Chronic pain affects marital communication and ability to cope

Chronic pain suffered by one spouse can affect marital communication and influence the partner's ability to cope with a chronic pain condition, according research reported in The Journal of Pain, published by the American Pain Society, www.americanpainsociety.org.

Psychological research has shown that how a spouse or partner responds to an individual's behavior affects how and when emotions are expressed. For example, validation of a partner's emotions by showing respect and acceptance promotes effective emotional regulation, trust and closeness. Conversely, invalidation of emotions, demonstrated by hostility or ignoring, increases emotional distance and is correlated with poor marital adjustment and depression.

In their study, researchers from Wayne State University and the Norwegian Center for Addiction Research tested how the sequences and base rates of couples' affective interactions were related to pain and emotional adjustment in both partners. They hypothesized that invalidating behavior followed by invalidation by either partner would be related to more severe pain, less marital satisfaction and depression.

Conversely, invalidation followed by a validating or neutral remark would be associated with better adjustment. They also expected that that the association of spousal behaviors and pain adjustment would be significantly stronger when the wife is the pain patient, based on previous research showing that women react more profoundly to pain and affective communication than men.

Couples for the study were recruited in a Midwestern U.S. city through newspaper advertising. They were eligible to participate if one spouse had a musculoskeletal pain condition lasting more than six months. The initial sample had 78 adults with chronic pain and their spouses. Women comprised 58 percent of the pain patients studied. Low back pain was the most frequently mentioned site of the worst pain and the leading diagnoses were osteoarthritis, disc problems and fibromyalgia.

Study subjects participated in a three hour interview sessions in which the final 15 minutes were devoted discussing a disagreeable topic, such as family finances. Each partner was interviewed about their perspectives on the problem topic and the couples were instructed to discuss and make progress toward resolving the issue.

Results of the analysis showed that husbands with pain are more likely to respond negatively to spousal invalidation. So, contrary to the study's hypothesis, men, either as patients or spouses, appeared to be more sensitive to their partners' responses. This finding contradicts previous research showing that women are more likely to experience greater pain, distress and depression. The authors noted that perhaps pain is disruptive to a husband's traditional roles, such as being the family provider, causing him to be more vulnerable for emotional upheaval from spousal invalidation behaviors.

From a clinical perspective, the authors believe their research shows patient gender is an important factor when assessing and treating pain patients and couples. Interventions, therefore, should be aimed at the couple, not just the pain patients, in order to help reduce invalidating behaviors and remarks and disruptive responses to them. Empathy training was recommended.