TORONTO - When one person in a relationship is in chronic pain, there can be an impact on daily life, family finances and communication.
A researcher who studies these couples - even the nuances of their conversations and body language - says a partner might be invalidating the feelings of a person in pain, which can lead to less intimacy.
"I'm particularly interested in how spouses validate the emotional distress of patients," says Annmarie Cano, an associate professor in the department of psychology at Wayne State University in Detroit.
"For instance, when patients are talking about their fears about their illness, or wondering if the illness is going to get any worse, how do spouses respond? What's the best way to respond?"
Cano gave a presentation on her research this spring at a symposium, held at the Constance-Lethbridge Rehabilitation Centre in Montreal, on the social effects of chronic pain.
Many researchers have found that women tend to report more pain than men, she said.
"Women perceive themselves as being more empathic and more concerned about their partners. However, we also find that women are more willing to be invalidating towards their husbands when the husbands are disclosing distress."
Subjects in her lab fill out surveys describing the extent to which they are empathetic about other people's experiences, and they are also videotaped in conversation with their partners.
The findings surprised Cano's colleagues at the symposium, she said, because society usually thinks of women as being more caring and concerned.
"I'm not saying this is all women, but I think there may be a subset of women," she explained in an interview.
"What I still have to look at is whether these women are distressed in their relationship and so perhaps it's harder for them to be empathic if they are in an unsatisfactory relationship."
She described how an interaction played out for one couple that came to the laboratory.
"We had one man who was talking about how despite the pain that he knew that they were always going to be together. And he paused and it was as if he was waiting for his wife to say something. And she said nothing," Cano said.
"She didn't look at him, she didn't touch him. That we would code as `invalidating' because something was needed, some kind of response on her part was needed. And he tried again. So what might happen at the beginning of an improvisation episode is someone keeps trying to get that validation and care and concern from the partner, but eventually he gave up."
Cano said she thinks it happens quite often, and it makes the person in pain feel more distant from the partner - something that's related to more depression. The "negative spiral of invalidation" leads to less intimacy, she said.
After the onset of chronic pain, marital and sexual satisfaction declines, according to research cited by Cano.
"If one partner cannot work any more, the other partner might have to go and find a job that pays more to kind of make up the difference. There's differences in household chores if someone mowed the lawn and took out the garbage and now the other spouse has to do that because of the pain."
Dr. Ken Craig, professor emeritus of psychology at the University of British Columbia, says some people are remarkably successful at keeping things going despite the persistent pain of arthritis, headaches or various other illnesses.
But when people treat the person with persistent pain as an invalid, they are "likely to reinforce, strengthen those unfortunate patterns of behaviour and create more dependency than is necessary," he said.
"You can get into a real vicious circle with chronic pain in the sense that it's best if people encourage getting on with life and minimizing the impact of the chronic pain. That's extremely difficult to do."
There's a "tricky balance" when it comes to the use of medication to relieve pain.
"People shouldn't be reluctant to use analgesics because they are - or can be - effective, but to excess it's inappropriate," said Craig.
Failure to exercise is another serious problem, he added.
Cano, who has interviewed and studied hundreds of couples since 2001, said she thinks that validating the feelings of pain can help.
"If the spouse responds in a validating way and says, `You know, honey, that sucks, I wish you didn't have to experience this. It's not fair,' it's something to say, `I hear what you say. It is a concerning thing."'