Social Support in Urologic Chronic Pelvic Pain Syndrome: The Stress-Buffering Model and Gender Differences
Ginting, Jessica V.
chronic pain , spouse responses to pain , social support
Chronic pain is recognized for its intra- and interpersonal stress, with greater social support being associated with better patient outcomes. Urologic Chronic Pelvic Pain Syndromes (UCPPS) are pain-associated conditions that are prevalent across genders and are strongly associated with diminished quality of life (QOL). To date, no gender-based research has examined such supportive behaviours in UCPPS samples. One model, the stress-buffering model of social support, suggests people with greater support within their proximal (e.g., marriage) and distal (e.g., physician) social environment may be protected from negative stressor impact (i.e., pain). Due to their strong associations with poorer QoL, I hypothesized catastrophizing and perceived pain control as important intrapersonal cognitive variables to also consider in such relations between pain and patient QoL. In this dissertation, I examined several research questions using two self-report studies: 1) Are there gender differences in social support for people with UCPPS?; 2) Does social support moderate the relationship between pain and patient outcome variables and are there gender differences in this effect?; and 3) If social support moderates the relationship between pain and outcomes, is this effect further moderated by cognitive variables and/or gender? In Studies 1 and 2, women with IC/PBS endorsed higher levels of solicitous and distracting spouse responses to pain behaviour than did men with CP/CPPS. Additionally, in Study 2 women reported greater support from friends than did men. In regard to moderation effects in Study 1, distracting spouse responses buffered the relationships between patient pain and mental QoL, and between pain and disability. However, spouse solicitousness had a detrimental effect on the relationship between patient pain and mental QoL but only at low levels of catastrophizing in the patient. The genders did not differ in the effect of spouse responses to pain behaviour in Study 1, and Study 1 results with respect to the stress-buffering role of distracting spouse responses were not replicated in Study 2. In Study 2, sources of social support from outside of the marriage also did not have a stress-buffering effect on the relationship between pain and patient outcome. Of the models reviewed, no one current model for understanding the role of social support or catastrophizing in chronic pain was sufficient to account for the findings reported in these studies. However, a dyadic emotion regulation perspective is suggested with implications for marital therapy with couples with chronic pain.