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Journal of Occupational Rehabilitation

, Volume 26, Issue 2, pp 216–228 | Cite as

Interpersonal Responses and Pain Management Within the US Military

  • Cindy A. McGeary
  • Tabatha H. Blount
  • Alan L. Peterson
  • Robert J. Gatchel
  • Willie J. Hale
  • Donald D. McGeary
Article

Abstract

Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n = 26) and the other group received treatment-as-usual (n = 18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345–356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p = .037), work-related fear avoidance (p = .008), pain interference (p = .026), affective distress (p = .039), and pain while lifting (p = .017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p = .011), household activity (p = 017), general activity (p = .042), self-reported disability (p = .030), lifting capacity (p = .005), and aerobic capacity (p = .009). Conclusions While findings are preliminary and of limited scope, it appears that the perception of significant others’ responses may be impacted by psychosocial and physical pain outcomes and may change after treatment. More work in this area is needed to uncover the benefits one might achieve when a significant other is included within the FR treatment framework.

Keywords

Pain management Military personnel Rehabilitation Cognitive behavioral therapy Social support 

Notes

Acknowledgments

The authors’ time and effort in preparation of this manuscript was supported in part by a research grant to the STRONG STAR Multidisciplinary PTSD Research Consortium from the US Department of Defense through the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program (Alan L. Peterson: W81XWH-08-02-0109; Robert Gatchel: W81XWH-08-2-113).

Compliance with Ethical Standards

Conflict of interest

The authors’ (Cindy McGeary, Tabatha Blount, Alan Peterson, Robert Gatchel, Willie Hale and Don McGeary) declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments of comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

References

  1. 1.
    Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain. 1985;23(4):345–56.CrossRefPubMedGoogle Scholar
  2. 2.
    US General Accounting Office. Veterans disability benefits: VA should improve its management of individual unemployability benefits by strengthening criteria, guidance, and procedures. Washington; 2006.Google Scholar
  3. 3.
    Maloney P, McIntosh EG. Chronic low back pain and depression in a sample of veterans. Percept Mot Skills. 2001;92(2):348. doi: 10.2466/PMS.92.2.348-348.CrossRefPubMedGoogle Scholar
  4. 4.
    Chapman JB, Lehman CL, Elliott J, Clark J. Sleep quality and the role of sleep medications for veterans with chronic pain. Pain Med. 2006;7(2):105–14. doi: 10.1111/j.1526-4637.2006.00110.x.CrossRefPubMedGoogle Scholar
  5. 5.
    Beckham JC, Crawford AL, Feldman ME, Kirby AC, et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychosom Res. 1997;43(4):379–89. doi: 10.1016/S0022-3999(97)00129-3.CrossRefPubMedGoogle Scholar
  6. 6.
    Lombardo ER, Tan G, Jensen MP, Anderson KO. Anger management style and associations with self-efficacy and pain in male veterans. J Pain. 2005;6(11):765–70. doi: 10.1016/j.jpain.2005.07.003.CrossRefPubMedGoogle Scholar
  7. 7.
    Trost Z, Vangronsveld K, Linton SJ, Quartana PJ, Sullivan ML. Cognitive dimensions of anger in chronic pain. Pain. 2012;153(3):515–7. doi: 10.1016/j.pain.2011.10.023.CrossRefPubMedGoogle Scholar
  8. 8.
    Becker WC, Fiellin DA, Gallagher RM, Barth KS, Ross JT, Oslin DW. The association between chronic pain and prescription drug abuse in veterans. Pain Med. 2009;10(3):531–6. doi: 10.1111/j.1526-4637.2009.00584.x.CrossRefPubMedGoogle Scholar
  9. 9.
    Goebel JR, Compton P, Zubkoff L, et al. Prescription sharing, alcohol use, and street drug use to manage pain among veterans. J Pain Symptom Manage. 2011;41(5):848–58. doi: 10.1016/j.jpainsymman.2010.07.009.CrossRefPubMedGoogle Scholar
  10. 10.
    Martie LM. The “relative” efficacy of involving family in psychosocial interventions for chronic illness: are there added benefits to patients and family members? Fam Syst Health. 2005;2005(23):312–28.CrossRefGoogle Scholar
  11. 11.
    Leonard M, Cano A. Pain affects spouses too: personal experience with pain and catastrophizing as correlates of spouse distress. Pain. 2006;126(1–3):139–46. doi: 10.1016/j-pain.2006.06.022.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cano A, Gillis M, Heinz W, Geisser M, Foran H. Marital functioning, chronic pain, and psychological distress. Pain. 2004;107:99–106.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014;69(2):119–130. Available from: PsycINFO, Ipswich, MA. Accessed Apr 3 2015 [serial online].Google Scholar
  14. 14.
    Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002;70(3):678–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Gatchel RJ, McGeary DD, Peterson A, et al. Preliminary findings of a randomized controlled trial of an interdisciplinary military pain program. Mil Med. 2009;174(3):270–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Reese JB, Somers TJ, Keefe FJ, Mosley-Williams A, Lumley MA. Pain and functioning of rheumatoid arthritis patients based on marital status: is a distressed marriage preferable to no marriage? J Pain. 2010;11(10):958–64.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gauthier N, Thibault P, Sullivan M. Catastrophizers with chronic pain display more pain behaviour when in a relationship with a low catastrophizing spouse. Pain Res Manag J Can Pain Soc (Journal De La Société Canadienne Pour Le Traitement De La Douleur). 2011;16(5):293–299. Available from: MEDLINE, Ipswich, MA. Accessed Apr 6 2015 [serial online].Google Scholar
  18. 18.
    Gatchel R, Bernstein D, Stowell A, Pransky G. Psychosocial differences between high-risk acute vs. chronic low back pain patients. Pain Pract Off J World Inst Pain. 2008;8(2):91–7. doi: 10.1111/j.1533-2500.2008.00176.x.CrossRefGoogle Scholar
  19. 19.
    Lackner JM, Gurtman MB. Pain catastrophizing and interpersonal problems: a circumplex analysis of the communal coping model. Pain. 2004;110(3):597–604.CrossRefPubMedGoogle Scholar
  20. 20.
    Smeets RJEM, Vlaeyan JWS, Kester ADM, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7(4):261–71.CrossRefPubMedGoogle Scholar
  21. 21.
    Whisman RA, Baucom DH. Initimate relationships and psychopathology. Clin Child Fam Psychol Rev. 2012;15(1):4–13.CrossRefPubMedGoogle Scholar
  22. 22.
    McCracken LM. Social context and acceptance of chronic pain: the role of solicitous and punishing responses. Pain. 2005;113(1):155–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Turk DC, Rudy TE. Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data. J Consult Clin Psychol. 1988;56(2):233–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Beck AT, Steer RA, Brown GK. Beck depression inventory manual. 2nd ed. San Antonio: Psychological Corporation; 1996.Google Scholar
  25. 25.
    Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survery (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRefPubMedGoogle Scholar
  26. 26.
    Ware JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1988;51(11):903–12.CrossRefGoogle Scholar
  27. 27.
    Million R, Hall W, Nilsen KH, Baker RD, Jayson MIV. Assessment of the progress of the back pain patient. Spine. 1982;7:204–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Mooney V, Cairns D, Robertson J. A system for evaluating and treating chronic back disability. West J Med. 1976;124(5):370–6.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Mooney V. Evaluating pain in the primary care office. J Musculoskelet Med. 1984;2:16–26.Google Scholar
  30. 30.
    Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain. 1994;58:387–92.CrossRefPubMedGoogle Scholar
  31. 31.
    Waddell G, Newton M, Henderson I, Somerville D, Main CJA. Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain disability. Pain. 1993;1993(52):157–8.CrossRefGoogle Scholar
  32. 32.
    Fairbanks JC, Couper J, Davies JB, O’Brien JP. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980;66:271–3.Google Scholar
  33. 33.
    Matheson LN, Mooney V, Grant JE, Leggett S, Kenny K. Standardized evaluation of work capacity. J back Musculoskelet Rehabil. 1996;6(3):249–64.CrossRefPubMedGoogle Scholar
  34. 34.
    Boothby JL, Thorn BE, Overduin LY, Ward CL. Catastrophizing and perceived partner responses to pain. Pain. 2004;109(3):500–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Leonard M, Cano A, Johansen A. Chronic pain in a couples context: a review and integration of theoretical and empirical evidence. J Pain Off J Am Pain Soc. 2006;7(6):377–90.CrossRefGoogle Scholar
  36. 36.
    Cano A, Weisburg J, Gallagher RM. Marital satisfaction and pain severity mediate the association between negative spouse responses to pain and depressive symptoms in chronic pain patients. Pain Med. 2000;1:35–43.CrossRefPubMedGoogle Scholar
  37. 37.
    Bushatz A. Military divorce rates down slightly in 2012. Retreived from http://www.military.com/daily-news/2013/01/23/military-divorce-rate-down-slightly-in-2012.html on September 23 2013.
  38. 38.
    Harth W, Geiler U, Tausk FA, Kusnir D. The difficult or impossible-to-treat problem patient. In: Harth W, et al., editors. Clinical management in psychodermatology. Berlin: Springer; 2009.Google Scholar
  39. 39.
    Cano A, Williams ACDC. Social interaction in pain: reinforcing pain behaviors or building intimacy? Pain. 2011;149:9–11.CrossRefGoogle Scholar
  40. 40.
    Cunningham JL, Hayes SE, Townsend CO, Laures HJ, Hooten WM. Associations between spousal or significant other solicitous responses and opioid dose in patients with chronic pain. Pain Med. 2012;13:1034–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Flor H, Kerns RD, Turk DC. The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients. J Psychosom Res. 1987;31(2):251–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Romano JM, Jensen MP, Turne JA, Good AB, Hops H. Chronic pain patient–partner interactions: further support for a behavioral model of chronic pain. Behav Ther. 2000;31(3):415–40.CrossRefGoogle Scholar
  43. 43.
    Williamson D, Robinson ME, Melamed B. Pain behavior, spouse responsiveness, and marital satisfaction in patients with rheumatoid arthritis. Behav Modif. 1997;21(1):97–118.CrossRefPubMedGoogle Scholar
  44. 44.
    Campbell CM, Kronfli T, Buenaver LF, et al. Situational versus dispositional measurement of catastrophizing: associations with pain responses in multiple samples. J Pain. 2010;11(5):443–53.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Rusu AC, Pincus T, Morley S. Depressed pain patients differ from other depressed groups: examination of cognitive content in a sentence completion task. Pain. 2012;153(9):1898–904.CrossRefPubMedGoogle Scholar
  46. 46.
    Choi Y, Mayer TG, Williams M, Gatchel RJ. The clinical utility of the Multidimensional Pain Inventory (MPI) in characterizing chronic disabling occupational musculoskeletal disorders. J Occup Rehabil. 2012;23:239–47.CrossRefGoogle Scholar
  47. 47.
    Wilson SJ, Martire LM, Keefe FJ, Mogle JA, Stephens MAP, Schulz R. Daily verbal and nonverbal expression of osteoarthritis pain and spouse responses. Pain. 2013;154(10):2045–53.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Band R, Wearden A, Barrowclough C. Patient outcomes in association with significant other responses to chronic fatigue syndrome: a systematic review of the literature. Clin Psychol Sci Pract. 2015;22(1):29–46.CrossRefGoogle Scholar
  49. 49.
    Hazard RG, Fenwick JW, Kalisch SM, et al. Functional restoration with behavioral support: a one-year prospective study of patients with chronic low-back pain. Spine. 1989;14:157–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Mayer TG, Gatchel RJ, Kishino N, et al. Objective assessment of comparison group and one-year follow up. Spine. 1985;10:482–93.CrossRefPubMedGoogle Scholar
  51. 51.
    Bendix T, Bendix AF, Lund C, Kirkbak S, Ostenfeld S. Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer-blinded study with one-year follow up. Scand J Rehabil Med. 1997;29:81–9.PubMedGoogle Scholar
  52. 52.
    Gatchel RJ, Noe CE, Pulliam C, et al. A preliminary study of Multidimensional Pain Inventory profile differences in predicting treatment outcome in a heterogeneous cohort of patients with chronic pain. Clin J Pain. 2002;18:139–43.CrossRefPubMedGoogle Scholar
  53. 53.
    Mayer TG, Mooney V, Gatchel RJ, Barnes D, Terry A, Smith S, Mayer H. Quantifying postoperative deficits of physical function following spinal surgery. Clin Orthop. 1989;244:147–57.PubMedGoogle Scholar
  54. 54.
    McCluskey S, Brooks J, King N, Burton K. The influence of’significant others’ on persistent back pain and work participation: a qualitative exploration of illness perceptions. BMC Musculoskelet Disord. 2011;12(1):236.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Pence L, Cano A, Thorn B, Ward LC. Perceived spouse responses to pain: the level of agreement in couple dyads and the role of catastrophizing, marital satisfaction, and depression. J Behav Med. 2006;29(6):511–22.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Romano JM, Jensen MP, Schmaling KB, Hops H, Buchwald DS. Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses. J Behav Med. 2009;32(6):558–69.CrossRefPubMedGoogle Scholar
  57. 57.
    Cano A, Barterian JA, Heller JB. Empathic and nonempathic interaction in chronic pain couples. Clin J Pain. 2008;24(8):678–84.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Miller LR, Cano A, Wurm LH. A motivational therapeutic assessment improves pain, mood, and relationship satisfaction in couples with chronic pain. J Pain. 2013;14(5):525–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PsychiatryThe University of Texas Health Science Center at San AntonioSan AntonioUSA
  2. 2.Department of PsychologyThe University of Texas at ArlingtonArlingtonUSA

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