New research examines coping and appraisal of disease-related pain

Growing evidence suggests how individuals cope with and appraise disease-related pain, such as arthritis or cancer, is related not only to their experience with pain but also to their physical and psychological functioning, according to new research presented here today in a plenary session talk at the American Pain Society's (www.ampainsoc.org) annual scientific meeting.

In his presentation titled "Pain Coping in Disease-Related Pain: Current State of the Science," Francis J. Keefe, Ph.D., professor of psychiatry and behavioral sciences and associate director for research in the Duke Pain and Palliative Care Initiative at Duke University Medical Center, described the conceptual background for research on pain coping and appraisal, especially in disease-related pain, and provided an in-depth evaluation of key themes on pain coping that have emerged from important recent research studies.

"We are clearly observing that studies of coping do help us better understand variations in pain and disability," explained Dr. Keefe. "It's important to remember that any type of pain has both mental and physical components to it.

"From recent burgeoning literature we have, such as examining studies in GI cancer and osteoarthritis patients," he continued, "what seems to be especially important in comprehending persons with disease-related pain is catastrophizing, or the tendency to focus on and exaggerate the threat value of painful stimuli and negatively evaluate one's own ability to deal with pain. We already know that pain catastrophizing is key to understanding chronic pain."

Dr. Keefe documented how daily diary studies are yielding critical new insights into a greater understanding of individual differences in pain coping and how treatment can alter the day-to-day relationship between pain and coping, or mood, noting that personal data assistants (palm-held devices like smart phones) may offer an effective platform for assessment and ultimately treatment.

"More definitive research is needed on pain mechanisms underlying coping," Dr. Keefe concluded. "In a recent study of cortical responses to pain and the relationship to catastrophizing, it was evident that a cortical vigilance network is engaged during mild pain, but with more intense pain, a diminished prefrontal cortical modulation impedes disengaging from and suppressing pain. Understanding these underlying mechanisms can help to develop more effective and specific pain therapies in the future."

Eating and smoking are pain coping efforts that seem to be self-defeating, added Dr. Keefe in describing a vicious cycle associated with the eating and pain relationship. "Increasing food intake may provide acute relief of pain and distress but it creates long-term problems such as weight gain, increased pain, inflammation and disability."

Dr. Keefe's plenary session talk recounted new research initiatives examining coping and appraisal in patient-partner dyads, the relationship of pain coping and appraisal to acceptance, and the role of culture in shaping coping efforts.

"Basic elements of coping skills training protocols include helping patients reconceptualize pain and pain control, systematic training in coping skills - such as relaxation, activity pacing, cognitive restructuring, distraction and imagery - and behavioral rehearsal and guided practice," Dr. Keefe explained. He cited key findings from a recent review of cancer pain studies that showed coping skills training (CST) interventions using imagery or hypnosis yielded consistent beneficial effects, although the ideal components and tailoring of CST remain to be defined.

Dr. Keefe summarized new directions for patients and caregivers in psychosocial interventions, including both partner-assisted and couples-based approaches. Key findings of one pilot study involving relationship enhancement for breast cancer patients and their partners showed patient improvements in symptoms (pain, fatigue, nausea), functional well-being, self image, body acceptance and relationship functioning, while caregiver enhancements included psychological distress reduction and posttraumatic growth.

Promising results are also evident in a pilot study of yoga practice for women with metastatic breast cancer, he reported. "When women practiced more a given day, they experienced more improvements the next day in pain, fatigue, vigor, acceptance and relaxation."

In summarizing the expanding body of literature and study results for coping with disease-related pain, Dr. Keefe concluded, "Developing and refining interventions to enhance pain coping can lead to major advances, including pain prevention, an improvement in the quality of life, and reducing the suffering of many individuals having disease-related pain. I believe there is even more important progress that lies ahead."