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A psychological model of coping with the demands of aging is outlined. Chronic pain is conceptualized as a challenge to normal aging, because it threatens identity, risks affective disorder (depression), and interferes with action. The sparse evidence for psychological interventions is reviewed, and a case is made for the types of interventions that should be developed to address the specific presentation of geriatric pain management., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)

Psychological interventions are a mainstay of modern pain management practice and a recommended feature of a modern pain treatment service. Systematic reviews for the evidence of psychological interventions are reviewed in this article. The evidence for effectiveness is strongest for cognitive behavioural therapy with a focus on cognitive coping strategies and behavioural rehearsal. Most evidence is available for treatments of adult pain, although adolescent chronic pain treatments are also reviewed. It is clear that treatment benefit can be achieved with cognitive behavioural methods. It is possible to effect change in pain, mood, and disability, changes not achieved by chance or by exposure to any other treatment. However, the overall effect sizes of treatments for adults, across all trials, are modest. Reasons for the relatively modest treatment effects are discussed within the context of all treatments for chronic pain being disappointing when measured by the average. Suggestions for improving both trials and evidence summaries are made. Finally, consideration is given to what can be achieved by the pain specialist without access to specialist psychology resource.

Objectives: To explore a community sample of adolescents for engagement with online pain resources. To assess if the use of the Internet to search for health information correlated with measures of coping, risk taking, catastrophizing about pain, and engaging in the self-management of pain., Design: A cross-sectional online study of community-based adolescents (n = 105) recruited via schools to examine their use of the Internet to seek pain-related information., Methods: Adolescents completed questionnaires of pain coping, catastrophic thinking, risk-taking behaviour, and medication use. Descriptive analyses were undertaken on event rates of pertinent behaviours, principally on information seeking and pain management behaviour. Correlational analyses were undertaken between coping and information seeking, and medication use., Results: Few participants engaged in online pain information seeking. Those who did were more likely to be female and scored higher on medication use, catastrophizing, risk taking, and the total score on the Pain Coping Questionnaire., Conclusions: Although adolescents are high users of the Internet, paradoxically they do not appear to use the Internet for information about pain and pain management. Further research should assess inhibitory and disinhibitory factors associated with information seeking about pain and chronic illness on the Internet., Statement of Contribution: What is already known on this subject? Internet use in adolescents is common, mobile, and displays a level of technical awareness unparalleled by adults. The internet is postulated in previous research to present a platform for the delivery of health care, particularly information to aid health decision-making for young people. What does this study add? This study explores how adolescents use the internet to look for health information, particularly on pain and where this falls in a general profile of coping with illness. Interestingly and counterintuitively, adolescents did not use the internet to look for health or pain information. We hypothesize that there may be something about information on pain management that does not readily transfer to the digital world in a way that is useful to adolescent users., (© 2012 The British Psychological Society.)

Proposed is a psychology of pain that focusses on normal psychological reactions to pain. A normal psychology of pain seeks to explain what normal people (those who would not meet any criteria for any psychological disorder) do when faced with pain. Herein, we focus on everyday pain defined as pain that is clinically unimportant that arises from normal everyday activity. Pain functions to interrupt current concerns and promote problem solving typically in the form of escape, pain management, or request for assistance. A model of analgesic problem solving is described. Focussing on pain as an interruption leads us to think about the purpose of analgesics in repairing attention and returning function. New endpoints for analgesic performance are offered. Similarly, a focus on pain as a motivation for analgesia demands that we understand how people self-medicate its relative success, and what influences patterns of self-medication. Finally, the problem of pain in children and adolescents, including self-medication in youth, is discussed. Although there is limited small-scale research on young people and their knowledge about analgesics, very little is known about their beliefs, attitudes to analgesics and their self-medication behaviour. Adolescents in most societies are left largely unguided. There is little child-specific communication about how to manage pain. Most children rely on parental knowledge, although increasingly the internet is becoming a source of advice for young people learning about analgesics., (© 2012 Blackwell Publishing Ltd.)

It is important to understand the processes that contribute to disability and distress in adolescents with chronic pain. For example, research has identified that when adolescents can positively adapt to the consequences of health condition, rather than attempt to change the condition itself, they also function better and experience less distress. This pattern of behavior is similar to what is referred to as "acceptance" of pain in the adult literature. Although acceptance is consistently associated with positive outcomes in adult studies, there has been less investigation of acceptance in adolescents. This study aimed to examine the reliability and validity of an adolescent-adapted version of the Chronic Pain Acceptance Questionnaire (CPAQ-A), and, using this instrument, to carry out a preliminary investigation of acceptance in adolescents with chronic pain. A sample of 122 highly disabled adolescents with chronic pain attending a specialty service completed the adapted CPAQ-A. They also completed standardized measures of their pain and daily functioning. Results supported the reliability and validity of the CPAQ-A. Correlation analyses showed that higher levels of acceptance were associated with lower levels of distress and disability, but not with lower pain intensity. Regression analyses were carried out to assess the independent contribution of acceptance after pain intensity and demographic variables were taken into account. In these analyses acceptance accounted for significant variance in disability, psychological distress, and developmental and family functioning. We discuss developmental aspects of acceptance in adolescents and clinical implications of these findings., (Copyright 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.)

Trying to control pain is a common human goal. But little is know about what happens when one loses control over pain. This paper reports an experiment with 74 healthy volunteers, half of whom were given control over a pain stimulus and subsequently lost control, and half of whom never had control over the pain. This study investigates whether having had control and lost it would result in a more unpleasant pain experience, more fear about impending pain, a heightened vigilance to pain, and greater interference on a secondary task. Participants in the experimental group first learned to avoid a painful stimulus by correctly responding to a card sorting task, but later on lost control over the painful stimulus. In the yoked comparison group, participants had no control over the painful stimulus from the beginning. Results indicated that losing control over pain and, relatedly, attempting to control uncontrollable pain have significant costs such as a higher fear of the impending pain stimulus and retarded performance on a secondary task. When attempts to avoid pain are blocked, individuals persist in their avoidance attempts, try harder, and narrow their focus of attention upon the problem to be solved. These findings are discussed within the context of a dual process model of coping with uncontrollable adverse events [Brandtstädter J, Renner G. Tenacious goal pursuit and flexible goal adjustment: explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 1990;5:58-67] and possible mechanisms for perseverance with ineffective solutions.

Cognitive-behavioral therapy has a substantial evidence base with regard to its effectiveness for individuals with chronic pain. Historically, although there has been some investigation in to the processes by which treatment succeeds or fails, few data are available regarding the unique contributions of processes from distinct cognitive behavioral approaches and how these processes may interact to affect patient functioning. The present investigation sought to evaluate three proposed process variables that have garnered empirical support within chronic pain settings, namely: pain intensity, catastrophizing, and acceptance. Participants were 252 consecutive patients who completed treatment on an interdisciplinary pain management unit. Using multiple regression, the contributions of changes in process variables to changes in treatment outcomes were assessed. In general, changes in both acceptance and catastrophizing accounted for significant variance independent of, and larger than, that accounted for by change in pain intensity. Changes in acceptance and catastrophizing accounted for roughly equivalent amounts of variance when entered immediately following changes in pain, and when entered following one another. The potential impact of these results is discussed in relation to the particular treatment delivered. Issues relating to change at the level of frequency or content of psychological experiences are considered relative to change in the functions of these experiences.

Sex differences exist in pain and the strategies used to cope with pain. Although it is has been proposed that such differences become apparent around puberty, somewhat surprisingly very little research has specifically investigated sex as a moderator of pain within adolescents. The primary aim of the current study was to investigate sex differences in pain and coping within a group of 46 male and 115 female adolescent chronic pain sufferers. All were aged between 11 and 19 years and had been referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases, United Kingdom. Patients completed a battery of measures including pain experiences and a pain coping questionnaire. No sex differences were found in pain chronicity, although males and females did differ in self-reported pain experiences (females reported higher pain). Sex differences were also found in coping behaviours. Females used more social support, positive statements and internalizing/catastrophizing, whereas males reported engaging in more behavioural distraction. Of these strategies internalizing/catastrophizing was found to mediate the relationship between sex and pain. This suggests that not only do sex differences exist in the pain experiences and pain-coping strategies of adolescents with chronic pain, but that internalizing/catastrophizing may be an important mechanism in understanding such differences. More research examining potential sex differences in children and adolescents is recommended.

Previous research suggests that to define the problem of chronic pain as a problem of coping may not be as useful as framing it as a problem of acceptance for some patients. The coping approach may encourage, or at least permit, a somewhat inflexible agenda of pain reduction or control while the acceptance approach may allow a more flexible agenda of willingness to have pain in some circumstances where that serves the goal of better life functioning. The purpose of this study was to continue to examine the relative utility of concepts of coping and acceptance of pain. Two hundred and thirty consecutive patients seeking assessment from a pain management service were the participants in the study. Patients completed the Coping Strategies Questionnaire (CSQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). A revised scoring method was used for the CSQ (to correct for technical limitations noted in the past) and recently developed subscales of the CPAQ were examined. Correlation results showed that the acceptance variables were reliably stronger predictors of distress and disability compared with coping variables. Regression analyses confirmed that, compared with coping variables, acceptance accounted larger unique increments in variance in measures of patient functioning regardless of whether the coping variables were given priority in the regression equations. Increasing data support the view that the pain management field may benefit from evolving toward incorporating a less control-oriented and more accommodating view of aversive private experiences in some circumstances.

Worry is a common feature of chronic pain. The purpose of this study was to examine the extent of worry experienced by adults with chronic pain, and to explore features of problem solving associated with worry and chronic pain. A further purpose was to investigate whether there were differences in worry and problem solving for those presenting at a pain clinic for treatment, compared to those who identified as chronic pain sufferers but who were not presenting for treatment. A final purpose was to examine whether the extent of worry and problem solving attitudes helped to predict the primary clinical features of chronic pain such as intensity, disability and depressive mood. One hundred and eighty five adults with chronic pain provided completed questionnaires assessing worrying, problem solving, pain severity, disability, catastrophic thinking and depressive mood. Analyses showed that worry and problem solving approaches sampled in this study were not abnormal. Furthermore, no differences were found between the clinical and non-clinical sample for worrying and problem solving. In relation to the predictive value of worrying and problem solving, analyses revealed that only worrying had a unique contribution in explaining depressive mood. The results are discussed within a context of a model of worry and chronic pain, in which worry about chronic pain may be functioning to promote awareness of an insoluble problem.

Patients and clinicians sometimes take coping with chronic pain primarily as a process of gaining more control over pain. An alternate approach might include helping the pain sufferer to discriminate parts of their situation that can be effectively controlled from those that cannot. When faced with situations that do not yield to attempts at direct control patients may gain better results from leaving those situations as they are and investing their efforts elsewhere. This study was designed to examine this type of expanded view of coping with pain, a view that includes both attempts at control and acceptance. 200 adults seeking treatment for chronic pain were the subjects of this investigation. They completed a number of self-report inventories including a measure called the Brief Pain Coping Inventory, an inventory assessing accepting responses to pain as well as pain management responses standardly targeted by cognitive-behavioral treatment methods. Preliminary results showed that the BPCI yields scores with adequate temporal consistency and validity. Further results showed that a number of the responses assessed by the BPCI were reliable predictors of patient functioning. In general less frequent struggling to control pain, fewer palliative and avoidant coping responses, and more explicit persistence with activity despite acknowledged pain were associated with less depression and anxiety and greater life functioning. These results demonstrate that, in some instances, attempts at avoidance and control of chronic pain may be less helpful compared with a willingness to experience pain and focus on functioning.

This paper investigates whether acceptance was related to less attention to pain, and to more engagement with daily activities. The results of two studies are reported. In a first cross-sectional study, 501 chronic pain patients completed self-report instruments on pain severity, attention to pain and acceptance. In a second diary study, 62 patients with chronic pain reported pain intensity, attention to pain and characteristics of goal-directed behaviour 8 times a day using an experience sampling method. Acceptance was measured using a self-report instrument. It was found that acceptance was related to less attention to pain (study 1 and study 2), more engagement with daily activities, a higher motivation to complete activities and a better efficacy to perform daily activities (study 2). Results are discussed in terms of how a positive life despite pain may be preserved by a flexible adjustment of personal goals to current limitations and adversities.

Acceptance of chronic pain entails that an individual reduce unsuccessful attempts to avoid or control pain and focus instead on participation in valued activities and the pursuit of personally relevant goals. Recent research suggests that pain-related acceptance leads to enhanced emotional and physical functioning in chronic pain patients above and beyond the influence of depression, pain intensity, and coping. In these studies, acceptance was measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Preliminary analyses of the CPAQ have supported its psychometric properties. The present study sought to further refine the CPAQ by examining its factor structure and evaluating the relations of these factors to other indices of pain-related distress and disability. Although a previously demonstrated factor structure of the CPAQ was generally supported, only factors assessing (a) the degree to which one engaged in life activities regardless of the pain and (b) willingness to experience pain had adequate reliability and validity and were significantly related to the other measures of patient functioning. A revised version of the CPAQ is suggested.

Research and treatment of chronic pain over the past 20 or more years have tended to focus on patient coping as the primary behavioral contribution to adjustment. The purpose of the present study was to compare a coping approach to chronic pain with a different behavioral approach referred to as acceptance of chronic pain. These approaches were compared in terms of their ability to predict distress and disability in a sample of patients seeking treatment for chronic pain. Subjects were 230 adults assessed at a university pain management center. All patients completed the coping strategies questionnaire and the chronic pain acceptance questionnaire among other standard measures. Results showed that coping variables were relatively weakly related to acceptance of pain and relatively unreliably related to pain adjustment variables. On the other hand, acceptance of chronic pain was associated with less pain, disability, depression and pain-related anxiety, higher daily uptime, and better work status. Regression analyses examined the independent contributions of coping and acceptance to key adjustment indicators in relation to chronic pain. Results from these analyses demonstrated that acceptance of pain repeatedly accounted for more variance than coping variables.

An analysis is reported of the variety of understandings available in British culture to understand acceptance of chronic pain. Q-factor analysis is used within a critical framework as Q-methodology. Thirty participants completed the procedure. Eight factors or accounts of accepting chronic pain were derived. These are reported as taking control, living day to day, acknowledging limitations, empowerment, accepting loss of self, more to life than pain, don't fight battles that cannot be won, and spiritual strength. Common features of accepting chronic pain are (1) the acknowledgement that a cure for pain is unlikely, (2) a shift of focus away from pain to non-pain aspects of life, and (3) a resistance to any suggestion that pain is a sign of personal weakness. Where accounts of chronic pain differ is in the extent to which acceptance of pain means a change in core aspects of self. Implications of this study for the study of chronic pain are discussed. In particular, how identity is managed in the context of threatening chronic pain is suggested as a fruitful area of future investigation., (Copyright 2002 Elsevier Science Ltd.)

Although it is now well accepted that attention-based cognitive coping strategies are effective in altering pain perception and have potentially useful analgesic qualities, there exists contradiction and equivocation as to the role of various factors in the production of that analgesia. Cioffi (1991) has suggested that the response to this equivocation has been a 'collective ennui' on the part of researchers. This article seeks to explore methodological and theoretical reasons for this reigning equivocation and offers some suggestions for moving beyond it. In particular, critical attention is focussed upon four possible sources of variance in experimental pain procedures: the choice of the pain induction procedure, the instructions given, the measures taken and the content of the taught strategy.