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Coping Profiles for Adolescent Useful for Pain Management
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Posted on: 11/30/1999
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Children who experience chronic pain often cope in ways different from adults. One method for assessing how children and adolescents (teens) cope is the Pain Response Inventory (PRI), which is used to predict how the pain affects the children's functioning. The authors of this study wanted to evaluate how well the pain coping profile worked among children who had a variety of painful conditions.
Researchers enrolled 254 patients, aged from 12 to 17 years, who had complained of pain for at least three months. The majority of the patients were white (90.7 percent) and female (76.8 percent). The complaints of pain included headaches (33.7 percent), neuropathic (nerve) pain (24.8 percent), muscle, bone, and/or joint pain (21.5 percent), abdominal pain (11.8 percent), diffuse (all over) pain (4.5 percent) and "other" (3.7 percent).
The children were asked to complete the PRI, which includes 60 questions that look into how the children respond to pain. The questions were answered on a scale of zero to 10, with zero meaning never or none and 10 meaning always or the worst or most. The children were also asked to complete the Functional Disability Inventory (FDI), which looks into the children's physical and psychosocial functioning two weeks before answering the questions. The scales range from zero (no trouble) to four (impossible).
The Children's Somatization inventory (CSI) looks at how severe the somatic symptoms are. These include dizziness and weakness, for example. There were 35 symptoms that were evaluated on a scale of zero (not at all) to four (a whole lot). Anxiety was also measured using the revised children's manifest anxiety scale (RCMAS), which used 37 questions with a yes (0)/no (1) response. Depression was measured with the Children's depression inventory (CDI), a 27-question test from zero to three, with zero being the lowest in symptoms and three being the highest.
Finally, pain intensity was measured through an interview with a psychologist and measured on a scale of zero (no pain) to 10 (worst pain possible).
After the questionnaires were completed, the patients underwent a physical exam and saw a physician, physical therapist, and clinical psychologist.
The results of the surveys showed that Avoidant copers (37 patients) isolated themselves. They scored higher levels of self-isolation, disengagement and stoicism. They had lower levels of seeking social support and discontinuing activities, as well as they hid their feelings. On the flip side, they also had more pain and catastrophizing than any other group.
Fifty-four patients fell into the Dependent copers group. They had high levels of catastrophizing the pain, although not as much as Avoidant copers. Dependent copers scored higher in seeking help and less in seeking isolation. Dependent copers also scored high for depression. Self-reliant copers (57 patients) most frequently used strategies to cope such a self-encouragement, acceptance, and minimization. They scored significantly lower on resting, disengagement and catastrophizing. They also scored lower for depression and anxiety.
A smaller group of 29 patients, the Engaged copers rated high in problem solving and asking for help, self-encouragement and distraction. They also had less depression and anxiety. Another large group of 69 patients, the Infrequent copers, did not score well on any type of coping strategy, but they also scored low on pain, disability, somatic symptoms, anxiety and depression. The authors write that perhaps this group of patients don't see pain as a significant stressor or, if that isn't it, they could be using coping mechanisms that weren't discussed in the PRI.
The authors conclude that their study confirmed the PRI's usefulness in assessing children who have chronic pain. They suggest that future studies of pain in adolescents look at behavior outcomes (absenteeism, use of medical services) to obtain a broader view of the issue.
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References:
Robyn Lewis Claar, et al. Pain coping profiles in adolescents with chronic pain. In Pain. November 30, 2008. Vol. 140. No. 2. Pp. 368-375.
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