Coping with pain

Geissen Robinson, and Riley present a stimulating conceptual model of coping with chronic pain in which the authors argue that maladaptive beliefs and coping are primary determinants of adjustment and influence adaptive beliefs and coping through their influence on perceptions of control. We discuss some aspects of the model that require further refinement. First, the assessments of beliefs, appraisals, and coping need to be independent of outcome, obviating the use of “adaptive” and “maladaptive” in conceptual models. Unqualified statements about the universal adaptiveness, or maladaptiveness, of appraisal and coping strategies are likely to be unusual, since some strategies may result in higher emotional adjustment but not physical adjustment or vice versa. Second, beliefs, appraisals, and coping are distinct conceptual dimensions. Conceptual models that delineate relevant dimensions of these constructs rather than unify these partially independent constructs will likely have greater utility. Third, broadening the conceptualization of pain appraisal to include the individual's interpretation of the meaning of the pain is likely to provide expanded understanding of the pain coping process. Fourth, factors active in the individual's environment, particularly social relationships, need to be integrated into any comprehensive model of coping with chronic pain. And fifth, the bidirectional relationships between beliefs, appraisals, and coping need to be integrated into conceptual models. These processes are interrelated and feed back to one another as the individual struggles to cope with the challenges and threat posed by pain. The inherent complexity of coping with pain requires conceptualizations that address its transactional nature and methodologies that capture this dynamic process. Our comments direct future investigators to address when coping works, in what way it works, and for whom it works.