Organization of coping strategies and their proximal associations with pain intensity in spinal pain patients.

BACKGROUND: Although coping strategies are well-established psychological correlates of chronic pain, their relative importance and combined organization in relation to pain intensity remain unclear. Clarifying whether coping strategies act as independent correlates or as an organized system is essential for refining psychosocial assessment and intervention. METHODS: In this cross-sectional study, 142 adults with spine-related pain in Brescia, Italy completed the Cope-NVI questionnaire, assessing five coping dimensions. A multi-method analytical framework was applied: multiple regression identified independent associations with pain intensity, bootstrap mediation analyses examined indirect associations among coping strategies, and k-means clustering identified person-centered coping profiles. Sensitivity analyses additionally adjusted for demographic and clinical characteristics. RESULTS: Multiple regression identified Avoidance and Positive Attitude as the only coping dimensions independently associated with pain intensity. These associations remained significant after adjustment for age, sex, pain duration, and pain location. Bootstrap mediation analyses indicated that associations of Social Support and Problem Orientation with pain intensity were largely accounted for by indirect associations through Avoidance and Positive Attitude. Cluster analysis identified three clinically interpretable coping profiles: Adaptive Copers (low Avoidance, high Positive Attitude; lowest pain), Moderate Copers, and Maladaptive Copers (high Avoidance, low Positive Attitude; highest pain). Cluster differences were observed primarily in coping characteristics and pain intensity rather than demographic or clinical variables. CONCLUSIONS: Coping strategies in spine-related pain appear to be hierarchically organized in relation to pain intensity, with Avoidance and Positive Attitude showing the strongest independent associations. These findings provide a framework for understanding how coping dimensions co-occur within individuals and may help inform psychosocial assessment and person-centered intervention strategies. Given the cross-sectional design, the observed mediation patterns should be interpreted as statistical associations rather than causal mechanisms. SIGNIFICANCE: This study clarifies how coping strategies jointly relate to pain intensity in individuals with spine-related pain. Using integrated regression, mediation, and cluster analyses, it identifies Avoidance and Positive Attitude as the coping dimensions most strongly associated with pain severity and demonstrates that coping strategies organize into clinically interpretable profiles. The findings support psychosocial assessment approaches that prioritize maladaptive avoidance and adaptive cognitive coping processes.