PAIN+ CPN

Smith SM, Li R, Wolfe H, et al. Couple Interventions for Chronic Pain: A Systematic Review. Clin J Pain. 2019 Nov;35(11):916-922. doi: 10.1097/AJP.0000000000000752. (Systematic review)
Abstract

OBJECTIVE: Couple interventions for chronic pain have been shown to more effectively reduce pain intensity for individuals with chronic pain (ICPs) than individual behavioral interventions or usual care. This systematic review identified randomized controlled trials of couple interventions to highlight strategies that could be incorporated into psychotherapy with ICPs and their romantic partners.

METHODS: The authors identified articles reporting randomized controlled trials of couple interventions for chronic pain. Three databases were searched (ie, PubMed, Embase, and PsycInfo), resulting in 18 studies and 22 articles.

RESULTS: Couple interventions resulted in statistically significant improvements in pain intensity compared with other conditions in 8% to 40% of the studies depending on the comparator group (i.e., control, individual intervention, another couple intervention), and in statistically significant improvements on a pain-related outcome compared with other conditions in 31% to 50% of the studies depending on the comparator group (ie, control, individual intervention, another couple intervention). Educating couples about pain was the most common strategy (83%). Jointly administered relaxation or meditation skills were included in nearly half of the interventions (48%). Many interventions taught cognitive-behavioral skills jointly to couples (39%) or to the ICP with partner encouragement (30%). Teaching couples how to request and provide assistance (30%), and encouraging partners to avoid reinforcing pain behaviors (39%), occurred frequently. ICPs and their partners were often asked to set goals (30%).

DISCUSSION: This review outlined strategies included in couple interventions for chronic pain that are derived from the cognitive-behavioral therapy, acceptance and commitment therapy, and operant behavioral traditions, but delivered relationally. Therapists working with ICPs and their partners may integrate these strategies into their practice to help couples who are managing chronic pain.

Ratings
Discipline Area Score
Psychologist 7 / 7
Physician 6 / 7
Comments from MORE raters

Physician rater

This article is concerned with a systematic review of couple therapy in couples where at least one person has chronic pain. Although the treatment involved (primarily CBT and acceptance and commitment therapy) had little effect on the experience of pain, an improvement in function and behaviour over and above standard individual therapy was found in a little less than half of all studies. The numbers of studies examined was small and it was difficult to standardise these and this affects the impact of the investigation. The results are what I would have expected from my experience in this area.

Physician rater

This is a logical intervention but the evidence for its value is not well known.

Psychologist rater

The inclusion of partners in interventions for chronic pain is not usual care but this article provides evidence that it should be. Although the review finds significant improvement with couples approaches, the exact mechanisms remain unknown.
Comments from PAIN+ CPN subscribers

Ms. Carolynn Bulmer (10/25/2019 2:12 PM)

I am a leader for a chronic pain/chronic illness self-help group in Vanderhoof B.C. We enjoy several couple relationship members and experience/share their pain management support techniques with each other. Personally, having chronic pain issues and supportive partner is the ideal way to be successful with pain management. I believe more clinicians should focus on treating partners rather than individuals when dealing with chronic pain as a patient illness.