Adaptive and maladaptive coping strategies in older adults with chronic pain after lumbar surgery

This study investigated whether adaptive and maladaptive coping strategies mediate the association between chronic pain and health-related quality of life among older adults experiencing chronic pain after lumbar surgery. Participants were 103 older adults with either or both of chronic lower back pain and leg pain after lumbar surgery (median age = 75 years, men = 44, women = 59). Intensity of chronic lower back and leg pain (11-point numerical rating scale), physical activities (Physical Activity Scale for the Elderly) as an adaptive coping strategy, maladaptive coping strategies (e.g. guarding, resting; Chronic Pain Coping Inventory), and health-related quality of life (12-item Short-Form Health Survey) were measured. Hypothetical models with adaptive and maladaptive coping strategies as mediators of pain intensity and health-related quality of life were tested using structural equation modeling. Model fitness was acceptable (adjusted goodness of fit index: 0.94-0.98, comparative fit index: 1.00, root mean square error of approximation: 0.00). The results showed that (1) the adaptive coping strategy of physical activity positively mediated the association between lower back and leg pain, and physical health but not mental and social health; (2) maladaptive coping strategies negatively mediated the association between pain and physical, mental, and social health; (3) physical activities were negatively associated with maladaptive coping strategies. This study demonstrated that adaptive and maladaptive coping strategies serve as mediators of the relationship between chronic pain and health-related quality of life in older adults after lumbar surgery.