DOES RELATIONSHIP STATUS AND QUALITY MODERATE DAILY RESPONSES TO PAIN IN WOMEN WITH CHRONIC PAIN?

Transcription

1 DOES RELATIONSHIP STATUS AND QUALITY MODERATE DAILY RESPONSES TO PAIN IN WOMEN WITH CHRONIC PAIN? SHANNON STARK TAYLOR, M.A., MARY DAVIS, PH.D., & ALEX ZAUTRA, PH.D. ARIZONA STATE UNIVERSITY

2 Burden of Chronic Pain Highly prevalent health condition Enormous societal costs: $ billion/year Substantial individual costs: $4,475/year Psychological costs: Depression and anxiety Institute of Medicine of the National Academies Report (2011)

3 What factors contribute to adjustment? Partnership status Slower declines in functional disability over time Fewer depressive symptoms Quality of the relationship Non-distressed marriages Lower distress and pain Partner s responses to pain More perceived spouse support Increased disability Solicitous spouse responses to pain behaviors Increased disability (Averill, Novy, Nelson, & Berry, 1996; Flor, Kerns, & Turk, 1987; Reese, Somers, Keefe, Mosely-Williams, Lumley, 2010; Romano et al., 1995; Ward & Leigh, 19930

4 Relationship Factors and Adaptation: Potential Mechanisms Social context influences responses to daily pain: Affective Negative Affect Positive Affect Cognitive Pain catastrophizing Pain coping difficulty Affective and cognitive responses linked to functional health (Crombez, Eccleston, Van Hamme, & De Vlieger, 2008; Holtzman & Delongis, 2007; Jensen, Turner, Romano, & Karoly, 1991; Novy et al., 1995)

5 Study questions 1. Benefits for happily partnered vs. unhappily partnered and unpartnered? Smaller pain-related increases in disability

6 Model 3 Partnership Groups Unpartnered Partnered Low Satisfaction Partnered- High Satisfaction Today s Pain Flare Today s Disability

7 Study questions 1. Benefits for happily partnered vs. unhappily partnered and unpartnered? Smaller pain-related increases in disability 2. Mediation of pain-disability benefit of happy partnerships? Pain cognitions Affective responses

8 Model 3 Partnership Groups Unpartnered Partnered Low Satisfaction Partnered- High Satisfaction Today s Pain Flare Today s Disability

9 Model 3 Partnership Groups Unpartnered Partnered Low Satisfaction Partnered- High Satisfaction Today s Pain Flare Today s Pain Cognitions and Affect Today s Disability

10 Participants 251 women M age = 57.33, range Pain diagnosis Osteoarthritis (n = 103) Fibromyalgia (n = 48 ) Both (n = 100) Relationship Status Living with a spouse/romantic partner: n = 145 Not living with a partner: n = 106

11 Method I. Initial questionnaire Demographics, relationship status Modified version of Marital Adjustment Scale (Locke & Wallace, 1959) Used to create 3 categorical groups: 0 = unpartnered (UnP; n = 106), 1 = partnered/low satisfaction (LowSat; n = 74) 2 = partnered/ high satisfaction (HighSat; n = 71)

12 Method II. Electronic daily diaries for 30 evenings Pain: rating scale Affect: PANAS (Watson, Clark & Tellegen, 1988) Catastrophizing: CSQ (Keefe, Brown, Wallston, & Caldwell, 1989) Today, I worried about whether my pain would ever end. Today I felt my pain was so bad I couldn t stand it anymore. Pain coping difficulty: Rate difficulty to cope with pain at time of day when pain was worst. Physical Disability: SF-36 RP subscale (Ware & Sherbourne, 1992) To what extent did you accomplish less than you would like due to your physical health?

13 Physical Disability (0-100) Pain and Disability LowSat UnP HighSat Low Pain High Pain -1 SD +1 SD

14 Catastrophizing (1-5) Pain and Catastrophizing LowSat UnP HighSat 1.75 Low Pain High Pain -1 SD +1 SD

15 Pain Coping Difficulty (1-5) Pain and Pain Coping Difficulty UnP = UnPartnered UnP LowSat HighSat LowSat = Partnered/Low Satisfaction HighSat = Partnered/High Satisfaction Low Pain High Pain -1 SD +1 SD

16 Negative Affect (1-5) Pain and Negative Affect LowSat HighSat UnP UnP = UnPartnered LowSat = Partnered/Low Satisfaction HighSat = Partnered/High Satisfaction Low Pain High Pain -1 SD +1 SD

17 Positive Affect (1-5) Pain and Positive Affect HighSat UnP LowSat Low Pain High Pain -1 SD +1 SD

18 Mediation Results Positive affect, catastrophizing, and pain coping difficulty predicted change in disability Positive affect Indirect effect = [95% CI ] Catastrophizing Indirect effect = [95% CI ] Pain Coping Difficulty Indirect effect = [95% CI ] All mediators included Cognitions remained significant mediators Positive affect no longer remained significant

19 Conclusions On days of high pain, happily partnered women were less likely to: Experience increased physical disability Catastrophize about the pain Feel the pain was difficult to manage Fewer maladaptive pain cognitions in response to increased pain helped happily partnered women better sustain physical functioning

20 Limitations Correlational Generalizability Measured overall relationship satisfaction rather than day-to-day changes Self-report

21 Implications When in pain, a supportive spouse may bolster one s capacity to: Use adaptive coping strategies Preserve positive affect and physical functioning Possible implications for future interventions Broadening treatment to include partner, other social supporters, teaching: How to facilitate patient s coping How to respond empathically: relationship-focused coping

22 Acknowledgements This project was supported by NIAMS grant R01AR046034, PI: Alex Zautra Mary Davis, Ph.D. Alex Zautra, Ph.D. Arizona Health and Aging Lab ASU Department of Psychology ASU Graduate School

23 References Averill PM, Novy DM, Nelson DV, Berry LA. Correlates of depression in chronic pain patients: a comprehensive examination. PAIN 1996;65: Crombez G, Eccleston C, Van Hamme G, De Vlieger P. Attempting to solve the problem of pain: a questionnaire study in acute and chronic pain patients. PAIN 2008;137: Flor H, Kerns RD, Turk DC. The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients. J Psychosom Res 1987;31: Holtzman S, DeLongis A. One day at a time: the impact of daily satisfaction with spouse responses on pain, negative affect and catastrophizing among individuals with rheumatoid arthritis. PAIN 2007;131: Institute of Medicine of the National Academies Report. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research The National Academies Press, Washington DC. Jensen MP, Turner JA, Romano JM, Karoly P. Coping with chronic pain: a critical review of the literature. PAIN 1991;47: Keefe FJ, Brown GK, Wallston KA, Caldwell DS. Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy. PAIN 1989;37: Keefe FJ, Caldwell DS, Baucom D, Salley A, Robinson E, Timmons K, Beaupre P, Weisberg J, Helms M. Spouse-assisted coping skills training in the management of osteoarthritic knee pain. Arthritis Care Res 1996;9: Locke HJ, Wallace KM. Short marital-adjustment and prediction tests their reliability and validity. Marriage Fam Living 1959;21: Novy DM, Nelson DV, Francis DJ, Turk DC. Perspectives of chronic pain: an evaluative comparison of restrictive and comprehensive models. Psychol Bull 1995;118: Reese JB, Somers TJ, Keefe FJ, Mosley-Williams A, Lumley MA. Pain and functioning of rheumatoid arthritis patients based on marital status: is a distressed marriage preferable to no marriage? J Pain 2010;11: Romano JM, Turner JA, Jensen MP, Friedman LS, Bulcroft RA, Hops H, Wright SF. Chronic pain patient-spouse behavioral interactions predict patient disability. PAIN 1995;63: Ward MM, Leigh JP. Marital status and the progression of functional disability in patients with rheumatoid arthritis. Arthritis Rheum 1993;36: Ware JE, Sherbourne CD. 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30: Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54: