Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives.

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Examining the Role of Structural and Functional Social Network Characteristics in the Context of Chronic Pain: An Ego-centered Network Design.

The well-being and functioning of individuals with chronic pain (CP) vary significantly. Social factors, such as social integration, may help explain this differential impact. Specifically, structural (network size, density) as well as functional (perceived social support, conflict) social network characteristics may play a role. However, it is not yet clear whether and how these variables are associated with each other. Objectives were to examine 1) both social network characteristics in individuals with primary and secondary CP, 2) the association between structural network characteristics and mental distress and functioning/participation in daily life, and 3) whether the network's functionality mediated the association between structural network characteristics and mental distress, respectively, functioning/participation in daily life. Using an online ego-centered social network tool, cross-sectional data were collected from 303 individuals with CP (81.85% women). No significant differences between individuals with fibromyalgia versus secondary CP were found regarding network size and density. In contrast, ANCOVA models showed lower levels of perceived social support and higher levels of conflict in primary (vs secondary) CP. Structural equation models showed that 1) larger network size indirectly predicted lower mental distress via lower levels of conflict; 2) higher network density increased mental distress via the increase of conflict levels. Network size or density did not (in)directly predict functioning/participation in daily life. The findings highlight that the role of conflict, in addition to support, should not be underestimated as a mediator for mental well-being. Research on explanatory mechanisms for associations between the network's structure, functionality, and well-being is warranted. PERSPECTIVE: This paper presents results on associations between structural (network size, density) and functional (social support, conflict) social network characteristics and well-being in the context of CP by making use of an ego-centered network design. Results suggest an indirect association between structural network characteristics and individuals with CP their mental well-being.

Social support for functional dependence, activity patterns, and chronic pain outcomes: A cross-lagged mediation panel study.

OBJECTIVE: Received social support undermining engagement in life activities of individuals with chronic pain (e.g., solicitousness, support for functional dependence) is consistently correlated with worse physical functioning, pain severity, and disability. Whether such responses lead to worse pain outcomes (operant model of pain) or the latter lead to more supportive responses undermining activity engagement (social communication and empathy models of pain) is unknown, given the lack of cross-lagged panel studies. Furthermore, the mediating role of activity patterns in such relationships over time is entirely unclear. This study aimed to bridge these gaps. METHOD: This was a 3-month prospective study with three waves of data collection (T1-T3; 6-week lag in-between), including 130 older adults (71% women; Mage = 78.26) with musculoskeletal chronic pain attending day-care centers. At every time point, participants filled out self-report measures of staff social support for functional dependence, activity patterns, physical functioning, pain severity, and interference. Scales showed good/very good test-retest reliability (ICC = .74-.96) and internal consistency (all α > .90). RESULTS: Parsimonious cross-lagged panel mediation models showed the best fit (χ²/df < 2.44; CFI > .96; GFI > .93; RMSEA < .09). Bidirectional effects were found over time, but poorer pain outcomes at T1 (higher pain severity/interference, lower physical functioning) more consistently predicted higher social support for functional dependence than vice versa. Poorer pain outcomes (T1) predicted more avoidance/less overdoing (T3), via increased received support for functional dependence (T2). CONCLUSION: Further research on the cyclical relationships between the study variables across chronic pain trajectories is needed to harness the power of interpersonal relationships in future self-management interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Public Chronic Pain Stigma and the Role of Pain Type and Patient Gender: An Experimental Vignette Study.

Research exploring the specific manifestations of chronic pain (CP) public stigma is scarce. One potential factor influencing public stigma manifestations may be the CP type, that is, the presence (secondary CP) or absence (primary CP) of a clearly identifiable pathophysiology. Furthermore, patient gender may play a key role, whereby pain-related gender stereotypes may evoke distinct gender role expectations towards men and women experiencing CP. The aim of the research was 2-fold. First, by means of an experimental vignette design, the general population's cognitive, affective, and behavioral responses were investigated, both towards primary versus secondary CP and towards men versus women. Second, a potential interaction was examined between CP type and patient gender. The research is divided into 2 separate samples: individuals with CP (N = 729) and individuals without CP (N = 283). Factorial ANOVA models were estimated with CP type, patient gender, and participant gender included as factors, age as control variable. The findings support, partly, the general hypothesis of higher (perceived) public stigma towards individuals with primary (vs secondary) CP. No main effects of patient gender were observed. Gender bias in stigmatizing manifestations only emerged in certain contextual circumstances (ie, pain type and participant gender). Different interaction effects (with a combination of gender, patient gender, or CP type) were significant for the distinctive outcome variables. Interestingly, throughout the findings, different patterns of results are found in both samples. The study contributes to the literature on CP stigma, as well as the psychometric examination of items assessing stigmatizing manifestations. PERSPECTIVE: This study examined the role of contextual factors chronic pain type and patient gender into cognitive, affective, and behavioral stigmatizing manifestations coming from the general population towards individuals with chronic pain through an experimental vignette study. The study contributes to the chronic pain stigma literature, as well as the psychometric examination of items assessing stigmatizing manifestations.

Pain-Related Beliefs, Coping, and Function: An Observational Study on the Moderating Influence of Country of Origin.

Chronic pain is a multidimensional experience and pain treatments targeting psychosocial factors reduce pain and improve function. These treatments often overlook the sociocultural factors that influence pain and the psychological factors associated with function in people with chronic pain. Although preliminary findings suggest that cultural background may influence pain and function via their effects on beliefs and coping, no previous study has directly tested if the country of origin moderates the associations between these psychological factors and pain and function. This study sought to address this knowledge gap. Five hundred sixty-one adults with chronic pain, born and living in the USA (n = 273) or Portugal (n = 288), completed measures of pain, function, pain-related beliefs, and coping. Between-country similarities were found in the endorsement of beliefs related to disability, pain control, and emotion, and in asking for assistance, task persistence, and coping self-statement responses. Portuguese participants reported greater endorsement of harm, medication, solicitude, and medical cure beliefs, more frequent use of relaxation and support seeking, and less frequent use of guarding, resting, and exercising/stretching. In both countries, disability and harm beliefs and guarding responses were associated with worse outcomes; pain control and task persistence were associated with better outcomes. Six country-related small effect-size moderation effects emerged, such that task persistence and guarding are stronger predictors of pain and function in adults from the USA, but pain control, disability, emotion, and medication beliefs are more important in adults from Portugal. Some modifications may be needed when adapting multidisciplinary treatments from one country to another. PERSPECTIVE: This article examines the similarities and differences in beliefs and coping endorsed by adults with chronic pain from 2 countries, and the potential moderation effects of country on the associations between these variables and pain and function. The findings suggest that some modifications may be needed when culturally customizing psychological pain treatments.

Friend or Foe? A Thematic Analysis of Adult Friendships and Chronic Pain Adjustment.

BACKGROUND: Chronic pain is a worldwide public health challenge. Despite chronic pain having biopsychosocial dimensions, its social contexts are less investigated. Although current evidence shows that chronic pain shapes and is shaped by interactions with romantic partners, research about friendships and chronic pain is scarce, and mostly focused on adolescents. AIM: Drawing upon theories on friendship and social support, this study aimed to investigate the role of adult friendships on chronic pain adjustment and, the effect of chronic pain on adult friendships. METHODS: This study drew upon a qualitative descriptive methodology. Sixteen adults with primary or secondary (non-cancer) chronic pain participated in individual semi-structured interviews, conducted using voice over internet protocol applications. Data analysis was guided by Clarke and Brown's guidelines for thematic analysis. RESULTS: The analysis of participants' (87.5% women; Mage = 43 years) stories revealed two themes. The first captured how friends promote/hinder adjustment to chronic pain by being: (1) (un)available and providing (un)needed support; and (2) (not)accepting and (not)accommodating to support life engagement. The second captured the negative effect of chronic pain on both parties' attitudes and behaviors towards the relationship, leading to smaller and more homogeneous friendship networks. CONCLUSIONS: This study stresses the relevance of including adult friends in interventions to reduce the negative effect of chronic pain on friendships, harnessing their power to promote chronic pain adjustment. The findings bring new insights on a topic that has rarely been investigated in the pain field, hence pointing out innovative directions for future research and practice.

Assessing Family Social Support for Functional Autonomy and Dependence in Pain: A Psychometric Study.

Assessing family supportive responses to pain behaviors is paramount, as these may help or hinder chronic pain (CP) adjustment. Current self-report measures of pain-specific family supportive dynamics are scarce, covering a limited range of responses. To address this gap, this paper aimed at the psychometric validation of a (revised) novel measure - the Informal Social Support for Autonomy and Dependence in Pain Inventory (ISSADI-PAIN). Three-hundred and three adults participated in this study (53.3% women; Mage = 49.31), 53.5% with current CP, 20.1% with acute pain (AP) in the previous week and 26.4% with no current pain. All participants completed the revised ISSADI-PAIN. Participants reporting AP/CP in the previous week also filled out measures of pain coping/outcomes. Exploratory and confirmatory factor analyzes supported a 3-factor structure: Perceived Promotion of Dependence (PPD; 5 items; α = .82), Perceived Promotion of Autonomy-Emotional (PPA-Emot; 3 items; α = .78), PPA-instrumental (PPA-Inst; 3 items; α = .82). Higher PPD was associated with higher AP disability and less wellness-focused coping; higher PPA-Emot was associated with more wellness-focused CP coping; PPA-Inst was associated with better/worse AP/CP outcomes and more frequent use of wellness-focused CP coping. Men with AP reported more PPD than women. The revised ISSADI-PAIN is an innovative, valid, and reliable measure of relevant functions of pain-related social support, which may influence pain persistence and adaptation. PERSPECTIVE: This article presents a novel self-report measure (ISSADI-PAIN) that assesses family support for functional autonomy and dependence in pain contexts. This measure may contribute to further research on the complexities of family supportive dynamics surrounding individuals with AP/CP, clarifying their role on pain persistence and adaptation processes.

The Informal Social Support for Autonomy and Dependence in Pain Inventory Spanish version.

Social support plays a crucial role in the quality of life of people with chronic pain. The Informal Social Support for Autonomy and Dependence in Pain Inventory assesses two functions of received social support: the promotion of autonomy and the promotion of dependence. The aim of this cross-sectional study was to adapt this instrument for its use in the Spanish population. The sample comprised 256 individuals with chronic pain. Participants were recruited through two local associations of people with fibromyalgia, a physiotherapy unit and a hospital pain unit. The data were collected in Spain between October 2018 and January 2020. The structure of the questionnaire was analysed using confirmatory factor analysis, average variance extracted, composite reliability and internal consistency indexes, and inter-correlations between the scales. The criterion-related validity of the instrument was analysed by investigating its relationship with pain intensity, positive and negative affect, daily functioning, activity impairment, wellbeing and satisfaction with life. The structure with the best fit had four related factors: emotional social support for the promotion of autonomy; instrumental social support for the promotion of autonomy; emotional social support for the promotion of dependence and instrumental social support for the promotion of dependence. The scales showed adequate internal consistency. An association was found between higher levels of instrumental social support for the promotion of dependence and higher levels of pain-related disability and decreased daily functioning. An association was also found between the promotion of autonomy and increased satisfaction with life. The Spanish version of the inventory shows appropriate psychometric properties. In the setting of disability prevention, this instrument is useful in assessing the support relationships between people with chronic pain and their relatives.

Cultural adaptation and psychometric validation of the Portuguese breakthrough pain assessment tool with cancer patients.

OBJECTIVES: Breakthrough cancer pain (BTcP) is a transient exacerbation of pain that occurs over persistent, stable, and adequately controlled cancer background pain. It is prevalent and bears severe consequences to patients' quality-of-life. The effective management of BTcP depends on fast and reliable (re)assessment. The Breakthrough pain Assessment Tool (BAT) is one of the most concise and reliable self-report instruments adapted to clinical contexts so far, showing good psychometric qualities in the United Kingdom, the Netherlands, and South Korea. As to promote the effective management of BTcP in Portuguese-speaking communities this study, first aimed to culturally adapt and validate the Portuguese version of the BAT (BAT-Pt). Second, and most importantly, it sought to provide novel evidence on its criterion validity by investigating its association with measures of psychological distress, which has not been yet investigated. METHODS: The BAT was translated into European Portuguese, using the back-translation method, and culturally adapted. Its psychometric properties (factor structure, internal consistency, construct and criterion validity) were analyzed in a cross-sectional multicenter study, with a sample of 65 cancer patients (49.2% women) recruited from eight hospitals in mainland Portugal (a priori power analysis determined a minimum sample of 50). Health professionals collected patients' clinical information, assessed their functional disability (ECOG Performance Status) and the adequacy of pain control. In addition to the Portuguese version of the BAT (BAT_Pt), patients completed the Portuguese versions of the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, a Distress Thermometer and answered questions about the adequacy of pain control. RESULTS: The BAT-Pt was very well accepted by experts and patients. As hypothesized, a Principal Axis Factor Analysis revealed two underlying factors accounting for 55.2% of the variance: (1) Pain Severity and Impact of BTcP and (2) Duration of BTcP and Medication Inefficacy. Two items (on episode frequency and medication efficacy) were analyzed separately given their lower/cross loadings. The BAT-Pt showed good internal consistency overall (α=0.79) and for each sub-scale, namely, Pain Severity and Impact of BTcP (n=5 items; α=0.86) and Duration of BTcP and Medication Inefficacy (n=2 items; rsb=0.62). The BAT-Pt showed good convergent validity, being moderately to strongly associated with overall pain severity and interference (0.46

Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship.

ABSTRACT: Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.

Gender awareness in medicine: adaptation and validation of the Nijmegen Gender Awareness in Medicine Scale to the Portuguese population (N-GAMS).

Health care professionals' gender awareness has been presented as a mechanism to minimize gender biases in health. The present paper aimed to adapt and validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS, Verdonk et al. in Sex Roles 58:222-234, 2008. https://doi.org/10.1007/s11199-007-9326-x) to the Portuguese population, also addressing some limitations of its original study, namely by: (1) testing the scale's three-fold underlying structure and (2) extending the study of its criteria-related validity, by analyzing sex-related differences in medical students' gender awareness and the associations between gender awareness and empathy and sexism. One thousand and forty-eight medical students (Mage = 22.90; 67.1% women) filled out the Portuguese version of the N-GAMS (N-GAMS.pt) along with measures of Physician Empathy and Sexism. A Parallel Analysis and an Exploratory Factor Analysis suggested the presence of three factors. A Confirmatory Factor Analysis showed a good fit of the hypothesized three-factor structure: (1) gender sensitivity (n = 6 items; α = .713), (2) gender-role ideologies towards patients (n = 7 items; α = .858) and (3) gender-role ideologies towards doctors (n = 5 items; α = .837), with a positive association between the latter two (r = .570; p < .001). The N-GAMS.pt also showed good criteria-related validity. Namely, as hypothesized: (1) more empathic students reported more gender sensitivity and lower endorsement of gender-role ideologies; (2) higher hostile and benevolent sexism were associated to higher endorsement of gender-role ideologies; and (3) higher hostile sexism was associated to lower gender sensitivity. Implications of the N-GAMS for research and interventional purposes are discussed.

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses' Pain Assessment and Management Practices.

OBJECTIVE: Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses' pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices. DESIGN: Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design. SUBJECTS: Female nurses participated in two experimental studies (N = 150/N = 158). METHODS: Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices. RESULTS: The low-SES patient's pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient's pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices. CONCLUSIONS: Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

Helping Your Partner with Chronic Pain: The Importance of Helping Motivation, Received Social Support, and Its Timeliness.

Objective: Like all intentional acts, social support provision varies with respect to its underlying motives. Greater autonomous or volitional motives (e.g., enjoyment, full commitment) to help individuals with chronic pain (ICPs) are associated with greater well-being benefits for the latter, as indexed by improved satisfaction of their psychological needs for autonomy, competence, and relatedness. The present study investigates the processes explaining why partners' autonomous or volitional helping motivation yields these benefits. Methods: A total of 134 couples, where at least one partner had chronic pain, completed a 14-day diary. Partners reported on their daily helping motives, whereas ICPs reported on their daily received support, timing of help, need-based experiences, and pain. Results: On days when partners provided help for volitional motives, ICPs indicated receiving more help, which partially accounted for the effect of autonomous helping motivation on ICP need-based experiences. Timing of help moderated the effects of daily received support on ICP need-based experiences. Conclusions: Findings highlight the importance of ICPs of receiving support in general and the role of timing in particular, which especially matters when there is little support being received.

What determines immigrant caregivers' adherence to health recommendations from child primary care services? A grounded theory approach.

AIM: To investigate the diversity and specificity of the determinants of immigrant caregivers' adherence to child primary care (CPC) health recommendations. BACKGROUND: Immigrant caregiver's adherence to CPC health recommendations is of utmost importance to minimize their children's health-related vulnerabilities. Some research has been conducted on the determinants of immigrants' access to health services, but much less is known about the determinants of their adherence to health professionals' recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps. METHODS: Interviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers' understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology. FINDINGS: 'Adherence to CPC health recommendations' is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children's health, usefulness of recommendations, perceived health-care professionals' competence, central role of vaccination in CPC and caregivers' socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children's care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers' adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers' adherence to CPC health recommendations and for child protection will be discussed.

Why and when social support predicts older adults' pain-related disability: a longitudinal study.

Pain-related social support has been shown to be directly associated with pain-related disability, depending on whether it promotes functional autonomy or dependence. However, previous studies mostly relied on cross-sectional methods, precluding conclusions on the temporal relationship between pain-related social support and disability. Also, research on the behavioral and psychological processes that account for such a relationship is scarce. Therefore, this study aimed at investigating the following longitudinally: (1) direct effects of social support for functional autonomy/dependence on pain-related disability, (2) mediating role of physical functioning, pain-related self-efficacy, and fear, and (3) whether pain duration and pain intensity moderate such mediating processes. A total of 168 older adults (Mage = 78.3; SDage = 8.7) participated in a 3-month prospective design, with 3 moments of measurement, with a 6-week lag between them. Participants completed the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Brief Pain Inventory, the 36-SF Health Survey, behavioral tasks from the Senior Fitness Test, the Pain Self-Efficacy Questionnaire, and the Tampa Scale for Kinesiophobia. Moderated mediation analyses showed that formal social support for functional dependence (T1) predicted an increase in pain-related disability (T3), that was mediated by self-reported physical functioning (T2) and by pain-related self-efficacy (T2) at short to moderate pain duration and at low to moderate pain intensity, but not at higher levels. Findings emphasized that social support for functional dependence is a risk factor for pain-related disability and uncovered the "why" and "when" of this relationship. Implications for the design of social support interventions aiming at promoting older adults' healthy aging despite chronic pain are drawn.

Beyond solicitousness: a comprehensive review on informal pain-related social support.

Adults with chronic pain cite social support (SS) as an important resource. Research has mostly focused on general SS or pain-specific solicitousness, resulting in a limited understanding of the role of SS in pain experiences. Drawing on SS theoretical models, this review aimed to understand how pain-related SS has been conceptualized and measured and how its relationship with pain experiences has been investigated. Arksey and O'Malley scoping review framework guided the study. A database search (2000-2015) was conducted in PsycINFO, CINAHL, MEDLINE, and EMBASE using a combination of subject headings/keywords on pain and SS; 3864 citations were screened; 101 full texts were assessed for eligibility; references of 52 papers were hand searched. Fifty-three studies were included. Most studies were either a-theoretical or drew upon the operant conditioning model. There are several self-report measures and observational systems to operationalize pain-related SS. However, the Multidimensional Pain Inventory remains the most often used, accounting for the centrality of the concept of solicitousness in the literature. Most studies focused on individuals with chronic pain self-report of spousal pain-related SS and investigated its main effects on pain outcomes. Only a minority investigated the role of pain SS within the stress and coping process (as a buffer or mediator). Little is known about mediating pathways, contextual modulation of the effectiveness of SS exchanges, and there are practically no SS-based intervention studies. Drawing on general SS models, the main gaps in pain-related SS research are discussed and research directions for moving this literature beyond solicitousness are proposed.

Older adults' preferences for formal social support of autonomy and dependence in pain: development and validation of a scale.

Chronic pain among older adults is common and often disabling. Pain-related formal social support (e.g., provided by staff at day-care centers, nursing homes), and the extent to which it promotes functional autonomy or dependence, plays a significant role in the promotion of older adults' ability to engage in their daily activities. Assessing older adults' preferences for pain-related social support for functional autonomy or dependence could contribute to increase formal social support responsiveness to individuals' needs. Therefore, this study aimed at developing and validating the preferences for formal social support of autonomy and dependence in pain inventory (PFSSADI). One hundred and sixty-five older adults with chronic musculoskeletal pain (Mage = 79.1, 67.3% women), attending day-care centers, completed the PFSSADI, the revised formal social support for autonomy and dependence in pain inventory, and a measure of desire for (in)dependence; the PFSSADI was filled out again 6 weeks later. Confirmatory factor analyses showed a structure of two correlated factors (r = .56): (a) preferences for autonomy support (α = .99) and (b) preferences for dependence support (α = .98). The scale showed good test-retest reliability, sensitivity and discriminant and concurrent validity; the higher the preferences for dependence support, the higher the desire for dependence (r = .33) and the lower the desire for independence (r = -.41). The PFSSADI is an innovative tool, which may contribute to explore the role of pain-related social support responsiveness on the promotion of older adults' functional autonomy when in pain.

Buffer or amplifier? Longitudinal effects of social support for functional autonomy/dependence on older adults' chronic pain experiences.

OBJECTIVE: This longitudinal study aimed to investigate (a) the moderating role of formal social support for functional autonomy versus dependence on the relationship between pain intensity and pain-related disability among older adults with chronic pain and (b) the mediating role of pain-related self-efficacy and pain-related fear in this moderation. METHOD: One hundred and seventy older adults (Mage = 78.0; SD = 8.7) with chronic musculoskeletal pain participated in a 3-month prospective study, with 3 measurement moments. Participants filled out the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Portuguese versions of the Brief Pain Inventory, the Pain Self-Efficacy Questionnaire, and the Tampa Scale of Kinesiophobia. RESULTS: Using structural equation modeling, it was found that perceived promotion of autonomy, at Time 1, moderated the relationship between pain intensity (T1) and pain-related disability (T2); this moderation was fully mediated by pain-related self-efficacy (T2). Perceived promotion of dependence was not a significant moderator. CONCLUSIONS: These findings highlight the importance of social support for functional autonomy in buffering the impact of pain intensity on older adults' pain-related disability. Also, they clarify the role of pain-related self-efficacy in this effect. Implications for the development of intervention programs, with formal caregivers, to reduce the impact of chronic pain on older adults' healthy ageing process, are discussed. (PsycINFO Database Record

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning.

Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain.

The Revised Formal Social Support for Autonomy and Dependence in Pain Inventory (FSSADI_PAIN): Confirmatory Factor Analysis and Validity.

UNLABELLED: Pain among older adults is common and generally associated with high levels of functional disability. Despite its important role in elders' pain experiences, perceived (formal) social support (PSS) has shown inconsistent effects on their functional autonomy. This suggests a moderator role of 2 recently conceptualized functions of PSS: perceived promotion of dependence versus autonomy. The present study aimed at revising and further validating the Formal Social Support for Autonomy and Dependence in Pain Inventory (FSSADI_PAIN), which measures these 2 PSS functions among institutionalized elders in pain. Two hundred fifty older adults (mean age = 81.36 years, 75.2% women) completed the revised FSSADI_PAIN along with measures of physical functioning (ie, Medical Outcome Study Short Form-36) and informal PSS (ie, Social Support Scale of Medical Outcomes Study). Confirmatory factor analyses showed a good fit for a 2-factor structure: 1) perceived promotion of autonomy (n = 4 items; α = .89), and 2) perceived promotion of dependence (n = 4 items; α = .85). The revised FSSADI_PAIN showed good content, discriminant, and criterion-related validity; it discriminated the PSS of male and female older adults and also of elders with different levels of physical functioning. In conclusion, the revised FSSADI_PAIN is an innovative, valid, and reliable tool that allows us to assess 2 important functions of PSS, which may play a relevant role in the prevention and reduction of pain-related physical disability and functional dependence among institutionalized older adults. PERSPECTIVE: This article presents a revised version of the FSSADI_PAIN that assesses elders' perceived promotion of functional autonomy/dependence as 2 independent functions of perceived social support. This measure may contribute to future research on the role of close interpersonal contexts on the promotion of active aging among elders with chronic pain.