Chronic pain affects one in three Americans and is the No. 1 cause of adult disability in the United States, according to the American Chronic Pain Association. Moreover, research finds that many people with chronic pain-such as back pain-are more likely to experience mental health problems like depression and substance abuse.

There is currently no cure for chronic pain, but there are ways of dealing with its symptoms so that life is more manageable.

Research by psychologist David A. Sbarra, PhD, an assistant professor of clinical psychology at the University of Arizona, has begun a series of studies that investigate how patients' spouses can sway how well patients learn to manage.

He's examining the notion that a spouse who offers their ailing partner "tough love"-providing caring support while motivating them to make the best of their situation-is much more helpful than either an uncaring partner or one who is oversolicitous.

His project is funded by a $10,000 award he won in July from the American Psychological Foundation's (APF) Raymond A. and Rosalee G. Weiss Innovative Research and Program Fund. The Weisses established the fund in 2003 to promote innovative research, and fund trustees accept proposals on either of two priority topics: violence prevention and intervention or research related to psychology and health.

With funding from the Weiss award, Sbarra, who received his doctorate in 2004 from the University of Virginia, will study how marital relationships help people cope with their chronic lower back pain (CLBP). Patients who accept the realities of their pain can better manage their lives, he notes.

"Pain is such a complex problem and so debilitating that it has a way of entangling us and getting us psychologically stuck," says Sbarra. "For couples who learn to live with and accept pain, what are the interpersonal strategies that seem to work best?"

The right support

Sbarra is working with Andrew Jones, PhD, a psychologist at the Southern Arizona Veterans' Affairs Health Care System, to recruit participants from its Multidisciplinary Pain Clinic who have had CLBP for longer than six months. The participants and their partners complete a series of questionnaires, including a pain-specific Stroop test, that determine how much the pain is affecting the sufferer and their spouse. Participants are also given handheld Palm Pilots and asked to record their pain level, current emotions and feelings about their relationship at three random intervals each day for 10 days.

Together, these data can paint a picture of patients' acceptance of their pain, Sbarra says. For instance, CLBP sufferers who answer questions about their pain by saying, for example, "It hurts and is bad, but I do the best I can," are further along the path toward accepting their condition than those who might say, "I just can't take it. I am just a wreck all the time."

Sbarra seeks to understand how a partner can help patients think more constructive thoughts.

Previous research has found that partners who are oversolicitous can actually have a negative effect on their spouse because overt displays of pain can be reinforced. For example, apparently well-meaning spouses might allow their partners to skip physical therapy sessions, which are often a painful part of the healing process. But by indulging the will of their partners, the spouses are reinforcing behavior that is ultimately detrimental to recovery.

"All support is not created equally," says Sbarra, "and we are trying to understand what types of support can help people move toward acceptance and the next best step forward."

A 'giant hand'

Sbarra's analogy of a good marital relationship involves one partner acting as a "giant hand" behind the other partner.

"If you fall or collapse, the hand is there," says Sbarra, "but meanwhile, the hand is always pushing the ailing partner toward acceptance." Insisting that a partner attend therapy can compassionately "push" the partner toward dealing with their condition.

Because chronic pain is such a widespread problem that affects patients' quality of life, Sbarra hopes this study will generate interest in further research on the issue.

"APF has been very generous in providing money to get this study off the ground," says Sbarra. "This will allow us to take the next step to pursue federal funding from the National Institutes of Health." Figuring out what the "masters of pain" are doing to successfully live with their conditions is an important step toward improving the lives of patients and their families.

Further Reading

For more information on APF grants, visit the APF Web site.