism in Chronic Pain Adjustment: A Longitudinal Study

Chronic pain is highly prevalent and remarkably intractable. Medication regimens to control chronic pain and to reduce associated disability have been shown to be insufficient. Pain management strategies that incorporate psychological interventions (e.g., cognitive-behavioral treatment), however, have been shown to be effective in improving patients’ functioning. Most of the evidence on the cognitive-behavioral model of chronic pain supports the pivotal role of pain coping in chronic pain adjustment, but discrepant findings challenge the interpretation that certain pain coping strategies are universally more important to patient functioning than others. Much of the literature has ignored how people assess their control and other contextual factors influencing the dynamic process of pain coping, which may account for inconsistencies in pain coping research. Coping flexibility (the ability to switch coping patterns to optimize coping) has seldom been examined in relation to pain coping, even though the cognitive-behavioral model of chronic pain has its roots in the Transactional model that emphasizes the role of coping flexibility in determining coping quality and adaptive outcomes. In the wider coping literature, a body of evidence has accrued which supports the role of coping flexibility in psychological adjustment. Research also suggests that dispositional intolerance of ambiguity (need for closure) and the ability to choose optimal coping patterns to suit circumstances (discriminative facility) provide the motivational and cognitive basis of coping flexibility respectively. A longitudinal study will address this literature gap by examining the role of coping flexibility and its underlying cognitive and motivational mechanisms in chronic pain adjustment. Using 300 Chinese patients with chronic musculoskeletal pain recruited from three multidisciplinary pain clinics in HongKong, measures of need for closure, discriminative facility, coping flexibility, and adjustment outcomes will be taken at baseline, and at 3- and 6- following baseline. Path analysis will be used to examine the role of pain coping flexibility and its underlying mechanisms in chronic pain adjustment. Hierarchical linear modeling and multivariate analysis of variance will be performed to evaluate the effect of pain coping flexibility on chronic pain adjustment over time. This project will be the first study to evaluate the relationship between appraisal coping flexibility and coping variability, and to incorporate the dual-process model in the study of the underlying mechanisms of pain coping flexibility. The findings will shed light on dispositional differences in pain coping and the design of non-pharmacological strategies to decrease morbidity and control chronicity in local and international contexts.

Funding Source: RGC - General Research Fund (GRF)