Coping with medical adversity: Characteristics of effective adjusters with chronic pain.

Abstract

Studies of multidimensional clinical profiles of people with chronic pain have supported the presence of at least two empirically distinct clusters: a Low Pain (LP) cluster characterized by low levels of reported pain, depression, and disability, and a Chronic Pain Syndrome (CPS) cluster characterized by high levels of reported pain, depression and disability. Recently, two investigations have also suggested the possibility of a third grouping of profiles characterized by low levels of depression and disability despite severe pain, as well as relatively high scores on measures of denial and the pain-related use of cognitive coping strategies. However, the presence of such a cluster and its distinctive dimensions have yet to be confirmed in broader, more heterogeneous chronic pain samples. This study investigates the reproducibility and distinctive features of this third grouping, identified in this study as Effective Adjusters (EA) in a community-based sample (n = 184; 141 females, 43 males) of people with mixed sources of chronic pain. Cluster analysis of individual adjustment profiles (composed of scores from self-report measures of pain severity, depression, and subjective disability) demonstrates the presence of the previously reported LP, CPS and EA groupings (along with a fourth grouping of profiles identified as 'Undefined Adjustment'). Comparison of the EA and CPS clusters using ANOVAs (with planned comparisons) revealed no significant differences on self-report measures of pain severity, pain-related appraisals of control and benefits. However the EA cluster of cases was characterized by significantly higher frequencies of conscious cognitive coping efforts and conscious disregard of pain, significantly higher ratings of pain-related choice and responsibility appraisals, and significantly lower frequency of pain-related catastrophizing thoughts. Background variables such as age, education, pain duration, medication use and number of active personal pain management strategies failed to differentiate the two clusters. This study provides empirical support for the validity of an EA cluster of adjustment profiles distinct from those characterized by LP and CPS adjustment profiles. The results add to evidence suggesting that among the population of chronic pain sufferers there exist distinct subgroupings of people with very different adjustment outcomes. The evidence suggests that these adjustment differences are likely related not only to overall pain severity but also to the presence of specific pain-related appraisals and conscious cognitive coping strategies. The findings support previous research which has shown a relation between adjustment outcomes and differences in pain-related catastrophizing and conscious cognitive coping efforts. At the same time, they extend previous results by suggesting that among people reporting relatively severe pain levels, pain-related appraisals of choice and responsibility rather than control and benefits are likely to be associated with adjustment differences.