Rethinking coping in chronic pain: a systematic review and dynamic interaction model of coping

Living with chronic pain presents significant challenges and disruptions, thus motivating the use of coping strategies to manage pain and its impact in everyday life. Yet how individuals cope with chronic pain and why some people show better functional outcomes is not clearly understood. Previous literature on coping has often focused on describing different coping strategies and their comparative effectiveness, often with the assumption that some are overall more adaptive. Existing theoretical models of coping often lack descriptions of how factors unfold over time and assume relationships between factors remain stable. However, pain coping is not only influenced by continuously changing internal and external contextual factors, but by changing interactions as the process reiterates over time. Moreover, the short- and long-term efficacy of different coping approaches depends on individual appraisal and changing contextual demands. In this review, we first synthesise selected theoretical models of coping in health-related stress or pain that were identified through a systematic search. Next, we present the "Dynamic Interaction Model of Coping in Chronic Pain" which builds on concepts from the stress and coping literature to address gaps in the selected models. Specifically, we outline how 5 central factors: (1) controllability, (2) predictability, (3) salience, (4) resources, and (5) motivation, interact in a dynamic coping process guided by updating predictions, feedback, and expectations. The model outlines putative pathways of moment-to-moment and long-term adaptations to chronic pain, and potential targets for intervention.