(Reuters Health) - People with chronic low back pain may feel it even more sharply if their spouses are critical and unsupportive of their condition, according to a recent study.

Women back-pain sufferers and those with depressive symptoms were the most vulnerable to spousal criticism, whether the harsh attitude was just perceived or overtly expressed, the study authors report in the journal Pain, online August 8.

“Most studies of spouse and family interactions with people with chronic pain have focused on the positive effects of adequate social support,” said lead author John Burns of Rush University in Chicago.

Negative responses seem to work in a cycle, Burns noted. Spouse criticism can lead to increased pain, even up to three hours later and patient pain such as grimacing, groaning and straining can lead to increased spouse criticism up to three hours later, Burns said he found in a prior study.

“These (new) findings point toward the harmful effects of specific negative spouse communication directed toward pain patients,” he said. They could become the basis of marital interventions that directly target the reduction of criticism and hostility, he added.

For the current study, the team observed 71 couples during a 10-minute discussion about whether spouse perspectives on how patients with degenerative disks, spinal stenosis and herniated disks could improve the ability to cope with pain.

The discussion was intended to produce conflict, but the degree of criticism or hostility wasn’t manipulated, the authors note. Afterwards, the member of the couple with back pain did a 10-minute structured activity that involved sitting, standing, walking, reclining, bending and stretching to lift an object while the spouse watched.

The research team meanwhile measured overt criticism and hostility from the spouse and perceived criticism on the part of the patient, as well as the patient’s pain intensity, pain behaviors and depressive symptoms.

During the discussion, researchers found the goal of inducing conflict was achieved and all the patients reported feeling significant increases in anxiety, anger and sadness.

During the activity, patients with higher depression scores were also more likely to perceive greater spouse criticism and feel greater pain. Likewise, greater hostility from the spouse observed by the research team was associated with higher depression and pain scores for the patient.

When the researchers adjusted for other factors that influence pain, however, the link between spousal hostility and patient pain levels only remained statistically meaningful for the women back-pain patients.

“Because the study required both patient and spouse to cooperate enough to participate, they generally got along just fine,” Burns said. “Even with these fairly happy couples, spouses uttered enough critical and hostile comments to negatively affect patient pain and function.”

The research team was also surprised by how spouses seemed genuinely concerned about pain during the discussion and would ask whether the task would cause pain. However, those spouses also tended to give “helpful” suggestions to patients, which were also critical.

“Marital problems are common and often quite significant among patients with chronic pain, yet in most current approaches to management, these issues are often addressed inadequately, if at all,” said psychologist Tim Smith of the University of Utah in Salt Lake City who wasn’t involved in the study.

“It is surprisingly easy to respond to a loved one by dismissing their experience, criticizing them, or reacting with hostility or contempt,” said Dr. Annmarie Cano of Wayne State University in Detroit, who also wasn’t involved in the study. “But these responses are painful, not only psychologically but physically as well.”

Burns said his team is developing a plan for a randomized clinical trial to test an anti-criticism marital intervention.

“Research to date has suggested that the best type of support is one that helps patients live the best life they can despite their pain,” said Kevin Alschuler of the University of Washington in Seattle, who also wasn’t involved in the study.

“This requires a careful balance, as missing the mark can contribute to greater pain, less activity, lower mood and lower quality of life,” he told Reuters Health by email. “The best support encourages activity and engagement but is also sympathetic to the challenge the person with pain faces.”

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Pain 2017.