Pain Catastrophizing and Social Support in Married Individuals with Chronic Pain: The Moderating Role of Pain Duration

In the current study, 96 married chronic pain patients were recruited from the community to test hypotheses about the roles of catastrophizing and psychological distress in relation to perceived support from close others. It was expected that pain duration would moderate the relationship between catastrophizing and perceived support and between catastrophizing and psychological distress. In addition, distress was hypothesized to mediate the relationship between the pain durationcatastrophizing interaction and support. Hierarchical regression analyses showed that pain duration interacted with catastrophizing such that at shorter pain durations, pain catastrophizing was related to more perceived solicitous spouse responses; however no such relationship existed for patients with longer pain durations. In contrast, catastrophizing was significantly related to less perceived spousal support (i.e. support not specific to pain) in patients with longer durations of pain whereas no significant relationship existed for patients with shorter pain durations. Pain duration did not interact with catastrophizing in relating to psychological distress, which precluded the examination of distress as a mediator between the pain duration-catastrophizing interaction and support. Moreover, psychological distress did not significantly mediate the relationships between pain catastrophizing and perceived support. These findings are discussed in the context of cognitive-behavioral and interpersonal perspectives of pain

Pain Affects Spouses Too: Personal Experience With Pain and Catastrophizing as Correlates of Spouse Distress

Chronic pain has adverse effects on individuals with chronic pain (ICPs) as well as their family members. Borrowing from an empathy model described by Goubert et al. (2005), we examined topdown and bottom-up factors that may be related to psychological well-being in the spouses of ICPs. A diverse community sample of 113 middle-aged spouses of individuals with chronic pain (ICPs) completed measures on pain severity and spouse pain catastrophizing (PCS-S; Cano et al., 2005). Results showed that almost half (48.7%) of spouses reported chronic pain themselves and that pain in the spouse accounted for within-couple differences on psychological distress. That is, in couples where only the ICP reported pain, ICP psychological distress was greater than their spouses. However, when both partners reported chronic pain, there was no significant difference in psychological distress between partners. Hierarchical regression analyses showed that spouse magnification catastrophizing was associated with depressive and anxiety symptoms, and that helplessness catastrophizing was associated with depressive symptoms for spouses of ICPs who also reported chronic pain but not for spouses of ICPs without chronic pain. The results are discussed in light of interpersonal processes that may affect spouses’ distress

A Preliminary Investigation of Affective Interaction in Chronic Pain Couples

The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic

Social Interaction in Pain: Reinforcing Pain Behaviours or Building Intimacy?

To date, pain research has focused almost exclusively on operant models to interpret the function and predict the consequences of pain-related interaction in chronic pain couples. However, evidence suggests that intimacy models of interaction may provide additional and alternative explanations for pain interaction. Specifically, intimacy models conceptualize verbal complaints about pain-related distress as emotional disclosure, which the partner may validate or invalidate. This review compares and contrasts models of pain-related interaction in chronic pain couples, describes limitations of the existing research, and offers directions for future research drawing upon a social support framework

The Significant Other Version of the Pain Catastrophizing Scale (PCS-S): Preliminary Validation

Researchers have hypothesized that pain catastrophizing has a social function. Although work has focused on the catastrophizing of individuals with chronic pain (ICPs), little is known about the pain catastrophizing of their significant others. The purpose of this study was to test the validity of a revised version of the original PCS [Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432–524.] in which individuals were instructed to report on their own catastrophizing about their significant other’s pain. In Study 1, a confirmatory factor analysis was conducted to determine the factor structure of the PCS-Significant Other (PCSS) in a diverse sample of university undergraduates (n=264). An oblique second-order 3-factor model with two cross-loadings provided the best fit and this model was invariant across gender and racial groups. This factor structure was cross-validated in Study 2 with a second sample of university undergraduates (n=213). Results indicated that the 3-factor structure with two cross-loadings was a viable model of significant others’ pain catastrophizing across gender and racial groups. In Study 3, this factor structure was replicated and the content validity of the PCS-S was examined in a sample of adult ICPs and their spouses (n=111). Spouse catastrophizing was related to ICP pain severity and interference as well as both spouses’ depressive symptoms. In addition, ICPs were at a greater risk for psychological distress when both spouses had higher levels of catastrophizing. The PCS-S has the potential to be a useful and valid measure of pain catastrophizing in the significant others of ICPs

Spousal Congruence on Disability, Pain, and Spouse Responses to Pain

We examined congruence between chronic pain patients and their spouses on their reports of patient pain severity, patient disability, and spouse responses to pain. Patients reported that they were more physically and psychosocially disabled than their spouses reported them to be. However, spouses reported that the patients’ pain was more severe than patients reported. Depressive disorders in the patient and gender interacted with patient–spouse ratings. For physical and psychosocial disability, depressed patient couples reported significantly larger differences in disability ratings than nondepressed patient couples. In addition, female patients’ disability was rated as more severe by the female patients than by their husbands. Male patient couples did not report differences on physical disability. Findings relating to other forms of disability and to spouse responses are also described.The results are discussed in the context of an interpersonal perspective of chronic pain and have implications for the assessment of pain and disability

Multilevel Analysis of Couple Congruence on Pain, Interference, and Disability

Couple congruence on ratings of pain severity and disability were examined using hierarchical linear modeling. Older community Individuals with Chronic Pain (ICPs) and their spouses completed the Multidimensional Pain Inventory (pain severity, interference, negative spouse responses to pain), Sickness Impact Profile (physical disability, psychosocial disability), and the Mood and Anxiety Symptom Questionnaire (psychological distress). Both spouses reported on ICPs\u27 pain and disability as well as their own psychological distress. Spousal incongruence was observed on interference and physical disability such that ICPs reported greater disability than their spouses reported for them. No significant incongruence was observed in pain severity or psychosocial disability. Predictors of couples\u27 mean ratings of pain and disability were identified. Specifically, couples in which the ICP was female reported higher couples\u27 ratings of pain severity and interference. ICP distress was related to higher couples\u27 ratings of all pain and disability variables whereas spouse distress was related to higher psychosocial disability ratings. ICPs\u27 perceptions of negative spouse responses were also positively associated with couples\u27 ratings of physical and psychosocial disability. In terms of congruence, ICP distress was associated with incongruence on interference, physical disability, and psychosocial disability whereas spouse distress predicted incongruence on pain severity, and interference. This study suggests that understanding couples\u27 pain outcome ratings involves an awareness of factors that might influence their perceptions and behaviors

When is your partner willing to help you? The role of daily goal conflict and perceived gratitude

Motivation to provide help might vary from day-to-day. Previous research showed that autonomously motivated help (i.e., helping because you enjoy/value this behavior), compared with controlled motivated help (i.e., helping because you feel you should do so), has beneficial effects for both the help provider and recipient. In a sample of chronic pain patients and partners (N = 64 dyads), this diary study examined whether (1) same- and prior day perceived gratitude (i.e., received appreciation for providing support) in partners and (2) same- and prior day goal conflicts in partners (i.e., amount of interference between helping one's partner in pain and other goals) predicted partners' helping motivation. Partners provided more autonomously motivated help on days that they perceived more gratitude from their partner and when they experienced less goal conflicts. Lagged analyses indicated that perceived gratitude (but not goal conflict) even predicted an increase in autonomous helping motivation the next day. Implications are discussed in the context of Self-Determination Theory

Empathic and Nonempathic Interaction in Chronic Pain Couples

Empathy and empathic response are receiving greater attention in pain research as investigators acknowledge that other forms of interaction may impact the pain process. The purpose of this study was to examine validation and invalidation as forms of empathic and nonempathic responses in chronic pain couples. Participants were 92 couples in which at least one spouse reported chronic musculoskeletal pain. Each couple participated in two videotaped interactions about the ways in which the pain has impacted their lives together. Trained raters then coded interactions for each partner’s use of validation and invalidation. Couples also completed surveys on spouse responses to pain, marital satisfaction, and perceived spousal support. Correlations demonstrated validation by spouses of persons with pain was associated with punishing, solicitous, and distracting spouse responses to pain, marital satisfaction, and perceived spousal support. In contrast, spouses’ invalidation scores were correlated with punishing spouse responses. Exploratory factor analyses were then conducted to determine the extent to which spouses’ responses to pain and spouse validation and invalidation loaded on similar factors. Results indicated that validation and invalidation are more closely related to punishing spouse responses than to solicitous or distracting spouse responses. These results have implications for theoretical and clinical work on spouse responding

Perceived Spouse Responses to Pain: The Level of Agreement in Couple Dyads and the Role of Catastrophizing, Marital Satisfaction, and Depression

The primary objective of this study was to examine whether individuals with chronic pain (“participants”) and their spouses agree on perceptions of solicitous, distracting, and punishing spouse responses to pain. The second aim was to examine the role of participant catastrophizing (a negative mental set about pain), participant and spouse marital satisfaction, and participant and spouse depression in participant perceptions of spouse responses, spouse perceptions of their responses, and agreement between participants and spouses. Individuals with chronic musculoskeletal pain and their spouses (N=108 couples) completed questionnaire packets. Examination of overall group averages (participants vs. spouses) indicated little or no differences between participant and spouse ratings. Examination of individual agreement in participant and spouse ratings indicated substantial disagreement. The proposed moderators predicted both participant and spouse perceptions and jointly made minor contributions to dyad agreement. Although neither participant nor spouse perceptions of spouse responses are necessarily a reflection of actual behavior, the lack of agreement in this study suggests it may not be valid to use only patient perceptions in research related to spouse responses