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The Journal of Pain Summary

Highlight from The Journal of Pain (Volume 19, No. 11, November 2018 Issue)

Spouse Criticism/Hostility Toward Partners with Chronic Pain: The Role of Spouse Attributions for Patient Control Over Pain Behaviors

John W. Burns, James Gerhart, Kristina M. Post, David A. Smith, Laura S. Porter, Asokumar Buvanendran, Anne Marie Fras, Francis J. Keefe

Studies of married couples show that high levels of spousal criticism and hostility are linked to greater pain intensity and decreased function for partners with chronic pain. Further, high levels of spouse criticism/hostility may be rooted in negative attributions regarding patient displays of pain behavior. A multicenter team of researchers hypothesized that spouse observations of pain behavior would be expected to

  • predict high levels of spouse reports of their own critical/hostile behavior toward patients, their own negative affect, and patient-perceived spouse critical/hostile behavior
  • predict low levels of spousal criticism/hostility when pain behavior was perceived to be due to the pain condition.

The study involved 105 married couples recruited through referrals at pain clinics operated at Rush University Medical Center in Chicago, IL, Duke University Medical Center in Durham, NC, and Memorial Hospital in South Bend, IN. Spouses with chronic low back pain completed electronic diary measures 5 times a day for 14 days. They assessed spouse observations of patient pain behavior, attributions regarding these behaviors, and spouse criticisms/hostility toward patients.

Results showed that spouse criticism and hostility directed toward their partners with chronic pain are negatively related to pain, mood, and function. Spouses witnessing high levels of behavior affected by patient perceptions predicted high levels of patient perceptions of critical/hostile behavior but also predicted high levels of spouse reports of their own critical/hostile behavior.

Further, spouses reporting relatively greater dissatisfaction with their marriages tended to make more negative attributions regarding the causes of patient pain behavior than a spouse with less dissatisfaction. The authors noted that frequent spousal suspicions that the patient exhibits pain behaviors to avoid activities could have a detrimental effect on the quality of the spouse’s relationship with the patient.

The authors concluded that their findings suggest replacing spouse internal and negative attributions with external, compassionate, and accepting explanations may be useful therapeutic targets for couples coping with chronic pain.