Association Between Coping Strategies and Pain-Related Outcomes Among Individuals with Chronic Orofacial Pain

Abstract

Background: Chronic orofacial pain is associated with substantial pain-related disability and emotional distress. Understanding the relationship between individuals’ coping strategies and pain-related outcomes is important yet understudied in this population. Purpose: To test the cross-sectional association of three coping strategies (pain catastrophizing, kinesiophobia and mindfulness) to four pain-related outcomes (depression, anxiety, pain intensity, and pain-related disability) among individuals with chronic orofacial pain, after accounting for relevant demographic and clinical variables. Methods: Individuals (N=303) with heterogeneous chronic orofacial pain (eg, trigeminal neuralgia, other trigeminal neuropathic pain, persistent idiopathic facial pain and other types) completed self-report measures of coping (Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, and the 15-item Five Facet Mindfulness Questionnaire), pain intensity and pain-related disability (Graded Chronic Pain Scale), and PROMIS measure of anxiety and depression. We conducted 4 two-step hierarchical regressions for each of the four pain-related and emotional outcomes, with the first step including demographic and clinical covariates, and the second step including the three coping variables together. Results: Pain catastrophizing was the only coping variable significantly associated with pain intensity (B=0.362, SE=0.115, p=0.002, 3% variance explained) and pain-related disability (B =0.813, SE=0.162, p<0.001, 7% variance explained). Pain catastrophizing (B=0.231-0.267, SE=0.046-0.051-0.050, p<0.001), kinesiophobia (B=0.201-0.316, SE=0.081-0.084, p<0.001-0.018), and mindfulness (B=0.231–0.306, SE=0.046-0.067, p<0.001) were each independently associated with symptoms of anxiety and depression, with the largest incremental variance added by catastrophizing (5–8%) and mindfulness (5%). Conclusion: Pain catastrophizing appears to be an important intervention target to improve pain intensity, pain-related disability, anxiety and depression among individuals with chronic orofacial pain. Kinesiophobia and mindfulness may be additional treatment targets for interventions to improve anxiety and depression.