Task-based approach to problem-solving, making an effort to change/eliminate the source of stress. The patient is focused on maintaining life activity, diverting his/her attention away from pain and undertaking exercises and efforts meant to diminish pain.
Advances in psychoneurology and health psychology have led to the development of research into personality components, which have a modifying function with reference to risk factors and help adapt to a disease and cope with the disease and its consequences, including pain. These factors are called personal resources, as opposed to deficits that impair response to stress and diminish the effectiveness of coping.26 In health psychology, they are also called health potentials.
SOC is a complex variable with the following three major components: comprehensibility, manageability and meaningfulness. SOC as a personality variable affects individuals’ functioning in different areas of their life and, as research has shown, in a varied and positive way, both directly and indirectly impacting their health. Individuals with strong SOC are in better mental and physical condition,30–32 are more likely to engage in physical activity, fulfill the given tasks, are capable of maintaining intimate relationships with other individuals33 and more readily accept unavoidable difficulties in their life.34 They have a higher level of satisfaction with life and a higher quality of life score.35,36 SOC plays a very important role in emotional coping with the challenges posed by the disease,37,38 encourages better functioning at work and prevents a burnout syndrome.39–41 The analysis of data obtained from 5,000 respondents led Larson42 to concluded that there is a strong correlation between SOC and healthy behavior, subjective evaluation of health and quality of life.
In the therapeutic process, specific consideration should be given to an individual’s resources that can affect functioning during illness. This behavior may shape functioning in the other direction as it would appear from specific disease.
What is the intensity of pain in the studied group and the relationship between subjects’ daily activity and pain intensity?
What is the level of SOC in the studied group?
What are coping strategies with pain employed by older patients with chronic diseases?
Is there a relationship between the SOC and coping strategies with pain in the studied group?
A total number of 188 individuals were included in the study, of whom 117 (62%) were female subjects and 71 (38%) were male subjects. The mean age of the study sample was 68.38 (standard deviation [SD] =6.35) years. The youngest individual was aged 60 years, and the oldest individual was aged 89 years. Male (mean [M]=68.35; SD =5.99) and female (M=68.40; SD =6.58) subjects were of similar age. Most subjects completed secondary education (58 individuals; 31.02%) and vocational education (47 individuals; 25.13%), with the least number of subjects having higher education diploma (30 individuals; 16.04%). All subjects had a diagnosis of a chronic medical illness with pain as a major symptom. Most of them suffered from osteoporosis and rheumatoid arthritis (123 individuals; 68%) and vascular disease (47 individuals; 20.74%), while the least number of patients suffered from slipped disk (four individuals; 4.26%).
The criteria in order to be included in the research were as follows: diagnosed with a chronic disease in which pain is the main symptom, lack of cognitive disorder that could preclude self-assessment of pain and answering the questionnaire.
The following standardized measures were used in the study.
catastrophizing and seeking hope (catastrophic thinking, praying and having hope).
This was used in the study to assess pain intensity with a score of 0 meaning “no pain” and a score of 10 meaning “worst imaginable pain”.
This was used to collect demographic data and variables associated with functioning in the disease.
The study was conducted in line with the principles stated in the Declaration of Helsinki.47 Permission to carry out the study was obtained from the Research Ethics Committee at Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum. The major criteria for the sample selection were a diagnosis of a chronic medical illness with chronic pain as one of the major symptoms and the written informed consent of a subject.
Statistical analysis was performed using STATISTICA 9.0 software. The level of statistical significance was set at 0.05. A correlation model was used in the data analysis, and the following statistical tests were employed. In order to describe variables in the groups, the mean, the SD and percentage were used. In order to determine the direction and the strength of a correlation between variables, the sample Pearson correlation test (in the case of a linear correlation between variables and if the variables were quantitative in nature) was used, or if the variables were quantitative in nature or there was no linear correlation between the variables, the nonparametric Spearman’s R correlation test was utilized, and analysis of variance or the Kruskal–Wallis tests were used when certain conditions were not met followed by the test for the post hoc analysis of the identified differences in order to define the significance of differences between many mean values.
Patients assessed the intensity of pain they experienced and its effect on three areas of life, activity, mobility and mood, on a 10-point scale. All mean scores were in the average range, yet a maximum difference between the scores was noted (Table 1).
Negative effect of pain on patients’ mood received the highest scores and was significantly different from the pain affecting patients’ activity (P=0.008) but was not different from the pain affecting patient’s mobility (P=0.187). There were slight differences between male and female subjects in how they assessed the effect of pain on different areas of their functioning, but these differences were not statistically significant.
The assessment of pain and its effect on various areas of functioning was similar in older male and female patients. The subjects under study (whole group) took an average of 1.45 analgesic tablets per day (SD =1.08), with most of them taking one to two tablets per day (Table 2).
Given the differences in the number of questions in the subscales, they cannot be compared. Significant difference can only be observed in scores within individual subscales (Table 3).
Abbreviations: M, mean; SD, standard deviation; SOC, sense of coherence.
The intensity of SOC and its components was similar in older male and female patients. Subjects were divided into the following three groups regarding SOC: low, average and high intensity – adding or subtracting 0.5 SD. The subjects were roughly evenly distributed across the three groups (Table 4).
Abbreviation: SOC, sense of coherence.
Praying, having hope and declarations of coping with pain were among the most often used coping strategies among patients in the study, while the reevaluation of pain sensations was the least often used strategy. Moreover, the subjects believed that they were able to control pain to a certain extent and reduce it although to a lesser extent (Table 5).
There were statistically significant differences in the intensity of some coping strategies used by male and female subjects (Table 6).
The following cognitive strategies of coping with pain sensations were significantly more often used by male subjects in coping with pain: reevaluation, ignoring sensations, and declaration of coping with pain. Moreover, they were more likely to use an avoidance strategy – distracting attention.
The SOC showed statistically significant negative correlation with subjective assessment of the effect of pain on mood and taking medication (Table 7).
Patients with stronger SOC were more likely to assess pain as weaker and its effect on mood as lesser. These patients were also taking fewer analgesics. SOC showed statistically significant correlation with pain-coping strategies (Table 8).
Older chronically ill patients with stronger SOC were less likely to use a catastrophizing strategy and were more likely to declare that they were coping with pain. They also believed that they could control and reduce pain they experienced. Given the intensity of the SOC, statistically significant variation of coping strategies such as catastrophizing, declaration of coping with pain and the extent to which subjects could control it were identified (Table 9).
Individuals with high SOC were less likely to catastrophize (MW=11.58), and this strategy was significantly less often used than in individuals with lower (MN=17.15) and average (MP=16.65) SOC. Individuals with low and average SOC differed from individuals with high SOC. The latter used mostly cognitive coping strategy – declaration of coping with pain (MN=17.52; MP=18.91; MW=22.71).
Similar differences were observed in the extent to which the subjects could reduce pain they experienced. Patients with high SOC were mostly convinced that they could reduce pain (MW=3.71) when compared with patients with both low and average SOC (MN=3.23 and MP=3.22; P=0.02).
Besides taking pain-relieving medication, older people utilize various strategies to cope with chronic pain. These range from cognitive to behavioral strategies. There is also evidence supporting effective use of the so-called religious ways of coping with pain.52 In a cross-sectional research, religious and nonreligious pain-coping strategies used by older people were investigated.48 The results showed that these strategies were quite often used by both female and male individuals, but women were found to be more likely to use those strategies. The present study has yielded similar results. Prayer and having hope proved to be most often applied pain-coping strategies in the study sample. The study showed that women were more likely to use those strategies, while men used cognitive strategies, reevaluating or ignoring pain sensation.
The study results show that in providing care for older people with chronic pain, not only a multifaceted assessment of somatic ailments is required, but it is also necessary to pay attention to individual resources. Hence, SOC seems to be particularly important as it helps the clinician select more constructive strategies to cope with the pain of the elderly.
Interrelationships between personal characteristics should be tested, as well as emotional functioning and the experienced pain in various somatic diseases.
Therapeutic education, including coping with pain, constitutes an important aspect in the care of older people suffering from chronic pain.
There are areas that require very intense educational activities of patients with chronic pain as our survey proves. However, the number of persons and the vast differentiation of the tested group require some caution when the results are being interpreted. Furthermore, a survey conducted in a correlation model limits the possibility to draw conclusions on its basis.
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