UF Researchers Find Spousal Attention May Be Too Much Of A Good Thing For Those With Chronic Pain

Published: August 28 2003

Category:Research

GAINESVILLE, Fla. — “Honey, let me help you with that” is music to the ears of most spouses, especially when it comes to unpleasant tasks, such as washing dishes or taking out the trash.

But for the 86 million Americans living with chronic pain – caused by maladies such as back injury, migraines and arthritis – the attention of overly solicitous spouses actually may be more harmful than helpful, University of Florida dental researchers report in the current issue of the Clinical Journal of Pain.

“We were interested in understanding the relationship between spousal responses and pain and disability, and whether those relationships might be different for men and women,” said Roger Fillingim, an associate professor of public health services and research at UF’s College of Dentistry.

Although previous studies have demonstrated higher levels of pain and disabilities among patients who report more solicitous or overly supportive spousal responses, what has not been examined until now is whether men and women differ in how they respond to spousal solicitousness, pain and disability and other pain-related variables, he said.

To answer that question, UF researchers evaluated the responses of 203 men and 114 women with chronic-pain on several surveys, pain-tolerance assessments and measures of physical function. In one questionnaire, patients were asked to rate the responsiveness of their spouses, who were then grouped into two categories – those who exhibited high solicitousness and those who displayed low solicitousness.

Other questionnaires asked patients to rate the severity of their pain, disability and depression. Scientists rated the severity of each patient’s disability after they completed tests of physical function gauging how fast they could walk around a 100-yard track, and assessed their ability to lift and carry weighted boxes, push and pull against a device that measures strength and withstand pain induced by temporarily cutting off blood flow to the arm.

“Overall, what we see is that for self-reported pain and disability, spousal responses were related to those two factors in male patients but not female patients,” Fillingim said.

Men with highly solicitous spouses were more likely to rate the severity of their pain and disability higher than men with spouses who were less solicitous. But despite their differing perceptions, men in both groups performed the same on the functional tasks – indicating little to no difference in physical performance.

Women who reported having highly solicitous spouses had lower pain tolerance and poorer performance on functional tasks than women who said their spouses were not solicitous. They also were twice as likely to use narcotic pain medications.

“What it looks like is that the spousal responses are related to how men say they’re doing, while with the women patients, spousal responses seem to be related to how they actually are doing,” Fillingim said.

According to Fillingim, patients may be predisposed to a certain physiological response to pain depending on the type of attention their spouses give them.

“The idea is if you are a chronic-pain patient and your spouse babies you, essentially you are being rewarded for being in pain. And the more reinforcement you get for engaging in pain behaviors, the more pain behaviors you will show,” Fillingim said. “Many physiological responses can be behaviorally conditioned, and I believe that pain is no exception to that rule,” he said.

This idea is consistent with research conducted by Dr. Herta Flor at the Central Institute of Mental Health in Mannheim, Germany. Flor’s study also categorized chronic pain patients on the basis of spousal solicitousness during administration of harmless but unpleasant shocks, both in the presence of their spouses and without them. When patients with highly solicitous spouses were shocked in the presence of their spouses, they rated the pain as being more severe, and EKGs of brain activity showed a larger response to the painful stimulus than when their spouses were not present. For those patients whose spouses were not described as solicitous, the presence of their spouses did not affect their brain responses or their perception of the pain.

“So this suggests that a social variable, the presence of a solicitous spouse, may actually alter how our brain responds to pain and how we perceive pain,” Fillingim said. “It may not just be behaviors we’re conditioning here, it may be physiological responses that can either help us or hurt us, depending on how the conditioning occurs.”

Pain patients have a chronic condition they have to learn to manage, very much like diabetes, Fillingim said. Incorporating patient and spousal training as part of their treatment plans may help couples manage chronic pain conditions more effectively. Spouses can be taught to give other supportive responses that are not solicitous, such as distraction techniques, for example, or encouraging their spouses to use proven relaxation and strategies to soothe themselves.

“The whole goal here is to increase the patient’s control, function and independence, rather than making the patient less functional and dependent on the spouse,” he said.

“Our study addresses a very complicated issue, the variables of which need further study to explain,” he said. “But it does suggest that the interaction between clinical pain and interpersonal relationships may very well be different for men and women, and we should probably try to take that into account as we’re evaluating patients, designing treatments and training spouses on how to be most appropriately supportive of their spouses who are in pain.”

Credits

Source
Lindy McCollum-Brounley, lbrounley@dental.ufl.edu, 352-392-4431

Category:Research