Chronic pain is a major health issue with broad implications for pursuing life roles and activities of daily living. In order to retain functioning, people engage in a variety of coping behaviours. These coping patterns have been found to differ between men and women, and while coping strategies are not adaptive or maladaptive by definition, there are general tendencies with respect to their adaptivity with regards to improved daily functioning.
The aim of this thesis is to gain a better understanding of the associations between gender, coping strategy use, and associated functioning in people with chronic pain.
First, a systematic review was conducted in order to identify the available literature and examine evidence regarding the relationship between gender, coping strategies and associated functioning in people experiencing chronic pain. Results of this review further provided a basis for a second study, employing a cross-sectional approach. The aim of the second research project was to investigate the associations between gender-specific coping patterns, pain beliefs and associated functioning in specific areas of daily living and with regards to a general disability level.
The findings of the systematic review highlighted the need for future research in the field of gender differences in coping and associated functioning, as only seven articles met the inclusion criteria. In general, it has been found that men engage in more coping strategies that are considered to be adaptive. Women on the other hand tend to use more maladaptive ways of coping with chronic pain. Overall, this results in poorer levels of functioning in daily living for the female gender. "Catastrophizing" is consistently associated with lower levels of functioning for both genders, with women, however, employing this coping approach more often than men. In men only, "catastrophizing" was associated with poorer functioning in the workplace. One other coping strategy that has been associated with functioning in daily living is "reinterpretation of pain sensations". Male gender and engagement in this coping pattern were both positively associated with return to work within 12 months. Emotional Approach Coping, comprising of initial identification, followed by processing and finally expression of emotions, has been found to be associated with less interference in activities of daily living also for men only. Another important aspect is the presence of emotional states, such as anxiety and depression. Men with high anxiety levels experienced greater interference in activities of daily living than men with low levels of anxiety. This association was not found for women and was unrelated to the use of coping strategies.
Results of the second study concur with the findings of the systematic review that "catastrophizing" is associated with higher general disability levels and with higher disability experienced in every area of daily living that was investigated. However, men and women of this sample were similar in their coping behaviours in general. Significant gender-specific differences in coping and associated functioning were found for "General Disability", as well as specific areas of daily living ("Sexual Behaviour", "Self-Care" and "Life-Support Activities") for the coping strategy "ignoring pain sensations" and the belief of being in "control over pain". Men who used "ignoring pain sensations" more often, experienced lower levels of disability with regards to "Sexual Behaviour" and "Life-Support Activities", while differences for "Self-Care" approached significance. These associations were also present for women (except for "Life-Support Activities"), however, were weaker and non-significant. Greater engagement in "ignoring pain sensations" was found to be related to lower "General Disability" levels for both men and women, however, this association was stronger for men. Men feeling more in "control over pain" experienced lower levels of disability in "Self-Care" and "Life-Support Activities", while these associations were present, but non-significant for women.
The findings of both studies together highlight that differences between men and women in engagement in coping behaviours and associated functioning in daily living are present with regards to fulfillment of life roles in some areas of daily living. It is important to consider these associations in clinical pain management in order to provide targeted therapy recommendations for both genders and to promote functioning in the best possible way.