Rethinking Coping in Chronic Pain – A systematic review and dynamic interaction model of cognitive and behavioural factors

Living with pain that persists over months or years can take a significant toll and requires the use of different strategies to manage the pain in everyday life. Yet how individuals cope with chronic pain and why some people show better functional outcomes is not clearly understood. Previous literature on coping has often focused on describing different coping strategies and their comparative effectiveness, often with the assumption that some are overall less adaptive than others. Existing theoretical models of coping often lack descriptions of how factors unfold over time and often assume relationships between factors remain stable. However, pain coping is not only influenced by continuously changing internal and external contextual factors, but by changing interactions as the process repeats over time. Moreover, the short- and long-term efficacy of different coping approaches depends on individual appraisal of the momentary coping process. In this review, we first systematically synthesise previously published theoretical frameworks that have conceptualised the coping process in health- related stress and pain. Then, we present the ‘Dynamic Interaction Model of Coping in Chronic Pain’ outlining how five central factors: 1) controllability, 2) predictability, 3) pain salience, 4) personal resources, and 5) motivation, interact in a dynamic coping process in chronic pain. The model outlines putative pathways of moment-to-moment and long-term adaptations to pain, and potential targets for intervention are discussed.