Coping, pain and disability in patients with chronic inflammatory and musculoskeletal diseases

Abstract

The main interest of this study is in the behavioural and psychological aspects of adjusting to a chronic, periodically painful disease. This study focuses on the concept of coping, the modes of coping, the context of coping, and the factors related to these.

Coping is defined as constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Coping responses are considered to result from the patients' assessments of the stresses that they face and of the resources available.

Antonovsky has addressed the issue of psychological resources with his theory about the sense of coherence. Antonovsky's theory of how mental resources can promote health offers a general frame of reference for studies of health. A strong sense of coherence means that environmental stimuli are experienced as comprehensible, manageable and meaningful.

In this thesis, management of pain and disability is studied in groups of patients with different types of musculoskeletal and chronic, inflammatory diseases: systemic lupus erythematosus (SLE); osteoarthritis (OA); rheumatoid arthritis (RA) and fibromyalgia; haemophilia and chronic low-back pain (CLBP). Common to these groups of patients are pain, as related to pathological changes in the joints, functional disability, chronicity and the unpredictable course of the disease. Thus, coping with these diseases involves facing a number of stresses and challenges. In addition to coming to terms with the meaning of the illness for one's life and the more existential issues of disease progression and deformity, patients must cope with pain, stiffness and physical-activity restrictions on a daily basis. Several questionnaires were used to collect data concerning the use of coping strategies, the role of patient education, pain, disability, emotional well-being and the sense of coherence.

The results indicated that comprehensive guidebooks are of value for patients with chronic musculoskeletal diseases although solely information does not lead to changes in psychological variables. Regarding the use of pain coping strategies the following results were found: The strategies most frequently used by the patients with haemophilia were distraction and pain control. Re-interpreting pain was a strategy which was rarely used in this sample, although it was correlated with lower levels of pain. The pattern of using the coping strategies distraction, pain control and re-interpreting pain was not dependent on the degree of pain. Furthermore, the use of the strategies was not complementary. If the patients increased the use of the strategies distraction, pain control and re-interpreting pain, they also increased the use of other strategies.

For the patients with chronic low-back pain it was found that the sense of coherence was related to the way in which patients perceived their disease and the way they adjusted to it. From the results of this thesis, a pattern emerges of the relationships between the factors which influence patients' emotional well-being and management of chronic inflammatory and musculoskeletal diseases. Pain and disability are the baseline conditions of the patient. Age and sense of coherence act as moderators, whereas the catastrophizing strategy can be identified as a mediator in the process of coping.