Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain

Health and Quality of Life Outcomes, Dec 2013

Background Sense of Coherence (SOC) is a measure of an individual’s capacity to use various coping mechanisms and resources when faced with a stressor. Chronic pain is one of the most prevalent and disabling conditions in clinical practice. This study examines the extent to which a strong SOC is associated with less pain and better health related quality of life (HRQoL) among patients with chronic pain. Methods We analyzed data from the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial which enrolled 250 patients with persistent (3 months or longer) musculoskeletal pain who were receiving care in an United States Department of Veterans Affairs (VA) primary care clinic. The abbreviated three-item SOC scale was used to measure personal coping capability. Participants were categorized into Strong SOC (score 0–1) and Weak SOC (score 2–6). The Brief Pain Inventory (BPI) was used to assess the severity and disability associated with pain. Additionally, pain self-efficacy (ASES) and catastrophizing (CSQ) were assessed. HRQoL was assessed with the 36-item Short-Form Health Survey (SF-36) social functioning, vitality, and general health subscales. Multiple linear regression models were performed to examine whether SOC was independently associated with pain-specific and HRQoL outcomes, after adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities and major depression. Results Of the 250 study patients, 61% had a strong SOC whereas 39% had a weak SOC. Multivariable linear regression analysis showed that a strong SOC was significantly associated with better general health, vitality, social functioning and pain self-efficacy as well as less pain catastrophizing. These significant findings were partially attenuated, but remained statistically significant, after controlling for major depression. SOC was not significantly associated with pain severity or pain disability. Conclusions A strong SOC is associated with better HRQoL and self-efficacy as well as less catastrophizing in patients with chronic pain. SOC may be an important coping mechanism (strategy) for patients with chronic musculoskeletal pain. Trial registration Clinicaltrials.gov Identifier: NCT00926588.

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Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain

Neale R Chumbler 0 Kurt Kroenke 1 2 6 Samantha Outcalt 2 Matthew J Bair 1 2 6 Erin Krebs 4 5 Jingwei Wu 3 Zhangsheng Yu 3 0 Department of Health Policy and Management, University of Georgia , Clayton Street, Office 305, Athens, GA 30602 , USA 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, IN , USA 2 VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center , Indianapolis, IN , USA 3 Department of Biostatistics, Indiana University School of Medicine , Indianapolis, IN , USA 4 University of Minnesota Medical School , Minneapolis, MN , USA 5 VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System , Minneapolis, MN , USA 6 Regenstrief Institute, Inc. , Indianapolis, IN , USA Background: Sense of Coherence (SOC) is a measure of an individual's capacity to use various coping mechanisms and resources when faced with a stressor. Chronic pain is one of the most prevalent and disabling conditions in clinical practice. This study examines the extent to which a strong SOC is associated with less pain and better health related quality of life (HRQoL) among patients with chronic pain. Methods: We analyzed data from the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial which enrolled 250 patients with persistent (3 months or longer) musculoskeletal pain who were receiving care in an United States Department of Veterans Affairs (VA) primary care clinic. The abbreviated three-item SOC scale was used to measure personal coping capability. Participants were categorized into Strong SOC (score 0-1) and Weak SOC (score 2-6). The Brief Pain Inventory (BPI) was used to assess the severity and disability associated with pain. Additionally, pain self-efficacy (ASES) and catastrophizing (CSQ) were assessed. HRQoL was assessed with the 36-item Short-Form Health Survey (SF-36) social functioning, vitality, and general health subscales. Multiple linear regression models were performed to examine whether SOC was independently associated with pain-specific and HRQoL outcomes, after adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities and major depression. Results: Of the 250 study patients, 61% had a strong SOC whereas 39% had a weak SOC. Multivariable linear regression analysis showed that a strong SOC was significantly associated with better general health, vitality, social functioning and pain self-efficacy as well as less pain catastrophizing. These significant findings were partially attenuated, but remained statistically significant, after controlling for major depression. SOC was not significantly associated with pain severity or pain disability. Conclusions: A strong SOC is associated with better HRQoL and self-efficacy as well as less catastrophizing in patients with chronic pain. SOC may be an important coping mechanism (strategy) for patients with chronic musculoskeletal pain. Trial registration: Clinicaltrials.gov Identifier: NCT00926588. - Introduction Musculoskeletal pain is the most common, frequently occurring, disabling and costly of all pain complaints in the primary care setting [1]. Nearly two-thirds of painrelated visits are the result of musculoskeletal pain, representing around 70 million outpatient visits in the U.S. each year [2]. In fact, back pain and joint pain alone lead to approximately 200 million lost work days per year [3,4]. Although pain medications are the second most common prescribed class of drugs in the US primary care setting, analgesics fail to provide adequate relief for many patients [5,6]. Thus, an important aspect of managing chronic pain includes strategies for enhancing coping strategies, reducing pain-related impairment, and improving healthrelated quality of life (HRQoL) and functional status [3,6]. Central to understanding HRQoL and functional status is the fact that certain social factors may maintain health and prevent adverse health consequences. Antonovsky [7] categorized this as the salutogenic orientation. This orientation views the presence of stressors as not an abnormality but rather a pervasive condition for individuals [8]. Antonovsky proposed that Sense of Coherence (SOC) is a key variable in maintaining health [7], postulating SOC as a dispositional orientation (i.e., orientation to life) that can help avert breakdown in stressful conditions through the use of appropriate coping responses [9]. In this sense, SOC is a global measure that indicates the availability of, and willingness to use, adaptive coping resources [8]. SOC has three components: 1) comprehensibility (belief that what happens in life is rational, predictable, and understandable); 2) manageability (belief that resources are available to help resolve difficulties as they arise); and 3) meaningfulness (adversity seen as a challenge and such a difficulty is worthy of engagement). Thus, individuals with a strong SOC, relative to those with a weak SOC, will be more lik (...truncated)


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Neale R Chumbler, Kurt Kroenke, Samantha Outcalt, Matthew J Bair, Erin Krebs, Jingwei Wu, Zhangsheng Yu. Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain, Health and Quality of Life Outcomes, 2013, pp. 216, 11, DOI: 10.1186/1477-7525-11-216