Chronic pain represents a major U.S. health care problem, resulting in significant patient and family suffering as well as costs estimated at $79 billion annually. The refractory nature of chronic pain problems has led to the examination of psychological, behavioral, and environmental factors that could be important influences on patient disability. Operant theory, supported by data from self-report studies, suggests that spouse responses to patient pain behaviors may contribute to the maintenance of pain behaviors and disability. However, no studies other than the previously funded research by these investigators have examined this proposition using direct observation and sequential data analytic methods. The broad, longterm objectives of the proposed research are to examine how patient-spouse interactions are related to patient functioning over time, and whether long-term changes in patient functioning can be predicted by pre- or posttreatment patient-spouse interactions. Specifically, this study will examine the extent to which observed patient-spouse behavioral interactions are associated with patient disability pre- and postmultidisciplinary pain treatment and at 6-month follow-up assessment. Further, we will investigate the role that three potentially important variables may play in these relationships: patient depression, gender, and marital satisfaction. Finally, the proposed research will attempt to replicate in a larger sample of pain patient couples findings from the previous funding period regarding the reliability and validity of the revised LIFE coding system and the identification of sequential patterns of patient pain behavior and spouse solicitous behavior. At each assessment, couples will be videotaped while performing a series of common household tasks validated in prior research. These videotapes will be scored using a system for coding sequential patterns of patient and spouse behaviors. Patient and spouse self-report measures of functional disability, pain behaviors and associated spouse responses, depression, and marital satisfaction will also be obtained. The results of this study may pave the way for the reliable identification of patient couples most in need of intervention focused on changing patient-spouse interactions and the development of treatments aimed at altering spouse behaviors contributing to patient disability.
