Research on coping with chronic pain: the importance of active avoidance of inappropriate conclusions.

Contemporary models of chronic pain hypothesize that psychological variables influence both pain and its impact [3,10]. Research in this area has focused mostly on the psychological variables of beliefs and coping. Beliefs refer to the thoughts that people have about pain. Thoughts such as the perceived controllability of pain, perceptions of oneself as disabled, and the belief that pain signals physical damage have been shown to be associated with measures of psychological functioning and disability [8,11,13]. Moreover, changes in these beliefs have been shown to be significantly associated with improvement following pain treatment [4,5,9]. Coping refers to the strategies people use to manage pain and its impact. Research has shown that the use of coping strategies such as guarding, resting, and asking for assistance is associated with important functioning variables in samples of individuals with chronic pain [11,12], and that changes in these coping responses are associated with treatment outcome [4,5,9]. Catastrophizing may be defined as excessive and unrealistic negative thoughts about pain and its impact on functioning. It can be viewed as either a cognitive [6] or a coping response [13]. Either way, research consistently demonstrates strong associations between catastrophizing and measures of dysfunction [2,11,12], and longitudinal studies show that decreases in catastrophizing over time are associated with improvement in patient functioning [4,5]. Although the results from these studies demonstrate that psychological variables are associated with pain and disability, research has not yet confirmed that these variables necessarily have a causal influence on pain or its impact. Karsdorp and Vlaeyen [7], in this issue, present the findings from a study examining the associations among psychological variables in a large sample of patients with fibromyalgia. Their analyses indicated that two avoidance coping responses made independent contributions to the prediction of disability when controlling for the other study variables. Karsdorp and Vlaeyen’s paper provides further support for the conclusion that what people think and do about chronic pain predicts disability. Their findings may also be used to highlight two difficulties that are often encountered in studies that involve multivariate analyses of cross-sectional data: (1) a pervasive temptation to draw causal conclusions from correlational data and (2) a tendency to use the results of multivariate analyses to draw conclusions regarding the potential unimportance of psychological factors. As authors should do when presenting the findings using crosssectional data, Karsdorp and Vlaeyen pointed out that it is not possible to draw causal conclusions from their findings. Despite this