Annmarie Cano

Facing others in pain: the effects of empathy.

Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Research Institute for Psychology & Health, Utrecht, The Netherlands Department of Psychology, University of British Columbia, Vancouver, BC, Canada Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, Leeds, UK Department of Psychology, University of Montreal, Quebec, Canada Sub-Department of Clinical Health Psychology, University College London, London, UK Department of Psychology, Wayne State University, Detroit, MI, USA

A Biopsychosocial Formulation of Pain Communication.

We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.

Pain and emotion: a biopsychosocial review of recent research.

OBJECTIVE AND METHOD Research on emotion and pain has burgeoned. We review the last decades literature, focusing on links between emotional processes and persistent pain. RESULTS Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. CONCLUSIONS Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain.

Comorbid chronic pain and depression: who is at risk?

UNLABELLED The purpose of this study was to investigate the prevalence and demographic risk factors of chronic pain and its comorbidity with depression. Computer-assisted telephone interviewing was utilized to obtain a representative community sample in the state of Michigan (n = 1,179). The prevalence of chronic pain due to any cause was 21.9%. Approximately 35% of participants with chronic pain also had comorbid depression (7.7% of the entire sample). Depression was not associated with pain types or sites. A multinomial-regression analysis revealed several demographic correlates of chronic pain and depression. Participants with chronic pain or comorbid pain and depression were more likely to be older, female, employed less than full-time, and have less education than persons without either condition. Logistic regression analyses showed that younger participants were more likely to have comorbid pain and depression than chronic pain only. A similar but marginally significant effect was found for African American participants. Compared to the depression-only group, those in the comorbid group were more likely to be women and middle-aged. These findings provide additional evidence on the prevalence of comorbid pain and depression in the community and suggest that certain demographic groups with chronic pain may especially benefit from depression screenings. PERSPECTIVE This article reports on the prevalence of chronic pain and co-occurring depression in a representative community sample. The high prevalence rates of pain and comorbid depression point to the clinical importance of assessing depression in chronic pain samples.

Marital functioning, chronic pain, and psychological distress

&NA; This study examined whether marital functioning variables related uniquely to psychological distress and diagnoses of depressive disorder independent of pain severity and physical disability. Participants were 110 chronic musculoskeletal pain patients. Hierarchical regression results showed that marital variables (i.e. marital satisfaction, negative spouse responses to pain) contributed significantly to depressive and anxiety symptoms over and above the effects of pain severity and physical disability. In contrast, marital variables were not significantly related to diagnoses of depressive disorder (i.e. major depression, dysthymia, or both) after controlling for pain variables. In multivariate analyses, physical disability and marital satisfaction were uniquely related to depressive symptoms whereas physical disability, pain severity, and negative spouse responses to pain were uniquely related to anxiety symptoms. Only physical disability was uniquely related to major depression. The results suggest that models of psychological distress in chronic pain patients might be enhanced by attributing greater importance to interpersonal functioning and increasing attention to anxiety.

Pain catastrophizing and social support in married individuals with chronic pain: the moderating role of pain duration

&NA; In the current study, 96 married chronic pain patients were recruited from the community to test hypotheses about the roles of catastrophizing and psychological distress in relation to perceived support from close others. It was expected that pain duration would moderate the relationship between catastrophizing and perceived support and between catastrophizing and psychological distress. In addition, distress was hypothesized to mediate the relationship between the pain duration‐catastrophizing interaction and support. Hierarchical regression analyses showed that pain duration interacted with catastrophizing such that at shorter pain durations, pain catastrophizing was related to more perceived solicitous spouse responses; however no such relationship existed for patients with longer pain durations. In contrast, catastrophizing was significantly related to less perceived spousal support (i.e. support not specific to pain) in patients with longer durations of pain whereas no significant relationship existed for patients with shorter pain durations. Pain duration did not interact with catastrophizing in relating to psychological distress, which precluded the examination of distress as a mediator between the pain duration‐catastrophizing interaction and support. Moreover, psychological distress did not significantly mediate the relationships between pain catastrophizing and perceived support. These findings are discussed in the context of cognitive‐behavioral and interpersonal perspectives of pain.

Social interaction in pain: Reinforcing pain behaviors or building intimacy?

To date, pain research has focused almost exclusively on operant models to interpret the function and predict the consequences of pain-related interaction in chronic pain couples. However, evidence suggests that intimacy models of interaction may provide additional and alternative explanations for pain interaction. Specifically, intimacy models conceptualize some verbal expressions of pain-related distress as emotional disclosure, which the partner may validate or invalidate. This review compares and contrasts models of interaction in chronic pain couples, describes limitations of the existing research, and offers directions for future research. Although models of pain empathy suggest that facial expressions and other nonverbal behaviors convey important information concerning pain and other emotions8, we focus this review on verbal communications for two reasons. First, it is not known whether nonverbal behavior can be understood using an intimacy framework. Second, others’ interpretations of nonverbal behaviors are affected by accompanying verbal communication12.

Life stressors and husband-to-wife violence

The current review critically evaluates the research conducted on the relationship between life stressors and husband-to-wife violence. Empirical work suggests that there may be multiple pathways accounting for the relationship between life stressors and husband-to-wife violence. Contrary to previous reviews of the literature, we found that the existing evidence supports a direct association between life stressors and husband-to-wife violence. In addition, a number of variables mediate and moderate the relationship between life stressors and violence including marital satisfaction, depression, attitudes accepting of husband-to-wife violence, violence in the family of origin, and alcohol abuse/dependence. In order to assist investigators interested in conducting research in this area, we conclude this review by identifying remaining problems in the research and recommending possible solutions.

Pain Affects Spouses Too: Personal Experience With Pain and Catastrophizing as Correlates of Spouse Distress

&NA; 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.

Catastrophizing about their children's pain is related to higher parent-child congruency in pain ratings: an experimental investigation.

Little is known about the variables that account for why parents underestimate the pain of their child. In the present experiment, the joint impact of parental catastrophizing about their childs pain and childrens facial pain expressions was examined upon pain estimates of their child undergoing a pressure pain test. In line with previous research, parents underestimated their childrens pain. Interestingly, it was found that pain was estimated as higher when the child showed more facial pain expressions and when parents catastrophized more about their childs pain. An intriguing finding was that catastrophizing about their childs pain was related to less parent–child incongruence in pain ratings. The discussion addresses the possible functions of catastrophizing of parents about their childrens pain, and delineates avenues for future research.