Pain appraisals, coping and adjustment in daily-life with chronic pain: an ecological momentary assessment study

Chadwick, Benjamin J. (2005). Pain appraisals, coping and adjustment in daily-life with chronic pain: an ecological momentary assessment study PhD Thesis, School of Psychology, The University of Queensland Australia.

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Author Chadwick, Benjamin J.
Thesis Title Pain appraisals, coping and adjustment in daily-life with chronic pain: an ecological momentary assessment study
School, Centre or Institute School of Psychology
Institution The University of Queensland Australia
Publication date 2005-03
Thesis type PhD Thesis
Supervisor Justin Kenardy
Tian Oei
Total pages 406
Collection year 2006
Language eng
Subjects 380101 Sensory Processes, Perception and Performance
380107 Health, Clinical and Counselling Psychology
Formatted abstract Models of chronic pain guided by Lazarus and Folkman’s (1984) Stress and Coping Theory have long suggested key psychological variables that may maintain chronic pain syndromes and influence psychosocial adjustment. Such research justifies psychological interventions for chronic pain management, and provides an evidence-base for targeting specific classes of behaviour and cognition for therapeutic change. However, the vast majority of this literature is based on between-subjects designs. It cannot be assumed that such designs reveal what occurs within people, with some research suggesting that relationships observed. Micro-level within-subjects designs are required to explore the relationship between pain, psychological factors and adjustment in daily life. The current study sought to test the hypothesis, derived from Stress and Coping Theory, that pain appraisals and coping are both important in influencing a chronic pain sufferer’s physical/social functioning, and activity-;level), and that their effect is not attributable to fruitful methodology that has been developed to address within-person research sectional ;questionnaire-based methodologies, such as questionable ecological validity and potential recall and judgment biases. EMA’s “daily-diary” format allows for longitudinal real-time assessment of pain and associated psychosocial variable in participant’s very-day environments.

In the first study the Pain Ambulatory Monitoring Survey (PAMS) – a short (54 item) measure of pain, appraisal, coping and adaptation – was developed and validated. PAMS was then used to investigate the independent effects of coping and appraisal in a conventional between-subjects study (n=124). It was found that coping and appraisal played independent roles in predicting distress, whilst only appraisals appeared to be related to function. Activity-level, on the other hand, appeared unrelated to either coping or appraisals.

In Study Two, PAMS was applied in an intensive week-long palm-held-computer based EMA study of 55 individuals with a variety of chronic pain conditions. Part A of Study Two consisted of a set of methodology-related analyses exploring compliance, convergent validity between momentary and recall-based measure, and possible measurement reactivity. In Par B, a set of repeated-measures multilevel models was used to asses whether pain appraisals were associated with the three indices of adjustment after controlling for pain-intensity and coping, and whether coping was associated with the adjustment indices after controlling the pain intensity and appraisals. Separate analyses were conducted to investigate these effects when the predictor variable were in the same-lag as (that is, measured at the same time as) and prior –lag to (that is, measured some hours before) the outcome measures. Findings supported as stress and coping model. Analyses of distress and activity-level revealed that appraisals reported in the same lag were associated with both outcomes. Some-lag coping behaviour (performed in the period immediately preceding the reported outcome) were associated with activity-level but not distress. Delayed effects were also apparent – appraisals and coping behaviours reported in the prior lag demonstrated independent effects on all outcome indices.

In conclusion, the quality of daily life amongst people with chronic pain appears to be influenced by both the strategies they volitionally use to cope with pain and the ways they appraise their pain, which are presumably less open to volitional control. These effects appeared to be at least somewhat independent, and could not be accounted for by the momentary intensity of pain. Therapeutic strategies targeting both appraisal and coping would appear to be justified, though on the basis of current finding encouragement of activity coping may be less important goals than limiting passive coping. The different pattern of results between studies on and two supports the need for within-subjects approaches, and the electronic-diary methodology appeared to be useful means of obtaining the kind of macro-level within-person data unavailable to conventional questionnaire-based research designs. Applications for PAMS monitoring in clinical setting is discussed.
Keyword Pain Ambulatory Monitoring Survey (PAMS)

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