The Journal of the Korea Contents Association (한국콘텐츠학회논문지)

The Korea Contents Association (한국콘텐츠학회)
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Mediating Effect of Coping Strategies in the Relationship between Pain Beliefs and Depression, Pain Disability among Chronic Back Pain Patients

만성요통환자에서의 통증신념과 우울, 통증생활방해와의 관계에서 대처전략의 매개효과

  • 김경아 (연세대학교 간호대학 일반대학원) ;
  • 추상희 (연세대학교 간호대학 김모임 연구소)
  • Received : 2017.08.31
  • Accepted : 2017.10.15
  • Published : 2017.10.28
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Abstract

The Purpose of this study was to investigate of coping strategies(active and passive) between pain beliefs and depression, pain disability among chronic back pain patients. Data were analyzed by the SPSS-WIN 21.0 program. Indirect SPSS macro(Bootsrapping)was used to analyze the multiple-mediation model of this study. The result showed that the mean score for pain belief was $3.42{\pm}9.67$, and he passive coping strategies was $29.68{\pm}8.04$, active coping was $25.49{\pm}4.22$. The mean score of depression was $25.49{\pm}11.56$. The pain disability index was $46.94{\pm}12.65$. It found that there were significant correlations among the 5 variables. The multiple mediated effects of passive coping and active coping on pain beliefs and depression were (b=.453, 95% CI=.228, .703) and on pain beliefs and pain disability were (b = .285, 95% CI = .131, .519) in chronic low back pain patients. This study discovered that the active coping strategies had a positive mediating effect in the relationship between pain beliefs and depression, pain beliefs and pain disability. And passive coping strategies had a negative mediating effect. Based on findings of this study, improving the active coping strategy programs or management is highly recommended in chronic back pain patients.

본 연구는 만성 요통 환자의 통증 신념과 우울, 통증 신념과 통증생활방해 사이의 통증대처(능동적 대처와 수동적 대처)의 매개 효과를 확인하고자 하였다. 수집된 자료는 SPSS-WIN 21.0 프로그램으로, 다중매개 효과는 Indirect SPSS macro (Bootsrapping)를 사용하여 분석하였다. 분석결과 통증신념은 $3.42{\pm}9.67$점이었고, 수동적 대처 $29.68{\pm}8.04$점, 능동적 대처 $25.49{\pm}4.22$점, 우울은 $25.49{\pm}11.56$점, 통증생활방해는 $46.94{\pm}12.65$점 이었으며, 이 5 가지 변수 간에 유의한 상관관계가 있었다. 만성요통 환자의 통증신념과 우울 사이에서 수동적 대처와 능동적 대처의 다중매개효과는 (b=.453, 95% CI=.228, .703)로 유의하였다. 통증신념과 통증생활방해에서 수동적 대처와 능동적 대처의 다중매개효과는 (b=.285, 95% CI=.131, .519)로 유의하였다. 능동적인 대처 전략은 통증 신념과 우울, 통증생활방해 사이의 관계에 긍정적인 중재 효과로 작용할 수 있음을 발견하였으며, 수동적 대처 전략은 부정적인 효과를 보임을 알 수 있었다. 따라서 만성 요통 환자를 대상으로 능동적 대처를 늘리는 대처 전략 프로그램이 필요하다.

Keywords

References

  1. http://health.mw.go,kr.
  2. F. Bailly, V. Foltz, S. Rozenberg, B. Fautrel, and L. Gossec, "The impact of chronic low back pain is partly related to loss of social role: A qualitative study," Joint Bone Spine, Vol.82, No.6, pp.437-441, 2015. https://doi.org/10.1016/j.jbspin.2015.02.019
  3. 정의균, 곽연희, 송재석, "만성 통증이 한국의 의료 이용 행태에 미치는 영향," 한국콘텐츠학회논문지, 제15권, 제2호, pp.363-369, 2015. https://doi.org/10.5392/JKCA.2015.15.02.363
  4. C. Stern, "Summaries of nursing care-related systematic reviews from the Cochrane Library: Bed rest for acute low-back pain and sciatica," Int J Evid Based Healthc, Vol.8, No.3, pp.153-154, 2010. https://doi.org/10.1111/j.1744-1609.2010.00172.x
  5. 석세일, 척추외과학, 최신의학사, 1997.
  6. D. A. Williams and B. E. Thorn, "An empirical assessment of pain beliefs," Pain, Vol.36, No.3, pp.351-358, 1989. https://doi.org/10.1016/0304-3959(89)90095-X
  7. J. A. Turner, M. P. Jensen, and J. M. Romano, "Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?," Pain, Vol.85, No.1-2, pp.115-125, 2000. https://doi.org/10.1016/S0304-3959(99)00259-6
  8. O. Airaksinen, J. I. Brox, C. Cedraschi, J. Hildebrandt, J. Klaber-Moffett, F. Kovacs, A. F. Mannion, S. Reis, J. B. Staal, H. Ursin, and G. Zanoli, "Chapter 4. European guidelines for the management of chronic nonspecific low back pain," Eur Spine J, Vol.15, No.2, pp.192-300, 2006. https://doi.org/10.1007/s00586-006-1072-1
  9. B. M. Hoffman, R. K. Papas, D. K. Chatkoff, and R. D. Kerns, "Meta-analysis of psychological interventions for chronic low back pain," Health Psychol, Vol.26, No.1, pp.1-9, 2007. https://doi.org/10.1037/0278-6133.26.1.1
  10. A. Cabak, A. Dabrowska-Zimakowska, A. Truszczynska, P. Rogala, K. Laprus, and W. Tomaszewski, "Strategies for Coping with Chronic Lower Back Pain in Patients with Long Physiotherapy Wait Time," Med Sci Monit, Vol.21, pp.3913-3920, 2015. https://doi.org/10.12659/MSM.894743
  11. C. Richardson and H. Poole, "Chronic pain and coping: a proposed role for nurses and nursing models," J Adv Nurs, Vol.34, No.5, pp.659-667, 2001. https://doi.org/10.1046/j.1365-2648.2001.01795.x
  12. G. K. Brown and P. M. Nicassio, "Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients," Pain, Vol.31, No.1, pp.53-64, 1987. https://doi.org/10.1016/0304-3959(87)90006-6
  13. N. C. Higgins, S. J. Bailey, D. L. LaChapelle, K. Harman, and T. Hadjistavropoulos, "Coping Styles, Pain Expressiveness, and Implicit Theories of Chronic Pain," J Psychol, Vol.149, No.7, pp.737-750, 2015. https://doi.org/10.1080/00223980.2014.977759
  14. I. Molton, M. P. Jensen, D. M. Ehde, G. T. Carter, G. Kraft, and D. D. Cardemas, "Coping with chronic pain among younger, middle-aged, and older adults living with neurological injury and disease," J Aging Health, Vol.20, No.8, pp.972-996, 2008. https://doi.org/10.1177/0898264308324680
  15. 신윤식, 만성요통 환자들에서 스트레스 지각과 대응 전략간의 관계, 연세대학교, 석사학위논문, 2001.
  16. 금정화, 통증 대처 및 무력감의 관계연구, 공주대학교 대학원, 석사학위논문, 2011.
  17. 김인자, 이은옥, "만성 요통 환자의 대처 유형과 건강 통제위, 자기효능감과의 관계," 류마티스 건강학회지, 제2권, 제1호, pp.1-16, 1995.
  18. 임유경, 최영민, 최지영, "기질 및 성격, 스트레스 대처방식과 우울증의 관계:정신과 내원 우울장애 환자들을 대상으로," 한국심리학회지, 제32권, 제2호, pp.331-350, 2013.
  19. 박순복, 우주영, "당뇨병 환자들의 내외통제성과 스트레스 대처능력이 우울함에 미치는 영향," 재활심리연구, 제19권, 제3호, pp.569-582, 2012.
  20. 차보경, 류마티스 관절염 환자의 통증 예측 모형, 고려대학교, 박사학위 논문, 2000.
  21. B. A. B. D. Inventory, Psychological Corporation, San Antonio, TX, 1978.
  22. Y. H. Lee and J. Y. Song, "A Study of the Reliability and the Validity of the BDI, SDS, and MMPI-D Scales," Korean Journal of Clinical Psychology, Vol.10, pp.98-113, 1991.
  23. C. A. Pollard, "Preliminary validity study of the pain disability index," Perceptual and motor skills, Vol.59, No.3, p.974, 1984. https://doi.org/10.2466/pms.1984.59.3.974
  24. M. Osterweis, A. Kleinman, and D. Mechanic, Pain and Disability: Clinical, Behavioral and Public Policy Perspectives, National Academy Press, Washington, DC, 1987.
  25. K. J. Preacher and A. F. Hayes, "Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models," Behav Res Methods, Vol.40, No.3, pp.879-891, 2008. https://doi.org/10.3758/BRM.40.3.879
  26. S. Ferrari, A. Chiarotto, M. Pellizzer, C. Vanti, and M. Monticone, "Pain Self-Efficacy and Fear of Movement are Similarly Associated with Pain Intensity and Disability in Italian Patients with Chronic Low Back Pain," Pain Pract, 2015(11).
  27. J. Soares and G. Grossi, "The relationship between levels of self-esteem, clinical variables, anxiety,depression and coping among patients with musculoskeletal pain," Scandinavian Journal of Occupational Therapy, Vol.7, pp.87-95, 2000. https://doi.org/10.1080/110381200750018887
  28. L. P. Barakat, L. A. Schwartz, K. Simon, and J. Radcliffe, "Negative thinking as a coping strategy mediator of pain and internalizing symptoms in adolescents with sickle cell disease," J Behav Med, Vol.30, No.3, pp.199-208, 2007. https://doi.org/10.1007/s10865-007-9103-x
  29. C. Ramirez-Maestre, R. Esteve, and A. E. Lopez, "Cognitive appraisal and coping in chronic pain patients," Eur J Pain, Vol.12, No.6, pp.749-756, 2008. https://doi.org/10.1016/j.ejpain.2007.11.004
  30. I. E. Lame, M. L. Peters, J. W. Vlaeyen, M. Kleef, and J. Patijn, "Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity," Eur J Pain, Vol.9, No.1, pp.15-24, 2005. https://doi.org/10.1016/j.ejpain.2004.02.006
  31. D. A. Jones, G. B. Rollman, K. P. White, M. L. Hill, and R. I. Brooke, "The relationship between cognitive appraisal, affect, and catastrophizing in patients with chronic pain," J Pain, Vol.4, No.5, pp.267-277, 2003. https://doi.org/10.1016/S1526-5900(03)00630-8
  32. E. Misterska, R. Jankowski, and M. Glowacki, "Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control," Med Sci Monit, Vol.19, pp.1211-1220, 2013. https://doi.org/10.12659/MSM.889729
  33. Y. M. Ko, W. B. Park, and J. Y. Lim, "Cross-cultural adaptation and clinimetric property of Korean version of the Chronic Pain Coping Inventory-42 in patients with chronic low back pain," Spine, Vol.35, No.6, pp.666-671, 2010. https://doi.org/10.1097/BRS.0b013e3181ba7a78
  34. A. Lynn Snow-Turek, M. P. Norris, and G. Tan, "Active and passive coping strategies in chronic pain patients," Pain, Vol.64, No.3, pp.455-462, 1996. https://doi.org/10.1016/0304-3959(95)00190-5
  35. R. S. Lazarus, A. DeLongis, S. Folkman, and R. Gruen, "Stress and adaptational outcomes: The problem of confounded measures," PsycNET, Vol.40, No.7, pp.770-779, 1985.
  36. M. P. Jensen, J. A. Turner, and J. M. Romano, "Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment," Pain, Vol.44, pp.263-269, 1991. https://doi.org/10.1016/0304-3959(91)90095-F