EFFECTS OF MARITAL INTERACTION ON CHRONIC PAIN AND DISABILITY - EXAMINING THE DOWN SIDE OF SOCIAL SUPPORT

Social support of patients with chronic illness has almost universally been expected to have positive effects on the adaptation to disability and, in some instances, on the underlying disease process. Theory and a growing empirical base challenge this assumption, at least among chronic pain conditions. Operant models of chronic pain suggest that positive attention from significant others to individuals' overt expressions of pain may inadvertently serve to maintain or increase these expression of pain and increase the likelihood of disability. Data from several studies, including new data reported herein, generally support the operant model. Positive attention from spouses to displays of pain are found to be associated with reports of higher reports of pain intensity, observed pain behavior frequency, and greater disability. Negative responding to pain is commonly found to be associated with reports of increased affective distress. This paper advances are formulated cognitive-behavioral model that emphasizes patients' appraisals and interpretations of their spouses' responses to communications of pain. The quality of the marital relationship is specifically documented as a critical mediator. Relationships between spouses' responses to pain and important dimensions of the pain experience are generally found to be present only among maritally satisfied couples. Further nuances related to the appraisal process are considered and directions for future investigations are described.