Temporal associations between spouse criticism/hostility and pain among patients with chronic pain: a within-couple daily diary study.
Chronic musculoskeletal pain can strain marriages, perhaps even to the point of engendering spouse criticism and hostility directed toward patients. Such negative spouse responses may have detrimental effects on patient well-being. While results of cross-sectional studies support this notion, we extended these efforts by introducing expressed emotion (EE) and interpersonal theoretical perspectives, and by using electronic diary methods to capture both patient and spouse reports in a prospective design. Patients with chronic low back pain (CLBP) and their spouses (N = 105 couples) reported on perceived spouse behavior and patient pain 5 times/day for 14 days using Personal Data Assistants (PDAs). Concurrent and lagged within-couple associations between patient's perceptions of spouse criticism/hostility and patient self-reported pain and spouses' observations of patient pain behaviors revealed that (1) patient perceived spouse criticism and hostility were correlated significantly with pain intensity, and spouse observed patient pain behavior was related significantly with patient perceived hostility at the same time point; (2) patient perceived spouse hostility significantly predicted patient pain intensity 3 hours later, and spouse observed pain behaviors significantly predicted patient perceived spouse hostility 3 hours later. Results support both EE and interpersonal models, and imply that a comprehensive model would combine these conceptualizations to fully illustrate how spouse criticism/hostility and patient pain interact to produce a negative spiral. Given that marital interactions are amenable to clinical intervention, improved insight into how spouse behavior and patient pain are tightly linked will encourage productive translational efforts to target this neglected area.
Rush University Medical School, Chicago, IL, USA University of Notre Dame, USA Duke University Medical Center, Durham, NC, USA.
John W
JW
Burns
Kristina M
KM
Peterson
David A
DA
Smith
Francis J
FJ
Keefe
Laura S
LS
Porter
Erik
E
Schuster
Ellen
E
Kinner
D000328:Adult; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006791:Hostility; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000523:psychology*; D011446:Prospective Studies; D057566:Self Report / Q000592:standards; D018454:Spouses / Q000523:psychology*; D013997:Time Factors
Chronic low back pain; Electronic diary methods; Lagged effects; Patient pain behavior; Spouse criticism/hostility