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Chronic pain is one specific health condition where couple relationships have been directly linked to physical and psychological outcomes. Understanding how relationship satisfaction, couple dynamics, and pain adjustment interrelate is crucial for nurses who provide patient-centered care for patients with pain.The current study was aimed at examining the associations of depressive symptoms and spouse response styles with relationship satisfaction in the context of West Haven-Yale Multidimensional Pain Inventory classifications.Seventy-eight middle-aged outpatients with chronic pain (average pain duration of 8.98 years (SD = 9.51)) were recruited from a pain clinic in southeastern Michigan. Participants completed the Multidimensional Pain Inventory, from which pain adjustment classifications (adaptive, dysfunctional, interpersonally distressed) and spouse response styles were derived, the Dyadic Adjustment Scale to assess relationship satisfaction, and the Mood and Anxiety Symptom Questionnaire to assess depressive symptoms.Interpersonally distressed patients scored lower on relationship satisfaction than those classified as either adaptive or dysfunctional, F(2,66) = 6.38, p < .01. Significant inverse associations were found between punishing spouse response styles and relationship satisfaction for both interpersonally distressed and dysfunctional adjustment classifications: r = –.53, p < .05; r = –.57, p < .01, respectively.Overall, findings indicate that relationship satisfaction may be an area of concern among interpersonally distressed pain patients and that spouse response style may be a particularly important area of clinical attention.