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5 Articles in this Series
Introduction
2018 IASP World Congress on Pain: A Preview
Informal Social Support for Pain: Moving the Research Forward
Spinal Cord Stimulation Evidence: What's Available and What's Needed
Symptomatic Treatment of Painful Diabetic Neuropathy
Translating Trials into Practice from a Primary Care Perspective

Informal Social Support for Pain: Moving the Research Forward

A systemic review presented by Sonia F. Bernardes, PhD, reveals gaps in the lack of specificity for informal social support for pain. A 2018 IASP World Congress on Pain highlight.

Sonia F. Bernardes, PhD, assistant professor at the department of social and organizational psychology at ISCTE-University Institute in Lisbon, presented “Pain-related Social Support: Where Do We Stand and How to Move Research Forward?”1 at the 2018 IASP World Congress on Pain in Boston. Her presentation provided an overview of the conceptualization and measurement of informal pain-related social support (SS) and how its relationship with pain experiences has been investigated, opening up the future directions of research. Referring to main findings of a comprehensive review of studies2 published between 2000 and 2015, trends and gaps in research on informal pain-related SS were shown.

According to Dr. Bernardes, interpersonal dynamics play an important role in chronic pain adaptation processes, and adults with chronic pain often refer to SS of significant others as one of their most valued social interactions. Informal SS refers to social resources that people perceive to be available or that have been received in case of need from significant others.

What the Current Research Lacks

However, current research on SS and pain has mostly focused on either general perceptions of SS or pain-specific solicitousness. “When we are using general measures of social support, we might not be tapping into the specificities of social support interactions,” Dr. Bernardes commented. On the other hand, solicitousness is associated with being attentive to a person’s pain behaviors by taking over one’s chores, for example. “This literature shows us consistent findings, and mainly a negative association with pain disability.” Thus, a narrow and negative perception of pain-related SS has been presented thus far, which, according to Dr. Bernardes, contrasts with reports on the variety and helpful and protective roles of other’s helping actions. “The lack of specificity and conceptual breadth and depth might run the risk of stagnation,” Dr. Bernardes said.

Conceptualization

The systemic review included 53 papers with the following inclusion criteria: were all primary quantitative studies on adults with chronic pain; used a functional and interpersonal perspective on SS; were all on informal SS (families, spouses, friends); SS had to be part of the main research question; and the focus had to be on pain-specific SS. Almost 40% of the studies were atheoretical, and 30% drew on operant conditioning models. “This means, in a way, that social support has mainly been conceptualized either as positive reinforcements on pain behaviors, or as a correlate of maladaptive beliefs.” Further, only 7.5% of studies actually drew on SS theoretical models to study pain-specific interactions.

Unsurprisingly, solicitousness and the multidimensional pain inventory (MPI) took a clear precedence (almost 90% of studies were using the MPI to assess solicitousness). However, several other minor types of pain-specific SS have begun to emerge, such as pain-related emotional support. “Also, there is a dominant focus on self-reports on past social support exchanges that is called ‘received’ social support and mostly from the perspective of individuals with chronic pain,” Dr. Bernardes said. “So, we know much less on the perspective of the providers of social support.”

Most of the studies were focused on the direct relationship between pain-related SS and pain outcomes; cross-sectional in nature. Predicting the indicators of pain-related SS, most focused on factors related to the patient and not the provider. Only three studies investigated the role of pain-related social support within the stress and coping process (as a buffer or mediator).

Applying Future Research

Future challenges to pain-related SS include the negligence of other important functions, such as support for the promotion of functional autonomy or emotional validation. “This means that we really need to expand the concept of pain-related social support, even investigating other functions of pain-related social support doing a more systematic use of existing measures other than the MPI, or even developing new ones to tap into other specific pain-related responses.” In addition, clear dyadic processes are needed to include both the patient and provider of pain-related social support, and dimensions of the changes such as timing, reciprocity, and responsiveness, which are rarely investigated. “We really need to know more about the ‘give-and-take’ in a pain context.”

 

References

1. Bernardes SF. "Pain-related Social Support: Where Do We Stand and How to Move Research Forward?" Presented at 2018 IASP World Congress on Pain, September 12-16, in Boston, MA.

2. Bernardes SF, Forgeron P, Fournier K, et al. Beyond solicitousness: a comprehensive review on informal pain-related social support. Pain. 2017;158(11):2066-2076.

 

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