Wednesday November 17 2010
It is unclear whether marriage affects pain or vice versa
“A happy marriage helps ease the agony of arthritis,” according to the Daily Mail. It said that researchers have found the emotional stability of a happy marriage has a powerful effect on physical sensations like pain.
The study behind the news assessed 255 people with rheumatoid arthritis, examining their current level of pain, physical and psychological functioning, and how this related to their marital status. The research found that being in an ‘unstressed’ marriage was associated with less psychological disability from their arthritis than being married and ‘stressed’ within the marriage. Being unmarried was associated with greater pain and psychological disability than being married and unstressed.
As pain and marital status were measured at the same time and this study cannot confirm what came first, i.e. whether a happy marriage alleviates pain or if greater pain impacts on relationships. As such, only limited conclusions can be drawn from it.
The personal experience of pain and disability is highly subjective and can be affected by many things, including psychological and emotional factors. Although it is plausible that good relationships may have some effect, this research alone cannot unpick this complex process and tell us how or whether a happy marriage is the answer to reduced arthritic pain and psychological stress.
Where did the story come from?
The study was carried out by researchers from Johns Hopkins University and other universities in the US. Funding was provided by the US National Institute of Mental Health Clinical Research Training in Geriatric Mood Disorders and the American Cancer Society. The study was published in the Journal of Pain, a peer-reviewed medical journal.
The Daily Mail has not considered the limitations of this small cross-sectional study, which cannot answer whether marital status directly affects arthritis-related pain and functioning.
What kind of research was this?
This was a cross-sectional study in which the researchers assessed a group of people with rheumatoid arthritis and looked at how marital status and adjustment to marriage affected their arthritis-related pain, disability and psychological health.
Limited conclusions can be drawn from this sort of study design, which cannot demonstrate any cause and effect relationship between the two factors. This is because it did not assess whether the participants’ relationship status led to changes in arthritis pain or if the severity of pain influenced their relationships. The experience of pain and disability is also highly subjective and is affected by many things, including psychological and emotional factors. This research design alone cannot unpick this complex process and tell us if or how a happy marriage is the answer to less pain.
What did the research involve?
The study involved 255 US citizens with rheumatoid arthritis, or RA (average age 55; 81% female). The participants were all entering a separate randomised controlled trial of writing skill training in RA patients. All met established criteria for the diagnosis of RA.
All participants provided demographic information and completed questionnaires on arthritis-related pain, physical disability and psychological effects.
If the person was married (62% of participants), marital adjustment was assessed using the Locke-Wallace Marital Adjustment Scale, which was reported to be one of the most widely used methods for measuring how well adjusted a person is to marriage or a relationship. It includes 15 questions assessing overall happiness, level of agreement on a number of issues, and ways of handling disagreements.
The researchers used the recommended cut-off score of 100 to classify married participants as either distressed (score of less than 100) or non-distressed (score of 100 or greater).
Doctors performed a comprehensive physical examination and rated the participants’ degree of RA severity and activity using a scale of 0 to 100. Participants rated their own pain, physical and psychological disability using the questionnaires: the McGill Pain Questionnaire and the Arthritis Impact Measurement Scales-2.
What were the basic results?
The researchers assessed the relationships between the various different factors measured. After controlling for the demographic variables and disease severity, better marital adjustment among married participants was associated with reduced psychological disability. Adjustment to marriage was not associated with pain or physical disability.
Of the 158 participants who were married, just over a quarter of them (28%) were classified as ‘distressed married’. After controlling for the demographic variables and disease severity, comparing distressed married, non-distressed married and unmarried participants (97/255), there was:
- greater pain among unmarried participants than in non-distressed married participants
- greater psychological disability among unmarried participants than in non-distressed married participants
- no difference in physical disability between groups
- no difference between distressed married and non-distressed married on measures of pain, psychological or physical disability
How did the researchers interpret the results?
The researchers conclude that being married is not associated with better health in rheumatoid arthritis but that being in a non-distressed marriage is linked with less pain and better functioning compared to not being married.
Limited conclusions can be drawn from this cross-sectional study examining correlations between current pain, physical and psychological functioning and marital status in people with rheumatoid arthritis.
The main finding of the study was that, when dividing people into groups of unmarried, married ‘distressed’ and married ‘non-distressed’, there was greater pain and psychological disability among unmarried people than in non-distressed married people. Among those who were married, better marital adjustment was associated with reduced psychological disability.
However, this study was cross-sectional in nature (i.e. assessed factors at only a single point in time), meaning that it cannot demonstrate cause and effect and tell us if or how marriage has any direct effect on arthritis pain or disability.
For example, while it could be assumed that stress in a marriage could lead to more psychological disability it is equally possible that the experience of chronic pain and disability has placed some psychological strain on the relationship and led to some degree of marital dissatisfaction. Among unmarried participants the research has also not considered whether or not they may have been in stable, happy relationships.
The sample size of the study was also small, which increased the risk that the results have occurred by chance. A further limitation of this study is that the participants had been recruited to take part in a separate study of writing skills training in RA. As such, it is unclear whether they had been subject to selection or recruitment criteria, which may mean this population was not completely representative of the average population with rheumatoid arthritis.
The experience of pain and disability is highly subjective and is affected by many things, including psychological and emotional factors. Although it is highly plausible that good interpersonal relationships would have an effect, this research design alone cannot unpick this complex process and tell us how or whether a happy marriage can lead to less pain.