CARE Scale: development and validation of a measure assessing the impact of relationships on self-care in chronic pain

Abstract

The impact of close relationships on daily choices related to pain management is understudied in chronic pain. However, daily activities and self care are integral to effective pain management. Additionally, the role of interpersonal relationships may be more salient to women. The goal of this study was to develop and test a measure assessing multiple dimensions of care for others in adults with chronic pain and to test for sex differences. The 22-item CARE Scale is comprised of 4 subscales: locus of care orientation (internal and external), limit setting capacity, and relationship guilt/fear related to pain. Sample items include: “I find that my fear of disappointing others leads me to do things that I know are not good for me (e.g., overwork, doing things that are stressful)” and “I push through pain so that I can meet the needs of others.” Initial testing was conducted with 445 adults (M=48.6 years, SD=12.6; 85.6% F) with chronic pain (> 3 months), who completed the CARE Scale anonymously online along with sociodemographic items. Subscale means (SD) were calculated and t-tests were used to determine sex differences. Canonical correlations were used to examine associations between subscales (values ranged from 0.173 – 0.622). Approximately half of the sample reported having moderate to extreme difficulty in each subscale domain, suggesting that relationship factors significantly impact pain management self-care. Significant sex differences were found for internal locus of care (p<0.001) and the guilt/fear subscales (p=0.003), with women reporting greater impact. For both men and women, higher scores on each subscale were associated with a reliant attitude toward pain medication (all subscale p-values <0.001). Additional analyses will be conducted in a clinic sample, allowing for additional validation and examination of how CARE subscales relate to pain characteristics, functional interference, and medication use. The impact of close relationships on daily choices related to pain management is understudied in chronic pain. However, daily activities and self care are integral to effective pain management. Additionally, the role of interpersonal relationships may be more salient to women. The goal of this study was to develop and test a measure assessing multiple dimensions of care for others in adults with chronic pain and to test for sex differences. The 22-item CARE Scale is comprised of 4 subscales: locus of care orientation (internal and external), limit setting capacity, and relationship guilt/fear related to pain. Sample items include: “I find that my fear of disappointing others leads me to do things that I know are not good for me (e.g., overwork, doing things that are stressful)” and “I push through pain so that I can meet the needs of others.” Initial testing was conducted with 445 adults (M=48.6 years, SD=12.6; 85.6% F) with chronic pain (> 3 months), who completed the CARE Scale anonymously online along with sociodemographic items. Subscale means (SD) were calculated and t-tests were used to determine sex differences. Canonical correlations were used to examine associations between subscales (values ranged from 0.173 – 0.622). Approximately half of the sample reported having moderate to extreme difficulty in each subscale domain, suggesting that relationship factors significantly impact pain management self-care. Significant sex differences were found for internal locus of care (p<0.001) and the guilt/fear subscales (p=0.003), with women reporting greater impact. For both men and women, higher scores on each subscale were associated with a reliant attitude toward pain medication (all subscale p-values <0.001). Additional analyses will be conducted in a clinic sample, allowing for additional validation and examination of how CARE subscales relate to pain characteristics, functional interference, and medication use.