What's in a Name? The Case of Emotional Disclosure of Pain-Related Distress

Published:February 02, 2017DOI:


      • Emotional disclosures of pain-related distress are a type of pain behavior.
      • These behaviors are not currently represented in self-report measures.
      • These behaviors are shaped by goals to reduce distress as well as other factors.
      • A next step is to identify healthy responses to these behaviors.


      Pain behavior plays a key role in many theoretical models of pain, with many of these models conceptualizing pain behaviors as potentially detrimental to patient functioning. We propose that a certain class of behaviors—talking to others about one's pain-related distress (ie, emotional disclosures of pain-related distress)—can be distinguished from other behaviors traditionally conceptualized as pain behaviors. Emotional disclosures of pain-related distress include verbally disclosing one's anger, sadness, or worry about the pain and its effects to another person. In this article, conceptual and empirical evidence is offered to indicate that these verbal behaviors are distinct from other pain behaviors such as bodily expressions and motions, facial expressions, pain ratings, and paraverbal expressions. Emotion and relationships models are also applied to assert that disclosures of pain-related distress may have functions that are not shared with other pain behaviors. In addition to an expanded conceptualization of these verbal expressions of distress about pain, further directions are provided to spur new research as well as clinical recommendations concerning appropriate responses to these behaviors.


      This article offers an expanded conceptualization of one type of pain behavior—emotional disclosure of pain-related distress—by showing the theoretical and empirical distinctions between this behavior and other pain behaviors. This perspective may enhance clinical work and research aimed at identifying adaptive responses to these behaviors to improve pain adjustment.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cano A.
        Why do spouses respond to pain behaviors the way they do? New directions for research and intervention based on Fordyce’s Operant Model.
        in: Fordyce’s Behavioral Methods for Chronic Pain. Wolters Kluwer, Philadelphia2014: 276-279
        • Cano A.
        • Leong L.E.
        • Williams A.M.
        • May D.K.
        • Lutz J.R.
        Correlates and consequences of the disclosure of pain-related distress to one’s spouse.
        Pain. 2012; 153: 2441-2447
        • Cano A.
        • Williams A.C.d.e.C.
        Social interaction in pain: Reinforcing pain behaviors or building intimacy?.
        Pain. 2010; 149: 9-11
        • Coan J.
        • Gottman J.
        The Specific Affect (SPAFF) coding system.
        in: Coa J. Allen J. Handbook of Emotion Elicitation and Assessment. Oxford University Press, New York, New York2007: 106-123
        • Craig K.D.
        Social communication model of pain.
        Pain. 2015; 156: 1198-1199
        • Curci A.
        • Rimé B.
        The temporal evolution of social sharing of emotions and its consequences on emotional recovery: A longitudinal study.
        Emotion. 2012; 12: 1404-1414
        • Dagan M.
        • Sanderman R.
        • Hoff C.
        • Meijerink W.
        • Baas P.
        • Van Haastert M.
        • Hagedoorn M.
        The interplay between partners’ responsiveness and patients’ need for emotional expression in couples coping with cancer.
        J Behav Med. 2014; 37: 828-838
        • Dahl J.
        • Stewart I.
        • Martell C.
        • Kaplan J.
        ACT & RFT in Relationships: Helping Clients Deepen Intimacy and Maintain Healthy Commitments Using Acceptance and Commitment Therapy and Relational Frame Theory.
        Context Press/New Harbinger Publications, Oakland, CA2013
        • Edmond S.
        • Keefe F.J.
        Validating pain communication: Current state of the science.
        Pain. 2015; 156: 215-219
        • Ehde D.
        • Dillworth T.
        • Turner J.
        Cognitive-behavioral therapy for individuals with chronic pain.
        Am Psychol. 2014; 69: 153-166
      1. Fordyce WE: Behavioral methods for chronic pain and illness. St. Louis, Missouri, Mosby, 1976

        • Forest A.L.
        • Kille D.R.
        • Wood J.V.
        • Holmes J.G.
        Discount and disengage: How chronic negative expressivity undermines partner responsiveness to negative disclosures.
        J Pers Soc Psychol. 2014; 107: 1013-1032
        • Gatchel R.J.
        • Peng Y.B.
        • Peters M.L.
        • Fuchs P.N.
        • Turk D.C.
        The biopsychosocial approach to chronic pain: Scientific advances and future directions.
        Psychol Bull. 2007; 113: 581-624
        • Goubert L.
        • Craig K.
        • Vervoort T.
        • Morley S.
        • Sullivan M.
        • Williams A.C.d.e.C.
        • Cano A.
        • Crombez G.
        Facing others in pain: The effects of empathy.
        Pain. 2005; 118: 285-288
        • Hadjistavropoulos T.
        • Craig K.D.
        A theoretical framework for understanding self-report and observational measures of pain: A communications model.
        Behav Res Ther. 2002; 40: 551-570
        • Hadjistavropoulos T.
        • Craig K.D.
        • Duck S.
        • Cano A.
        • Goubert L.
        • Jackson P.
        • Mogil J.
        • Rainville P.
        • Sullivan M.
        • de C Williams A.C.
        • Vervoort T.
        • Dever Fitzgerald T.
        A biopsychosocial formulation of pain communication.
        Psychol Bull. 2011; 137: 910-939
        • Keefe F.J.
        • Caldwell D.S.
        • Baucom D.
        • Salley A.
        Spouse-assisted coping skills training in the management of osteoarthritic knee pain.
        Arthritis Care Res. 1996; 9: 279-291
        • Keefe F.J.
        • Caldwell D.S.
        • Baucom D.
        • Salley A.
        • Robinson E.
        • Timmons K.
        • Beaupre P.
        • Weisberg J.
        • Helms M.
        Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: Long-term followup results.
        Arthritis Care Res. 1999; 12: 101-111
        • Kerns R.D.
        • Haythornthwaite J.
        • Rosenberg R.
        • Southwick S.
        • Giller E.
        • Jacob M.C.
        The Pain Behavior Check List (PBCL): Factor structure and psychometric properties.
        J Behav Med. 1991; 14: 155-167
        • Kerns R.D.
        • Turk D.C.
        • Rudy T.E.
        The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).
        Pain. 1985; 23: 345-356
        • Khan C.
        • Iida M.
        • Parris Stephens M.
        • Fekete E.
        • Druley J.
        • Greene K.
        Spousal support following knee surgery: Roles of self-efficacy and perceived emotional responsiveness.
        Rehabil Psychol. 2009; 54: 28-32
        • Leeuw M.
        • Goossens M.
        • Linton S.
        • Crombez G.
        • Boersma K.
        • Vlaeyen J.
        The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence.
        J Behav Med. 2007; 30: 77-94
        • Lewinsohn P.
        A behavioral approach to depression.
        in: Friedman R. Katz M. Psychology of depression: Contemporary theory and research. Wiley, Oxford, England1974: 157-178
        • McCracken L.M.
        Contextual Cognitive-Behavioral Therapy for Chronic Pain.
        International Association for the Study of Pain, Seattle2005
        • McCrystal K.
        • Craig K.
        • Versloot J.
        • Fashler S.
        • Jones D.
        Perceiving pain in others: Validation of a dual processing model.
        Pain. 2011; 152: 1083-1089
        • Morley S.
        • Doyle K.
        • Beese A.
        Talking to others about pain: Suffering in silence.
        in: Devor M. Rowbotham M. Wiesenfeld-Hallin Z. Proceedings of the Ninth World Congress on Pain: Progress in Pain Research and Management. IASP Press, Seattle2000: 1123-1129
        • Osman A.I.
        • Barrios F.X.
        • Kopper B.
        • Osman J.R.
        • Grittmann L.
        • Troutman J.A.
        • Panak W.J.
        The Pain Behavior Checklist (PBCL): Psychometric properties in a college sample.
        J Clin Psychol. 1995; 51: 775-782
        • Pakenham K.
        • Samios C.
        Couples coping with multiple sclerosis: A dyadic perspective on the roles of mindfulness and acceptance.
        J Behav Med. 2012; 36: 389-400
        • Papini M.
        • Fuchs P.
        • Torres C.
        Behavioral neuroscience of psychological pain.
        Neurosci Biobehav Rev. 2015; 48: 53-69
        • Porter L.S.
        • Keefe F.J.
        • Baucom D.H.
        • Hurwitz H.
        • Moser B.
        • Patterson E.S.
        • Kim H.J.
        Partner-assisted emotional disclosure for gastrointestinal cancer: Results of a randomized clinical trial.
        Cancer. 2009; 115: 4326-4338
        • Porter L.S.
        • Keefe F.J.
        • Lipkus I.
        • Hurwitz H.
        Ambivalence over emotional expression in patients with gastrointestinal cancer and their caregivers: Associations with patient pain and quality of life.
        Pain. 2005; 117: 340-348
        • Porter L.S.
        • Keefe F.J.
        • Wellington C.
        • Williams A.C.
        Pain communication in the context of osteoarthritis: Patient and partner self-efficacy for pain communication and holding back from discussion of pain and arthritis-related concerns.
        Clin J Pain. 2008; 24: 662-668
        • Prkachin K.M.
        Pain behaviour is not unitary.
        Behav Brain Sci. 1986; 9: 754-755
        • Prkachin K.M.
        • Hughes E.
        • Schultz I.
        • Joy P.
        • Hunt D.
        Real-time assessment of pain behavior during clinical assessment of low back pain patients.
        Pain. 2002; 95: 23-30
        • Reis H.
        • Shaver P.
        Intimacy as an interpersonal process.
        in: Duck S. Handbook of Interpersonal Relationships. Wiley, Chichester1988: 367-389
        • Revicki D.A.
        • Chen W.
        • Harnam N.
        • Cook K.F.
        • Amtmann D.
        • Callahan L.F.
        • Jensen M.P.
        • Keefe F.J.
        Development and psychometric analysis of the PROMIS pain behavior item bank.
        Pain. 2009; 146: 158-169
        • Rimé B.
        Emotion elicits the social sharing of emotion: Theory and empirical review.
        Emot Rev. 2009; 1: 60-85
        • Schwartz L.
        • Jensen M.P.
        • Romano J.M.
        The development and psychometric evaluation of an instrument to assess spouse responses to pain and well behavior in patients with chronic pain: The Spouse Response Inventory.
        J Pain. 2005; 6: 243-252
        • Sullivan M.
        • Neish N.
        The effects of disclosure on pain during dental hygiene treatment: The moderating role of catastrophizing.
        Pain. 1999; 79: 155-163
        • Tait R.C.
        • Chibnall J.T.
        Attitude profiles and clinical status in patients with chronic pain.
        Pain. 1998; 78: 49-57
        • Törneke N.
        • Learning R.F.
        An Introduction to Relational Frame Theory and Its Clinical Application.
        Context Press/New Harbinger Publications, Oakland, CA2010
        • Turk D.C.
        • Flor H.
        Pain > pain behaviors: The utility and limitations of the pain behavior construct.
        Pain. 1987; 31: 277-295
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Vowles K.
        • Wetherell J.
        • Sorrell J.
        Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention.
        Cogn Behav Pract. 2009; 16: 49-58
        • Williams A.C.d.e.C.
        Facial expression of pain: An evolutionary account.
        Behav Brain Sci. 2002; 25: 439-488
        • Williams A.C.d.e.C.
        • Craig K.D.
        A science of pain expression?.
        Pain. 2006; 125: 202-203
        • Zaki J.
        • Williams W.
        Interpersonal emotion regulation.
        Emotion. 2013; 13: 803-810