Models of family functioning and their contribution to patient outcomes in chronic pain

This paper analyzes the relationship between family functioning and chronic pain, and evaluates a model which integrates the role of family variables with the pain-coping process in patients with rheumatoid arthritis (RA) and fibromyalgia (FM). Family variables, assessed by subscales of the Family Environment Scale (FES), and different components of the pain-coping process varied significantly in their contribution to pain, psychological functioning, and disability in these two chronic pain disorders. High system maintenance control and low independence contributed significantly to pain in RA and FM, respectively, while low family cohesiveness contributed to psychological disturbances in FM subjects. Lack of promotion of activity and recreation in the family was associated with greater disability in both groups. In addition to family variables, helplessness proved to be a potent predictor of pain and psychological functioning in both groups, and disability in FM subjects. Pain-coping had its predominant influence on pain. As an exploratory test of the model, the data confirm the importance of examining this integrated framework in longitudinal, prospective studies, and its potential utility in clinical assessment and intervention.This research was supported by a Multipurpose Arthritis and Musculoskeletal Diseases Center grant AR40770 from the National Institute of Arthritis and Musculoskeletal Diseases at the University of California, San Diego. Portions of this paper were presented at the convention of the American Psychological Association, August 1992, in Washington, DC, and at the meeting of the Society of Behavioral Medicine, March 1993, in San Francisco.The authors gratefully acknowledge Teresa A. Krall, M.A., and Karen Schoenfeld-Smith, M.A. for their valuable assistance in statistical analysis for this article.