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Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain

Neale R Chumbler1*, Kurt Kroenke234, Samantha Outcalt2, Matthew J Bair234, Erin Krebs56, Jingwei Wu7 and Zhangsheng Yu7

Author Affiliations

1 Department of Health Policy and Management, University of Georgia, Clayton Street, Office 305, Athens, GA 30602, USA

2 VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA

3 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

4 Regenstrief Institute, Inc., Indianapolis, IN, USA

5 VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA

6 University of Minnesota Medical School, Minneapolis, MN, USA

7 Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

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Health and Quality of Life Outcomes 2013, 11:216  doi:10.1186/1477-7525-11-216

Published: 26 December 2013



Sense of Coherence (SOC) is a measure of an individual’s capacity to use various coping mechanisms and resources when faced with a stressor. Chronic pain is one of the most prevalent and disabling conditions in clinical practice. This study examines the extent to which a strong SOC is associated with less pain and better health related quality of life (HRQoL) among patients with chronic pain.


We analyzed data from the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial which enrolled 250 patients with persistent (3 months or longer) musculoskeletal pain who were receiving care in an United States Department of Veterans Affairs (VA) primary care clinic. The abbreviated three-item SOC scale was used to measure personal coping capability. Participants were categorized into Strong SOC (score 0–1) and Weak SOC (score 2–6). The Brief Pain Inventory (BPI) was used to assess the severity and disability associated with pain. Additionally, pain self-efficacy (ASES) and catastrophizing (CSQ) were assessed. HRQoL was assessed with the 36-item Short-Form Health Survey (SF-36) social functioning, vitality, and general health subscales. Multiple linear regression models were performed to examine whether SOC was independently associated with pain-specific and HRQoL outcomes, after adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities and major depression.


Of the 250 study patients, 61% had a strong SOC whereas 39% had a weak SOC. Multivariable linear regression analysis showed that a strong SOC was significantly associated with better general health, vitality, social functioning and pain self-efficacy as well as less pain catastrophizing. These significant findings were partially attenuated, but remained statistically significant, after controlling for major depression. SOC was not significantly associated with pain severity or pain disability.


A strong SOC is associated with better HRQoL and self-efficacy as well as less catastrophizing in patients with chronic pain. SOC may be an important coping mechanism (strategy) for patients with chronic musculoskeletal pain.

Trial registration Identifier: NCT00926588.