Attempting to solve the problem of pain: A questionnaire study in acute and chronic pain patients Geert Crombez a, * , Christopher Eccleston b , Guido Van Hamme c , Petra De Vlieger a a Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, B-9000 Ghent, Belgium b Pain Management Unit, School for Health, The University of Bath, UK c Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium Received 25 March 2007; received in revised form 8 October 2007; accepted 18 October 2007 Abstract When faced with the problem of pain one can attempt a solution aimed at relief (assimilation) or a solution aimed at acceptance (accommodation). Using this dual process model of adaptation to pain, this study compares acute and chronic pain patients on their approach to problem solving. Three hundred and sixty-four patients were recruited from clinical settings, 303 with chronic pain and 61 with acute pain, and completed a range of measures of both affect and pain-related behavior, including the Pain Solutions Ques- tionnaire. The effects of overall duration of pain were also investigated. Chronic pain patients reported greater disability and cat- astrophic thinking about pain than acute pain patients, and assimilative coping was associated with greater disability, greater attention to pain, and more catastrophic thinking about pain, beyond the effects of demographic variables and pain severity. Pain duration did not moderate these associations. Only in the case of catastrophic thinking about pain was it found that the effects of assimilative coping were moderated by pain duration. For chronic pain patients, catastrophic thinking about pain was greater when assimilative coping was higher. These results are discussed within the context of a goal directed motivational model of adaptation to chronic pain. Ó 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Keywords: Chronic pain; Pain; Problem solving; Disability; Distress; Coping; Attention; Catastrophizing 1. Introduction Some adults with a persistent pain problem eventu- ally find an analgesic solution, but many do not. Turk [21] estimated that specialist treatments of chronic pain reduce pain on average by 30%. For those who do not find pain relief two main paths remain: either to persist in attempting to discover a solution for their pain, or to disengage from the search for analgesia and reengage in non-pain related goals of life [11]. Conceptualizing chronic pain as a problem to be fixed, and those who have chronic pain as active agents attempting to solve the problem, affords an investigation of the person as problem-solver. Following Brandtsta ¨dter and Renner’s [2] dual pro- cess theory of goal motivated behavior, we developed an instrument to assess how adults frame problems of pain and how they attempt solutions, the Pain Solutions Questionnaire (PaSol) [7]. Within this broad approach individuals are assumed to have two dominant modes of coping with adversity such as pain. These modes have been named assimilative and accommodative coping. In short, assimilative coping involves directing efforts at curing pain and accommodative coping involves relin- quishing pain relief as the primary goal by reducing its importance. These opposing methods of coping are cap- tured within the PaSol. In a first study, we found that an 0304-3959/$34.00 Ó 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2007.10.020 * Corresponding author. Tel.: +32 9 264 64 61; fax: +32 9 264 64 89. E-mail address: Geert.Crombez@UGent.be (G. Crombez). www.elsevier.com/locate/pain Pain 137 (2008) 556–563