Rush University Medical School, Chicago, IL, USA University of Notre Dame, USA Duke University Medical Center, Durham, NC, USA.
Pain. 2013 Dec;154(12):2715-2721. doi: 10.1016/j.pain.2013.07.053. Epub 2013 Aug 6.
Chronic musculoskeletal pain can strain marriages, perhaps even to the point of engendering spouse criticism and hostility directed toward patients. Such negative spouse responses may have detrimental effects on patient well-being. While results of cross-sectional studies support this notion, we extended these efforts by introducing expressed emotion (EE) and interpersonal theoretical perspectives, and by using electronic diary methods to capture both patient and spouse reports in a prospective design. Patients with chronic low back pain (CLBP) and their spouses (N = 105 couples) reported on perceived spouse behavior and patient pain 5 times/day for 14 days using Personal Data Assistants (PDAs). Concurrent and lagged within-couple associations between patient's perceptions of spouse criticism/hostility and patient self-reported pain and spouses' observations of patient pain behaviors revealed that (1) patient perceived spouse criticism and hostility were correlated significantly with pain intensity, and spouse observed patient pain behavior was related significantly with patient perceived hostility at the same time point; (2) patient perceived spouse hostility significantly predicted patient pain intensity 3 hours later, and spouse observed pain behaviors significantly predicted patient perceived spouse hostility 3 hours later. Results support both EE and interpersonal models, and imply that a comprehensive model would combine these conceptualizations to fully illustrate how spouse criticism/hostility and patient pain interact to produce a negative spiral. Given that marital interactions are amenable to clinical intervention, improved insight into how spouse behavior and patient pain are tightly linked will encourage productive translational efforts to target this neglected area.
慢性肌肉骨骼疼痛会影响婚姻关系，甚至可能导致配偶对患者产生批评和敌意。这种负面的配偶反应可能对患者的健康产生不利影响。虽然横断面研究的结果支持这一观点，但我们通过引入表达情感（EE）和人际关系理论视角，并使用电子日记方法在前瞻性设计中同时捕捉患者和配偶的报告，扩展了这些研究。105 对慢性下腰痛（CLBP）患者及其配偶报告了他们对配偶行为和患者疼痛的感知，使用个人数据助理（PDA）每天 5 次，持续 14 天。患者对配偶批评/敌意的感知与患者自我报告的疼痛和配偶观察到的患者疼痛行为之间的同期和滞后的夫妻间关联表明：（1）患者感知到的配偶批评和敌意与疼痛强度显著相关，配偶观察到的患者疼痛行为与患者同时点的敌意感知显著相关；（2）患者感知到的配偶敌意显著预测 3 小时后的疼痛强度，配偶观察到的疼痛行为显著预测 3 小时后的配偶敌意感知。结果支持 EE 和人际关系模型，这意味着一个综合模型将结合这些概念，充分说明配偶批评/敌意和患者疼痛如何相互作用产生负面螺旋。鉴于婚姻互动可以进行临床干预，深入了解配偶行为和患者疼痛之间的紧密联系将鼓励有针对性地针对这一被忽视领域进行富有成效的转化努力。
