Living with a spouse or partner, especially if the union is a satisfying one, is related to better functional health among individuals in chronic pain [30
], but the mechanisms whereby such relationships yield benefits have not been fully elaborated. Findings from the current study provide clues about how patients in satisfying spousal relationships are able to fare better over the long term compared to their less satisfied or unpartnered counterparts. On days of high pain, happily partnered patients were less likely to experience increased physical disability, catastrophize about the pain, or feel the pain was difficult to manage compared to women in less happy unions and unpartnered women. How were happily partnered women better able to sustain their physical functioning during an increase in pain? We examined whether affect and/or cognitions served as mediators of this partnership status difference, and found that it was the capacity of happily partnered women to experience less catastrophizing and difficulty coping with an increase in pain that contributed to their increased ability to limit their pain-related physical disability relative to unhappily partnered or unpartnered women. These findings highlight the relative importance of pain-related cognitions reflecting coping efficacy for preserving today’s physical functioning during increases in pain.
It is plausible that it is not sharing a happy union, but rather attributes of women who manage to have happy unions, that can account for their capacity to manage changes in pain day to day. For example, happily partnered women may possess more traits associated with resilience and/or fewer traits associated with vulnerability to adversity than unhappily partnered or unpartnered women. Arguing against this explanation, however, is the equivalence of groups in mean levels of pain, disability, positive affect, negative affect, catastrophizing, and pain coping difficulty across diary days. Thus, it appears that that it is the social environment that patients perceive rather than attributes of the patients themselves that are providing women in happy partnerships with resources to be resilient in managing their changes in pain.
The current findings complement those reported by Delongis and Holtzman [13
] in their daily process study of partnered rheumatoid arthritis patients. They asked how spousal relations relate to within-person pain coping and found that patient reports of higher than usual satisfaction with spouses’ support in the morning buffered the relation between morning increases in pain and evening increases in negative affect and catastrophizing. Thus, patients were able to limit the negative emotional and cognitive consequences of pain when they felt satisfied with their spouses’ support. The current study did not assess ongoing patient satisfaction with spouse support, but did determine how they generally regard their spouses’ behavior. Happily partnered women reported being more satisfied overall with how their spouses responded to their most recent increase in pain than did unhappily partnered women. Taken together, the findings suggest that the daily benefits that patients experience in happy unions are due to patients’ perceptions that their spouse’s support is highly responsive to their needs, bolstering the patients’ capacity to use adaptive coping strategies and preserving their positive affect and physical functioning during increases in pain.
How can the current findings help to inform intervention efforts targeting chronic pain? One possibility is broadening treatment focus beyond the individual. Because individuals are embedded within social networks, a promising treatment approach includes training key social network members to be responsive to the patient. Over the past 15 years, some intervention approaches for chronic pain have involved spouses in the treatment, in an attempt to teach spouses how to elicit and positively reinforce patient’s efforts to cope with pain [20
]. Although improving relationship satisfaction typically is not the purpose of the interventions that include spouses, such an approach may yield benefits to patients via enhanced marital adjustment. For example, patients who reported increased marital satisfaction following a spouse-assisted coping skills intervention had less physical disability and showed less pain behavior relative to those who did not report increased marital adjustment [20
]. Thus, teaching spouses how to assist patients’ own coping efforts may, in fact, provide training in how to be a responsive, satisfying partner, or at least bolster the patients’ perception that the spouse is responsive. A complementary approach could include building a couple’s socioemotional regulation skills by teaching partners to respond empathically to one another when dealing with pain and other stressors [13
]. For instance, when spouses responded with supportive, caring gestures to their partners during days of increased family stress, relationship tension declined on the following day. An intriguing possibility is that bolstering the capacity for relationship-focused coping during stress may promote optimal physical, psychological, and social functioning in couples and families managing chronic pain. Efforts such as these may yield benefits by building emotional intimacy in these relationships, providing an ongoing context for more empathic partner communication and more adaptive patient responses to partner support [4
]. The accumulating evidence suggests that maximizing the beneficial impacts of available social resources relationship quality may be an important avenue to effective coping and sustained quality of life in pain patients.
The current study has some important limitations. First, because the data are correlational, we cannot make causal statements regarding the relations between partnership status and pain-related increases in disability. Second, the participants in this study were all women and primarily Caucasian and middle-aged, so that the generalizability of these findings to younger, more ethnically diverse, and/or male chronic pain patients remains to be determined. Third, although our focus is on the value of happy partnerships for adaptation in chronic pain, in reality we assessed only the patients’ global perceptions of their relationships. A more comprehensive approach would assess relational vulnerability and resilience factors (e.g., daily spousal strain and satisfaction) not only of pain patients but also of partners to more fully capture the interpersonal processes within couples that promote or hinder daily well-being of both spouses. Finally, all assessments were based on self-reports. Inclusion of objective measures (e.g., physiological indices) would provide a more comprehensive framework with which to understand the impacts of social context of patient functioning. This study also had some notable strengths. The sample was large and comprised of patients with two of common chronic pain conditions, increasing the likelihood that the findings have relevance from a broad swath of patients with chronic pain. Moreover, reports of pain, affect, and functional health were collected daily, reducing recall bias and yielding reliable estimates of the day-to-day covariation between pain, affect, and functional health.
In conclusion, pain-related shifts in disability may be minimized by being embedded in a satisfying spousal relationship that shapes a patient’s coping responses to pain toward strategies that are more adaptive. Although relationship status had effects that were quite modest in magnitude, those effects should be considered within a broader understanding of the multifactorial nature of pain-related disability. To uncover its true significance, a small effect must be evaluated in the context of its real world impact [7
]. In this case, small benefits in disability over a lifetime of managing chronic pain may indeed have a substantial impact on quality of life for pain patients. These findings highlight the potential utility of interventions that move beyond a focus on the individual patient and target the patient’s social milieu and her perception of it. Additional research elaborating the interpersonal processes whereby satisfying spousal relations facilitate resilience in patients is critical to inform the development of such treatments.