Impact of Chronic Pain on Marriage

When one spouse hurts, the other spouse is usually acutely aware of it. Having the understanding and support of a loved one can help us through painful conditions. But what happens when the pain lasts longer than expected? How do partners cope when the problem becomes chronic or even permanent?

Does the supportive partner remain as tuned in to the patient's distress and needs? How accurately can the supportive spouse gauge the patient's level of pain? And what is the effect on the relationship?

These are all important questions that social scientists are exploring. In this study, researchers from Canada look at the degree to which a partner's sensitivity to a hurting spouse affects the marriage. They looked at the supportive spouse's sensitivity to changes in pain and disability in their pained partner.

Chronic pain patients were filmed while lifting a series of heavy objects. Patients included in the study had neck or back pain lasting more than 12 months. Most patients reported long-term pain lasting many years. After the lifting activity, they rated their pain on a scale from zero (no pain) to 10 (severe pain).

Before lifting the weights, they filled out several surveys assessing pain, depression, and fear of reinjury. They also completed a 53-item questionnaire that measures psychosocial effects of chronic pain. This tool is called the Multidimensional Pain Inventory (MPI) (patient version).

After completing the lifting tasks, the patient's spouses watched the videotape of the activity. The partner gauged the level of their spouses' pain while lifting. The same zero to 10 scale was used. Each supportive spouse also filled out a survey called the MPI-spouse version.

The goal was to see how accurate the supportive spouse was in judging their partner's pain. This value was referred to as empathic accuracy. The difference between patients' reported pain and the spouses' estimate of their partners' pain was labeled the discrepancy index.

A second measure called the covariation index was also calculated. This reflects how sensitive the supportive spouses were to changes in the patients’ pain during all the lifting tasks (there were 18 objects to pick up).

Both measurements are needed to get an accurate idea of empathic accuracy. In the analysis of the results, there were no differences between men and women in their sensitivity toward their partner's pain. The authors found several factors that influenced empathic accuracy. These included the pain patient's facial and body expressions of pain, level of catastrophic thinking, and fear of reinjury. The supportive spouses own level of pain catastrophizing was evaluated, but it was not considered a contributing factor.

Most spouses were able to accurately estimate the partners' pain during the lifting tasks. The also reported that patients in pain had worse outcomes when their spouse was aware of the patient's pain. It appeared that patients with disabling pain showed more outward signs to alert their spouse of their pain.

Less empathic spouses were more likely to ignore the pain partner and express anger, frustration, or irritation toward them. There have been some other experts who suggest ignoring a spouses' pain or inaccurately assessing pain may be a way to protect the relationship.

Previous studies have shown that fearful facial expressions and high levels of disability demonstrated by the patient are not relied upon by partners/spouses as much as by strangers observing the painful patient. The results of this study confirm those findings.

The authors suggest that spouses rely on more subtle indicators of pain that weren't measured by the tools used in this study. Empathic accuracy may come from interactions between couples specific to each couple. Living with a person in pain over a long period of time may result in less obvious pain behaviors that are exhibited by the patient and perceived by the spouse.

And finally, having a highly empathic spouse was not an advantage. Patients with chronic pain whose spouse was in tune with their pain had lower function, less social activity, and worse outcomes. The authors conclude that it's not necessary to have an accurate idea of a spouse's pain to have a happy marital relationship.

More study is needed to fully understand empathic accuracy between couples in a marriage. The tools used in this study were accurate in judging pain. This is helpful information since there are many factors that can affect judgment of pain. Future studies can rely on the methods used in this study to help sort out all the other variables present.

Nathalie Gauthier, BSc, et al. Individual and Relational Correlates of Pain-Related Empathic Accuracy in Spouses of Chronic Pain Patients. In The Clinical Journal of Pain. October 2008. Vol. 24. No. 8. Pp. 669-677.

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