A Brief Survey of the COVID-19 Pandemic's Impact on the Chronic Pain Experience.

BACKGROUND: The COVID-19 pandemic has forced sweeping social and behavioral changes that have adversely affected the general population. Many changes, such as business closures, working from home, increased psychological distress, and delayed access to health care, could have unique adverse effects on patients diagnosed with chronic pain (CP). The present study sought to examine perceived changes in the CP experience brought about by the COVID-19 pandemic. DESIGN: Participants included 487 self-reported patients with musculoskeletal, neuropathic, or postsurgical pain recruited using CloudResearch. A 53-item survey was created to assess changes in perceived pain, mood, control over pain, physical activity, employment, and medical access since the onset of the pandemic. RESULTS: Results suggested a worsening of the pain experience, particularly for women, with greater pain, negative affect, sedentary functioning, perceived decline in treatment quality, and increased treatment delays. Of note, pandemic-related declines in control over pain, which represents an important clinical target, are associated with other pandemic-related declines and also mediates relevant associations. CONCLUSIONS: For frontline treatment providers, particularly primary care nurses and physicians, these findings may be relevant in order to reduce the likelihood of a worsening of symptoms, loss of self-efficacy regarding management of pain and/or potential maladaptive increase in the use of pain medications.

Coupling with COVID: The Role of Dyadic Coping in Relationship Satisfaction and Psychological Distress during the COVID-19 Pandemic.

Models of dyadic coping suggest that facing a stressful situation, such as the COVID-19 pandemic, with one's partner to meet their needs is associated with positive outcomes. This study explored dyadic coping and its association with relationship satisfaction and distress in the time of the COVID-19 pandemic. Data were collected online from 564 participants. Participants completed measures of dyadic coping, relationship satisfaction, COVID anxiety, and OCD, and asked to describe their experience in an open-ended question. Results showed that experiences were quite polarized. Significant gender differences and differences for couples with/without children were noted for distress and relationship satisfaction. There was a significant interaction between dyadic coping and relationship satisfaction for women when predicting COVID OCD; however, post-hoc analysis showed that this interaction was only significant for women with children. The potential exponential burden that female couple members may face during COVID-19 as well as implications for intervention, are discussed.

The Impact of Emotional Regulation Strategies on Pain Catastrophizing in the Context of Interpersonal Relationships.

OBJECTIVES: The Communal Coping Model suggests that pain catastrophizing may serve to elicit support from others. What is not known is how emotional regulation, namely emotional inhibition, impacts pain catastrophizing within the context of an interpersonal relationship. Individuals who have a greater tendency to emotionally inhibit may have a greater likelihood to use catastrophizing as a means for seeking support, particularly in relationships characterized by satisfaction and emotional validation. METHODS: Data were collected from 50 undergraduate couples at the University of Michigan-Dearborn. Participants were videotaped during the completion of an acute pain cold pressor task and completed measures involving pain catastrophizing, emotional inhibition, and relationship dynamics (ie, Ambivalence Over Emotional Expressiveness Questionnaire, White Bear Suppression Inventory, Dyadic Adjustment Scale). In addition, the videotaped interactions were coded for both invalidation/validation and overt expressions of pain catastrophizing. RESULTS: Emotional inhibition, and both validation and invalidation were associated with pain catastrophizing. Observed validation and invalidation were not, however, directly associated with relationship satisfaction. Hierarchical linear regression showed a significant interaction between thought suppression and relationship satisfaction to predict pain catastrophizing. DISCUSSION: Results show relationship satisfaction moderates the association between pain catastrophizing and thought suppression in a manner in which couples with high levels of relationship satisfaction who also engage in thought suppression are more likely to use pain catastrophizing as a cognitive strategy to elicit support. This study offers direction into treatment and suggests that couples based cognitive-behavioral treatments that aim to utilize adaptive cognitive and behavioral coping strategies, as well as emotional exploration and validation, may be beneficial.

Social Media and Couples: What Are the Important Factors for Understanding Relationship Satisfaction?

The current study sought to examine specific Facebook behaviors, related to one's relationship and their association with relationship satisfaction. Data were collected from 115 undergraduates who were in a relationship and had an active Facebook account. Participants completed a number of measures focused on their relationship and gave the researcher access to their Facebook profiles to record the frequency of all posts (comments and status updates), pictures, tags, and likes from the previous two weeks. Each of these behaviors was then coded as relationship-specific (involving one's partner) or not. Descriptive statistics were calculated for each relationship-specific Facebook behavior. A number of participants did not include relationship information on their Facebook page. Only relationship status and having one's partner in a profile picture were significantly associated with relationship satisfaction. The current study is the first of its kind to examine the association between relationship-specific Facebook behaviors and relationship satisfaction, beyond that of one's relationship status or profile photo alone. The results of this study provide an initial glimpse into the specific relationship-oriented behaviors that individuals engage in on social media. Furthermore, the results provide guidance on macro- versus micro-analysis of online behavior for other researchers who are examining social media and couples' relationships.

Couples' Relationship Satisfaction and Its Association with Depression and Spouse Responses Within the Context of Chronic Pain Adjustment.

BACKGROUND: Chronic pain is one specific health condition where couple relationships have been directly linked to physical and psychological outcomes. Understanding how relationship satisfaction, couple dynamics, and pain adjustment interrelate is crucial for nurses who provide patient-centered care for patients with pain. AIMS: The current study was aimed at examining the associations of depressive symptoms and spouse response styles with relationship satisfaction in the context of West Haven-Yale Multidimensional Pain Inventory classifications. METHODS: Seventy-eight middle-aged outpatients with chronic pain (average pain duration of 8.98 years (SD = 9.51)) were recruited from a pain clinic in southeastern Michigan. Participants completed the Multidimensional Pain Inventory, from which pain adjustment classifications (adaptive, dysfunctional, interpersonally distressed) and spouse response styles were derived, the Dyadic Adjustment Scale to assess relationship satisfaction, and the Mood and Anxiety Symptom Questionnaire to assess depressive symptoms. RESULTS: Interpersonally distressed patients scored lower on relationship satisfaction than those classified as either adaptive or dysfunctional, F(2,66) = 6.38, p < .01. Significant inverse associations were found between punishing spouse response styles and relationship satisfaction for both interpersonally distressed and dysfunctional adjustment classifications: r = -.53, p < .05; r = -.57, p < .01, respectively. CONCLUSIONS: Overall, findings indicate that relationship satisfaction may be an area of concern among interpersonally distressed pain patients and that spouse response style may be a particularly important area of clinical attention.

Pain catastrophizing differs between and within West Haven-Yale Multidimensonal Pain Inventory (MPI) pain adjustment classifications: theoretical and clinical implications from preliminary data.

OBJECTIVES: Pain catastrophizing is associated with multiple pain outcomes, and is differentially associated with the adaptive coping (AC), dysfunctional (DYS), and interpersonally distressed (ID) coping classifications of the West Haven-Yale Multidimensional Pain Inventory (MPI). We examined how catastrophizing, and the underlying components of magnification, rumination, and helplessness, may relate to MPI classifications and differentially relate to pain outcomes across classification groups to inform clinical treatment planning. MATERIALS AND METHODS: Sixty-nine adults (70% women) diagnosed with musculoskeletal pain were recruited from 2 pain clinics and completed self-report measures of pain severity, the MPI, Pain Catastrophizing Scale, and the Mood and Anxiety Symptom Questionnaire. RESULTS: Patients in the DYS and ID groups reported the greatest levels of rumination, helplessness, and overall catastrophizing, as well as the greatest depression, anxiety, and pain interference compared with the AC group. Catastrophizing related to average pain only in the DYS group (P<0.05), however, catastrophizing was associated with depression, anxiety, and interference (Ps<0.05) among those in the AC group, with a similar pattern observed among the ID group. DISCUSSION: Our findings suggest a continued need for targeting catastrophizing and negative affect among pain patients. However, our data suggest that even among relatively well-adjusted patients, there may be clinical utility in assessing catastrophic thinking given the associations of it with pain-related outcomes. The present findings additionally support the value of enlisting multiple theoretical perspectives such as the stress appraisal and attentional models in future research and clinical applications.

Correlates of spousal empathic accuracy for pain-related thoughts and feelings.

OBJECTIVES: This study explored correlates of spousal ability to infer the thoughts and feelings of individuals with chronic pain (ICPs). METHODS: Participant couples (N=57), who consisted of at least 1 couple member with chronic pain, engaged in a videotaped discussion about pain, after which they completed an empathic accuracy procedure where spouses of ICP were asked to infer thoughts/feelings of ICPs. RESULTS: Overall levels of partner empathic accuracy were similar to other studies of couples. Several characteristics of the pain experience and the marital relationship correlated with empathic accuracy for thoughts and feelings. Specifically, partner catastrophizing about the ICP's pain was associated with less empathic accuracy for thoughts, whereas ICP pain severity was related to a greater empathic accuracy for feelings. Several significant interactions were also found, with marital satisfaction and partner's own pain experience acting as moderators. DISCUSSION: These findings provide support for models of empathy that argue that characteristics of the pain condition and characteristics of the observer are important contributors to observers' understanding of pain. In addition, the findings support previous research that suggests there are different processes for understanding the emotional versus the cognitive experience of others.

Association between pain catastrophizing, spouse responses to pain, and blood pressure in chronic pain patients: a pathway to potential comorbidity.

BACKGROUND: Chronic pain has been shown to be highly comorbid with other medical conditions. Theoretical and empirical associations between pain and cardiovascular health can be made based on the current literature. Psychosocial variables associated with the pain experience may, however, have an impact on cardiovascular health. PURPOSE: The purpose of this study was to examine how cognitive and interpersonal aspects of chronic pain, including pain catastrophizing (PC) and negative spouse responses (NSR), relate to systolic and diastolic blood pressure (SBP, DBP) as cardiovascular risk factors. METHODS: Data were collected from 57 treatment-seeking patients with chronic musculoskeletal pain. Participants completed the West Haven-Yale Multidimensional Pain Inventory, Pain Catastrophizing Scale, and pain severity ratings based on an analog pain scale. In addition, participants consented to a medical chart review to collect blood pressure and prescribed medication data. Hierarchical linear regressions were used to test associations between PC and NSR, and blood pressure while controlling cardiac medication status. RESULTS: A positive association between PC and both SBP and DBP was found. A positive association was also found for NSR and SBP. These findings suggest that psychosocial aspects of chronic pain may represent a direct risk for elevated blood pressure and, thus, increased risk for cardiovascular health problems. CONCLUSIONS: Psychosocial aspects of pain may constitute a form of chronic stress as described in the cardiovascular reactivity literature. The findings highlight the need for comprehensive multidimensional treatments of pain.

How do I empathize with you? Let me count the ways: relations between facets of pain-related empathy.

UNLABELLED: This study examined the extent to which components of empathy (ie, empathic accuracy, empathic tendencies, and empathic responses) were correlated within the context of chronic pain couples. Additionally, the interrelationships between these empathy variables and spouse responses to pain were investigated. Participants were 57 couples in which at least 1 spouse reported chronic musculoskeletal pain. Each couple participated in a videotaped interaction about the impact of pain in their lives together, after which they completed an empathic accuracy procedure. The interactions were coded for the spouse's use of empathic responses. Couples also completed surveys about pain severity, pain interference, empathic tendencies, marital satisfaction, and perceived spousal responses (ie, solicitous and punishing responses) to pain. Spousal empathic responses and empathic accuracy were not related to one another nor were they related to spousal empathic tendencies, or solicitous spouse responses. Spousal punishing responses were negatively related to empathic responses. The association between solicitousness and empathic responses was moderated by spousal marital satisfaction. The findings suggest that there are not clear associations among these empathy variables. The results also indicate that the climate in which solicitousness is provided may influence the extent to which spouses display empathic responses. PERSPECTIVE: The findings have implications for models of pain empathy and suggest that future research is needed to understand relations between aspects of empathy. Moreover, interventions aimed at addressing the empathic climate in which support is delivered may help spouses more empathically and effectively communicate with and assist partners with pain management.

A preliminary investigation of cognitive appraisal and cardiovascular reactivity and recovery in Arab Americans.

BACKGROUND: Arab Americans exhibit higher rates of hypertension and other cardiovascular risk factors relative to national averages. While research suggests some minorities may exhibit increased cardiovascular reactivity (CVR) to, and slowed recovery from, stress compared to Whites, which may represent a risk factor for hypertension and cardiovascular disease, this has not been studied in Arab Americans. This study examined differences between Arab Americans and Whites in cognitive appraisal, and blood pressure and heart rate (HR) reactivity and recovery to laboratory stressors. METHODS: The undergraduate sample included 27 Arab Americans (16 female) and 27 gender matched Whites. Eligible participants completed two stressful laboratory tasks (mental arithmetic [MA] and stress-recall [SR]). Cognitive appraisals were assessed for each task, and physiological data were collected during baseline, each laboratory task, and recovery. Ethnicity differences in baseline cardiovascular values and cognitive appraisals were examined with t-tests, while differences in CVR and recovery were tested with ANCOVA, controlling for initial values. RESULTS: Arab Americans showed lower baseline systolic blood pressure and mean arterial pressure than Whites. Arab Americans also reported greater threat and stress associated with MA, and greater threat for SR. No CVR differences were observed during MA; however during and after SR, Arab Americans evidenced lesser systolic and diastolic blood pressure reactivity and lesser HR recovery compared to Whites. CONCLUSIONS: Overall, Arab Americans showed lesser reactivity than Whites, but also exhibited slower HR recovery. These results may be attributable to physiological habituation to chronic stress associated with minority status.

Pain affects spouses too: personal experience with pain and catastrophizing as correlates of spouse distress.

Chronic pain has adverse effects on individuals with chronic pain (ICPs) as well as their family members. Borrowing from an empathy model described by Goubert et al. (2005), we examined top-down and bottom-up factors that may be related to psychological well-being in the spouses of ICPs. A diverse community sample of 113 middle-aged spouses of individuals with chronic pain (ICPs) completed measures on pain severity and spouse pain catastrophizing (PCS-S; Cano et al., 2005). Results showed that almost half (48.7%) of spouses reported chronic pain themselves and that pain in the spouse accounted for within-couple differences on psychological distress. That is, in couples where only the ICP reported pain, ICP psychological distress was greater than their spouses. However, when both partners reported chronic pain, there was no significant difference in psychological distress between partners. Hierarchical regression analyses showed that spouse magnification catastrophizing was associated with depressive and anxiety symptoms, and that helplessness catastrophizing was associated with depressive symptoms for spouses of ICPs who also reported chronic pain but not for spouses of ICPs without chronic pain. The results are discussed in light of interpersonal processes that may affect spouses' distress.

Chronic pain in a couples context: a review and integration of theoretical models and empirical evidence.

UNLABELLED: Researchers have become increasingly interested in the social context of chronic pain conditions. The purpose of this article is to provide an integrated review of the evidence linking marital functioning with chronic pain outcomes including pain severity, physical disability, pain behaviors, and psychological distress. We first present an overview of existing models that identify an association between marital functioning and pain variables. We then review the empirical evidence for a relationship between pain variables and several marital functioning variables including marital satisfaction, spousal support, spouse responses to pain, and marital interaction. On the basis of the evidence, we present a working model of marital and pain variables, identify gaps in the literature, and offer recommendations for research and clinical work. PERSPECTIVE: The authors provide a comprehensive review of the relationships between marital functioning and chronic pain variables to advance future research and help treatment providers understand marital processes in chronic pain.

The significant other version of the Pain Catastrophizing Scale (PCS-S): preliminary validation.

Researchers have hypothesized that pain catastrophizing has a social function. Although work has focused on the catastrophizing of individuals with chronic pain (ICPs), little is known about the pain catastrophizing of their significant others. The purpose of this study was to test the validity of a revised version of the original PCS [Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524.] in which individuals were instructed to report on their own catastrophizing about their significant other's pain. In Study 1, a confirmatory factor analysis was conducted to determine the factor structure of the PCS-Significant Other (PCS-S) in a diverse sample of university undergraduates (n=264). An oblique second-order 3-factor model with two cross-loadings provided the best fit and this model was invariant across gender and racial groups. This factor structure was cross-validated in Study 2 with a second sample of university undergraduates (n=213). Results indicated that the 3-factor structure with two cross-loadings was a viable model of significant others' pain catastrophizing across gender and racial groups. In Study 3, this factor structure was replicated and the content validity of the PCS-S was examined in a sample of adult ICPs and their spouses (n=111). Spouse catastrophizing was related to ICP pain severity and interference as well as both spouses' depressive symptoms. In addition, ICPs were at a greater risk for psychological distress when both spouses had higher levels of catastrophizing. The PCS-S has the potential to be a useful and valid measure of pain catastrophizing in the significant others of ICPs.

Factors associated with marital satisfaction and mood among spouses of persons with chronic back pain.

UNLABELLED: Few studies have examined the impact of chronic pain on the spouse. In this study the impact of pain and disability as rated by both the patient and the spouse on spouse marital satisfaction and affective distress was examined in 110 couples. Zero-order correlations indicated that absolute ratings of perceived disability by the spouse, rather than discrepancies between spouse and patient ratings, were most highly associated with spouse marital dissatisfaction and affective distress. Predictors of spouse marital satisfaction and distress were examined by using simultaneous multiple regression. Spouse ratings of greater physical disability were significantly related to greater spouse affective distress. Spouse ratings of higher psychosocial disability, lower spouse marital satisfaction, and being a patient of male gender were marginally related to higher spouse affective distress. Spouse marital dissatisfaction was significantly associated with patient ratings of greater psychosocial disability and lower pain. Spouse-rated psychosocial disability and affective distress were also marginally related to spouse marital satisfaction. These findings highlight the importance of patient disability, particularly limitations in function as perceived by the spouse, on spouse adjustment. PERSPECTIVE: The impact of chronic pain on the spouse of the person with pain has received little empirical attention. The present study examines the relationship between patient and pain-related factors and psychosocial adjustment in the spouse.

What are the marital problems of patients with chronic pain?

Throughout the past two decades, researchers have studied the close relationships of patients to understand the role that these relationships play in the maintenance and alleviation of pain and the role that pain plays in affecting relationships. In this article, a brief review of the evidence is provided, showing a link between marital functioning and pain, and the marital problems reported by patients with chronic pain in our studies also are described. We provide information about several promising couples pain management and couples therapy approaches that appear to help couples manage pain together. Recommendations for clinical and research directions also are offered.