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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 Translated title: Coping with chronic pain: the role of assessment variables and coping strategies for the prediction of anxiety and depression in a sample of patients with chronic pain

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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).

          Translated abstract

          Objective: The objective of this research was to study the relations and interactions between cognitive assessment procedures and coping strategies proposed in the Lazarus and Folkman model (1984) as processes mediating the adaptation of patients to their pain, using as adaptation criteria the level of anxiety (STAI/R) and depression (BDI), in order to determine variables and coping strategies that predict a better adaptation to chronic pain, taking the variables separately. Material and methods: The population study included 168 patients with chronic pain attending the Multidisciplinary Pain Unit at the General University Hospital of Valencia. The patients answered to a first set of questionnaires used to record social and demographical data (age, sex, marital status, education level), clinical diagnosis and pain severity measured on a visual analogical scale (VAS). Afterwards, they answered to another set of questionnaires focused on the assessment of pain, such as pain assessment variables, pain coping strategies (PCS), and level of anxiety and depression measured on STAI/R and BDI, respectively. Results and conclusions: On a descriptive level and considering the whole study population, the results show that pain severity reported by patients ranged between moderate and severe, that patients perceived their pain as exceeding their own coping resources and that patients rated low their self-effectiveness in order to manage, control or relieve pain, this being a disabling and limiting factor in their everyday life. In our study population, the most frequently used strategies for coping with pain were self-assertion, search of information and religion, and their anxiety and depression scores were moderate or high. On a predictive level, both anxiety and depression can be mainly explained by assessment variables, being the emotional repression the most relevant variable for predicting anxiety and the feeling of loss the most relevant variable for predicting depression (things that could be done and enjoyed in the past, but not anymore).

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          Most cited references 74

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          Pain Mechanisms: A New Theory

           R Melzack,  P D Wall (1965)
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            The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment.

            Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.
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              Coping with chronic pain: a critical review of the literature.

              A growing number of investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. This article reviews the empirical research which has examined the relationships among beliefs, coping, and adjustment to chronic pain. Although preliminary, some consistent findings are beginning to emerge. For example, patients who believe they can control their pain, who avoid catastrophizing about their condition, and who believe they are not severely disabled appear to function better than those who do not. Such beliefs may mediate some of the relationships between pain severity and adjustment. Although coping strategies appear to be associated with adjustment in chronic pain patients, methodological problems limit conclusions regarding the strength and nature of this association. Our recommendations for future research include the development of coping and belief measures which: (1) do not confound different dimensions (e.g., coping, beliefs, and adjustment) in the same measure; (2) assess specific (rather than composite) constructs; (3) are psychometrically sound; and (4) assess behavioral coping strategies more objectively. We also recommend a greater use of experimental research designs to examine causal relationships among appraisals, coping, and adjustment.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                February 2005
                : 12
                : 1
                : 8-16
                Affiliations
                Valencia orgnameUniversidad de Valencia orgdiv1Facultad de Psicología orgdiv2Departamento de Personalidad, Evaluación y Tratamientos Psicológicos
                Valencia orgnameUniversidad Católica San Pedro Mártir
                Valencia orgnameConsorcio Hospital General Universitario orgdiv1Unidad Multidisciplinar del Dolor
                Article
                S1134-80462005000100003

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 47, Pages: 9
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