Coping with Pain and Stress Related to Illness

Individuals with SCD cope well, are often able to work, remain active in social and recreational activities, and are well adjusted psychologically. Many others, however, cope poorly, lead more limited lives, and become depressed and overly reliant on health care services for their pain management. Although some of the variability in adjustment is a result of disease severity, psychological factors, including coping strategies and social support, are significantly re lated to psychosocial and functional adjustment across the life span.

In adults, several factors have been related to good adjustment to SCD. Adults who have lower levels of daily stress, higher efficacy expectations, and high levels of family support have better psychological adjustment. Adults who take an active approach to coping with pain by using multiple cognitive and behavioral strategies such as diverting attention and calming self-statements are more active in household, work, and social activities. Other psychosocial factors have been associated with poorer adjustment to SCD. Adults from conflicted families and adults who use palliative coping methods for dealing with stress have poorer psychological adjustment. Overall poor psychosocial and functional adjustment also occurs in individuals who deal with pain by catastrophizing, engaging in fear and anger self-statements, and using passive strategies such as resting while neglecting to use other strategies when an episode of pain occurs. This pattern of pain coping has been associated with more severe pain; greater reductions in household, social, and occupational activities during painful episodes; and more frequent hospitalizations and emergency room visits.

In children and adolescents, there are similar relationships among these dimensions of coping, family support, and adjustment. It is interesting that factors in the parents such as maternal adjustment and the pain-coping strategies that parents use are also related to the child's adjustment. Furthermore, coping strategies in parents and their children are related, possibly because children learn to cope with their own pain by observing their parent's reactions to pain.

There is a growing recognition for the need to treat individuals with this disease from a multidisciplinary perspective. There are now comprehensive SCD centers that emphasize the importance of integrating psychosocial and educational programs with clinical and basic science research. The goals of these centers often include providing multiple types of psychological treatments such as biofeedback and individual and family therapy along with traditional medical management approaches to enhance pain management and overall coping in patients and their families.

Karen M. Gil

Duke University

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