Sequential analysis of chronic pain behaviors and spouse responses.

Social reinforcers such as spouse behaviors have been hypothesized to be important in maintaining chronic pain behavior. This study used direct observation to test whether solicitous and aggressive spouse behaviors systematically precede and follow patient pain behaviors. Fifty chronic pain patients and spouses and 33 control couples were videotaped performing specified tasks. Spouse solicitous behaviors were significantly more likely to precede and follow nonverbal pain behaviors, and nonverbal pain behaviors were significantly less likely to follow spouse aggressive behaviors in pain than in control couples. Within couples, spouse solicitous behaviors preceded and followed verbal and nonverbal pain behaviors beyond chance levels more often in pain than in control couples. Results support an operant conceptualization of factors maintaining chronic pain behaviors.