Social context and acceptance of chronic pain: the role of solicitous and punishing responses
Abstract
Much of the behavior of chronic pain sufferers happens in social contexts where social influences can play a role in their suffering and disability. Researchers have investigated relations of social responses with verbal and overt pain behavior and, more recently, with patient thinking, such as catastrophizing. There has not yet been a study of social influences on patient acceptance of chronic pain. The purpose of the present study was to investigate the relations between solicitous, punishing, and distracting responses, from significant others in the patient's life, with components of patient acceptance of pain. 228 consecutive patients referred to a multidisciplinary pain center provided data for this study including their responses to the Chronic Pain Acceptance Questionnaire and the Multidimensional Pain Inventory. Primary results showed that, as predicted, both solicitous and punishing responses from significant others were negatively associated with acceptance of pain. These relations remained, independent of patient age, education, pain level, and level of general support from the significant other. These results suggest that social influences can play a role in patients' engagement in activity with pain present and their willingness to have pain without trying to avoid or control it.
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There is a strong and negative relationship between solicitous and punishing responses and pain acceptance, maintaining its predictor value even a year after medical intervention.
“Furthermore, relatively large studies involving participants with chronic pain have found a strong and negative relationship between solicitous and punishing responses and pain acceptance (68), maintaining its predictor value even a year after the medical intervention (69).”
From Anxiety, Reinforcement Sensitivity and Social Context in Accepting the Experience of Pain Among Rheumatoid Arthritis Patients (2020) · cites this paper as [68]
About 20% of people with chronic pain have depression, compared with less than 7% of the general population, and this pattern is found worldwide.
“Approximately 20% of individuals with chronic pain also have depression, while less than 7% of the general population experiences this disorder, and these findings hold not just for the U.S. but around the world 231–235.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [235]
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“Failure to control such experiences leads to negative emotions, such as anxiety and depression, and feelings of helplessness and frustration, which in turn have adverse health-related consequences [8].”
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de Matos, M. O., Bernardes, S. F., & Goubert, L. (2017) · Pain · doi:10.1097/j.pain.0000000000000990 · Cited by 17 · see citing works
Ojala, T., Piirainen, A., Sipilä, K., Suutama, T., & Häkkinen, A. (2013) · Disability and Rehabilitation · doi:10.3109/09638288.2012.694572 · Cited by 15 · see citing works
Kostova, Z., Zufferey, M. C., & Schulz, P. J. (2015) · Pain Research and Management · doi:10.1155/2015/497512 · Cited by 15 · see citing works
“Providing the right social support is still a challenge and such support has often proven to be elusive and unreliable in helping patients to manage the disease (2); however, it is crucial in helping them to accept the implications of the disease (3,4).”
Reed, D. E., Cobos, B. A., Nabity, P. S., Doolin, J., & McGeary, D. D. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-72216-2.00015-6 · Cited by 15 · see citing works
Drug-Induced Peripheral Neuropathy: Diagnosis and Management
Merheb, D., Dib, G., Zerdan, M. B., Nakib, C. E., Alame, S., & Assi, H. I. (2021) · Current Cancer Drug Targets · doi:10.2174/1568009621666210720142542 · Cited by 13 · see citing works
van den Elzen, M. E. P., Versnel, S. L., Duivenvoorden, H. J., & Mathijssen, I. M. J. (2012) · Aesthetic Plastic Surgery · doi:10.1007/s00266-012-9897-y · Cited by 14 · see citing works
“The abundant number of studies on acceptance covers cohorts of patients with a specific chronic disease or chronic pain [4–6, 9, 12, 13, 15, 16, 18, 20, 21, 26, 27].”
BackgroundThe Effect of Everyday-Life Social Contact on Pain
Weiss, M. H., Gründahl, M., Jachnik, A., Lampe, E. C., Malik, I., Rittner, H. L., Sommer, C., & Hein, G. (2024) · Journal of Medical Internet Research · doi:10.2196/53830 · Cited by 12 · see citing works
“…experience: in general, the perception of social support versus no support decreases pain [1], but extensive solicitous concern may enhance pain intensity and related factors such as functional disability and pain catastrophizing [95,96] and foster pain expression in patients with pain [87,93].”
Interpersonal Responses and Pain Management Within the US Military
McGeary, C. A., Blount, T. H., Peterson, A. L., Gatchel, R. J., Hale, W. J., & McGeary, D. D. (2015) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-015-9605-2 · Cited by 11 · see citing works
“Others have also used these individual scales for pain coping research [22].”
BackgroundMohammadi, S., Alinajimi, F., Esmaeilian, N., Dehghani, M., & Khatibi, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01386 · Cited by 10 · see citing works
“This is in line with the nature of caregiver distracting responses, which aim to distract the patient’s attention from the pain and help them to engage in another activity (McCracken, 2005).”
BackgroundNyberg, V., Novo, M., & Sjölund, B. H. (2014) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-1872 · Cited by 10 · see citing works
Promoting Patient and Caregiver Engagement in Self-Management of Chronic Illness
Dabbs, A. D., Song, M., Geest, S. D., & Davidson, P. M. (2013) · Nursing Research and Practice · doi:10.1155/2013/180757 · Cited by 11 · see citing works
Positive Encounters as a Buffer: Pain and Sleep Disturbances in Older Adults’ Everyday Lives
Huo, M. L., Ng, Y. T., Fuentecilla, J. L., Leger, K. A., & Charles, S. T. (2020) · Journal of Aging and Health · doi:10.1177/0898264320958320 · Cited by 9 · see citing works
“Poor sleep may also result in other health problems that co-occur with pain, consistent with findings documenting sleep issues as a mechanism underlying long-term pain and other well-being outcomes (e.g., depression; Campbell et al., 2013; Finan et al., 2013; Moldofsky, 2001).”
ResultRabey, M. I., Buldo, B., Helland, M. D., Pang, C., Kendell, M., & Beales, D. J. (2021) · British Journal of Pain · doi:10.1177/20494637211062045 · Cited by 9 · see citing works
Ziadni, M. S., You, D. S., Wilson, A. C., & Darnall, B. D. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000606 · Cited by 9 · see citing works
Verifiability and Symptom Endorsement in Genuine, Exaggerated, and Malingered Pain
Akca, A. Y. E., Slootmaekers, L., & Bošković, I. (2020) · Psychological Injury and Law · doi:10.1007/s12207-020-09375-w · Cited by 8 · see citing works
“…that individuals with certain personality traits, such as high levels of fantasy proneness (i.e., richness in imagination; Peace & Masliuk, 2011; Merckelbach et al. 2017), as well as people who have difficulties in recognizing internal sensations, a trait known as alexithymia (see Peace &…”
BackgroundContextual and time dependent pain in fibromyalgia: An explorative study
Fors, E. A., Landmark, T., & Bakke, Ø. (2012) · BMC Research Notes · doi:10.1186/1756-0500-5-644 · Cited by 8 · see citing works
Miller, M. M., Williams, A. E., Scott, E. L., Trost, Z., & Hirsh, A. T. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.07.006 · Cited by 8 · see citing works
Partners’ Experiences of Chronic Pain: A Qualitative Evidence Synthesis
Borthwick, C., Penlington, C., & Robinson, L. J. (2024) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-024-10012-w · Cited by 7 · see citing works
“Solicitous responses (where others are overly concerned and eager to help) and punishing responses (where pain is ignored or met with anger) have been associated with increased pain and disability (McCracken, 2005).”
Social determinants of health and youth chronic pain
Chen, Y., Liu, Z., Werneck, A. O., Huang, T., Damme, T. V., Kramer, A. F., Cunha, P. M., Zou, L., & Wang, K. (2024) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2024.101911 · Cited by 7 · see citing works
Short- and Long-term Effects of Support Visibility on Support Providers' Negative Affect
Marini, C. M., Wilson, S. J., Tate, A. M., Martire, L. M., & Franks, M. M. (2019) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbz114 · Cited by 7 · see citing works
Psychosocial Adjustment of Spousal Caregivers of Patients With Chronic Pain
Mercurio-Riley, D. A., Lee, G. K., Chronister, J. A., & Swigar, E. A. (2013) · SAGE Open · doi:10.1177/2158244013512130 · Cited by 7 · see citing works
“McCracken (2004) found that solicitous behaviors (i.e., excessive expression of sympathy) by SCCPP are related to increased patient pain behaviors, while punishing responses from SCCPP such as anger, ignoring, and frustration are also related to maladaptive patient outcomes, including less activity…”
BackgroundPinel, L., Perez-Nieto, M. A., Redondo, M., Rodríguez-Rodríguez, L., & León, L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.554990 · Cited by 7 · see citing works
“Furthermore, relatively large studies involving participants with chronic pain have found a strong and negative relationship between solicitous and punishing responses and pain acceptance (68), maintaining its predictor value even a year after the medical intervention (69).”
BackgroundResultBreaking the Pain Barrier: Understanding and Treating Human Suffering
Kehoe, A., Barnes‐Holmes, Y., Cochrane, A., Stewart, I., & Hume, J. B. (2007) · Cited by 6 · see citing works
da Silva, P. H. B., & Inumaru, S. M. S. M. (2015) · Fisioterapia em Movimento · doi:10.1590/0103-5150.028.004.ao14 · Cited by 6 · see citing works
Masselin-Dubois, A. (2016) · Douleurs Évaluation - Diagnostic - Traitement · doi:10.1016/j.douler.2016.08.003 · Cited by 7 · see citing works
Hopwood, C. J., Creech, S. K., Clark, T. S., Meagher, M. W., & Morey, L. C. (2007) · Rehabilitation Psychology · doi:10.1037/0090-5550.52.4.443 · Cited by 6 · see citing works
“The MPI has also demonstrated validity in predicting treatment outcome (Michaelson, Sjölander, & Johansson, 2004), use of sick leave (Marhold, Linton, & Melin, 2002), pain-related behavior (Turk & Okifuji, 1997), pain acceptance (McCracken, 2005), future pain following automobile accidents (Olsson, Bunketorp, Carlsson…”
BackgroundOrfgen, H., & Dijkstra, A. (2015) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1973 · Cited by 6 · see citing works
Toward a Fully Functional, Flexible, and Defused Approach to Pain in Young People
McCracken, L. M. (2006) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2006.04.001 · Cited by 5 · see citing works
Self-citationGhomian, S., & Shairi, M. R. (2014) · Cited by 5 · see citing works
Baum, E., Abdi, S., Probst-Hensch, N. M., Zinsstag, J., Vosseler, B., Tschopp, R., & van Eeuwijk, P. (2023) · PLoS ONE · doi:10.1371/journal.pone.0293137 · Cited by 4 · see citing works
Salazar‐Méndez, J., Cuyúl-Vásquez, I., Ponce‐Fuentes, F., Núñez‐Cortés, R., Méndez-Rebolledo, G., & Fuentes, J. (2024) · PeerJ · doi:10.7717/peerj.17507 · Cited by 4 · see citing works
“In chronic pain rehabilitation, it is essential to address the factors mentioned above ( McCracken, 2005 ).”
Psychological aspects of chronic pain: a literature review
Walker, S. (2005) · Southern African Journal of Anaesthesia and Analgesia · doi:10.1080/22201173.2005.10872415 · Cited by 4 · see citing works
“To the contrary, such a diagnosis may lead to adoption of the sick role, increased inactivity or elevated levels of emotional discomfort, and thus feed a cycle of maintenance rather contribute to the alleviation of the person’s condition.(1,12) Thus the minimum requirement for the effective assessment and treatment of…”
BackgroundPsychoneuroendocrine Associations with Momentary Pelvic Pain in Endometriosis
van Stein, K. R., Stoffel, M., Marshall, A., Germeyer, A., Herpertz, S. C., Grinevich, V., Eckstein, M., & Beate, D. (2025) · International Journal of Behavioral Medicine · doi:10.1007/s12529-025-10402-w · Cited by 3 · see citing works
“Secondly, on the interpersonal level, distracting support may be weakly, but negatively correlated with patients’ pain acceptance [55].”
Donohue, G. F., Meredith, P. J., Strong, J., Page, L., & Andrews, N. E. (2026) · European Journal of Pain · doi:10.1002/ejp.70236 · Cited by 3 · see citing works
“…Tripp, and Nickel 2011; Romano et al. 1995; Schwartz et al. 2005), more pain interference (small-medium effects) (Boothby et al. 2004; Buenaver et al. 2007; Issner et al. 2012) and less activity engagement (small effect) (McCracken 2005) and greater physical dysfunction (Romano et al. 1995).”
Pain rehabilitation in Sweden : a quality registry study
Nyberg, V. (2011) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 3 · see citing works
The value of social relationships in the biopsychosocial model of pain
Ghio, D., & Peters, S. (2024) · British Journal of Pain · doi:10.1177/20494637241297274 · Cited by 3 · see citing works
“Solicitous and punishing responses to pain, which have been examined by McCracken 8 in the family and friends support, also extend to the clinical-patient communication.”
Caes, L., Goubert, L., Sullivan, M. J. L., & Chambers, C. T. (2013) · Ghent University Academic Bibliography (Ghent University) · Cited by 2 · see citing works
- Authors
- McCracken, L. M.
- Affiliations
- Royal National Hospital for Rheumatic Diseases (GB)
- Corresponding author
- McCracken, Lance M.
- ORCID
- McCracken, Lance M.
- Venue
- Pain
- Published
- 2005-01
- Volume
- 113
- Issue
- 1
- Pages
- 155-159
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2115910704
- Cited by
- 136
- References
- 24
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 8 · 2020: 6 · 2019: 6 · 2018: 11 · 2017: 5 · 2016: 4 · 2015: 8 · 2014: 8 · 2013: 9 · 2012: 9
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic pain, pain acceptance, social support, significant others, pain catastrophizing, Chronic Pain Acceptance Questionnaire, Multidimensional Pain Inventory
- MeSH terms
- Adaptation, Psychological, Chronic Disease, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Pain, Pain Measurement, Predictive Value of Tests, Regression Analysis, Severity of Illness Index, Social Behavior, Social Environment, Social Support
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