Beyond operant theory of observer reinforcement of pain behavior

Operant theory has guided theoretical and empirical developments in the field of chronic pain for decades. This model has been the primary perspective from which behavioral interventions for chronic pain have been drawn. Recent evidence suggests that there is a need to expand upon the operant model with conceptual models found in the interpersonal, empathy, and pain communication literature. Although they each have a unique focus (e.g., communication, empathy), they each highlight the interpersonal dynamics that can impact the experience of pain for patients. Evidence is needed to know the extent to which treatment can intervene on these influential relationship variables and further, to elucidate the unique interplay between the communication of spouses in the context of pain and behavioral responses of close others. The theoretical models found in the interpersonal, empathy, and pain communication literature provide a way to view pain expressions in the context of the relationship and the deeper idiosyncratic meaning that these may have for an individual with chronic pain (ICP). These models provide a richer understanding of the motivations and antecedents that lead an observer to respond to a loved one’s pain behaviors and the effects of different observer responses on an ICP’s subjective rating of pain. Addressing communication, empathy, and intimacy correlates of observer responses to pain and gathering a better understanding of the communicative role of pain behaviors is necessary, as this is likely the direction that treatments for chronic pain are headed.