Page 109 Guide to Pain Management in Low-Resource Settings

Psychological Evaluation of the Patient with Chronic Pain 97

What are typical cognitive factors Coping with pain includes all attempts made by a per-
infl uencing pain? son to infl uence the pain, whether by thought or deed.

Th e classical as well as the operant conditioning model Coping strategies can be positive (adaptive) or negative
presuppose the existence of pain. Th e fl aw in both mod- (maladaptive). Adaptive thinking strategies include: “I
els is that they do not take cognitive-emotional factors know the pain will be better tomorrow” or “I’ll try to
into account. Moreover, physiological processes are not think about something pleasant, to take my mind off the
considered in the operant model. An extension occurs pain.” Examples of maladaptive thinking strategies are:
in the theory of the cognitive-behavioral approach. In “I can’t bear the pain any longer—there’s nothing I can
this model the interaction between pain and cognitive, do by myself” or “I have no future if the pain goes on.”
aff ective, and behavioral factors is the central point. Th e Th oughts also have an eff ect on the pain behavior of the
central assumption here is that the aff ective, as well as patient. Adaptive behavioral strategies include: “After
the behavioral, levels are decisively determined by a my work is done, I will take a short break, and after that
person’s convictions and attitudes toward pain. Within I can do something I want to do,” or “After a little walk
the cognitive framework of pain, it is necessary to dif- in the sun I will feel better.” Maladaptive coping strate-
ferentiate between self-verbalization, which refers to the gies can be problematic behaviors: “Drinking alcohol
moment, and metacognition, which refers to a long pe- will reduce my pain” or avoidance behaviors: “After only
riod of time. Th e tendency to a single cognition gener- a hour’s activity I have to have a rest of not less than two
ally leads to behavioral consequences. Attributable self- hours.” Assessment of coping strategies allows having
verbalization such as catastrophizing, such as, “Th e pain an infl uence on the education of the patient in order to
will never end” or “Nobody can help me” leads to an support adaptive strategies. For example: ‘It is better to
overestimation of pain. Hypothetically, as a result of an do the work of the day in short periods of time and have
overestimation of the level of pain, avoidance tenden- a little rest, rather than to do all the work in two hours
cies may result, as a consequence further pain stimuli and have to rest for the remainder of the day.”
are not freshly evaluated, and adaptive strategies to In this area there are cultural diff erences, which de-
cope with pain will not be carried out. Maladaptive pend, among other factors, on access to the health sys-
metacognitions such as fear-avoidance beliefs are ac- tem. Murray et al. [12] examined cultural diff erences
companied by the assumption that the pain scenario between patients with diagnosed cancer and the pain
will defi nitely not proceed favorably and by the as- involved with qualitative interviews. Patients in Scot-
sumption that every strain for the body will aff ect the land reported as the main issue the prospect of death,
state negatively. Th ere is no longer a belief in the resto- saying that suff ering of pain is unusual and spiritual
ration of physical functionality [13]. needs are evident. In comparison, patients in Kenya re-
ported physical suff ering as the main issue, especially as
What is meant by observational learning? analgesic drugs are unaff ordable. Th ey feel comforted

Th e concept of model learning stems from social learn- and inspired by belief in God. Taking these fi ndings into
ing theory. Within this concept, the approach to pain in account, it is necessary to take a close view of patients’
one’s family of origin is of central importance. Learning resources and problems in coping with pain.
does not only occur as a result of imitation of behavioral Within the fi eld of research, common instruments
models, for example, that one should lie down as soon to assess coping strategies of patients with chronic mus-
as a headache is evident. Yet expectations and attitudes culoskeletal pain are the Coping Strategy Questionnaire
are adopted, such as the overinterpretation of all somat- [15] or the Chronic Pain Coping Inventory [3].
ic symptoms as dangerous and in need of treatment.
What are possible social impacts that can
What are possible infl uences infl uence healing in a negative way?
of coping strategies? Constant chronic pain not only leads to physical and
Since the development of the multidimensional con- psychological impairment but can also cause multiple
cept of psychological coping by Lazarus and Folkman problems in daily social life, and sometimes the patient
[6], there has been increasing interest in the concept, is alone in coping with the pain alone. Social problems
particularly in the development of psychological in- in combination with poor coping strategies can also in-
terventions, such as cognitive-behavioral therapy. tensify the risk for chronicity of pain.