“We – are – family….” Pain and significant others

Although pain is personal and only felt by the individual, the effects pervade to those closely around. It appears to be a two-way street though, with significant others having an impact upon levels of physical activity and evidence of similar attentional biases in chronic pain patients and their caregivers. Have a look at the papers below:

Pain. 2012 Jan;153(1):62-7. Epub 2011 Oct 15.

Do main caregivers selectively attend to pain-related stimuli in the same way that patients do?


Family Research Institute, Shahid Beheshti University, G.C., Tehran, Iran.


Despite increasing interest in the attentional biases of pain patients towards pain-related stimuli, there have been no investigations of whether the main caregivers of chronic pain patients also selectively attend to pain-related information. We compared the attentional biases to painful or happy faces of 120 chronic pain patients, 118 caregivers, and 50 controls. Analyses found that both patients and caregivers demonstrated biases towards painful faces that were not observed in control participants or to happy faces. Those patients and caregivers who were high in fear of pain demonstrated greater biases than those low in fear of pain, and the biases of the high-in-fear-of-pain group differed significantly from zero. When sub-groups of caregivers were compared, it was found that biases towards painful faces were not observed for those caregivers who accurately identified the level of pain the patient currently reported. In contrast, those caregivers who overestimated or underestimated the patients’ pain demonstrated biases that were significantly greater than zero. These results add to the growing weight of evidence suggesting that biases towards pain-related stimuli are observed in chronic pain patients, but that the nature of the stimuli is important. In addition, the results suggest that caregivers, particularly those who either under- or overestimate the level of pain that the patient reports, also demonstrate similar biases. Future research should investigate the links between caregivers’ biases and the way in which caregivers respond to pain.


Pain. 2011 Nov;152(11):2521-7. Epub 2011 Aug 27.

Factors contributing to physical activity in a chronic low back pain clinical sample: a comprehensive analysis using continuous ambulatory monitoring.


Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA. kalschul@uw.edu


Back pain is one of the most common causes of disability in industrialized nations. Despite this, the variables that contribute to disability are not well understood and optimal measurement strategies of disability have not yet been determined. The present study sought to comprehensively assess the strongest predictors of physical activity as a proxy for disability. New patients in a chronic pain specialty clinic completed questionnaires to assess the predictors of physical activity and engaged in 5 days of home data collection wearing an accelerometer to assess physical activity in daily life, which is how disability was operationalised in this study. Analysis of repeated measures patient data revealed that, of 3 composite variables each representing a theoretical model, the model representative of operant factors significantly predicted physical activity. Subsequent analyses showed that pain sensitivity, fear avoidance, and solicitous spousal responses account for a significant amount of the variance in physical activity. These findings suggest that external sources of reinforcement or punishment may serve to influence physical behavior beyond that of internal cues such as fear avoidance or pain. Implications for treatment are discussed, including the potential benefits of specifically incorporating the patient’s sources of operant reinforcement or punishment into treatment.

RS Comment:

To be truly biopsychosocial, significant others and their influences must be considered. Positive strategies to involve and educate care givers, families and friends should form part of the treatment programme. I recommend that all those involved should develop an understanding of the issues of pain. We often listen to and subscribe to the beliefs of those closest to us and this powerful dynamic can be of real benefit. On occasion I am asked whether partners can attend the sessions. I encourage this participation as well as teaching techniques that are required to be used regularly at home, for example desensitisation strategies.


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