Active or Passive Pain Coping: Which Predicts Daily Physical and Psychosocial Functioning in People With Chronic Pain and Spinal Cord Injury?

Impact and Implications Using innovative data collection methods that allow for examination of daily dynamics of coping and physical and social outcomes, this study found that daily increases in passive coping had more widespread effects on same-day depressive symptoms, pain catastrophizing, and decreased same-day positive affect and well-being, whereas days of higher than usual active coping was associated with increased same-day pain catastrophizing. Teaching skills to boost the adoption of active coping skills is a key component of most behavioral and cognitive behavioral therapy-based interventions for people with chronic pain. These findings highlight the potential need for clinicians to evaluate the use and reduce the frequency of passive coping in their clients. Purpose/Objective: Despite medical and psychotherapeutic treatments, chronic pain is one of the most challenging and disabling conditions for individuals with spinal cord injury (SCI). A growing body of research has demonstrated that pain coping strategies are effective for the adjustment of pain. However, we still lack an understanding of how passive pain coping and active pain coping relate to daily physical and psychosocial functioning for people with chronic pain and SCI. The current study used end-of-day (EOD) diary data to examine associations of passive and active pain coping with same-day independence, positive affect and well-being, social participation, pain catastrophizing, depressive symptoms, and pain interference in adults with chronic pain and SCI. Research Method/Design: This observational study in N = 124 individuals with SCI (mean age = 47.53 years; 74.2% male, 25.8% female) used a combination of baseline surveys and seven consecutive days of end-of-day (EOD) diaries. Results: Results of multilevel modeling showed that, beyond the effects of key demographic variables, clinical variables (e.g., time since injury, mobility) and daily pain intensity, increased daily passive coping (from that person's average) related to increased same-day depressive symptoms (B = .29; p < .001), pain catastrophizing (B = .28; p < .001) and decreased same-day positive affect and well-being (B = -.31; p = .02). Increased daily active coping was related to higher same-day catastrophizing (B = .09; p < .05). Conclusions/Implications: Behavioral interventions for pain often emphasize adoption and practice of new active coping strategies. Findings highlight the potential importance of also addressing passive coping strategies in services of improvement in physical and psychosocial outcomes in individuals with chronic pain and SCI.