An Observational Study Examining the Association Between Chronic Pain Coping Strategies and Unplanned Health Care Use by Individuals Attending an Interdisciplinary Pain Clinic

Abstract

Objective: To characterize a chronic pain clinic population and determine whether specific coping strategies were associated with an unplanned health care visit(s) after controlling for predisposing, enabling, and need characteristics associated with health care utilization. Design: Observational study based on questionnaire data obtained in a southeastern Ontario chronic pain clinic. The analysis was guided by Andersen’s Behavioural Model of Health Services Use. Methods: Participants (N = 559) were classified according to number of visits made for pain to emergency departments, urgent-care, and walk-in clinics in the previous year. Modified Poisson regression was used to determine the association between coping strategies and unplanned health care use and to identify other characteristics associated with visits. Results: Thirty-one percent (n = 176) of attendees reported at least one unplanned visit for pain in the year prior to attendance in the clinic. In adjusted analysis, the chronic pain coping strategies associated with higher unplanned visit(s) for pain were positive self-statements (RR = 1.06, 95% CI = 1.00-1.13, p = .03) and asking for assistance (RR = 1.09, 95% CI = 1.03-1.15, p < .01), while guarding (RR = 0.91, 95% CI = 0.85-0.98, p = .01) reduced use. Unplanned visit(s) were also associated with age, moderate to severe depression, greater opioid use, lower household income, and high-frequency primary care visits for pain. Conclusions: In addition to certain predisposing and enabling characteristics, coping strategies are correlated with unplanned health care use for pain. Prospective studies, using objective measures of service use, are needed to determine if the nature and direction of these associations are stable over time.