Thursday January 22 2015
Emotional states can affect feelings of pain
"It’s official: men really shouldn’t be at the birth,” is the bizarre headline in The Times, as it reports on a pain study on women who were not even pregnant, let alone giving birth.
Researchers wanted to explore whether a woman’s “attachment style” (whether they sought or avoided emotional intimacy) had any influence on whether it was beneficial to have their partners present while having painful medical procedures.
They administered a series of painful laser pulses to 39 female volunteers in both the presence and absence of their romantic partners, while recording the women’s pain ratings.
The study found that the more women reported wanting to avoid closeness and intimacy, the more pain they experienced when their romantic partner was present.
However, describing the partner as “present” is misleading. The partner was in the same room, but hidden behind a curtain, so they could not see each other or have basic physical contact, such as holding hands. They were also told not to communicate. This does not mimic real-life situations, where a partner might be able to offer support. Therefore, media attempts to extrapolate these findings to childbirth are misguided.
The study makes the interesting point that health professionals should not assume a romantic partner is the best choice to accompany a patient undergoing a painful medical procedure. A relative or friend may be a better option.
Where did the story come from?
The study was carried out by researchers from King’s College London, the University of Hertfordshire and University College London. It was funded by the Volkswagen Foundation, the European Research Council and the Economic and Social Research Council.
The study was published in the peer-reviewed journal Social, Cognitive and Affective Neuroscience on an open-access basis, so it is free to read online or download as a PDF.
The Times’ reporting of this study was poor. Its headline of “It’s official: men really shouldn’t be at the birth” fails to communicate the fact that this study did not actually involve pregnant women.
The term “It’s official” is also deeply unhelpful. It implies that there is some official guideline dictating who should be a woman’s birth partner. Even if there were such a guideline, a small study involving 39 non-pregnant women wouldn’t be a reason to change it.
Other UK media sources ran similar reports to The Times, with the honourable exception being BBC News, which reported the study accurately, though they did not explain that the partner was silent and behind a curtain.
What kind of research was this?
This study was a comparative case series. It looked at whether the degree of pain women experience during medical procedures is affected by the presence or absence of their romantic partner. It also looked at whether this is influenced by the woman’s “attachment style” in terms of whether they sought or avoided emotional intimacy in their relationships.
Previous research on the subject has been mixed, with some studies indicating that the presence of someone close is beneficial in reducing pain, and others suggesting that the opposite is true. The researchers decided to look at how personality factors, specifically “adult attachment style”, might influence the effects of the presence of someone close, when a woman is experiencing pain.
What did the research involve?
The researchers recruited 39 heterosexual couples in a romantic relationship, using university circular emails. The female participants had to fulfil the specific criteria to be included. They had to:
- be right-handed
- have been in their current relationship at least a year
- have no history of mental illness
- have no history of medical or neurological conditions
- have no history of substance abuse
- had not taken any medication, including painkillers, on the day of testing
The average age of participants was about 25 for women and 27 for men, and they were predominantly white British. They were paid £30 per couple for participating.
The couples all underwent three experiments, in which the woman was given moderately painful laser pulses on one of their fingers, lasting for around 10 minutes. They were told that the experiments were aimed to test empathy in the partner, rather than the actual intention of rating the level of pain experienced by the woman. These experiments were performed in different orders across the couples.
In one experiment, the male partner was asked to rate his empathy for his partner while she was receiving the painful stimuli. Each partner was given visual information on the intensity of the laser, but they could not see each other as they were divided by a curtain.
In the second experiment, the partner was asked to rate his empathy for another participant who had previously taken part in the experiment, by viewing information on the laser intensities they had received, while their own partner received laser stimuli. In this experiment, the male partner was therefore unable to pay attention to his own partner and they were still separated by a curtain.
In the third experiment, the researchers led couples to believe that due to a technical fault, the file for the previous participant would not load onto the lab computer. The partner was therefore going to rate his empathy on a computer next door, and would be absent from the testing room.
Couples were instructed not to communicate during the procedures, to avoid biasing participants’ pain ratings.
In each experiment, the women were asked to rate the intensity of the pain on an 11-point scale, ranging from 0 (no pinprick sensation) to 10 (the worst pinprick sensation imaginable). The level of laser stimulation was set individually for each woman before the experiments, during “familiarisation with the equipment” so that it delivered a pain rating of 8. During each experiment, the women entered their ratings on a computer screen, using a numeric keypad.
The researchers also positioned 11 electrodes on each woman’s scalp to measure the brain’s electrical activity while she was having the laser stimulation. Using the EEG recording, researchers measured whether this electrical activity “spiked” in response to the laser pulses.
Each woman also completed a validated 36-item questionnaire on close relationships, to measure the extent to which she either sought closeness or emotional intimacy in relationships. The questionnaire included 18 questions about “attachment style”.
What were the basic results?
The study found that the more women reported wanting to avoid closeness, the more pain they experienced when their romantic partner was present, and the stronger their “peaks” in brain activity.
Whether the partner was focusing on them or on another woman’s pain made no difference to the pain experienced.
How did the researchers interpret the results?
The researchers say that the effects of a partner’s presence on women’s pain ratings depended on their “attachment style” and that a partner’s presence may not have beneficial effects on the experience of pain when the individual in pain has “higher attachment avoidance”.
Partner support during painful procedures may need to be tailored to individual personality traits, they conclude. Senior author Dr Katerina Fotopoulou, from UCL Psychology & Language Sciences, says: “Individuals who avoid closeness may find that the presence of others disrupts their preferred method of coping with threats on their own. This may actually maintain the threat value of pain and ultimately heighten individual’s pain experience.”
This small study found that during painful stimuli, how much pain women reported experiencing depended on their attachment style – with more pain being experienced by women who have a "higher attachment avoidance", when their romantic partner was present.
The study was interesting, but had several limitations. The major one was that it did not allow the partners to communicate, have visual contact or basic physical contact, such as holding their hand during the painful procedures. This does not reflect the support that would be expected from a partner in a real life situation and may have influenced the results. In addition, the study's findings may not be generalisable to older couples or those from ethnic minorities.
Neither is it certain if these results would apply to real life painful procedures or experiences –including childbirth. As Dr Fotopoulou points out: “The physical and psychological nature of labour pain may simply be different than other types of pain. Future studies could test how having a partner present during labour affects the pain felt by women who tend to avoid closeness in relationships.”
It makes sense that some women – or people in general – may feel they can cope with pain better when alone than with a partner. Deciding who should be present during labour is entirely personal, although many women find the support of someone close, whether it is a partner, friend or relative, comforting.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.