Pain Communication in Couples with Chronic Pain

Abstract

Having a partner with chronic pain (CP) can lead to relationship strain. In couples, poor verbal or non-verbal communication about pain is associated with increased disability (Cano, Johansen, & Geisser, 2004), mental health issues (Kiecolt-Glaser & Newton, 2001), and negative emotions in partners (Miaskowski, Zimmer, Barret, Dibble, & Wallhagen, 1997). There is limited research directly examining pain communication in couples as pain is occurring. Existing CP research in couples has mostly been based on retrospection and self-report, and such research has tended to not include both partners. This investigation was designed to extend our understanding of pain communication in couples. Specifically, the goals for this study were to determine: (1) if couples with a partner with CP and couples without a partner with CP differ in terms of how well they agree on the pain intensity experienced by a partner; (2) if partners with CP encode pain differently than individuals without CP; (3) if partners of individuals with CP decode expressions of pain differently than partners of individuals without CP; (4) if non-verbal and self-reported pain responses are influenced by relationship variables and pain cognition in couples with and without a partner with CP; and (5) if the communication of pain in couples where one partner is experiencing pain is consistent with the processes described in the biopsychosocial models of pain communication. Couples where one partner reported current CP (n = 66) and couples without CP (n = 65) completed questionnaires measuring facets of their relationship and experiences with pain. Next, one partner underwent a pain task while the other partner observed. In couples with a CP partner, the person with CP completed the task. In couples without a CP partner, the pain task was sometimes completed by the male partner and sometimes by the female partner based on the gender of the last person with CP to complete the task (i.e., in order to ensure matching with the CP group). Ratings of pain intensity (partner completing the task) and perceived pain intensity (observing partner) were recorded at multiple intervals and facial expressions were video-recorded throughout the pain task. Agreement between partners on pain intensity ratings did not differ in couples with and without CP. Pain was encoded and decoded similarly by individuals with and without CP. Women completing the task provided higher pain intensity ratings and had more pain-related facial activity than men. Despite higher pain intensity ratings in women during the task, pain intensity ratings in observers who were men and observers who were women did not differ. Relationship variables and pain cognitions interacted with the presence of CP to affect pain-related facial expression, but not pain intensity ratings, during the task. Individuals with CP showed a stronger positive relationship between catastrophizing and pain-related facial activity compared to individuals without CP. In observing partners, lower scores on relationship variables (i.e., satisfaction and perceived support) were associated with reduced facial activity for partners of individuals with CP and increased facial activity partners of individuals without CP. The results highlight the importance of considering social and contextual influences in pain responses. When examined alone, pain responses do not differ in couples with and without a partner with CP. When considering the moderating influence of relationship and pain cognition variables, differences in pain-related facial expressions based on the presence of CP emerge. Additionally, the results indicate that pain-related facial expressions are more strongly affected by social and contextual variables than selfreport, consistent with pre-existing psychosocial formulations of pain communication.