Interpersonal Relationships Integral to Managing, Treating Pain

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The more a person felt listened to and understood by his/her romantic partner, the less pain he/she reported.
The more a person felt listened to and understood by his/her romantic partner, the less pain he/she reported.

Pain is a complex experience that can affect all aspects of a person's life. Numerous studies indicate that not only do people with chronic pain have worse depression and marital satisfaction, but so do their spouses.1 Additionally, there are decades of research evidence that show that spouses' behaviors can affect their partner's pain experience.2

At the Relationships and Health Lab at Wayne State University run by Annmarie Cano, PhD, we conceptualize pain as an interpersonal phenomenon that not only affects relationships, but is also affected by relationships.

More and more, we are coming to understand how people with pain can be affected by important people around them (e.g., a doctor or spouse). Some of the more commonly identified social factors resulted from the operant model of pain behaviors, whereby spouses' reactions to seeing their partners express pain either reinforce or punish those pain expressions, affecting future pain and disability.2

For example, after seeing a loved one limp, sigh, or grimace (all different types of pain behaviors), spouses may encourage the person to rest, or they may be critical toward him/her. But there is more to pain than behaviors and the operant model. Thoughts and feelings are important but commonly overlooked factors that contribute to pain perceptions within a social context.

Drawing from the broader research on relationships, one of the most important factors is empathy. With respect to pain, not only is empathy from a medical practitioner strongly related to patient adherence with treatment recommendations and health benefits,3 but it may also help a person cope with pain as it is occurring.

We recently conducted an experimental study in which one member of a couple endured a pain stimulus with his/her partner present.4 The results showed that the more a person felt listened to and understood by his/her romantic partner, the less pain he/she reported.4


In addition, empathic feelings were induced in some of the observing partners with simple instructions to think about how the other person feels; it is possible that these instructions helped people to notice signs of pain and respond supportively. The findings of this study suggest that perspective-taking is a way to help foster empathic feelings in observers and to help people when they are experiencing pain in the moment. The results may apply not only to romantic partners, but also to health care professionals. 

Pain catastrophizing involves an exaggerated, negative response to anticipated or actual pain, in which the person feels helpless and overwhelmed. Pain catastrophizing has been consistently linked to more severe pain and disability. But rather than seeing pain catastrophizing as an anxious thinking style, others view it as an interpersonal process where a person expresses their pain and catastrophizing in an attempt to elicit social support and to manage distress interpersonally.5,6

These expressive pain displays could also be used to induce others to lower their expectations, demands, or conflicts with the individual. This interpersonal coping style has a great deal of research support but has lacks widespread incorporation into clinical work.

Research has found that catastrophizers experience and express more intense pain, and they perceive more intense pain in others. And so, while catastrophizing is an important factor for people who experience pain, catastrophizing in caregivers is an important factor that influences their ability to detect pain and their style of responding to it.

For instance, a caregiver high in catastrophizing may become so overwhelmed by their own distress that they are less effective at helping, or they could be excessively solicitous, inadvertently contributing to the patient's disability.

On the other end of the spectrum is pain stoicism, the degree to which a person will endure pain without displaying feelings and without complaints; it can be conceptualized as beliefs about how one should behave in the face of pain.7 Stoicism is not merely the opposite of pain catastrophizing; in one of our studies, stoicism and pain catastrophizing measures were inversely correlated around r = -0.30 (only a medium effect size)4.

Stoicism in both people in pain and observers affects their pain perceptions and responses. People with stoic beliefs provide less information to observers about the severity of pain they experience, making it more difficult for observers to perceive and assess pain. As a result, stoicism may be a barrier to effective pain management.

Additionally, observers who value stoicism are less empathetic to their partners' complaints and expressions of pain. In general, research indicates that, on average, men rate themselves as higher on stoicism than women, and older adults report greater stoicism than do younger people.

Because we see pain as an interpersonal phenomenon, we advocate for incorporating spouses and caregivers in the assessment and treatment of pain. Each of the above constructs can be assessed using brief questionnaires. Understanding these factors will help to provide an understanding of how each person experiences, expresses, perceives, and responds to pain, assisting health care providers in addressing their unique treatment needs.

Laura Leong, PhD, CPsych, is a licensed clinical and forensic psychologist in Ontario, Canada. Her research focuses on the importance of empathy and validation in couples coping with pain.

References

1.         Leonard MT, Cano A, Johansen AB, J Pain, 2006;7(6):377-390.

2.         Romano JM, et al.. Behavior Ther., 2000;31(3):415-440.

3.         Squier RW Soc Sci Med, 1990;30(3):325-39.

4.         Leong LEM, Wayne State University Dissertations. 2013;Paper 780.

5.         Sullivan MJL, D.A. Tripp, and D. Santor, Gender differences in pain and pain behavior: The role of catastrophizing. Cognitive Ther and Research, 2000;24:121-134.

6.         Sullivan MJL.Canadian Psychology/Psychologie canadienne, 2012;53(1):32.

7.         Yong HH, et al. J Gerontol B Psychol Sci Soc Sci, 2001;56(5):279-284.

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