People with chronic low back pain and other chronic pain conditions sometimes experience diminished support from their partners or other family members over time, along with increases in negative responses toward them (e.g. criticism, hostility). A number of studies have linked such responses with worsening pain and function—but it hasn’t been clear whether the relationship is causal or the phenomena are just correlated. Now a study published in the September 2017 issue of the journal Pain has suggested that spousal criticism and hostility during a controlled discussion in a lab indeed predicted worse pain and function in the spouse with back pain in the immediate aftermath.
The study, led by researchers at Rush University Medical Center in Chicago, included 71 married couples (ages 18 to 70) in which one spouse had chronic low back pain and the other did not. Unlike earlier studies on the relationship between spousal support and pain, this one was conducted in a laboratory, giving the researchers more control over the spouses’ interactions and a subsequent set of tasks designed to induce pain in the spouse with low back pain. The idea was to see whether criticism and hostility from the spouse without pain predicted more pain for the other.
The interaction consisted of a 10-minute discussion about the spouse’s sense of how the patient could improve the way he or she coped with pain. The topic for discussion was chosen from a list of possible topics created and ranked by each couple. The ranking helped the researchers “prescribe” topics that would be most likely to evoke a negative interaction. Following the discussion, the spouse with low back pain rated the level of criticism and hostility they perceived from their partner. Criticism and hostility were also scored by objective raters who observed a video of the discussions. The spouse with low back pain then spent 10 minutes engaging in everyday activities that were likely to cause pain, including sitting, reclining, bending, and lifting a weighted box, while their spouse watched from a seat about 10 feet away.
The subjects who experienced greater criticism and hostility from their spouse (both perceived and objectively rated) had greater self-rated pain intensity as well as more observable behaviors indicative of pain (such as grimacing) during the pain-inducing tasks. The researchers concluded that “the results support the hypothesis that spouse criticism and hostility—actually expressed or perceived—may worsen CLBP [chronic low back pain] patient symptoms.” They noted that this pattern was especially strong in female patients and in those who had depression. Therefore, “negative marital communication patterns may be appropriate targets for intervention, especially among these two at-riskgroups,” they wrote.
The study had a couple of important limitations. Since it was conducted in a lab, it’s not clear whether the researcher-facilitated discussion between the spouses was a good representation of discussions that might take place in real life. The study also didn’t account for the effect that the other spouse’s presence may have had on the one performing the pain task. So more research is still needed to confirm a causal relationship between spousal criticism and hostility and pain symptoms.
Bottom line: It’s not unusual for a person who needs emotional support to get the opposite reaction from the very people who should be most supportive. Nor is it unusual for people close to others with chronic conditions to feel put upon or overwhelmed at times by the person’s neediness. But the results of the study suggest that addressing the way couples interact could be a valuable part of treating CLBP and other chronic pain conditions. If you or your spouse has CLBP and the treatment already includes some type of psychological therapy, consider discussing the way you and your spouse interact with the therapist; if needed, work with the therapist to address problems with critical or hostile communication. If neither of you is working with a therapist and you are concerned that negative interactions are exacerbating your back pain or your spouse’s pain, raise the issue with your primary care doctor or back-pain specialist or with your spouse’s doctor. He or she might recommend therapy.
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