Coping strategies as predictors of pain and disability in older people in primary care: a longitudinal study

Abstract

BackgroundMusculoskeletal pain in older adults is common. It is hypothesised that coping strategies may be predictive of pain intensity and pain-related disability at six months after initial consultation in primary care.MethodConsecutive patients aged fifty years and over with musculoskeletal pain were recruited from general practice consultations. A self-completion postal questionnaire was sent to participants at baseline, with a follow-up questionnaire mailed six months later. Coping was assessed using The Coping Strategies Questionnaire (CSQ), pain and pain related disability were measured using domains of The Chronic Pain Grade (CPG). Associations between coping strategies and pain and disability were investigated using ordinary least squares regression.ResultsCrude analysis revealed catastrophizing at baseline was predictive of higher levels of pain and disability at baseline and was predictive of disability at six months. The association between catastrophizing and pain and pain related disability at follow-up was not significant once adjustments were made for age, gender and baseline anxiety and depression. Increasing behaviour and self-statements were not associated with pain or disability at follow-up. Ignoring pain sensations was predictive of increased pain at follow-up.ConclusionThis study highlights the relationship between catastrophizing in predicting pain and pain related disability may be mediated by other factors such as anxiety and depression. Ignoring sensations in those with high levels of pain may be maladaptive in older people with musculoskeletal pain.

Influencia de los factores psicosociales en la experiencia de dolor músculo-esquelético: Una revisión de la literatura

“…Una reciente revisión sistemática (87) demostró que la depresión es un factor predictor del desarrollo de dolor crónico no oncológico en personas mayores de 18 años. De los estudios incluidos en esta revisión, el catastrofismo y la depresión fueron los factores cognitivo-afectivos más estudiados y que presentaron mayor correlación con el dolor musculoesquelético (25,27,28,31,37,38).…”

“…El catastrofismo es la tendencia a generar pronósticos irracionalmente negativos en relación con una amenaza percibida (20). Diversas investigaciones han confirmado la correlación positiva entre el catastrofismo, la intensidad del dolor y grado de discapacidad percibida (25,27,28). Slepian y cols.…”

Comparison of the cognitive performance of elderly caregivers with and without chronic pain

“…A study conducted in the United Kingdom evaluated 502 participants with mean age of 65.2 years and compared the subjects according to the intensity of the pain (above or below the median), noting that the group with the highest level of pain had higher rates of depression, anxiety and worse overall health when compared to the group with low pain intensity (29) . Another fact that corroborates the literature is the higher number of continuous use medications in the group with chronic pain when compared to the group without chronic pain, with statistically significant results (30) .…”

“…Individuals with pain may have a higher prevalence of depression symptoms, sleep disorders, and increased use of medications (4) . Chronic pain is often present among the elderly, resulting in serious and potentially debilitating consequences, demonstrating the importance of consistent pain analyses, assessing the individual's symptoms, functional status and clinical history, as well as the location and timing of pain onset.…”

Fatores preditores de dor em idosos do Município de São Paulo, Brasil: Estudo SABE 2006 e 2010

“…A dor é internacionalmente reconhecida como um agravo recorrente na vida dos idosos, e alguns estudos identificaram os seguintes fatores como associados à dor na velhice: idade e sexo 2,5,6 , obesidade 4,7,8,9 , ansiedade e depressão 6,7,9,10,11,12 , doenças osteoarticulares 11 , distúrbios do sono e fadiga 7,8,12 , algumas doenças crônicas como hipertensão, diabetes, doenças cardiovasculares e pulmonares, bem como quedas e fraturas 8 . No Brasil, ainda são escassas as pesquisas sobre fatores preditores de dor em idosos, sobretudo estudos epidemiológicos realizados com amostras representativas da população, capazes de comparações com estudos internacionais 3,4,13 .…”