Co-authored by Indre Baltrušaityte and Kat Merwin

This post is a summary of a recently published article from the CaSH Lab: Mohammadi, S., Chambers, C. T., & Rosen, N. O. (2018). Expression of pain behaviors and perceived partner responses in individuals with chronic pain: The mediating role of partner burden and relationship quality. The Clinical Journal of Pain, 34,927–935. doi:10.1097/AJP.0000000000000610

We can often easily recognize when a loved one is in pain simply based on their body language, facial expressions, or even sounds (e.g., groaning, wailing) that they make. Such expressions of pain are needed for an individual experiencing pain to encourage and receive support from others, especially their partner. However, these expressions of pain may encourage partners to respond in different ways, which include (but are not limited to):

  • Solicitous responses (e.g., taking over chores and responsibilities)
  • Distracting responses (e.g., encouraging the person experiencing pain to work on a hobby)
  • Punishing responses (e.g., expressing anger and frustration) [1].

(Both solicitous and distracting responses are typically considered as “helpful” responses by individuals with pain.)

When an individual with chronic pain expresses that they are in pain, how a partner is perceived to respond to these expressions of pain (such as the response styles mentioned above) can influence the well-being of the individual who is in pain [2]. Additionally, other factors—such as partner burden and relationship quality—may help explain the association between the expression of pain and perceptions partners’ responses to pain.

Supporting an individual experiencing pain may mean that the partner will have to make some changes to their social or professional life in order to devote more time to helping their partner and taking on additional responsibilities. All of these changes and extra responsibilities placed on the shoulders of the partner may cause individuals with chronic pain to begin to view themselves or their pain as a burden on their partner [3]. Viewing ones’ own pain as a burden on a partner may lead individuals with chronic pain to perceive their partner’s responses to their pain in more negative ways. The aim of the current study was to examine the associations between expressions of pain behaviors and perceived partner responses to pain (i.e., solicitous, distracting, and punishing responses), as well as the possible role of perceived partner burden and relationship quality.

What did we expect?
We expected that when individuals with chronic pain expressed more pain, they would also report perceiving their pain as a greater burden on their partners—which in turn would be associated with individuals with chronic pain perceiving poorer relationship quality. We also expected that poorer relationship quality would be associated with reporting fewer solicitous and distracting responses, and more punishing partner responses.

What did we do?
We asked 158 individuals with chronic pain to complete questionnaires about pain behaviors, perceptions of partner burden, relationship quality, and perceptions of partners’ responses to pain (i.e., solicitous, distracting, and punishing).

What did we find?

  • The more an individual expressed their pain, the more likely were to view their pain as a burden on their partner, which in turn was associated with poorer relationship quality.
  • Poorer relationship quality was associated with reporting more perceived punishing responses (such as expressing anger) and less positive responses (i.e., distracting or solicitous partner responses).

 What does this mean?
Considering the importance of partners’ responses to the well-being of individuals in pain, the current findings explain the link between patients’ pain behaviors and their perception of their partners’ responses to pain. The findings suggest that greater partner burden and poorer relationship quality may be the pathway through which pain behaviors relate to the perceptions of partner responses to pain.

What can we do?
Given these findings, interventions for improving the lives of couples coping with chronic pain could target reducing perceptions that chronic pain is a burden on one’s partner, helping increase and focus more on positive partner responses to pain, and work on improving the overall quality of the relationship.

References

[1] Mohammadi, S., Dehghani, M., Sanderman, R., & Hagedoorn, M. (2017). The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity: A moderated mediation model. Journal of Health Psychology, 32, 422-438. doi: 10.1080/08870446.2016.1275628

[2] Newton-John, T. R., & Williams, A. C. (2006). Chronic pain couples: Perceived marital interactions and pain behaviours. The Journal of Pain, 123, 53-63.doi: 10.1016/j.pain.2006.02.009

[3] Rha, S. Y., Park, Y., Song, S. K., Lee, C. E., & Lee, J. (2015). Caregiving burden and the quality of life of family caregivers of cancer patients: The relationship and correlates. European Journal of Oncology Nursing, 19, 376-382. doi: 10.1016/j.ejon.2015.01.004.

[4] Grunfeld, E., Coyle, D., Whelan, T., Clinch, J., Reyno, L., Earle, C. C., … Glossop, R.  (2004). Family caregiver burden: Results of a longitudinal study of breast cancer patients and their principal caregivers. Canadian Medical Association Journal, 170, 1795-1801.doi: 10.1503/cmaj.1031205

[5] Brouwer, W. B. F., van Exel, N. J. A., van de Berg, B., Dinant, H. J., Koopmanschap, M. A., & van den Bos, G. A. (2004). Burden of caregiving: Evidence of objective burden, subjective burden, and quality of life impacts on informal caregivers of patients with rheumatoid arthritis. Arthritis & Rheumatism, 51, 570-577. doi: 10.1002/art.20528

[6] Leonard, M. T., Cano, A., & Johansen, A. B. (2006). Chronic pain in a couples context: A review and integration of theoretical models and empirical evidence. The Journal of Pain, 7, 377-390. doi: 10.1016/j.jpain.2006.01.442

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