MODELS OF FAMILY FUNCTIONING AND THEIR CONTRIBUTION TO PATIENT OUTCOMES IN CHRONIC PAIN

This paper analyzes the relationship between family functioning and ch ronic pain, and evaluates a model which integrates the role of family variables with the pain-coping process in patients with rheumatoid art hritis (RA) and fibromyalgia (FM). Family variables, assessed by subsc ales of the Family Environment Scale (FES), and different components o f the pain-coping process varied significantly in their contribution t o pain, psychological functioning, and disability in these two chronic pain disorders. High system maintenance control and low independence contributed significantly to pain in RA and FM, respectively, while lo w family cohesiveness contributed to psychological disturbances in FM subjects. Lack of promotion of activity and recreation in the family w as associated with greater disability in both groups. In addition to f amily variables, helplessness proved to be a potent predictor of pain and psychological functioning in both groups, and disability in FM sub jects. Pain-coping had its predominant influence on pain. As an explor atory test of the model, the data confirm the importance of examining this integrated framework in longitudinal, prospective studies, and it s potential utility in clinical assessment and intervention.