Pain-Related Coping Behavior in ALS: The Interplay between Maladaptive Coping, the Patient's Affective State and Pain

Abstract

Background: Pain is a common symptom in patients with amyotrophic lateral sclerosis (ALS). Coping plays a central role in adjustment to pain.

Objective: This study evaluates the use of different pain coping strategies in patients with ALS and investigates the interplay of maladaptive coping, and the patient's affective state and pain.

Methods: One hundred and fifty ALS patients from three German outpatient clinics completed the Brief Pain Inventory (BPI), the ALS-Functional Rating Scale-Extension (ALSFRS-EX), the ALS Depression Inventory (ADI-12), the subscale "emotional functioning" of the ALS Assessment Questionnaire (ALSAQ-40) and the Coping Strategies Questionnaire (CSQ). Based upon the results of correlational analyses, multiple regression analyses were performed to identify predictors of pain severity and to explore factors contributing to maladaptive coping.

Results: Pain was prevalent in 56% (n = 84) of the patients. Patients applied different adaptive coping strategies as well as the maladaptive strategy "catastrophizing". Regression analysis indicated that the CSQ-subscale "catastrophizing" significantly predicted pain intensity, explaining 34.0% of the variance (p < 0.001). Pain-related catastrophizing was associated with higher pain-related functional impairments and worse emotional functioning. The ADI-12 sum score as an indicator for depressive symptoms contributed significantly to the maladaptive coping strategy "catastrophizing" (p < 0.001) and explained 40.8% of the variance.

Conclusion: Patients with ALS apply different strategies to cope with pain. Catastrophizing is an important determinant of higher pain intensity ratings and is associated with higher pain interferences and decreased emotional well-being. Pain-related catastrophizing is promoted by depressive symptoms. Catastrophizing and depressive symptoms thus represent important targets of individualized pain-management strategies.

Keywords: amyotrophic lateral sclerosis; depressive symptoms; motor neuron disease; pain; pain coping.

Figure 1

Use of pain coping strategies in ALS patients with pain, indicating the mean values of the CSQ subscale scores on a scale from 0 “never do that” to 6 “always do that”. The different pain coping strategies are grouped into active (highlighted in light grey) and passive coping strategies (highlighted in grey) and are arranged in descending order of the mean subscale scores within the respective category of coping style.

Figure 2

Correlation matrix presenting the correlations between demographic and clinical data as well as the results of the patient-reported outcome measures referring to the ALS patients with pain. For visualization of the degree of the association between the variables, a color scale from shades of red to shades of blue was used, which refers to the interpretation of effect sizes in terms of weak (0.10 to 0.29), moderate (0.30 to 0.49) and strong (0.50 to 1.00). Referring to the four groups of variables (demographic data, clinical variables, measure of affective state and pain-related variables), Bonferroni-adjusted p-values: 0.05/4 = 0.0125 were deemed significant and are boldfaced.

Figure 3

Scatter plot of the relationship between the CSQ subscale score for “catastrophizing” and the average pain intensity ratings according to the BPI. A linear regression line has been superimposed.

Figure 4

Scatter plot of the relationship between the CSQ subscale score for the coping strategy of “catastrophizing” and the ADI-12 sum score as a measure of depressive symptoms. A linear regression line has been superimposed.