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Empathic behaviors promote emotion regulation and pain tolerance in couples
S96
Abstracts
The Journal of Pain
(480) Does appraisal of the conditioning stimulus alter subsequent pain ratings of the test stimulus in a conditioned pain modulation paradigm?
(482) Effects of pain level and pain variability on coping strategies of patients with dystonia
M Bernaba, K Johnson, and S Mackey; Stanford University, Palo Alto, CA
Patients with dystonia experience involuntary contraction of muscles that may produce painful, twisted postures. This study investigated effects of pain level and pain variability on coping behaviors and daily activities. We hypothesized that substantial changes in pain levels would have similar effects as constant high levels of pain, and expected to see modifications in coping styles for different types of pain. Fifty-eight dystonia patients from four different countries (US, Canada, England, and Australia) completed the Pain Interference and Coping with Health Injuries and Problems Scales. Ages ranged from 18 to 69. There was a significant interaction between pain level and pain variability in the Pain Interference responses; pairwise comparisons indicated that low levels of variable pain appear to interfere with life events as much as high levels of constant pain. Main effects of pain level were found for palliative and distractional coping behaviors. Patients with higher pain levels indicated that they engaged in more palliative and distractional coping behaviors than patients reporting lower pain levels. Pain variability didn’t matter – patients with large variation in their pain levels did not adopt different coping behaviors from people experiencing more constant pain. These data suggest that unpredictable pain disrupted lives as much as high, constant, pain, yet patients with unpredictable pain did not adopt different coping behaviors. Promotion of different coping behaviors for this subset of dystonia patients with low levels of variable pain may be warranted.
Protocols for Conditioned Pain Modulation (CPM, often referred as endogenous analgesia and diffuse noxious inhibitory control) are useful to understand mechanism of pain modulation. While there are many variations of this ‘‘pain inhibits pain’’ protocol, a common approach uses heat pain as the ‘‘test stimulus’’ and cold pain as the ‘‘conditioning stimulus’’. The general premise is that the ‘‘conditioning stimulus’’ reduces the perceived pain of ‘‘test stimulus’’ under normal circumstances. Given that heat pain and cold pain may have confounding interactions when presented together, we sought to understand the impact of ‘‘conditioning stimulus’’ appraisal on CPM. Healthy individuals, age 18 - 45, are eligible for this study. We first did baseline testing to establish the magnitude of the CPM effect. The test stimulus was a fixed heat for 30 seconds and the conditioning stimulus was cold water that was given for 2 minutes. During the testing, both stimuli were titrated to as close as an individual’s 5/10 pain level. We repeated the CPM protocol twice under two appraisal conditions in randomized order: either threatening appraisal of cold water or reassurance appraisal of cold water. Baseline ratings of cold water was 4.05, standard deviation of 2.68; ratings of the cold water during threatening appraisal was an average of 4.9, standard deviation of 2.70; and ratings during reassurance was an average of 2.7 with a standard deviation of 2.1. Baseline CPM magnitude was an average of 29.95%, while following threatening appraisal the average CPM magnitude was 28.51%; and the average CPM magnitude following reassurance appraisal was 32.8%. Our preliminary results confirm with prior studies showing reappraisal changes pain rating of stimuli being evaluated. Furthermore, our results suggest that reappraisal of the conditioning stimulus does not significantly impact the test stimulus. This has implications for future CPM work.
K Purdy; University of South Carolina, Spartanburg, SC
(481) Empathic behaviors promote emotion regulation and pain tolerance in couples
(483) Does it matter if I’m satisfied? Predictors of satisfaction with pain treatment in older cancer patients
L Leong and A Cano; Wayne State University, Detroit, MI
H Collins, R Roker, and T Baker; University of South Florida, Tampa, FL
The purpose of this study was to determine the extent to which an empathy prime would promote empathic behaviors in couples, and result in better emotion regulation and greater pain tolerance during a cold pressor task. Based on empathy and intimacy theories, it was expected that observers who were instructed to take the perspective of their partner would express more empathy and that their partners would have lower pain compared to a control group. In contrast, operant models predict that greater empathy reinforces pain, resulting in worse pain and pain behaviors. A sample of 128 undergraduate romantic couples participated where one partner was randomly assigned to complete the cold pressor task while the other partner sat close by and observed. Couples were randomly assigned to: a) an empathy group in which observers were first primed to take the perspective of the pain participant, or b) a control group that received no priming. Trained raters coded empathic and nonempathic observer behaviors during the task. Despite the fact that observers in the empathy group reported feeling greater empathy and concern, they did not demonstrate greater empathic behaviors during the task, nor did pain participants in the empathy group report lower pain, catastrophizing, or greater pain tolerance, compared to the control group. However, when collapsing across groups, greater empathic behaviors were related to greater pain tolerance, while nonempathic behaviors were positively related to pain and pain behaviors. The results of this study support theories of couples emotion regulation and intimacy: empathy for pain is a positive relationship behavior which is related to improved pain tolerance, and is not reinforcing of greater pain behaviors. Interventions for pain should aim to increase partners’ empathic behaviors to support successful emotion regulation in the face of pain. Supported by funding from Wayne State University.
Patient satisfaction with healthcare providers and pain treatment has been associated with medication adherence, health outcomes, and compliance with prescribed medical regimens. The purpose of the investigation was to examine indicators of patient satisfaction with pain treatment in older adults receiving outpatient services at a comprehensive cancer center. One hundred and fiftyone Black and White patients, 55+ years of age (65.3467.76), completed a series of questions assessing demographic (race, sex, income, education), social (communication, trust), behavioral characteristics (self-efficacy for pain management), health status (comorbidities, pain interference), and pain indicators (total, worst, least, average, and current pain). Over half of the sample were female (57.4%) and White (79.4%). Preliminary analyses for the total sample showed a significant association between satisfaction with pain treatment and chronic pain self-efficacy (r = 0.18, p < 0.05), number of chronic conditions (r = 0.20, p < 0.05), and communication (r = 0.23, p < 0.01). Results from the multivariate analysis showed a significant model, with discrimination (b = -0.24, p < 0.01), communication (b = 0.22, p < 0.05), and number of chronic conditions (b = 0.27, p < 0.01), explaining 14% of the total variance in satisfaction with pain treatment. Chronic pain self-efficacy also approached significance. While the importance of identifying and examining social issues that impact satisfaction with treatment was established, additional work is needed to understand how modifiable factors, such as communication and self-efficacy, may influence health outcomes, particularly among elderly minority populations. Future research should be directed at developing models that assess how social, cultural, and behavioral factors collectively influence the day-to-day experience of cancer-related pain and perceptions of optimal pain treatment among this population.
Abstracts
The Journal of Pain
(480) Does appraisal of the conditioning stimulus alter subsequent pain ratings of the test stimulus in a conditioned pain modulation paradigm?
(482) Effects of pain level and pain variability on coping strategies of patients with dystonia
M Bernaba, K Johnson, and S Mackey; Stanford University, Palo Alto, CA
Patients with dystonia experience involuntary contraction of muscles that may produce painful, twisted postures. This study investigated effects of pain level and pain variability on coping behaviors and daily activities. We hypothesized that substantial changes in pain levels would have similar effects as constant high levels of pain, and expected to see modifications in coping styles for different types of pain. Fifty-eight dystonia patients from four different countries (US, Canada, England, and Australia) completed the Pain Interference and Coping with Health Injuries and Problems Scales. Ages ranged from 18 to 69. There was a significant interaction between pain level and pain variability in the Pain Interference responses; pairwise comparisons indicated that low levels of variable pain appear to interfere with life events as much as high levels of constant pain. Main effects of pain level were found for palliative and distractional coping behaviors. Patients with higher pain levels indicated that they engaged in more palliative and distractional coping behaviors than patients reporting lower pain levels. Pain variability didn’t matter – patients with large variation in their pain levels did not adopt different coping behaviors from people experiencing more constant pain. These data suggest that unpredictable pain disrupted lives as much as high, constant, pain, yet patients with unpredictable pain did not adopt different coping behaviors. Promotion of different coping behaviors for this subset of dystonia patients with low levels of variable pain may be warranted.
Protocols for Conditioned Pain Modulation (CPM, often referred as endogenous analgesia and diffuse noxious inhibitory control) are useful to understand mechanism of pain modulation. While there are many variations of this ‘‘pain inhibits pain’’ protocol, a common approach uses heat pain as the ‘‘test stimulus’’ and cold pain as the ‘‘conditioning stimulus’’. The general premise is that the ‘‘conditioning stimulus’’ reduces the perceived pain of ‘‘test stimulus’’ under normal circumstances. Given that heat pain and cold pain may have confounding interactions when presented together, we sought to understand the impact of ‘‘conditioning stimulus’’ appraisal on CPM. Healthy individuals, age 18 - 45, are eligible for this study. We first did baseline testing to establish the magnitude of the CPM effect. The test stimulus was a fixed heat for 30 seconds and the conditioning stimulus was cold water that was given for 2 minutes. During the testing, both stimuli were titrated to as close as an individual’s 5/10 pain level. We repeated the CPM protocol twice under two appraisal conditions in randomized order: either threatening appraisal of cold water or reassurance appraisal of cold water. Baseline ratings of cold water was 4.05, standard deviation of 2.68; ratings of the cold water during threatening appraisal was an average of 4.9, standard deviation of 2.70; and ratings during reassurance was an average of 2.7 with a standard deviation of 2.1. Baseline CPM magnitude was an average of 29.95%, while following threatening appraisal the average CPM magnitude was 28.51%; and the average CPM magnitude following reassurance appraisal was 32.8%. Our preliminary results confirm with prior studies showing reappraisal changes pain rating of stimuli being evaluated. Furthermore, our results suggest that reappraisal of the conditioning stimulus does not significantly impact the test stimulus. This has implications for future CPM work.
K Purdy; University of South Carolina, Spartanburg, SC
(481) Empathic behaviors promote emotion regulation and pain tolerance in couples
(483) Does it matter if I’m satisfied? Predictors of satisfaction with pain treatment in older cancer patients
L Leong and A Cano; Wayne State University, Detroit, MI
H Collins, R Roker, and T Baker; University of South Florida, Tampa, FL
The purpose of this study was to determine the extent to which an empathy prime would promote empathic behaviors in couples, and result in better emotion regulation and greater pain tolerance during a cold pressor task. Based on empathy and intimacy theories, it was expected that observers who were instructed to take the perspective of their partner would express more empathy and that their partners would have lower pain compared to a control group. In contrast, operant models predict that greater empathy reinforces pain, resulting in worse pain and pain behaviors. A sample of 128 undergraduate romantic couples participated where one partner was randomly assigned to complete the cold pressor task while the other partner sat close by and observed. Couples were randomly assigned to: a) an empathy group in which observers were first primed to take the perspective of the pain participant, or b) a control group that received no priming. Trained raters coded empathic and nonempathic observer behaviors during the task. Despite the fact that observers in the empathy group reported feeling greater empathy and concern, they did not demonstrate greater empathic behaviors during the task, nor did pain participants in the empathy group report lower pain, catastrophizing, or greater pain tolerance, compared to the control group. However, when collapsing across groups, greater empathic behaviors were related to greater pain tolerance, while nonempathic behaviors were positively related to pain and pain behaviors. The results of this study support theories of couples emotion regulation and intimacy: empathy for pain is a positive relationship behavior which is related to improved pain tolerance, and is not reinforcing of greater pain behaviors. Interventions for pain should aim to increase partners’ empathic behaviors to support successful emotion regulation in the face of pain. Supported by funding from Wayne State University.
Patient satisfaction with healthcare providers and pain treatment has been associated with medication adherence, health outcomes, and compliance with prescribed medical regimens. The purpose of the investigation was to examine indicators of patient satisfaction with pain treatment in older adults receiving outpatient services at a comprehensive cancer center. One hundred and fiftyone Black and White patients, 55+ years of age (65.3467.76), completed a series of questions assessing demographic (race, sex, income, education), social (communication, trust), behavioral characteristics (self-efficacy for pain management), health status (comorbidities, pain interference), and pain indicators (total, worst, least, average, and current pain). Over half of the sample were female (57.4%) and White (79.4%). Preliminary analyses for the total sample showed a significant association between satisfaction with pain treatment and chronic pain self-efficacy (r = 0.18, p < 0.05), number of chronic conditions (r = 0.20, p < 0.05), and communication (r = 0.23, p < 0.01). Results from the multivariate analysis showed a significant model, with discrimination (b = -0.24, p < 0.01), communication (b = 0.22, p < 0.05), and number of chronic conditions (b = 0.27, p < 0.01), explaining 14% of the total variance in satisfaction with pain treatment. Chronic pain self-efficacy also approached significance. While the importance of identifying and examining social issues that impact satisfaction with treatment was established, additional work is needed to understand how modifiable factors, such as communication and self-efficacy, may influence health outcomes, particularly among elderly minority populations. Future research should be directed at developing models that assess how social, cultural, and behavioral factors collectively influence the day-to-day experience of cancer-related pain and perceptions of optimal pain treatment among this population.