Advertisement

Spouse and Patient Beliefs and Perceptions About Chronic Pain: Effects on Couple Interactions and Patient Pain Behavior

      Highlights

      • Patient and spouse beliefs about chronic pain affects their behavior.
      • Spouse uncertainty about the source of patient pain is related to critical/invalidating comments toward the patient.
      • Spouse uncertainty is also related to negative attributions regarding the meaning of patient pain behavior.

      Abstract

      Patient beliefs and perceptions about the causes and meaning of their chronic pain are related to their psychosocial functioning. Beliefs and perceptions about chronic pain held by spouses may also be related to patient functioning. We used a laboratory procedure to evaluate whether spouse beliefs about and perceptions of chronic pain were related to spouse negative responses toward patients with chronic low back pain during a conflictual discussion and to their attributions about patient pain behavior during a subsequent pain-induction task. Patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task. Findings were that a) spouse perceptions that patient's pain was a mystery were significantly related to greater patient perceived spouse critical/invalidating responses toward the patient during the discussion; and b) spouse perceptions that patient's pain was a mystery were related to internal and negative attributions spouses made while observing patients display pain behaviors during the structured pain behavior task. Inasmuch as both spouse critical/invalidating speech toward patients and negative attributions regarding the cause of patient behavior are related to poor patient functioning, spouse uncertainty about the source and potential legitimacy of their partner's pain may play crucial roles in affecting patient well-being.

      Perspective

      Spouse beliefs about and perceptions of patient chronic pain were related to spouse behavior toward patients during a discussion and to attributions explaining patient pain during physical activity. If spouse confusion and doubt about patient pain is related to negative behavior and attributions, then modifying these perceptions may be a fundamental intervention target.

      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:

      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

      References

        • Alschuler KN
        • Otis JD
        Significant others’ responses to pain in veterans with chronic pain and clinical levels of post-traumatic stress disorder symptomatology.
        Eur J Pain. 2013; 17: 245-254
        • Beck AT
        • Steer RA
        • Brown GK
        Manual for Beck Depression Inventory – II.
        Psychological Corporation, San Antonio, TX1996
        • Beck AT
        • Steer RA
        • Garbin MG
        Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.
        Clin Psychol Rev. 1988; 8: 77-100
        • Burns JW
        • Gerhart J
        • Post KM
        • Smith DA
        • Porter LS
        • Buvanendran A
        • Fras AM
        • Keefe FJ
        Spouse criticism/hostility toward partners with chronic pain: The role of spouse attributions for patient control over pain behaviors.
        J Pain. 2018; 19: 1308-1317
        • Burns JW
        • Johnson BJ
        • Mahoney N
        • Devine J
        • Pawl R
        Anger management style, hostility, and spouse responses: Gender differences in predictors of adjustment among chronic pain patients.
        Pain. 1996; 64: 445-453
        • Burns JW
        • Peterson KM
        • Smith DA
        • Keefe FJ
        • Porter L
        • Schuster E
        • Kinner E
        Temporal associations between spouse criticism/hostility and pain among patients with chronic pain: A within-couple daily diary study.
        Pain. 2013; 154: 2715-2721
        • Burns JW
        • Post KM
        • Smith DA
        • Porter LS
        • Buvanendran A
        • Fras AM
        • Keefe FJ
        Spouse criticism and hostility during marital interaction: Effects on pain intensity and behaviors among individuals with chronic low back pain.
        Pain. 2018; 159: 25-32
        • Burns JW
        • Quartana P
        • Gilliam W
        • Gray E
        • Matsuura J
        • Nappi C
        • Wolfe B
        • Lofland K
        Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: Evaluation of an ironic process model.
        Health Psychol. 2008; 27: 645-652
        • Cano A
        • Barterian JA
        • Heller JB
        Empathic and nonempathic interaction in chronic pain couples.
        Clin J Pain. 2008; 24: 678-684
        • Cano A
        • Leong LE
        • Williams AM
        • May DK
        • Lutz JR
        Correlates and consequences of the disclosure of pain-related distress to one's spouse.
        Pain. 2012; 153: 2441-2447
        • Cano A
        • Miller LR
        • Loree A
        Spouse beliefs about partner chronic pain.
        J Pain. 2009; 10: 486-492
        • Carlson CR
        • Collins FL
        • Stewart JF
        • Porzelius J
        • Nitz A
        • Lind
        The assessment of emotional reactivity: A scale development and validation study.
        J Psychopathol Behav Assess. 1989; 11: 313-325
      1. Cook WW, Medley DM: Proposed hostility and pharisaic-virtue scales for the MMPI. J Appl Psychol 194;38:414-418

        • Edwards LC
        • Pearcea SA
        • Turner-Stokes L
        • Jones A
        The Pain Beliefs Questionnaire: An investigation of beliefs in the causes and consequences of pain.
        Pain. 1992; 51: 267-272
        • First MB
        • Spitzer RL
        • Gibbon M
        • Williams JBW
        Structured clinical interview for DSM-IV Axis I Disorders-Non-patient edition (SCID-I/NP, Version 2.0).
        Biometrics Research Department, New York, NY1996
        • Grant LD
        • Long BC
        • Williams JD
        Women's adaptation to chronic back pain: Daily appraisals and coping strategies, personal characteristics and perceived spousal responses.
        J Health Psychol. 2000; 7: 545-563
        • Hanley MA
        • Raichle K
        • Jensen M
        • Cardenas DD
        Pain catastrophizing and beliefs predict changes in pain interference and psychological functioning in persons with spinal cord injury.
        J Pain. 2008; 9: 863-871
        • Jensen MP
        • Karoly P
        • Huger R
        The development and preliminary validation of an instrument to assess patients' attitudes toward pain.
        J Psychosom Res. 1987; 31: 393-400
        • Jensen MP
        • Romano JM
        • Turner JA
        • Good AB
        • Wald LH
        Patient beliefs predict patient functioning: Further support for a cognitive-behavioural model of chronic pain.
        Pain. 1999; 81: 95-104
        • Jensen MP
        • Tomé-Pires C
        • de la Vega R
        • Galán S
        • Solé E
        • Miró J
        What determines whether a pain is rated as mild, moderate, or severe? The importance of pain beliefs and pain interference.
        Clin J Pain. 2017; 33: 414-421
        • Kazak AE
        • Jarmas A
        • Snitzer L
        The assessment of marital satisfaction: An evaluation of the Dyadic Adjustment Scale.
        J Family Psychol. 1988; 2: 82-91
        • Keefe FJ
        • Block AR
        Development of an observation method for assessing pain behavior in chronic low back pain patients.
        Behav Ther. 1982; 13: 363-375
        • Keefe FJ
        • Blumenthal J
        • Baucom D
        • Affleck G
        • Waugh R
        • Caldwell DS
        • Beaupre P
        • Kashikar-Zuck S
        • Wright K
        • Egert J
        • Lefebvre J
        Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: A randomized controlled study.
        Pain. 2004; 110: 539-549
        • Leff J
        • Vaughn C
        Expressed Emotion in Families. Its Significance for Mental Illness.
        Guilford Press, London1985
        • Leonard MT
        • Issner JH
        • Cano A
        • Williams AM
        Correlates of spousal empathic accuracy for pain-related thoughts and feelings.
        Clin J Pain. 2013; 29: 324-333
        • Li Q
        • Loke AY
        A systematic review of spousal couple-based intervention studies for couples coping with cancer: Direction for the development of interventions.
        Psychooncology. 2014; 23: 731-739
        • Magaña AB
        • Goldstein JM
        • Karno M
        • Miklowitz DJ
        • Jenkins J
        • Falloon IR
        A brief method for assessing expressed emotion in relatives of psychiatric patients.
        Psychiatr Res. 1986; 17: 203-212
        • Manne SL
        • Zautra AJ
        Spouse criticism and support: Their association with coping and psychological adjustment among women with rheumatoid arthritis.
        J Personality Soc Psychol. 1989; 56: 608-617
        • Martire LM
        • Keefe FJ
        • Schulz R
        Older spouses' perceptions of partners' chronic arthritis pain: Implications for spousal responses, support provision, and caregiving experiences.
        Psychol Aging. 2006; 21: 222-230
        • Martire LM
        • Schulz R
        • Keefe FJ
        • Rudy TE
        • Starz TW
        Couple-oriented education and support intervention for osteoarthritis: Effects on spouses' support and responses to patient pain.
        Family Syst Health. 2008; 26: 185-195
        • Miró J
        • Huguet A
        • Jensen MP
        Pain beliefs predict pain intensity and pain status in children: Usefulness of the pediatric version of the survey of pain attitudes.
        Pain Med. 2014; 15: 887-889
        • Moseley GL
        • Nicholas MK
        • Hodges PW
        A randomized controlled trial of intensive neurophysiology education in chronic low back pain.
        Clin J Pain. 2004; 20: 324-330
        • Nieto R
        • Raichle KA
        • Jensen MP
        • Miró J
        Changes in pain-related beliefs, coping, and catastrophizing predict changes in pain intensity, pain interference, and psychological functioning in individuals with myotonic muscular dystrophy and facioscapulohumeral dystrophy.
        Clin J Pain. 2008; 28: 47-54
        • Pasch L A
        • Bradbury TN
        Social support, conflict, and the development of marital dysfunction.
        J Consult Clin Psychol. 1998; 66: 219-230
        • Peterson KM
        • Smith DA
        An actor-partner interdependence model of spousal criticism and depression.
        J Abnormal Psychol. 2010; 119: 555-562
        • Porter LS
        • Keefe FJ
        • Hurwitz H
        Disclosure between patients with gastrointestinal cancer and their spouses.
        Psychooncology. 2005; 14: 1030-1042
        • Porter LS
        • Keefe FJ
        • 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
        • Schwartz L
        • Slater MA
        • Birchler GR
        The role of pain behaviors in the modulation of marital conflict among chronic pain couples.
        Pain. 1996; 65: 227-233
        • Spanier GB
        The measurement of marital quality.
        J Sex Marital Ther. 1979; 5: 288-300
        • Spielberger CD
        Manual for the State-Trait Anxiety Inventory (STAI).
        Consulting Psychologists Press, Palo Alto, CA1983
        • Thorn BE
        • Eyer JC
        • Van Dyke BP
        • Torres CA
        • Burns JW
        • Kim M
        • Newman AK
        • Campbell LC
        • Anderson B
        • Block PR
        • Bobrow BJ
        • Brooks R
        • Burton TT
        • Cheavens JS
        • DeMonte CM
        • DeMonte WD
        • Edwards CS
        • Jeong M
        • Mulla MM
        • Penn T
        • Smith LJ
        • Tucker DH
        Literacy-adapted cognitive behavioral therapy versus education for chronic pain at low-income clinics: A randomized controlled trial.
        Ann Intern Med. 2018; 168: 471-480
        • Turner JA
        • Jensen MP
        • Romano JM
        Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?.
        Pain. 2000; 85: 115-125
        • Vaughn C
        • Leff J
        The measurement of expressed emotion in the families of psychiatric patients.
        Br J Soc Clin Psychol. 1976; 15: 157-165
        • Weiner B
        An Attributional Theory of Motivation and Emotion.
        Springer-Verlag, New York1986
        • Williams DA
        • Thorn BE
        An empirical assessment of pain beliefs.
        Pain. 1989; 36: 351-358
        • Williamson GM
        • Martin-Cook K
        • Weiner MF
        • Svetlik DA
        • Saine K
        • Hynan LS
        • Dooley WK
        • Schulz R
        Caregiver resentment: Explaining why care recipients exhibit problem behavior.
        Rehabil Psychol. 2005; 50: 215-223