Spouses Influence Chronic Pain

When Does Support Encourage Dependence?

From the WebMD Archives

Sept. 3, 2003 -- We love to hear it: "Let me help you with that." But for people with chronic pain -- back pain or arthritis -- an overly solicitous spouse may be more harmful than helpful, a new study suggests.

"Chronic pain affects people's lives so broadly," lead researcher Roger B. Fillingim, PhD, with the University of Florida College of Dentistry in Gainesville, tells WebMD.

"Besides the pain symptoms, there is impact on their daily functioning -- the degree to which people can't or don't do things," he says. "There is also the emotional distress, the negative thinking, the suffering." His study appears in the current issue of The Clinical Journal of Pain.

Indeed, chronic pain is very complex -- and there's a fine line between helping someone in pain and being overly protective.

"Too often, a doctor makes a statement like, 'Don't lift anything over 10 pounds,' and that makes wives more protective. She starts saying, 'Oh, don't do that -- you need to rest' -- rather than encouraging them," says Fillingim. "They want to help but they don't know how."

Gender Differences

Studies have pointed to this delicate link between a person's disability and a spouse's response. By being overly protective -- or showing too little empathy -- a spouse can increase the level of pain and disability, some researchers have said.

Also, women are more sensitive to pain, and are at greater risk of experiencing chronic pain, as studies have shown.

"We're realizing, more and more, that it's a very important factor -- these differences between men and women," says Jennifer Haythornthwait, PhD, a pain researcher and director of the Behavioral Medicine Clinic at Johns Hopkins University School of Medicine. She agreed to comment on Fillingim's study.

Fillingim "does a nice job of speaking to the complexity of this process," she tells WebMD. "It's not just about how men and women differ in their pain experiences, but how husbands and wives respond differently to the cues we all give out when we're hurting."

Rating Empathy, Disability

Fillingim's study involved 114 women and 213 men -- all suffering from chronic pain, mostly lower back pain. All took part in several tests looking at the impact of pain on their lives.

The patients were asked to rate their level of disability, their anxiety over their pain, and how solicitous -- or supportive -- their spouse or significant other was.

Each also took a series of "everyday function" tests: walking 100 yards, lifting objects of various weights and carrying them, rating their pain.

Those men who described their spouses as "highly solicitous" experienced more severe pain and reported more disability, says Fillingim.

"I emphasize the word 'reported' because, when we looked at actual functioning, they didn't differ from those men who did not describe their wives as solicitous," he says. "They said they were doing worse, but they were not."

For women, the situation was entirely different. Those with solicitous husbands didn't report significantly more pain or disability -- but their actual physical functioning was poorer. It took them longer to walk and they were able to lift and carry less weight. Also, their actual pain tolerance was lower than the other women's.

A husband's support was evident in another important way: One-half of women who described their husbands as highly solicitous were on medication, but only 25% of those who described their husbands as less solicitous were on pain medications.

For men, their spouses' support did not affect whether they took pain medications or not, reports Fillingim.

Doctor, Physical Therapist May Help

Whether we tune into another's chronic pain is indeed a male-female issue. Women are more sensitive to cues from others, says Fillingim. "So it may take less time for wives to notice that their husbands are in pain."

Likewise, "if you think of men as relatively blunt objects, which we sometimes are, we may have to be hit over the head to see that our spouse needs support," he adds.

That doesn't mean that women become overly dramatic, when sending cues about pain, adds Haythornthwait. "They may indeed be in more pain, feeling more disability, so people respond to them. Their environment becomes more supportive of them."

Some spouses may benefit from learning -- with the help of a doctor and physical therapist -- how to help their spouse in the most appropriate way, Fillingim adds. However, Haythornthwait says the evidence is too much a "snapshot" and too inconclusive to take as a certainty.

WebMD Health News


SOURCES: The Clinical Journal of Pain, Sept. 2003. Roger B. Fillingim, PhD, University of Florida College of Dentistry, Gainesville. Jennifer Haythornthwait, PhD, director of the Behavioral Medicine Clinic, Johns Hopkins University School of Medicine.
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