Dear peppermintpatty -

Having been in this movie for almost 10 years, I've had some time to reflect on the problem. Unfortunately, a huge issue is the tendency of not just individuals with chronic pain (ICPs) to engage in "pain catastrophizing" (“an exaggerated, negative focus on pain and is related to psychological distress, pain severity, and other negative outcomes in pain samples” or - simply put - an unproductively aversive response to the pain combined with a grasping for how life used to be) but their spouses to do so either as well or on their own. And while an underlying predisposition may have been present all along, typically due to depression and/or anxiety, it may never have been a huge problem in the marriage until the chronic pain hit. I think we're probably in agreement on this point, but I'm not sure.

In my case, I can't say that my wife’s catastrophizing was never an issue in the marriage (I was on notice when I lost a job early on), but where she had grown up entirely under the specter of her father's chronic illnesses, it completely took over when I got my CRPS. To the point that where I came to terms with this fairly quickly through a Mindfulness Based Stress Reduction (MBSR) class, she was unwilling to consider addressing the issue in any context.

This may be instructive: The significant other version of the Pain Catastrophizing Scale (PCS-S): preliminary validation, Cano A, Leonard MT, Franz A, Pain 2005 Dec 15; 119(1-3):26-37, PubMed Central FULL TEXT @ http://www.ncbi.nlm.nih.gov/pmc/arti...ihms104448.pdf

Abstract
Researchers have hypothesized that pain catastrophizing [“an exaggerated, negative focus on pain and is related to psychological distress, pain severity, and other negative outcomes in pain samples”] has a social function. Although work has focused on the catastrophizing of individuals with chronic pain (ICPs), little is known about the pain catastrophizing of their significant others. The purpose of this study was to test the validity of a revised version of the original PCS [Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524.] in which individuals were instructed to report on their own catastrophizing about their significant other's pain. In Study 1, a confirmatory factor analysis was conducted to determine the factor structure of the PCS-Significant Other (PCS-S) in a diverse sample of university undergraduates (n=264). An oblique second-order 3-factor model with two cross-loadings provided the best fit and this model was invariant across gender and racial groups. This factor structure was cross-validated in Study 2 with a second sample of university undergraduates (n=213). Results indicated that the 3-factor structure with two cross-loadings was a viable model of significant others' pain catastrophizing across gender and racial groups. In Study 3, this factor structure was replicated and the content validity of the PCS-S was examined in a sample of adult ICPs and their spouses (n=111). Spouse catastrophizing was related to ICP pain severity and interference as well as both spouses' depressive symptoms. In addition, ICPs were at a greater risk for psychological distress when both spouses had higher levels of catastrophizing. The PCS-S has the potential to be a useful and valid measure of pain catastrophizing in the significant others of ICPs. [Emphasis added.]

PMID: 16298062 [PubMed - indexed for MEDLINE] PMCID: PMC2679670 Free PMC Article

http://www.ncbi.nlm.nih.gov/pubmed/16298062

And at page 11 of PubMed version of the article:

Spouse catastrophizing was also correlated with ICP depressive symptoms. Specifically, ICP catastrophizing was not related to their own depressive symptoms when their spouses reported low levels of catastrophizing but was positively related to their own depressive symptoms when their spouses also reported a high level of catastrophizing. This result was found when accounting for spouses’ perceptions of pain and interference and their own depressive symptoms, indicating a robust effect. It is possible that catastrophizing in both spouses results in specific behaviors that may exacerbate depressive symptoms in ICPs. For instance, the typical high catastrophizing couple may consist of a worried ICP and a healthy spouse who is over-involved in the ICP’s care and emotional wellbeing (i.e. solicitous). In these cases, ICPs may be concerned about the future of their pain and perceive themselves as a burden on their spouses. High catastrophizing couples may also be unable to meet each other’s need for intimacy because they are so focused on the pain problem. On the other hand, a catastrophizing ICP who has a partner low in catastrophizing might be better able to manage their thoughts and feelings. ICPs who express their concerns to their low catastrophizing spouses may be met with support, validation, and reassurance as suggested in the communal coping model of catastrophizing. Therefore, these ICPs may be protected from high levels of depressive symptoms. No such interaction was found for spouse depressive symptoms. Spouses’ depressive symptoms may be more a function of their own interpretations of events. Future research will determine whether these processes are at work. [Citations omitted; emphasis added.]

That said, I can't endorse traditional "cognitive behavoral therapy," in which the issue of pain catastrophizing is central, where that behavior is itself addressed in an aversive context rather through an approached grounded in love of self and other. See, Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning, Jensen MP, Turner JA, Romano JM, Pain 2007 Sep; 131(1-2): 38-47, PubMed Central FULL TEXT @ http://www.ncbi.nlm.nih.gov/pmc/arti...ihms-29341.pdf :

Treatment was focused on (1) increasing strength, flexibility, endurance, and sitting and standing times; (2) assisting the patient in returning to customary work, household, and avocational activities; (3) instruction in and practice of specific pain coping strategies thought to be adaptive (use of regular exercise, pacing, coping self-statements, and task persistence); (4) decreasing use of coping strategies and responses thought to be maladaptive (guarding, resting, asking for assistance, catastrophizing); (5) medication management, with a focus on decreasing and eliminating the use of sedative and opioid medications; and (6) encouraging a shift in cognitions from those thought to be maladaptive (e.g., that one is necessarily disabled by pain, that hurt necessarily means that damage is occurring and that activities associated with increased pain should be avoided) towards cognitions thought to be adaptive (e.g., that one can control pain and its impact). Patients’ family members (usually spouses) were asked to participate with the patient during the last two days of treatment in order to (1) observe patient functioning and how program staff encouraged patient functioning and (2) meet with the program psychologist to discuss how they can best support the treatment gains made by the patient. [Page 4 of PMC copy.]

In fact, and I after running various PubMed searches, I am unaware of any evidence that strengthening exercise unless combined with the use blocks or other medical treatments, was ever proved useful for a patient with CRPS. My personal experience was certainly to the contrary: for days after a session my legs felt like they were packed with broken glass, even to the PT who discharged me!

Nevertheless, not only would I agree with the proposition that chronic pain will almost always make a bad marriage worse, there is evidence to suggest that a bad marriage (along with other chronic stress factors) could lay the foundation for RSD in the first place! Check this out:

Hostile Marital Interactions, Proinflammatory Cytokine Production, and Wound Healing, Janice K. Kiecolt-Glaser, PhD; Timothy J. Loving, PhD; Jeffrey R. Stowell, PhD; William B. Malarkey, MD; Stanley Lemeshow, PhD; Stephanie L. Dickinson, MAS; Ronald Glaser, PhD, Arch Gen Psychiatry. 2005;62:1377-1384 FULL TEXT @ http://archpsyc.ama-assn.org/cgi/reprint/62/12/1377.pdf

Abstract
CONTEXT: A growing epidemiological literature has suggested that marital discord is a risk factor for morbidity and mortality. In addition, depression and stress are associated with enhanced production of proinflammatory cytokines that influence a spectrum of conditions associated with aging. OBJECTIVE: To assess how hostile marital behaviors modulate wound healing, as well as local and systemic proinflammatory cytokine production. DESIGN AND SETTING: Couples were admitted twice to a hospital research unit for 24 hours in a crossover trial. Wound healing was assessed daily following research unit discharge. PARTICIPANTS: Volunteer sample of 42 healthy married couples, aged 22 to 77 years (mean [SD], 37.04 [13.05]), married a mean (SD) of 12.55 (11.01) years. INTERVENTIONS: During the first research unit admission, couples had a structured social support interaction, and during the second admission, they discussed a marital disagreement. MAIN OUTCOME MEASURES: Couples' interpersonal behavior, wound healing, and local and systemic changes in proinflammatory cytokine production were assessed during each research unit admission. RESULTS: Couples' blister wounds healed more slowly and local cytokine production (IL-6, tumor necrosis factor alpha, and IL-1beta) was lower at wound sites following marital conflicts than after social support interactions. Couples who demonstrated consistently higher levels of hostile behaviors across both their interactions healed at 60% of the rate of low-hostile couples. High-hostile couples also produced relatively larger increases in plasma IL-6 and tumor necrosis factor alpha values the morning after a conflict than after a social support interaction compared with low-hostile couples. CONCLUSIONS: These data provide further mechanistic evidence of the sensitivity of wound healing to everyday stressors. Moreover, more frequent and amplified increases in proinflammatory cytokine levels could accelerate a range of age-related diseases. Thus, these data also provide a window on the pathways through which hostile or abrasive relationships affect physiological functioning and health.

PMID: 16330726 [PubMed - indexed for MEDLINE] Free Article

http://www.ncbi.nlm.nih.gov/pubmed/16330726

take care,
Mike