Coping is complicated: Examining the roles of coping strategies and pain self-efficacy for black Veterans with chronic pain

Abstract: Black patients with chronic pain routinely receive insufficient pain management, which contributes to myriad worse outcomes. This inadequate care stems from various factors, including systemic marginalization, provider bias, and patient-level factors. The present study focused on two patient factors: pain self-efficacy and coping strategies. It explored whether the relationship of pain intensity and pain interference was explained by active (less interference) and passive (greater interference) coping strategies, and it investigated if pain self-efficacy strengthened or weakened these mediating relationships. As part of a larger study, Black veterans with chronic pain completed measures assessing pain interference, coping strategies, and self-efficacy. Simple mediation analyses indicated that the relationship between pain intensity and interference was mediated by passive, but not active, coping. Higher pain intensity predicted greater passive coping, which led to worse pain interference. A parallel mediation analysis affirmed this mediating effect when controlling for active coping. Moderated mediation analyses found that pain self-efficacy moderated the mediating effect of passive, but not active, coping. Participants with lower (vs. higher) pain self-efficacy used more passive coping (in absolute terms) across pain intensity levels, but those with higher (vs. lower) self-efficacy experienced greater increases in their passive coping as their pain intensity increased. A parallel moderated mediation analysis affirmed this moderated mediation effect when controlling for active coping. These results suggest that passive coping is a possible mechanism by which pain intensity leads to interference among Black veterans with chronic pain, and that self-efficacy modulates this effect. Future research should replicate these results in other patient samples, investigate other possible moderators (e.g., PTSD), and design interventions to reduce the use of passive coping strategies while simultaneously increasing pain self-efficacy.

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