The Relationship of Locus of Control and PsychosociaI-Behavioral Response in Chronic Headache

It has been suggested that patients' perceptions of the impact chronic headache has on their lives as well as perceived control of their headaches may be associated with the intensity, duration, and exacerbation of pain they experience. The present study examined associations among International Headache Society (IHS) diagnostic category, pain characteristics such as severity and duration, perceived impact and control of headaches, and adaptive response. Two hundred twenty-five patients with migraine, tension-type, or combined migraine and tension-type headache served as subjects. General activity level was related to IHS diagnosis, with migraine headache patients reporting that they are more active than tension-type headache patients (F(2, 196) = 5.69, P < .01). Headache locus of control was not significantly related to IHS diagnosis, however external headache locus of control was significantly related to headache intensity (r = .32, P < .001, r = .25, P < .001), as well as to patients' perceptions of the extent to which pain interfered with various domains of their lives (r = .33, P < .001, r = .28, P < .001), and adaptive response (F(6, 402) = 4.68, P < .001). It appeared that perceived control over headaches and perceived impact of headaches were not related to IHS diagnostic category and were not strongly related to each other, but were related to headache severity.     

Spousal congruence on disability, pain, and spouse responses to pain

We examined congruence between chronic pain patients and their spouses on their reports of patient pain severity, patient disability, and spouse responses to pain. Patients reported that they were more physically and psychosocially disabled than their spouses reported them to be. However, spouses reported that the patients' pain was more severe than patients reported. Depressive disorders in the patient and gender interacted with patient-spouse ratings. For physical and psychosocial disability, depressed patient couples reported significantly larger differences in disability ratings than non-depressed patient couples. In addition, female patients' disability was rated as more severe by the female patients than by their husbands. Male patient couples did not report differences on physical disability. Findings relating to other forms of disability and to spouse responses are also described. The results are discussed in the context of an interpersonal perspective of chronic pain and have implications for the assessment of pain and disability.     

A Motivational Therapeutic Assessment Improves Pain,Mood, and Relationship Satisfaction in Couples With Chronic Pain

The current study tested whether a therapeutic assessment improved pain and well-being in couples facing chronic pain. Couples (N = 47) in which 1 spouse had chronic pain completed surveys about pain, mood, marital satisfaction, and empathy, followed by an interview and an assessment session to which they were randomly assigned: a tailored assessment of their marriage and pain coping that incorporated motivational interviewing strategies, or a control condition that included education about the gate control theory of pain. Multilevel modeling revealed that couples in the motivational assessment group experienced significant decreases in pain severity and negative mood, and increases in marital satisfaction and positive mood from baseline to postassessment, relative to the education control group. All participants experienced increases in empathy toward their partner except for spouses in the control group, who experienced declines in spousal empathy. The motivational assessment and control groups did not experience differential change in any of the variables at 1-month follow-up. Moderators of improvement were also explored, including age, race, gender, education, pain duration, spouse pain status, and marriage duration. The results provide preliminary evidence for the short-term benefits of a brief motivational assessment to improve psychosocial functioning in both patients and spouses.PerspectiveThis article presents preliminary evidence in support of a brief therapeutic psychosocial assessment for couples with chronic pain. Assessments such as this may potentially help patients and their spouses feel more optimistic about pain treatment and increase the likelihood of entering treatment.     

Pain and the marital relationship: psychiatric distress

Psychologic assessment and treatment of the family of the chronic pain patient has been thought to be of benefit in the outcome of pain therapy. The present study was designed to determine the presence of psychologic symptoms in the spouses of pain patients and the relationship of distress levels between the marital pair. Forty-four couples were studied. Demographic data was collected and each individual completed the SCL-90, a widely used and validated measure of psychologic symptom severity. There was a significant correlation (P = less than 0.001) on psychiatric distress scores between pain patients and their spouses particularly when pain patient distress scores were high. Distress levels tended to decrease with age and were highest among the unemployed and lowest in the retired. In addition spouses were significantly higher than nonpatient norms on most symptom subscales. These data underline the importance of conjoint assessment of the chronic pain patient and the spouse, and have implications for treatment.     

Pain-specific beliefs, perceived symptom severity, and adjustment to chronic pain.

Cognitive theories of appraisal argue for the importance of beliefs as determinants of adjustment to stress. The current investigation sought to examine the relation between beliefs about chronic pain and adjustment in a group of chronic pain patients. Patients' belief in themselves as disabled was found to be inversely related to activity level for patients reporting low and medium levels of pain severity. This same belief correlated with professional services utilization and was negatively related to psychological functioning. Believing in a medical cure for pain was also positively related to professional services utilization. Finally, an expressed belief in the appropriateness of solicitous responses from family members was negatively related to psychological functioning for patients reporting relatively low levels of pain. Although these findings support the broad-based hypothesis that the illness-relevant beliefs of chronic pain patients are associated with their multidimensional pain adjustment, they emphasize the importance of beliefs concerning whether or not one is disabled by pain. The findings also highlight the fact that the belief/functioning relation is not always direct and can be moderated by perceived pain severity.     

Chronic pain couples: perceived marital interactions and pain behaviours

Patient adjustment to chronic pain is well known to be influenced by the spouse and his or her response to patient expressions of pain. However, these responses do not occur in a vacuum, and the aim of the present study was to investigate patient-spouse interactions in chronic pain in detail. Ninety-five patient-spouse dyads completed questionnaires relating to mood, marital satisfaction and communication, and 80 couples also took part in semi-structured interviews. Data were analysed using quantitative and qualitative methods. Results showed that spouses of chronic pain patients reported engaging in a far wider repertoire of responses to pain behaviours than has been recognised to date. New response categories of 'hostile-solicitous' and 'observe only' were identified. Patients generally interpreted solicitous responses less favourably than spouse responses which encouraged task persistence. Male spouses identified fewer pain-related situations than female spouses but were more likely to report responding solicitously to patient pain behaviours. Marital satisfaction was significantly higher in patients who rated themselves as talking more frequently about their pain. Spouse perceived frequency of pain talk was not related to spouse marital satisfaction. There were no gender differences in marital satisfaction. The results of this study challenge some of the assumptions that have been held regarding chronic pain patient-spouse interactions.     

Couple Therapy and Chronic Headache: A Preliminary Outcome Study

This brief report examines the factors that led to successful completion of couple therapy with 8 chronic headache patients and their spouses, as opposed to another 8 couples who dropped out of treatment. Overall, the couples who successfully completed therapy were in less strifeful marriages and were confronted with specific life change events as opposed to the couples who dropped out, who gave evidence of chronic marital difficulties. Family and couple therapy for chronic headache sufferers is recommended on a selective basis.     

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.     

Spousal responses are differentially associated with clinical variables in women and men with chronic pain

OBJECTIVES: Spousal responses have been related to clinical variables in patients with chronic pain. For example, solicitous responses from spouses have been associated with greater levels of pain and disability among patients with chronic pain. However, few investigators have determined whether spousal solicitousness produces different effects in women versus men with chronic pain. The present study examined pain reports, medication use, psychosocial factors, functional measures, and pain tolerance in patients with chronic pain. METHODS: Subjects included 114 female and 213 male chronic pain patients, who described their spouses as either high or low in solicitousness on the Multidimensional Pain Inventory. Measures of pain severity, affective distress, physical function, medication use, and pain tolerance were examined in women and men with high versus low scores on spousal solicitousness. RESULTS: Among males only, high spousal solicitousness was associated with greater numerical ratings of pain and greater self-reported disability compared with patients with low solicitous spouses. Among females only, the high spousal solicitousness patients showed lower pain tolerance, greater pain-related interference, poorer performance on functional tasks (eg, timed walking, lifting, and carrying tasks), and greater use of opioid medications. In both women and men, spousal solicitousness was associated with higher scores on the MPI pain severity scale. DISCUSSION: These results extend previous findings demonstrating a relationship between spousal responses and patients' adjustment to pain; however, the pattern of these effects appears to be moderated by the sex of the patient. Implications for assessment and treatment of chronic pain are discussed.     

Marital satisfaction and distress in chronic low-back pain patients and their spouses

This study examined the relation between marital satisfaction, psychological distress, self-reported pain, disability, and clinical findings in 63 chronic low-back pain (CLBP) patients from primary health care centers. The relation between marital satisfaction and psychological distress in their spouses was also studied. Marital dissatisfaction in female CLBP patients was significantly associated with psychological distress, as well as with patient self-reported pain and disability. Marital dissatisfaction in their male spouses was also strongly related to psychological distress. In male CLBP patient couples, marital dissatisfaction and psychological distress were much less significantly related. This gender difference should be taken into account in the treatment of CLBP couples.     

A preliminary investigation of affective interaction in chronic pain couples

The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic.     

The psychological profiles of patients with whiplash-associated headache

Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-9O-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.     

Sequential and Base Rate Analysis of Emotional Validation and Invalidation in Chronic Pain Couples: Patient Gender Matters

The purpose of this study was to examine the extent to which communication patterns that foster or hinder intimacy and emotion regulation in couples were related to pain, marital satisfaction, and depression in 78 chronic pain couples attempting to problem-solve an area of disagreement in their marriage. Sequences and base rates of validation and invalidation communication patterns were almost uniformly unrelated to adjustment variables unless patient gender was taken into account. Male patient couples’ reciprocal invalidation was related to worse pain, but this was not found in female patient couples. In addition, spouses’ validation was related to poorer patient pain and marital satisfaction, but only in couples with a male patient. It was not only the presence or absence of invalidation and validation that mattered (base rates), but the context and timing of these events (sequences) that affected patients’ adjustment. This research demonstrates that sequences of interaction behaviors that foster and hinder emotion regulation should be attended to when assessing and treating pain patients and their spouses.

Perspective

This article presents analyses of both sequences and base rates of chronic pain couples’ communication patterns, focusing on validation and invalidation. These results may potentially improve psychosocial treatments for these couples, by addressing sequential interactions of intimacy and empathy.     

How Do I Empathize With You? Let Me Count the Ways: Relations Between Facets of Pain-Related Empathy

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.     

The role of the family in relation to chronic pain: review of the literature

As families maintain the primary responsibility for the care of the chronic pain sufferer, this paper examines the family's aetiological role in chronic pain, the ways in which the family influences and maintains pain, and the impact that chronic pain has on the family unit. Although some of the research is contentious, it can be concluded that, (a) there is a tendency for patients to come from families which include another member suffering from pain or illness, (b) that it is conceivable that spouses reinforce pain behaviors in their partners, and (c) that it is possible that the chronic pain sufferer may significantly subscribe to poor marital relationships, poor sexual adjustment and high levels of emotional distress.     

Headache and other types of chronic pain

OBJECTIVE: To compare pain severity, disability, psychological distress, and quality of life between patients with headache and nonheadache treatment-seeking chronic pain patients. METHODS: Six hundred forty-three patients seeking treatment at a university pain clinic were divided into 3 categories based on primary pain complaint and the presence of focal or diffuse pain complaints: headache, nonheadache focal (pain involving <50% of the body), and nonheadache diffuse (pain involving >/=50% of the body). Patients completed questionnaires to identify pain severity, disability, depression, anxiety, and quality of life. RESULTS: Patients with headache differed from nonheadache patients for all evaluated parameters. Average pain severity on a 0 to 10 point severity scale was 5.55 for headache, 6.93 for nonheadache focal, and 8.05 for nonheadache diffuse. Pain occurred an additional 1.51 to 1.71 days per week for patients without headache. Compared to patients with headache, patients without headache reported greater frequency of reduced daily activities and complete disability related to pain. In addition, patients without headache and with diffuse pain reported more depression (78.2% vs. 45.8%) and anxiety (70.0% vs. 39.1%) than patients with headache. Quality of life measures were significantly reduced in patients with either nonheadache focal or diffuse conditions compared to patients with headache. CONCLUSIONS: Even when considering patients with focal rather than diffuse chronic pain complaints, patients with headache are dissimilar from other patients with chronic pain. Pain severity, frequency, disability, psychological distress, and quality of life are significantly more prominent or impaired in patients with chronic pain without headache compared to patients with headache.     

家庭亲密度和适应性与脑梗死后抑郁的相关性分析

目的探讨家庭亲密度和适应性与脑梗死后抑郁的关系。方法采用汉密尔顿抑郁量表、家庭亲密度和适应性量表对108例首次发病脑梗死患者进行调查,根据是否存在抑郁,分为抑郁组（63例）和非抑郁组（45例）。比较两组患者家庭亲密度和适应性的差别,并进行家庭亲密度和适应性评分与抑郁的相关性分析。结果抑郁组实际亲密度和实际适应性评分均低于非抑郁组患者（P〈0．01）,亲密度不满意程度和适应性不满意程度评分均高于非抑郁组患者（P〈0．01）。抑郁与实际亲密度和实际适应性均呈负相关（P〈0．05）,与亲密度不满意程度和适应性不满意程度均呈正相关（P〈0．05）。结论家庭亲密度和适应性差是脑梗死后抑郁的重要原因。     

Men with cardiovascular disease and their spouses: coping, health, and marital adjustment

This study examined the coping methods, health perceptions, and marital adjustment of 37 middle-aged men with chronic cardiovascular disease and their spouses. Despite variation in disease types and the absence of disease among the spouses, the couples were similar in their coping responses. Both partners used more emotionally focused strategies than problem-focused strategies to cope with chronic illness. Subjective health perceptions were more useful than objective indices for predicting coping. Preillness and current marital adjustment were satisfactory for both partners. The major implications for nursing practice are in the area of assessment, and suggested interventions are discussed.     

Perceived self-efficacy and headache-related disability

BACKGROUND: Headache-specific self-efficacy refers to patients' confidence that they can take actions that prevent headache episodes or manage headache-related pain and disability. According to social cognitive theory, perceptions of self-efficacy influence an individual's adaptation to persistent headaches by influencing cognitive, affective, and physiological responses to headache episodes as well as the initiation and persistence of efforts to prevent headache episodes. OBJECTIVE: The objective of the present study was to construct and validate a brief measure of headache specific self-efficacy and to examine the relationship between self-efficacy and headache-related disability. METHODS: A sample of 329 patients seeking treatment for benign headache disorders completed the Headache Management Self-Efficacy Scale and measures of headache-specific locus of control, coping, psychological distress, and headache-related disability. A subset of 262 patients also completed 4 weeks of daily headache recordings. RESULTS: As predicted, patients who were confident they could prevent and manage their headaches also believed that the factors influencing their headaches were potentially within their control. In addition, self-efficacy scores were positively associated with the use of positive psychological coping strategies to both prevent and manage headache episodes and negatively associated with anxiety. Multiple regression analyses revealed that headache severity, locus-of-control beliefs, and self-efficacy beliefs each explained independent variance in headache-related disability.     

Anxiety sensitivity, fear, and avoidance behavior in headache pain

Recent research has implicated anxiety sensitivity (AS), the fear of anxiety-related sensations, as a mitigating factor involved in fear and avoidance in patients with chronic back pain [Understanding and treating fear of pain (2004) 3]. Given reported similarities between individuals experiencing chronic pain and those experiencing recurrent headaches, it is theoretically plausible that AS plays a role in influencing fear of pain and avoidance behavior in people with recurrent headache. This has not been studied to date. In the current study we used structural equation modeling to examine the role of AS in fear and avoidance behavior of patients experiencing recurrent headaches. Treatment seeking patients with recurrent headaches completed measures of AS, headache pain severity, pain-related fear, and pain-related escape and avoidance behavior. Structural equation modeling supported the prediction of a direct significant loading of AS on fear of pain. Headache severity also had a direct loading on fear of pain. Results also revealed that AS and headache severity had indirect relationships to pain-related escape and avoidance via their direct loadings on fear of pain. Headache severity also had a small direct loading on escape and avoidance behavior. These results provide compelling evidence that AS may play an important role in pain-related fear and escape and avoidance behavior in patients with recurrent headaches.