Perceived validation and criticism in pain: Development of a new measure in chronic pain

Abstract

Background: Research suggests that the way others react to a pain flare-up impacts on psychological and pain-related symptoms in chronic pain (CP). Experiencing validation from others is associated with less negative emotions and better functioning. Contrarily, experiencing criticism is linked to greater pain intensity and worse functioning. Nonetheless, studies are limited by an exclusive focus on spouses rather than significant other relationships, the use of proxy constructs (e.g. social support, responsiveness, solicitousness) rather than specific measures of validation and criticism and a focus on significant others′ behaviour rather than patients′ subjective experience. This study examines the psychometric properties of a new measure-Perceived Validation and Criticism in Pain Questionnaire (PVCPQ), and tests its contribution to functional impairment beyond pain intensity, sociodemographic and medical-related variables, positive and negative affect, safeness and compassion from others. Methods: Women with CP (N = 172), 130 (75.6%) of whom had fibromyalgia, completed an online battery of questionnaires (PVCPQ; numeric pain rating scale; work and social adjustment scale; positive and negative affect schedule; social and pleasure scale; compassionate engagement and action scale). Exploratory factor analysis (EFA), reliability analysis, correlational analysis and hierarchical regression analysis were performed. Results: EFA showed a 23-item two-factor solution with good psychometric properties. Criticism in pain (but not validation in pain) contributed to functional impairment above and beyond the variance explained by pain intensity, sociodemographic and medical variables, positive and negative affect, safeness and compassion from others. Conclusions: These findings suggest that the PVCPQ is a psychometrically valid new measure of perceived validation and criticism in pain that contributes to explaining pain-related functional impairment. Significance: The current study provides a new 23-item measure of perceived validation and criticism by others in chronic pain that overcomes the limitations of existing measures. It adds to the literature by suggesting that perceived criticism (but not validation) contributes to functional impairment beyond sociodemographic variables, pain intensity, affect and related constructs such as social safeness and compassion from others. These results suggest that psychosocial interventions that aim | 137

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“…Pain acceptance implies that an individual continues to pursue life goals and valued activities despite pain, and stops trying to control or avoid pain experiences ( Carriere et al, 2018 ). Feeling validated by others aids acceptance of pain, poses a barrier to internalised stigma, and increases problem-solving behaviour, which in turn can result in better functionality and increased quality of life ( Nicola et al, 2019 ; Penn et al, 2019 ; Andrade Carvalho et al, 2021 ). Our study also indicates that experienced validation can stimulate problem-solving behaviour and acceptance of pain.…”

“…A possible explanation might be that a partner’s or friend’s responsiveness and solicitousness (e.g. providing pain medication, helping with chores, asking how they can help) are not necessarily regarded as validation ( Andrade Carvalho et al, 2021 ). An important aspect of active engagement is expressing a shared responsibility in coping with pain and other complaints.…”

Neurophysiological and psychosocial mechanisms of fibromyalgia: A comprehensive review and call for an integrative model

“…The importance of these findings is underscored by repeated observations that patients with FM exhibit greater loneliness, even when compared to patients with other pain disorders, less perceived social support, and increased perceived invalidation from others (Davis et al, 2001;Kool and Geenen, 2012;Kool et al, 2009;Santiago et al, 2017). A study conducted in a chronic pain sample composed mainly of women with FM found that, even when accounting for potential confounders, the perception of others as disregarding, shaming, or judging towards one's pain experience predicted individual pain-related disability (Carvalho et al, 2020). Interpersonal rejectionbe it actual, anticipated, or perceivedand other forms of social disconnection affect pain ratings and pain-and emotion-related neural activity, disrupt pain modulation (Karayannis et al, 2019;Landa et al, 2020;Wolf et al, 2015), and enhance inflammatory activity (Eisenberger et al, 2017).…”