Identification of strategies used to cope with chronic pain in older persons receiving primary care from a Veterans Affairs Medical Center.
Academic Article
Overview
abstract
OBJECTIVES: To identify the strategies used by older persons to cope with chronic noncancer pain, determine the perceived effectiveness of the strategies, and ascertain factors associated with their use. DESIGN: Cross-sectional telephone survey. SETTING: Primary care practice located at a Veterans Affairs Medical Center in New England. PARTICIPANTS: Two hundred forty-five patients (aged 65-90) with chronic pain. MEASUREMENTS: Qualitative methods were used to ascertain participants' coping strategies, and their effectiveness was determined using a five-category response scale (1=not at all effective to 5=extremely effective). In multivariate analyses, associations between participants' demographic, medical, psychosocial, and pain characteristics and prevalent coping strategies were assessed. RESULTS: Participants had a mean age+/-standard deviation of 75+/-5.1; 84% were male. Overall, 240 (98%) participants had employed at least one coping strategy in the previous month; the mean number used per participant was 2.8+/-1.4. Prevalent coping strategies included analgesic medications (used by 187/240=78% participants), exercise (35%), cognitive methods (37%), religious activities (21%), and activity restriction (20%). The proportion of participants who used a given strategy and rated it quite a bit or extremely effective exceeded 50% for only five of the 15 identified strategies. Women were more likely than men to use cognitive coping methods (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.5-6.8) and religious activities (OR=2.6, 95% CI=1.2-5.7). Participants with chronic pain due to a musculoskeletal cause were more likely to use analgesic medications than those with pain due to all other causes (OR=3.2, 95% CI=1.6-6.4), whereas those with trauma-related pain were less likely to use exercise than those with pain due to all other causes (OR=0.2, 95% CI=0.1-0.7). CONCLUSION: Older primary care patients use a broad variety of coping strategies to cope with chronic pain. Studies are needed to confirm these findings in other older populations and to characterize the longitudinal effects of the coping strategies. Given the finding that the perceived effectiveness of most coping strategies was modest, efforts to increase their effectiveness in older persons are indicated.
