Strategies of Coping with Chronic Pain as It Relates to the Locus of Control over Health (Strategies of Coping with Chronic Pain)

Transcription

1 Ryszard Kościelak University of Finance and Management in Warsaw Faculty of Psychology Strategies of Coping with Chronic Pain as It Relates to the Locus of Control over Health (Strategies of Coping with Chronic Pain) Abstract The aim of the research undertaken was to establish a possible correlation between the manifested strategies of coping with chronic pain and the locus of control over one s health. The research entailed an examination of a group of 60 women, complaining of chronic pain ailment originating from migraine and a control group of 60 women, not complaining of such ailments. The examined persons consisted of an age bracket between 44 to 55 years old, of a medium to higher educational background. Both groups were tested with MHLC, version B and CSQ. The posited differences between the test and control group were confirmed in terms of locus of pain control over their health and the manifested strategies of coping with pain. Persons with chronic pain ailment were far less likely to attribute control over their own health to themselves as compared to healthy persons. In relation to strategies of coping with pain, both groups most often applied the strategy of a declared or active coping with the pain, with the healthy group being more likely to apply this strategy. The analysis of links between the results of persons examined by the MHLC and CSQ scales has shown a partial significant statistical correlation. Long-term pain represents a serious medical and psychological problem, thus it is most important to understand its mechanisms, reasons and the related psychological make-up of a person. Such research may provide effective help for patients. Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:38

2 52 Ryszard Kościelak Introduction Pain accompanies a person throughout their life, thus it has become the subject matter of numerous sciences, including medicine, biology, psychology and others. Some research conducted on the experience of pain established the correlation between the active strategies of coping with pain and the interior placement of control over one s health (Derbis, Ortenburger, 2004). The positive interrelation between one s own actions and one s belief of the ability to control one s health has been shown in some research focused on finding medical information. This connection, however, was apparent chiefly in persons for whom health was highly valued. In research concerned with finding information it was shown that strategies of combating pain and denials has had the highest influence over coping with pain and illness (Miniszewska, 2002). The quoted results show that there is a possibility of a connection between strategies of coping with pain and the locus of control over one s health. Hence research presented in this articles was undertaken. Longterm pain represents a serious medical and psychological problem, thus it is most important to understand its mechanisms, reasons and the related psychological make-up of a person. Such research may provide effective help for patients. The phenomenon of pain has been know to people since the beginning of time, despite this until the middle of the twentieth century it was treated as a side-effect of an illness, a symptom or the final effect of disturbance in the human body. It is known today that chronic pain is itself a problem and is not always connected with an illness or a bodily disturbance. Pain may pose serious obstacles for a patient, they must learn to live with it, this problem is especially serious if the pain is of a chronic character. Pain also poses a problem for clinicians, particularly in view of their failure to gain the desired effect of elevating the patient s pain after using all the means available. Pain also poses a challenge for scientists attempting to find cures to treat it and to learn about its mechanisms. It also burdens the patient s family, who battle against pain together with Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:38

3 Strategies of Coping with Chronic Pain 53 the patient, and in many situations take upon themselves the maintenance and the fulfillment of needs of the suffering member of family (Derbis Ortenburger, 2004; Gurowiec, 2002). There are many kinds of pain, which have a different biological role and have different inspection mechanisms. Depending on the accepted criteria, there are many divisions of the pain phenomenon. In order to differentiate these kinds of pain I will apply time characteristics to the acute pain and chronic phenomenon. The majority of the conducted research concentrates on acute pains, as these pains are easily triggered. Unfortunately, these results can not be generalized and applied to persons experiencing chronic pain, as their condition is entirely different. Persons experiencing an acute physiological pain often feel fear, which abates only after diagnosis and the commencement of treatment. However, in the case of chronic pain the feeling of fear does not abate after the diagnosis of its cause. Often, in quite the opposite way to acute pain, it increases with time as the illness develops and the treatment does not render effects. Persons suffering from chronic pain can exhibit feelings of helplessness, anger or frustration (Sheridan, Radmacher, 1992). Chronic pain is regarded as a separate medical entity and is distinguished from physiological pain in many aspects. Chronic pain, which lasts even after all known methods of treatment are applied or remains despite no longer fulfilling any necessary functions ceases to be a symptom, but becomes a separate illness (Derbis, Ortenburger, 2004). Chronic pain effects many aspects of the patients live. Often on its basis a chronic pain syndrome develops, which creates constraints in functioning, and can lead to depression and other emotional disturbances, also dependence on medication, family crises and vocational and financial problems (Melzack, Wall, 1999). The origins of the concept of locus of control over one s health was provided by Julian Rotter s theory of social learning. Levenson (1974) continued studies of the locus of control concept. He divided the internal and external control into two separate dimensions (he did not treat them as a continuum). In terms of external localization he described two com- Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:38

4 54 Ryszard Kościelak ponents: those attributed to the control of other people and influences of chance. The described dimensions were used in the research of localization of locus of control over health. They also fall into the scales of the MHLC (Multidimensional Health Locus of Control) questionnaire. In the research (Grissom, Keefe, 1988) on the connection between psyche and experience of pain the existence of a correalation was discovered between active strategies of dealing with pain and the internal locus of control. There are also connections between the strategy of placing faith (or praying) and the belief in the ability to control the experienced pain. In clinical practic e it was observed that if a patient experiencing strong, long-term pain is provided with a sense of control over their pain, the experience of the pain may be reduced. Pain, which can not be controlled is more arduous (Melzack Wall, 1999). People differ between themselves as to their strategies of coping with illness, pain or stress. These strategies remain constant for given person, according to the given situations or task and are dependent on conscious choice, in contrast with the styles of coping, which do not engage conscious processes (Strelau, 2006). Coping has been defined by Lazarus and Folkman (1984) as changing, discovering and behavioral efforts, which are aimed at meeting external and internal demands, as judged by the individual as burdening and depleting their resources. This means that coping is a series of targeted efforts undertaken in connection with a certain judgment of a given situation (Heszen-Niejodek, 2003). It is an ever-changing process and it represents an answer to a threat. Two types of coping were distinguished: that concentrated on the problem and on emotions (Strelau, 2006). Much research is chiefly focused on attempts of isolating the ways of coping with illness, pain, which would aid treatment, foster adaptation to a difficult condition or would delay the development of symptoms. A number of different types of these reactions have been found, for example, denial, acceptance, fight, a feeling of uselessness. Based one research to date, strategies of alleviation and denial have the best influence on coping with illness and pain (Miniszewska, 2002). Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:38

5 Strategies of Coping with Chronic Pain 55 Materials and Methods The subject matter of the undertaken examination was the description of a link between strategies of coping with pain and the locus of a sense of control over the health in persons suffering from chronic pain. The undertaken examinations had the aim of researching the link between different strategies of coping with pain and the sense of control. The undertaken research was also directed at testing whether there are differences, in relation to the choice of strategies and the locus of control, between the group with chronic pain and the control group. Two groups of women were examined. One contained women suffering because of chronic migraine pain and the other, women who did not experience long-term pain ailment. Based on the above-referred to background three main research hypotheses were formulated: 1. The existence of differences between the group with chronic pain ailment and the control group not experiencing such ailments in terms of locus of control over one s health. 2. The existence of differences between the the group with chronic pain ailment and the control group not experiencing such ailments in terms of applied strategies of coping with pain. 3. The existence of a link between the demonstrated strategies of coping with pain and the ability to control one s health in the group of persons with chronic pain. The measurement of strategies of coping with pain was conducted through applying the Pain Coping Strategies Questionnaire (CSQ), polish version ( Juczyński, 2001). The Questionnaire was established in 1983 and the authors were Anne C. Rosenstiel, Frances J. Keefe (1983). The conclusions contained in CSQ originate from a clinical surveys and laboratory research. The test consists of 42 conclusions, which describe different types of coping with pain, and also two questions as to the ability of applying different strategies in order to reduce or eliminate pain. These ways of reducing pain are classified into two cognitive strategies and one behavioral. The questionnaire consists of seven scales: diverting attention, Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

6 56 Ryszard Kościelak reinterpreting pain sensations, catastrophizing, ignoring pain sensations, praying (having faith), declared self-copping and active coping with pain. The remaining two questions of control over the ability to reduce pain have been split. The patients provide answers on Likert s seven level scale. The questionnaire has sufficient psychometrical parameters. Internal consistency of the entire questionnaire is based on Cronbach s α and is CSQ is applied to an examination of adults, who demonstrate pain symptoms. It is also possible to examine healthy persons with it. The questionnaire enables one to predict adaptation of a patient to situations of chronic pain and to adjudge abilities of applying different strategies of coping with pain ( Juczyński, 2001). The locus of control over health was tested using the Multidimensional Health Locus of Control Scale (MHLC) polish version ( Juczyński, 2001). MHLC was developed by Kenneth A. Wallston, Barbara S. Wallston, Robert DeVellis (1978). The test is available in two versions (A and B) and is a development on an earlier one-dimensional scale. Both versions of the test are equally valid. For the purpose of this research, version B of the questionnaire was chosen, as it is characterized by a higher stability compared to version A. Levenson (1974) theory provides the theoretical basis for MHLC. Cronbach s α indicator for version B is: for internal control 0.64, influence of chance 0.59, other influences The MHLC scale consists of 18 items, which describe the examine person s beliefs. Scale W relates to self-control over one s health, scale I describes the attribution of control to others (especially doctors), whereas scale P contains statements attributing the decisive role to chance. MHLC may be used in advancement of healthy living and in epidemiological research. The results must be shown with the aid of combining all three scales. The higher the result on a given scale the stronger the belief of the examined person about the deciding role of a given factor ( Juczyński, 2001). The research was carried out on a group of 120 women: 60 were the test group, 60 were the control group. The participating women were aged between 45 to 55 years old, the average age was 49.6 (the median being 50 years), in the control group 50.2 (median 50.5 years). In both Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

7 Strategies of Coping with Chronic Pain 57 groups there was an even educational divide between secondary and tertiary education. The test group was selected deliberately to contain persons suffering from chronic pain related to migraine. All women belonging to the test group had been diagnosed to be suffering from chronic pain and were undergoing therapy. The length of time of the ailment in the tested persons varied, but it was assumed that it had to be present for at least 6 months. The control group contained persons not complaining of chronic pain and not undergoing any related treatment. At the beginning of each examination information was given to the participants as to the purpose of the research and manner of responding. The examined persons completed questionnaires themselves and voluntarily in the presences of the examiner, they were not remunerated for their participation in the research. The examination was carried out in a relaxed atmosphere, at the place of residence of the participants, with no third parties being present. The persons examined were informed of the anonymity of their answers. Additional data collected from the women participating in the research concerned their age and their education. Examination using the CSQ questionnaire lasted about 15 to 20 minutes. The examined persons indicated their experience of pain sensation on a seven level scale of reactions (0 never, 6 always). The completion of MHLC questionnaires took the examined persons around 10 minutes. Prior to the commencement of the examination, the examined persons were requested to provide honest opinions in accordance with their own beliefs. The examined persons described their opinion to the statements on a six level scale (from 1 I definitely agree to 6 I definitely disagree). Most of the examined persons displayed an interest in the examination. Results The calculated descriptive statistics of the MHLC and CSQ scales enabled comparison of the average results of the tests in both groups, which Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

8 58 Ryszard Kościelak allowed for the verification of the two initial hypotheses. In order to verify the third hypothesis, an analysis of the correlations between the scales of both questionnaires was carried out. Table 1 contains the description of the statistical results of the examined group (N = 60) in three scales of the MHLC questionnaire in version B: internal locus of control over health, control by others and the control by chance. Table 1. Descriptive statistics of the results of the test group relating to MHLC questionnaire, version B Selected descriptive statistics Scale: Average Median Dominant Skew Kurtosis Minimum Maximum Internal control Control by others Control by chance In the test group there was a tendency of attributing more to the control by chance. The arithmetical average (x = 22.07) and the median (Me = 22) is in this scale is greater than in the remaining two. Women in the test group chose chance as the factor having the greatest control over their health. Internal control and the control by others are both on a similar level. It is important to remember, however, that the questionnaire is based on the Levinson concept and that both the control by others and the influence of chance represent indicators of external control. Consequently, it may be supposed that for women in the test group the belief of external control over their health is dominant. The distribution of the examined features in the test group is approximately normal, as the skew and kurtosis fit the range ( 1.1). Table 2 contains the descriptive statistics of the control group (N = 60) in three scales of the MHLC questionnaire in version B: internal locus of control over health, control by others and the control of chance. The Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

9 Strategies of Coping with Chronic Pain 59 examined persons from the control group chose themselves as the most important factor of influence over their health. The dominant feature is internal control: the arithmetic average and the median are higher than in the two other scales. The distribution of the examined features in the test group is close to normal, as the skew indicator fits the range ( 1.1). The results of the influence of chance scale exceed the range. This means that an extremely strong positive skew has occurred and the distribution of this feature in the control group is not normal. Table 2. Descriptive statistics of the results of the control group relating to MHLC questionnaire, version B Selected descriptive statistics Scales Average Median Dominant Skew Kurtosis Minimum Maximum Internal control Control by others Control by chance Hypothesis 1 assumes that there are differences between the group with chronic pain ailment and the control group not complaining of such ailments relating to the locus of control over health. Differences have emerged between the test group and the control group. In the test group the dominant belief relating to control over health is that it is largely influenced by chance. However, in the control group the dominant belief was internal control. The most significant difference between averages was shown in the internal locus of control, whereas in the other scales the differences are not as significant. To analyze the relevance of differences in the scales of internal control and other control a parametric test was used, as the results confirm the model assumptions of the test. In the case of the scale of influence by chance it had to be considered whether the test in parametric, as the data did not met the model assump- Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

10 60 Ryszard Kościelak tions of the parametric test: skew and kurtosis go beyond the range ( 1.1), thus the distribution of characteristics is not normal. For the internal control scale and other controls test t was applied for non-dependent samples, the scale of control of chance was analyzed using Manna-Whitney U test. The results of the analysis of the significance of the differences between both groups in the MHLC questionnaire, version B, is shown in Table 3. Table 3. The significance of differences between the averages of the test and control groups in the MHLC questionnaire Scales Student s t test Significance Manna- -Whitney s U Test Significance (p) Internal control t(49) = x x Control by others t(56) = x x Control by chance x x Z = In the scale of internal locus of control of health the observed differences between the groups proved to be significant (p < 0.01). In the scale of control by others the observed differences of averages for both groups were not as significant. In accordance with expectations, the differences did not prove to be significant (p > 0.05). This means that persons in the test group do not differ significantly from the control group in attributing their pain to control by others. In relation to the differing control by chance the significance of the differences between the averages was calculated by using Manna- -Whitney U test. As a result of size of the sample being greater than 20 persons, the U statistics were recalculated to Z statistics for greater groups. The difference between the two groups proved to be insignificant. The significance was very far from the allowable threshold (p < 0.05). The differences between the groups in relation to the locus of sense of control over health showed chiefly on the internal control scale. Persons with chronic pain ailment are less likely to attribute control over their health to themselves compared with healthy persons. In terms of attribut- Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

11 Strategies of Coping with Chronic Pain 61 ing control over their health to other people or the influence of chance the differences were not great and not significant statistically. Table 4 contains descriptive statistics of the results of the test group (N = 60) in the seven scales of the questionnaire CSQ. Table 4. Descriptive statistics of the results of the test group relating to the CSQ questionnaire Selected descriptive statistics Scales Average Median Dominant Skew Kurtosis Minimum Maximum Diverting attention Reinterpreting pain sensations Catastrophizing Ignoring Praying Declared self- -coping Active coping Control over pain Reduction of pain Women in the test group most often apply the strategy of declared self-coping and praying. In these scales the average of the results is the greatest. The less often applied strategies are strategies of active coping, diverting attention and catastrophizing, whereas the examined persons least often apply the strategies of reinterpreting pain sensations and ignoring them. The examined person perceive their ability of controlling pain as not much greater than average, and their ability to reduce pain as less than Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

12 62 Ryszard Kościelak average. The distribution of characteristics of catastrophizing, ignoring, declared self-coping may be regarded as normal, as the skew and kurtosis in these scales fits the range ( 1.1). In the remaining scales (detracting attention, reinterpreting pain sensations, praying) the skew fits the range, but kurtosis goes beyond the accepted range. The distribution of the characteristics cannot therefore be regarded as normal. Table 5 contains the statistical description of the results of the test group (N = 60) in the seven scales of the questionnaire CSQ. Table 5: Descriptive Statistics of the results of the control group in the questionnaire CSQ Selected Descriptive Statistics Scales Average Median Dominant Skew Kurtosis Minimum Maximum Diverting attention Reinterpreting pain sensations Catastrophizing Ignoring Praying Declared selfcoping Active coping Control over pain Reduction of pain Hypothesis 2 assumes differences between the test group and the control group in relation to the manifested strategies of coping with pain. In order to check whether differences between the groups in the Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

13 Strategies of Coping with Chronic Pain 63 results of the CSQ questionnaire are significant the Mann-Whitney non-parametrical U test was applied to all scales apart from the scale of increased active coping. This test was chosen as the scale of the questionnaire did not meet the model parametric test: skew and kurtosis go beyond the range ( 1.1) or the variations in groups do not differ (the test was used to check the homogeneity of the Leven variations). Whereas the scale of increased active coping was calculated using the student s t test for independent samples. The results of the analysis of the significance of differences between the results of both groups in the CSQ questionnaire are presented in Table 6. Table 6. The significance of differences between the results of the test and control group in the CSQ questionnaire Scale Manna- -Whitney U test Significance (p) Student s test t Significance (p) Diverting attention Reinterpreting pain sensations Z = x x Z = x x Catastrophizing Z = x x Ignoring Z = x x Praying Z = x x Declared self- -coping Z = x x Active coping x x t(58) = Control over pain Reduction of pain Z = x x Z = x x Differences between the test group and the control group in the results of the CSQ questionnaire proved to be significant only in two scales: declared self-coping and active coping. The differences between the average in the declared self-coping scale were calculated using Mann-Whitney U test. As a result of size of the sample being greater than 20 persons, Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

14 64 Ryszard Kościelak the U statistics were recalculated to Z statistics for greater groups. The difference between them proved to be statistically significant to the level of p < In the scale of increased active coping, the significance of differences was calculated applying the parametric student s t test for independent samples. The difference between them proved to be statistically significant to the level of p < In accordance with expectations in the remaining scales the differences between the two groups proved to be not significant statistically (p > 0.05). This means that the women in the test group do not differ significantly in terms of applying these strategies (diverting attention, reinterpreting pain sensations, catastrophizing, ignoring pain sensations, praying, control over pain and the ability to reduce pain) from the women in the control group. The significance of the differences in these scales varies significantly form the allowable level. The differences between the averages in theses scales were calculated applying Mann- Whitney U test. Hypothesis 2 concerning the existences of differences between the group with chronic pain ailments and the control group in relation to the applied strategies of coping with pain was proved. These differences are demonstrated only in two scales, however, of declared self-coping and active self-coping. It is impossible to conclude in this case about the frequent application of these strategies by one of the groups and not using of this strategy by the other, as both groups obtained high results in relation to the scale of declared self-coping and active coping. This means that both groups frequently apply both these strategies, but the women in the control group demonstrate a significant intensity of applying them. In the test group the scale of praying also showed higher results, however the differences between the two groups were not statistically significant. In hypothesis 3 it was assumed that there is a link between manifested strategies of coping with pain and the locus of controlling one s health in the group with chronic pain. In persons with chronic pain demonstrating an internal locus of control the predominant strategies are diverting attention, reinterpreting pain sensations, ignoring of pain sensations and active coping with pain. Persons with chronic pain demonstrating an external Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

15 Strategies of Coping with Chronic Pain 65 locus of control chiefly apply the strategies of catastrophizing and having faith (praying). Kendall s tau test was used tn order to verify the third hypothesis. The test appropriate for changeable variables is Pearson s r, however, due to the fact that the data do not meet the model expectations of this type of test, a non-parametric test was chosen. The tau-kendall rating uses a value scale from 1 to + 1. The absolute value shows the strength of this dependence, the closer it is to 1 or 1 the stronger the dependence. Whereas the coefficient points to the direction of the dependence. Table 7 shows the results of the analysis of the correlation between the scales of the questionnaire MHLC in version B and CSQ relating to the test group. The analysis has shown that there are significant statistical correlations between the scale of the MHLC test attributing of control over health to chance with the scale of the CSQ questionnaire ignoring pain sensations and the MHLC scale control by chance with the CSQ scale praying. Both correlation have a moderate value (fitting the range of 0.3 to 0.5) and are positive correlations. Co-variability of the correlating scales is simple. The correlation did not occur in comparing the MHLC scale relating to the influence of chance and the CSQ scale relating to the ability to control pain described by the examined persons. Table 7. Correlation between the scales of test MHLC, version B and CSQ in the test group Correlations Correlated scales Kendall s tau Bilateral Significance (p) MHLC internal and CSQ Diverting of attention MHLC internal and CSQ Reinterpreting MHLC internal and CSQ Catastrophizing MHLC internal and CSQ Ignoring MHLC internal and CSQ Praying MHLC internal and CSQ Declared self-coping MHLC internal and CSQ Active coping MHLC internal and CSQ Control over pain Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

16 66 Ryszard Kościelak Table 7. Correlation between the scales, cont. Correlated scales Correlations Kendall s tau Bilateral Significance (p) MHLC internal and CSQ Reduction of pain MHLC others and CSQ Diverting of attention Correlated scales Kendall s tau Bilateral Significance (p) MHLC others and CSQ Reinterpreting MHLC others and CSQ Catastrophizing MHLC others and CSQ Ignoring MHLC others and CSQ Praying MHLC others and CSQ Declared self-coping MHLC others and CSQ Active coping MHLC others and CSQ Control over pain MHLC others and CSQ Reduction of pain MHLC chance and CSQ Diverting of attention MHLC chance and CSQ Reinterpreting MHLC chance and CSQ Catastrophizing MHLC chance and CSQ Ignoring MHLC chance and CSQ Praying MHLC chance and CSQ Declared self-coping MHLC chance and CSQ Active coping MHLC chance and CSQ Control over pain MHLC chance and CSQ Reduction of pain The third examination hypothesis was partly proven. There were links between the demonstrated strategies of coping with pain and the locus of control of one s health in the group of persons with chronic pain. The strongest and equally significant statistically correlations connect the scale of control by chance (MHLC) and the scales of ignoring pain sensations and praying (CSQ). Other links are weak, but also occur, with the exception of a lack of correlation between control by chance (MHLC) and own Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

17 Strategies of Coping with Chronic Pain 67 control of pain (CSQ). The correlation between the remaining scales in the questionnaire exist, however they are not completely as assumed in the hypotheses detailed. It emerged that in the examined group, person with internal locus of control do not apply the strategy of diverting attention there was a slight negative correlation. They also do not apply strategies of reinterpreting pain sensations, ignoring pain sensations and active coping in this case there was a slight correlation with a negative characteristic, but it was insignificant. The link between the internal control of health with the strategy of ignoring pain sensations was partially proven, a weak positive correlation between the scales was shown. It is not significant, however it is possible that with greater size of the group the significance would be at the appropriate level. It emerged also that the strategy of ignoring pain sensation is more often applied by the examined persons with an external locus of control (control by chance) rather then persons with internal control. In the third hypothesis persons with chronic pain with an external locus of control were assumed to apply catastrophizing and having faith (praying) strategies. Internal locus of control, according to Levinson s theory, consists of control by others and the influence of chance. The application by the examined persons of catastrophizing was demonstrated in both scales of external locus of control. There were positive correlations, however of weak intensity. They proved to be statistically insignificant, however with a greater group size they would have been significant. In the case of applying the strategy of praying, the examination results were diversified. In persons attributing control over their health to other people the correlation was insignificant. In persons believing in the influence of chance, the application of praying strategy was demonstrated. A moderate correlation was observed between scales, which proved to be statistically significant. It emerged then that the third hypothesis was proved partially. Only a weak, not significant statistically correlation between the internal control of health and the strategy of ignoring pain sensations was shown, whereas there was a moderate statistically significant positive correlation of attributing control over health to chance and the strategy of praying, a weak correlation between the strategy of catastrophizing and the control by others and control by chance was Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

18 68 Ryszard Kościelak also shown (both these correlations were not significant statistically). The connection between the strategy of praying and control of others was not proved (the correlation was insignificant). In contrast to the forwarded additional hypotheses, the strategy of active coping with pain does not correlate negatively with external control and positively with external locus of control. A number of more pronounced correlations were also observed, these were not however statistically significant. In the examined group a result in the scale of attributing control over health to others shows a positive link with the scale of declared self-coping with pain and a negative link with scales of reduction of pain and reinterpreting pain sensations. With examined persons attributing control over health to chance a negative correlation with the scale of reducing pain and a positive correlation with declared self-coping was shown. For comparison, the correlation between the scales of MHLC questionnaire, version B and CSQ in the control group was also calculated. The results of the analysis were presented in Table 8. Table 8. Correlations between the scales of the MHLC test, version B and CSQ in the control group Correlated scales Correlations Kendall s tau Bilateral Significance (p) MHLC internal and CSQ Diverting of attention MHLC internal and CSQ Reinterpreting MHLC internal and CSQ Catastrophizing MHLC internal and CSQ Ignoring MHLC others and CSQ Praying MHLC internal and CSQ Declared self-coping MHLC internal and CSQ Active coping MHLC internal and CSQ Control over pain Correlated scales Kendall s test Bilateral Significance (p) MHLC internal and CSQ Reduction of pain MHLC others and CSQ Diverting of attention MHLC others i CSQ Reinterpreting Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

19 Strategies of Coping with Chronic Pain 69 MHLC others i CSQ Catastrophizing MHLC others i CSQ Ignoring MHLC others i CSQ Praying MHLC others and CSQ Declared self-coping MHLC others and CSQ Active coping MHLC others and CSQ Control over pain MHLC others and CSQ Reduction of pain MHLC chance and CSQ Diverting attention MHLC chance and CSQ Reinterpreting MHLC chance CSQ Catasphrophizing MHLC chance and CSQ Ignoring MHLC chance and CSQ Praying MHLC chance and CSQ Declared self-coping MHLC chance and CSQ Active coping MHLC chance and CSQ Control over pain MHLC chance and CSQ Reduction of pain The analysis of results of the control group showed significant correlations between the internal control of health (MHLC scale) and the scale of active coping (CSQ) and between the scale of control by chance (MHLC) and declared self-coping (CSQ). The first of these links has a low value (less than 0.3) and it is a negative correlation. This means that in the control group, the greater the declared internal control over health the rearer the application of active coping strategy is. The second significant correlation has a moderate value (it falls within the range of ) and is a positive correlation. Similarly to the test group there was no correlation between the MHLC scale of control by chance and the CSQ scale of self-control over pain. In the remaining scales there were positive and negative correlations of varying intensity, which proved to be not significant statistically. There were also two more clearer correlations, these were not, however, statistically significant. The results of the control group in the scale of internal locus of pain control showed negative link with the ability of coping with pain. With persons attributing control over Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

20 70 Ryszard Kościelak their health to others a positive link with the scale of praying (having hope) became apparent. The remaining correlations were very low. The test group differs from the control group in relation to the value of correlations between the scales of the questionnaires. It was shown that person from the test group attributing control over their health to chance apply the strategy of ignoring pain and praying, further persons demonstrating the belief of control by others and by chance apply the strategies of catastrophizing and active coping with pain. In the control group these dependencies were not clear or did not occur. In healthy persons demonstrating the belief of control by others there is a correlation with the strategy of praying and in persons with a control of chance belief, the strategy of declared selfcoping with pain. A positive link between coping with pain and an internal locus of control was observed in the test group, and a negative correlation between this strategy and the strategy of internal coping was observed in the control group. All the calculations were arrived at with the help of the program SPSS for Windows (version 12.0 PL). During the use of the program the book Metody badawcze w naukach społecznych (Frankfort-Nachmias, Nachmias, 2000) proved helpful. Discussion The conducted research had the goal of obtaining answers to the research hypotheses put forwarded. The group of women with chronic pain were subjected to a MHLC test, version B and CSQ. For comparison of results a group of healthy women were also examined (control group). In the test group the results showed that the internal locus of control may lead to these persons applying ineffective strategies of coping with pain. Lots of research points to the fact that persons with an internal control locus cope better in difficult situations. Faith in one s own strengths has a positive impact on the process of healing and the well-being of patients. Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

21 Strategies of Coping with Chronic Pain 71 Other research points to the fact that persons with external control follow doctor s orders better (Heszen, Sęk, 2007). The results obtained in the test group demonstrate the dominance of control by chance (external control) over other scales in the questionnaire. In comparison with the control group, it was shown, that women with chronic pain demonstrate a significantly greater rate of attributing control over their health to chance. In the control group, healthy women most often demonstrate an internal locus of control. In comparison of MHLC results obtained by Juczyński (2001) based on a group of healthy persons of over 36 years, the test group showed lower results in all scales of the questionnaire and a different distribution of answers. In the test group the attribution of control to chance is dominant, whereas in Juczyński s research, in the group of persons over 36 years old the examined persons showed an internal locus of control. The control group obtained similar results as those obtained by Juczyński in the group over 36 years. In the research, the existence of differences between the group with chronic pain ailments and the control group in relation to their locus of controlling pain was assumed. The assumed differences are clear and statistically significant only in relation to the scale of internal locus of control. In the remaining scales the observed differences proved to be insignificant, but in relation to the scale of control by others they did not diverge much from the assumed level of significance (p < 0.05). The attribution of control to chance and the influence of others (external control) is connected with an increase of the state of patient s dissatisfaction, an increase in negative emotions and leads to the cessation of actions leading to the satisfaction of the individual (Marcinkowska-Bachlińska, Małecka- Panas, 2006). It is clear from some of the conducted research that external locus of control is connected with an increase in pain sensations and the choice of less effective strategies of coping with it. Both groups were examined using the CSQ questionnaire to examine the manifested strategies of coping with pain. The test group most often applies the strategy of declared self-coping and of praying, and less often applies diverting attention and active coping. However, healthy persons Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

22 72 Ryszard Kościelak in the control group most often apply the declared self-coping strategy. A hypothesis was raised during the research regarding the existence of differences between the application of different strategies by the group of persons with chronic pain and by healthy persons. These differences were shown in all scales, however only two of them, the scale of declared self-coping and active coping, proved to be statistically significant. It is impossible however to conclude in this case the application of these strategies by one of the groups and the non-application by the other, as both groups most often apply these strategies. The control group applies these strategies to a greater level than the test group. In research conducted by Marcinkowska-Bachlińska and Małecka-Panas (2006) the gained results point to a more frequent application of the strategy of castastrophizing and praying by the ill persons. The quoted research was conducted on a selected group of persons with refluxive disease during which chronic pain ailments occur. In comparing the author s own research with the abovereferred to, it was observed that the group with chronic pain divers to the group with refluxive disease in the extend of applying the castastrophizing strategy, in the group with chronic pain this strategy is not a strategy applied most often. In relation to the strategy of praying there is a greater similarity between the two groups, which may be influenced by the particularity of the examined group. In the examinations conducted on persons with chronic pain significant positive correlations occurred between the external control and the scale of ignoring pain sensations and praying. This means that the more persons with chronic pain are convinced about the control by chance of occurrences the more likely they are to apply the strategy of ignoring pain sensations and praying. The correlations between the majority of scales of the questionnaire (excluding the absence of a link of control by chance and own control of pain) were shown. Two of these correlations proved to be statistically significant. Only a partial confirmation was established between the result in the MHLC and CSQ scales. It was assumed that particular strategies will occur more often with a greater result of an appropriate locus of control. The internal locus of control was to correlate Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

23 Strategies of Coping with Chronic Pain 73 with diverting attention, reinterpreting pain sensations, ignoring pain sensations and active coping. It emerged that in a given examined group, persons with internal locus of control do not apply the strategy of diverting attention or reinterpreting pain sensations or active coping very often. In relation to the link between the internal control of health and the strategy of ignoring pain sensations, a weak (insignificant) positive correlation between the scales was shown. It also appeared that the strategy of ignoring pain is more often applied by examined persons with external control locus rather than internal control locus. In the test group with internal control locus, the greatest link occurred between strategies of active coping and pain reduction. This correlation is however insignificant and negative, this means that persons in chronic pain, the greater the internal control the less likely the examined persons apply these strategies. In the third hypothesis the assumption related to the existence of a connection between external locus of control with person with chronic pain and the more frequent application of catastrophizing and praying (having faith). According to Levinson s theory the external locus of control consists of control by others, and the influence of chance. In both of these scales a positive correlation with the strategy of catastrophizing was shown. In relation to the application of the strategy of praying (having faith) the results of the examinations were diverse. In persons attributing control over their health to other people the correlation was slight. In persons believing in the influence of chance the application of the praying strategy was confirmed. The hypotheses forwarded in the undertaken research were at least partially confirmed. Between the group with chronic pain and the group with healthy persons there were differences in the locus of control of health. These were manifested mainly in relation to internal control and were most apparent and statistically significant. The group of persons with chronic pain significantly more rarely demonstrated an internal locus of control than the group of healthy persons. More often, however, it believed in the control by chance. Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39

24 74 Ryszard Kościelak The group with chronic pain differs from the healthy group in relation to the applied strategies of coping with pain. The statistically significant differences were shown to in the scale of declared and active coping with pain. Both groups most often apply these strategies, but in the control group this is more frequent. Further the test group applies the strategy of praying more often then the control group. There were correlations between the scales of the MHLC questionnaire and CSQ. The strongest correlations were in relation to control by chance and ignoring pain sensations and praying. The greater the belief of persons with chronic pain that of the control by chance of occurrences, the more often they would apply the strategy of ignoring pain sensations and praying. One of the directions of further research could be the comparison of men and women based on the assessment described herein. Both genders differ in many ways, including the brain construction, body, hormonal reactions, emotionally and socially. Men are physically stronger, relating to an one-time effort, and more resistant to stress. Women on the other hand, cope better with long term activation, sleep disturbances, but are more sensitive to acute pain. They react to it quicker and more severely, but their ability to withstand long-term suffering is greater. Similar differences exist in relation to sensitivity to touch. The results of observations show that these differences exist, it would be useful to research these dependencies in comparison with coping with pain and the locus of control in men and women (Moir, Jessel, 1991). Many people agree with the stereotypical viewpoint that men apply strategies of coping with pain concentrated on the problem, whereas women on emotions. Some of the research confirms this viewpoint. However in others where the differing social positions or education were taken into account, the differences proved to be only slight. The way of dealing with pain depends on one s status, financial resources, personal characteristics and social code. It would certainly be worth it to examine these correlations in terms of coping with pain (Sęk, Cieślak, 2006). An analysis similar to the one above could also be conducted on children and teenagers. Skowrońska and Szewczyk (2001) conducted exami- Plopa(red.)Polish...l_vol.4no1 (wersja 2_s. 234).indd :02:39