Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part V: Maladaptive Coping
SOURCE: Pain Medicine 2016 (Jan); 17 (1): 64-73 ~ FULL TEXT
Elizabeth A. DiNapoli, Michael Craine, Paul Dougherty,
Angela Gentili, Gary Kochersberger, Natalia E. Morone,
Jennifer L. Murphy, Juleen Rodakowski, Eric Rodriguez,
Stephen Thielke, Debra K. Weiner
Mental Illness Research, Education & Clinical Center,
VA Pittsburgh Healthcare System, Pittsburgh,
Pennsylvania Geriatric Research,
Education & Clinical Center,
VA Pittsburgh Healthcare System, Pittsburgh, PA
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OBJECTIVE: As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping – a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP.
METHODS: A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors’ clinical practice.
RESULTS: We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management.
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CONCLUSIONS: To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.
KEYWORDS: Aged; Assessment; Chronic Low Back Pain; Chronic Pain; Elderly; Low Back Pain; Maladaptive Coping; Primary Care
From the FULL TEXT Article:
Older adults who experience chronic low back pain (CLBP) develop behavioral and cognitive coping strategies to tolerate or reduce pain. These coping strategies have been shown to significantly predict pain, functional capacity, and chronification of LBP. For example, adaptive coping strategies are generally associated with reduced pain, positive affect, and better psychological adjustment , whereas maladaptive coping strategies have been linked with negative outcomes such as psychological distress, increased pain, and heightened disability. [2-4] Please see Table 1 for examples of maladaptive and adaptive coping strategies. Research has found age-related differences in pain coping strategies across the life span. [5, 6] While older adults are more likely than younger adults to use a narrower range of pain-related coping strategies (e.g., less cognitive and more emotion-focused strategies), they tend to use these strategies more consistently and effectively.  As aging is associated with significant heterogeneity, many older adults with CLBP are at risk of engaging in maladaptive coping strategies. Fortunately, coping remains malleable with age, and maladaptive coping strategies can be effectively changed with interventions. [8, 9] Therefore, it is increasingly important for providers to assess pain coping strategies in this population.