Historically, investigations of coping with chronic pain primarily have sought methods for gaining greater control over pain and pain-related distress. Recently, it has been suggested to expand the framework of coping so that control efforts are redirected from circumstances where they fail, and so that coping can more explicitly incorporate potentially more practical and flexible notions of acceptance. The purpose of the present study was to evaluate the role of control-oriented and acceptance-oriented coping responses for patient functioning using a prospective design. Participants included 120 adult patients with chronic pain who completed measures of coping, pain, disability, depression, and pain-related anxiety at two time points, separated by an average of 3.7 months (SD = 2.6 months). Factor analyses revealed four factors within the coping data: Pain Management, Pain Control, Help Seeking, and Activity Persistence. A series of correlation and linear regression analyses was performed to assess the relations of these factors at initial assessment to functioning later in time. In general, Activity Persistence was associated with better functioning over time while control-oriented responses were associated with greater difficulty. The factor representing more or less traditional pain management methods showed surprisingly limited relations with aspects of patient functioning. Analyses of concurrent change in coping and functioning highlighted a unique, apparently unhelpful, role of Pain Control. These results support the inclusion of contextual acceptance-related processes in current frameworks for understanding adjustment to chronic pain.