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The role of significant others in the management of persistent musculoskeletal pain

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It has long been acknowledged that persistent musculoskeletal pain can be influenced by environmental factors, with an important source being the interaction between the pain sufferer and their ‘significant other’ (spouse/partner/relative). It is proposed that significant others can reinforce an individual’s unhelpful pain cognitions, such as fear of movement, catastrophizing, and pessimism about treatment effectiveness, possibly as a result of their own unhelpful beliefs about pain (Leonard et al, 2006, McCluskey et al, 2014a). It has also been shown that overly-solicitous behavior from significant others can reinforce potentially detrimental behaviors in their relatives with pain, such as over-use of pain medication, disturbed gait or limping, unduly resting/lying down, seeking compensation, or absence from work (Haughli et al, 2011).

Despite the proposed importance of significant others on an individual’s recovery from persistent musculoskeletal pain, relatively little research has been conducted in this field and gaps in the evidence remain. Firstly, the majority of data is either collected from individuals with pain reporting their own perceptions of their significant other’s beliefs and behaviours, or significant other behaviours are observed and reported by a researcher or clinician – data is rarely collected from significant others themselves. Furthermore, the majority of this research is largely conducted with those who report some level of disability or incapacity, probably resulting in an unrepresentative focus on the negative influences of significant others. Our recent research has begun to focus on the ways that significant others may act as a positive reinforcement and be a valuable source of support to those with persistent musculoskeletal pain (de Vries et al., 2011; Brooks et al., 2013). Findings from our latest UK-Dutch study conducted with the significant others of those who had managed to remain at work with chronic musculoskeletal pain reveal novel insights about the specific contribution made by significant others, illustrating a highly congruent ‘partnership’ approach (McCluskey et al, 2014b).

This focus on the positive and supportive role of significant others adds to the under-represented ‘social’ dimension of the biopsychosocial model currently applied to the understanding and treatment of pain, and indicates that significant others could be useful assets in pain management and vocational rehabilitation programmes. However, this is a complex interpersonal process that needs to be better understood. For example, it has been suggested that empathic responses from significant others build intimacy, enhancing adjustment to pain (Cano & Leong, 2012). However, empathy could also easily translate into solicitousness, which may be viewed by some as an indicator of relationship strength, but which has a negative effect on pain outcome (Rosland et al, 2012). Significant others themselves may also have their own support needs in order to reduce the burden placed on them and help to attenuate any maladaptive appraisals of persistent pain (Campbell et al., 2011; Snelgrove and Liossi, 2013).

The most recent evidence and healthcare policy suggests that self-management strategies are most effective when employed in collaboration with an individual’s sources of ongoing social support. Support from significant others will become increasingly more important due to the growing demands placed on healthcare as a result of an ageing population. Further understanding of the role of significant others in this context may usefully inform more effective means of assisting those with persistent musculoskeletal pain to deal with the behavioural and affective components of their condition.

About Serena McCluskey

Serena McCluskeyDr Serena McCluskey is a Chartered Psychologist and Senior Research Fellow at the University of Huddersfield whose research interests focus on the psychosocial influences on musculoskeletal pain and work participation. Serena has undertaken several UK government-funded research projects in this area, and is currently developing an area of research exploring how ‘significant others’ (spouses/partners/relatives) may support self-management and work participation for individuals with persistent musculoskeletal pain.

References

Brooks J, McCluskey S, King N, & Burton K (2013). Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain. BMC Musculoskelet Disord, 14 PMID: 23363454

Campbell P, Wynne-Jones G, & Dunn KM (2011). The influence of informal social support on risk and prognosis in spinal pain: a systematic review. Eur J Pain, 15 (5), 4440-14 PMID: 20970363

Cano A, Leong L. Significant others in the chronicity of pain and disability. In: Hasenbring MI, Rusu AC, Turk DC, editors. From Acute to Chronic Back Pain: Risk Factors, Mechanisms, and Clinical Implications. Oxford: Oxford University Press; 2012. p. 339-54.

de Vries HJ, Brouwer S, Groothoff JW, Geertzen JH, & Reneman MF (2011). Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers’ experiences. BMC Musculoskelet Disord, 12 PMID: 21639884

Haugli L, Maeland S, & Magnussen LH (2011). What facilitates return to work? Patients’ experiences 3 years after occupational rehabilitation. J Occup Rehabil, 21 (4), 573-81 PMID: 21442204

Leonard MT, Cano A, & Johansen AB (2006). Chronic Pain in a Couples Context: A Review and Integration of Theoretical Models and Empirical Evidence J Pain, 7, 377-390

McCluskey S, Brooks J, King N, & Burton K (2014). Are the treatment expectations of ‘significant others’ psychosocial obstacles to work participation for those with persistent low back pain? Work , 48 (3), 391-8 PMID: 24284682

McCluskey S, de Vries HJ, Reneman M, Brooks J, Brouwer S. Family support in maintaining work participation with chronic musculoskeletal pain: a UK-Dutch study. Paper presented to Society for Back Pain Research Annual Conference 2014b, Dublin, Ireland.

Rosland AM, Heisler M, & Piette JD (2012). The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med, 35 (2), 221-39 PMID: 21691845

Snelgrove S, & Liossi C (2013). Living with chronic low back pain: a metasynthesis of qualitative research. Chronic illness, 9 (4), 283-301 PMID: 23585633

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