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      Afrontamiento del dolor crónico: el papel de las variables de valoración y estrategias de afrontamiento en la predicción de la ansiedad y la depresión en una muestra de pacientes con dolor crónico

      Revista de la Sociedad Española del Dolor
      Sociedad Española del Dolor
      Chronic pain, Transactional model, Dolor crónico, Evaluación, Ansiedad, Depresión, Modelo transaccional, Assessment, Anxiety, Depression

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          Abstract

          Objetivo: El objetivo de la investigación consiste en estudiar las relaciones e interacciones existentes entre los procesos de valoración cognitiva y estrategias de afrontamiento afrontamiento propuestos en el modelo de Lazarus y Folkman (1984) como procesos mediadores en el ajuste de los pacientes su dolor, utilizando como criterio de adaptación el nivel de ansiedad (STAI/R) y depresión (BDI), con la finalidad de poder determinar qué variables de valoración y qué estrategias de afrontamiento predicen un mejor ajuste al dolor crónico, tomando las variables criterio por separado. Material y métodos: La muestra del estudio está compuesta por 168 pacientes con dolor crónico que acuden a la Unidad Multidisciplinar del Dolor en el Hospital General Universitario de Valencia. Los pacientes completaron una bateria de cuestionarios donde, en una primera parte se recogían los datos sociodemográficos (edad, sexo, estado civil, nivel de estudios), el diagnóstico clínico, y el nivel de dolor a través del EVA (escala visual analógica). Posteriormente completaban un conjunto de cuestionarios centrados en la evaluación de su dolor como son las variables de valoración del dolor del paciente, las estrategias de afrontamiento al dolor (CAD), y el nivel de ansiedad rasgo y depresión, evaluados a partir del STAI/R y del BDI, respectivamente. Resultados y conclusiones: A nivel descriptivo, y considerando a la totalidad de la muestra, los resultados muestran que el nivel de dolor informado por los pacientes oscila entre moderado e intenso, percibiendo que su dolor supera sus propios recursos para hacerle frente, y percibiéndose a sí mismos con una baja autoeficacia para manejar, controlar o disminuir el dolor, siendo este un factor incapacitante y limitante en su vida diaria. Las estrategias de afrontamiento ante el dolor más utilizadas por la muestra han sido la autoafirmación, la búsqueda de información y la religión, mostrando puntuaciones en ansiedad y depresión moderadamente elevadas. A nivel predictivo, tanto la ansiedad como la depresión es explicada mayoritariamente por variables de valoración siendo el elemento más importante en la predicción de la ansiedad la represión emocional, mientras que en el caso de la depresión, la variable más relevante en su predicción será la valoración de pérdida (lo que uno antes podía hacer o disfrutar y ahora no).

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          Most cited references69

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          Stress, Appraisal, and Coping

          <p><b>The reissue of a classic work, now with a foreword by Daniel Goleman!</b><p>Here is a monumental work that continues in the tradition pioneered by co-author Richard Lazarus in his classic book <i>Psychological Stress and the Coping Process</i>. Dr. Lazarus and his collaborator, Dr. Susan Folkman, present here a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping which have become major themes of theory and investigation.</p> <p>As an integrative theoretical analysis, this volume pulls together two decades of research and thought on issues in behavioral medicine, emotion, stress management, treatment, and life span development. A selective review of the most pertinent literature is included in each chapter. The total reference listing for the book extends to 60 pages.</p> <p>This work is necessarily multidisciplinary, reflecting the many dimensions of stress-related problems and their situation within a complex social context. While the emphasis is on psychological aspects of stress, the book is oriented towards professionals in various disciplines, as well as advanced students and educated laypersons. The intended audience ranges from psychiatrists, clinical psychologists, nurses, and social workers to sociologists, anthropologists, medical researchers, and physiologists.</p>
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            Chronic pain patient-spouse behavioral interactions predict patient disability.

            Based on behavioral theory, it has been hypothesized that spouse solicitous responses to the pain behaviors of chronic pain patients may contribute to the maintenance of pain behaviors and disability. Self-report data support this hypothesis, but direct observational measures have not been used to study this association. In this study, 50 chronic pain patients and their spouses were videotaped while engaging in common household activities. and patient pain behaviors and spouse solicitous behaviors were coded from the tapes. Spouse solicitous responses to non-verbal pain behaviors were significant predictors of physical disability in the more depressed patients, and were significant predictors of rate of non-verbal pain behavior in patients who reported greater pain. Spouse solicitous responses did not predict psychosocial dysfunction or total self-reported pain behaviors. The result support behavioral theory and indicate the need for further study of the association between spouse solicitousness and patient pain behaviors/disability.
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              Spouse criticism and support: their association with coping and psychological adjustment among women with rheumatoid arthritis.

              Examined whether psychological adjustment of women with rheumatoid arthritis would be related to the support and criticism the patient received from the husband. Interviews were conducted with the husbands of 103 women with rheumatoid arthritis. Spouse interviews were content coded for critical remarks. Wives completed a revised version of the Ways of Coping Scale and a scale of the perceived supportiveness of the spouse. Husbands completed rating scales assessing their perceived vulnerability to illness and the degree of burden they experienced in providing assistance to their wives. Path analyses revealed that patient adjustment was significantly related to the attitude of the spouse. Patients with a highly critical spouse engaged in more maladaptive coping behaviors and reported a poorer psychological adjustment. Independent of spousal criticism, patients who perceived their spouse as being supportive engaged in more adaptive coping. A path model was fit to the data that suggested that the spouse may affect adjustment indirectly through influencing the patient's selection of adaptive or maladaptive coping responses.
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                Author and article information

                Journal
                S1134-80462005000100003
                http://creativecommons.org/licenses/by/4.0/

                Emergency medicine & Trauma
                Chronic pain,Transactional model,Dolor crónico,Evaluación,Ansiedad,Depresión,Modelo transaccional,Assessment,Anxiety,Depression

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