By Emily Reynolds
Pain is not a purely biological phenomenon: Discrimination, fear of work and general psychological stress have been shown to contribute to experiencing chronic pain. Many researchers therefore take a bio-psychosocial approach and examine the multiple factors that have an impact on and are affected by Pain.
A new study in Stress & health examines the long-term effects of social factors on pain. The team from the Universities of Georgia and Southern California, Los Angeles, focuses specifically on families involved in the 1980s “farm crisis” in the American Midwest. During that time, many lost their jobs, land values plummeted, and businesses failed – finding that financial burden was related to experiencing pain nearly 30 years later.
The data come from a 27-year longitudinal study that included 508 married couples, all of whom were in early midlife when the study began in 1991.
The team pursued a number of actions for the study. The financial burden on the family in 1991, 1994 and 2001 was measured on a four-point scale, and participants also answered questions related to financial burden (e.g., “We have enough money to support ourselves to afford the kind of clothing we need ”). The feeling of control was measured ten years apart in 1991 and 2001, with participants saying how much they agreed with statements such as “Sometimes I feel like I am being pushed around in life”.
Pain was assessed two times later in the study, with participants reporting how much pain they had experienced in the previous month, how severe that pain was, and how much it affected life and work. Participants were also given a list of nearly 50 physical illnesses and asked to indicate what experiences they had had over the past year. These ranged from colds to cancer.
At all points, the team found a correlation between family financial stress and sense of control – that is, those who suffered financial stress also felt a lack of control over their lives. Financial distress and a sense of lack of control at the start of the study were also directly related to physical pain at later time points, indicating that physical pain can be a result of stress not only at the same time but many years later. Those with higher family incomes had less overall physical pain.
The Trajectories The financial stress over the course of the study was also relevant to the experience of pain. Those who were increasingly financially burdened over the years of the study also saw a corresponding decrease in their sense of control over the same period. This was the case even when other factors such as age and physical illness were taken into account, and was also associated with pain later in the study.
However, it is unclear what actually drives the link between loss of control and physical pain. The team has numerous suggestions: For example, a feeling of being out of control could lead people to make bad decisions, which in turn lead to pain or physical illness. Chronic stress can also lead to long-lasting changes in the brain circuits involved in our stress response. Therefore, neurological processes can lead to pain experiences even many years after the onset of stress. Future research may investigate these possibilities as well as other causes of loss of control.
However, the results are limited. For example, people with higher family incomes could afford better health care and adopt healthier lifestyles when it comes to diet, exercise, and non-strenuous work practices, which in turn could result in less pain.
However, the study suggests that there is a direct link between loss of control and negative physical and emotional factors. Interventions that increase people’s sense of control may not improve structural or social factors that cannot be changed, such as a poor economy or unemployment, but can help mitigate their physical and emotional effects.
– Middle-Aged Family Financial Burdens, Sense of Control, and Pain in Later Years: An Examination of Rural Husbands and Wives
Emily Reynolds is an associate at BPS Biomedarticles