Coping activities in chronic low back pain: relationship with depression

To help clarify the nature of coping activities in chronic pain, this study compared how depressed (n = 37) and non-depressed (n = 40) chronic low back pain (CLBP) patients attempted to cope with pain-specific and general non-pain life Stressors, relative to matched healthy control subjects (n = 40). We hypothesized that depressed mood, rather than pain alone, would account for differences in coping activities between groups. Specifically, we expected that depressed CLBP patients would report a greater proportion of passive and avoidant coping responses and less active problem solving coping attempts than non-depressed patients and controls. Results indicated that depressed CLBP patients reported more passive-avoidant coping activities than did non-depressed CLBP patients and controls, whereas coping responses were similar for non-depressed CLBP patients and controls. Additionally, subjects across groups tended to report more passive-avoidant coping in response to the specific back pain Stressor (i.e., exacerbation of back pain during activity) than to other life Stressors. Finally, the magnitude of reported differences in coping attempts across groups varied as a function of the type of Stressor (i.e., specific back pain Stressor vs. general stressful life events), particularly with regard to a disinclination to seek social support in response to the back pain exacerbation. We conclude that: (1) chronic back pain patients may employ different coping activities when attempting to manage pain exacerbations than when confronting more general life Stressors, and (2) an increased rate of passive-avoidant coping responses (relative to matched healthy controls) is associated with the combination of CLBP and concurrent depressed mood, rather than with CLBP alone. These results suggest that although some patients may selectively employ passive-avoidant coping activities in response to pain exacerbations, an over-reliance on passive-avoidant coping activities is not characteristic of all CLBP patients but is more likely a function of depressed mood.