707: How Relationship Factors Shape Pain: Closeness and Solicitousness in Patient-Spouse Dyads

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Pain Category (ICD-11), Chronic primary musculoskeletal pain, Psychology, Imaging (e.g. fMRI, PET, MRS)

Background and Aims: Pain behavior is shaped by social context, particularly partner behavior. Research shows that the presence of a solicitous partner affects pain ratings and neural processing (e.g., Nees et al., 2022), while attachment style also modulates pain responses, albeit in a different manner (Krahé et al., 2015). This raises the question about how broader relationship characteristics - and their relation to solicitousness – influence pain-related behaviors and neural processes in patient–spouse interactions. In the present study, we focused on interpersonal closeness (IC) and explored whether IC contributes to socially reinforced pain.

Methods: We investigated patients with chronic back pain (CBP, N=11), healthy controls (HC, N=13), and their spouses. We asked for pain and social life reports, together with a fMRI hyperscanning session to capture the individual- and dyadic-level behavioral and neural processes associated with the modulation of pain of the patients. During the scanning session, patients received painful stimulation either in the video presence or absence of their spouse while neural activation and behavior were measured. Spouses observed real-time videos of their partner receiving painful stimulation while neural activation was measured. IC and solicitousness were assessed via self-report from both individuals.

Results: In the behavioral analyses, we found that IC, as a function of group (CBP/HC), significantly predicted pain intensity, but not unpleasantness ratings, of the painful stimulation. Greater IC was associated with lower intensity ratings in patients, but independent of the presence or absence of the spouse. We also found no significant interaction between IC and spouse solicitousness. Subsequently, we will assess whether IC is associated with socially-reinforced pain processing at the neural level, which will be presented in relation to partner responses. We expect increased activation in the insula, cingulate cortex, and the prefrontal cortex as related to IC.

Conclusions: The present study demonstrates that IC may modulate pain-related behaviors in chronic pain patients but is not associated with solicitousness. This suggests that IC and solicitousness may reflect distinct pathways and that IC-triggered effects may not be directly based on operant learning mechanisms (i.e., no difference between presence and absence as a learning-related “stimulus”). This underscores differential roles of solicitousness and broader relationship characteristics for pain treatments. The study also provides a basis for future hyperscanning research on patient–spouse neural coupling. Neural marker analyses are ongoing and will be presented in the poster.

References: Krahé, C., Paloyelis, Y., Condon, H., Jenkinson, P. M., Williams, S. C. R., & Fotopoulou, A. (2015). Attachment style moderates partner presence effects on pain: A laser-evoked potentials study. Social Cognitive and Affective Neuroscience, 10(8), 1030–1037. https://doi.org/10.1093/scan/nsu156

Nees, F., Ditzen, B., & Flor, H. (2022). When shared pain is not half the pain: Enhanced central nervous system processing and verbal reports of pain in the presence of a solicitous spouse. PAIN, 163(9), e1006. https://doi.org/10.1097/j.pain.0000000000002559

Presenting Author: Afton Bierlich
Submitting Author: Afton Bierlich

Senior Author: Frauke Nees, Herta Flor

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr. Mina Misic - Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
• Dr. Katrin Usai - Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
• Dr. Francesca Zidda - Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
• Prof. Dr. Dr. h.c. Dr. h.c. Herta Flor - Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
• Prof. Dr. Frauke Nees - Institute of Medical Psychology, LMU Munich