Efficient pain assessment in clinical settings.

The need for efficient and practical assessment techniques of the multidimensional nature of chronic pain remains paramount in clinical settings. Visual analogue scales (VASs) and simple behavioral observation methods have been proposed as efficient, reliable, and valid measures of the subjective (sensory and affective) and overt behavioral aspects of the pain experience. The relationships among VASs and the UAB Pain Behavior Scale were examined among 48 chronic pain patients. Ratings of overt behavior were significantly related to both the VAS sensory and VAS affective ratings. Regression analysis indicated that the VAS scores accounted for significant amount of the variance (27.7%) in UAB scores. Moreover, the affective dimension of self-reported pain tended to be more strongly related to the visible manifestations of pain than were ratings of pain intensity.     

The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621-630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment of emotional responses to pain. Innovations in clinical practice: a source book, 14, 309-321]. To assess this emotional reaction to pain in chronic pain patients, McCracken, Zayfert and Gross [McCracken, L., Zayfert, C., & Gross, R. (1992). The Pain Anxiety Symptom Scale: development and validation of a scale to measure fear of pain. Pain, 50, 67-73] developed the Pain Anxiety Symptom Scale (PASS) composed of four subscales: Cognitive Anxiety, Fearful Appraisal, Escape Avoidance and Physiological Anxiety. The present study extended previous work by examining the relationship among pain anxiety dimensions, use of active and passive coping strategies and arthritis self-efficacy as predictors of functional status in 154 rheumatoid arthritis (RA) patients. Functional status was assessed using the Five-Factor Model of the Arthritis Impact Scale, 2nd ed., (AIMS2): Physical Functioning, Affective Experience, Symptoms, Social Interaction and Role Function. Hierarchical multiple regression analysis on each of the AIMS2 criterion variables showed that pain anxiety, pain and symptom self-efficacy, health status and coping strategies were able to explain between 9 and 38% of the variance in the five AIMS2 variables. The present results support the hypothesized role of pain anxiety along with previously established contributions of self-efficacy and coping strategies, in affecting physical, social, emotional and role functioning in chronic RA patients.     

Psychological and social correlates of the back pain classification scale

The Back Pain Classification Scale (BPCS) identifies patients whose low back pain reflects a primary psychological disturbance. BPCS scores were related to the MMPI, State-Trait Anxiety Inventory, Multiple Affect Adjective Check List, and Social Readjustment Rating Scale scores; to distribution, intensity, and activities affecting pain; and to social characteristics of 116 patients. High scores on the BPCS (psychological disturbance) are associated with elevated MMPI profiles, and with more widely distributed and more intense pain. Stepwise multiple regression solutions indicate that the MMPI Hypochondriasis (Hs) scale accounts for 15.5% of the variance. No other variable accounts for as much as 3% of the variance. Scores on Hs relate primarily to words in the BPCS psychologically disturbed pole, supplying convergent validity to the BPCS. BPCS scores are unrelated to social characteristics, implying usefulness with the variety of patients seen for evaluation of low back pain.     

The Rorschach Concept Evaluation Technique

The Back Pain Classification Scale (BPCS). identifies patients whose low back pain reflects a primary psychological disturbance. BPCS scores were related to the MMPI, State-Trait Anxiety Inventory, Multiple Affect Adjective Check List, and Social Readjustment Rating Scale scores; to distribution, intensity, and activities affecting pain; and to social characteristics of t 16 patients. High scores on the BPCS (psychological disturbance) are associated with elevated MMPI profiles, and with more widely distributed and more intense pain. Stepwise multiple regression solutions indicate that the MMPI Hypochondriasis (Hs) scale accounts for 15.5% of the variance. No other variable accounts for as much as 3% of the variance. Scores on Hs relate primarily to words in the BPCS psychologically disturbed pole, supplying convergent validity to the BPCS. BPCS scores are unrelated to social characteristics, implying usefulness with the variety of patients seen for evaluation of low back pain.     

Psychosocial Subgroups, Coping, and Chronic Low-Back Pain

The purpose of this study was to compare psychosocial subgroups in terms of pain coping strategies, pain severity, physical impairment, pain behavior, affective distress, and response to pain management treatment. The Multidimensional Pain Inventory (MPI) was used to classify 67 chronic low-back pain (CLBP) patients into the following psychosocial subgroups: Dysfunctional, Interpersonally Distressed, Adaptive Coping, and Anomalous. These MPI subgroups were compared on the Pain Behavior Checklist, Behavioral Observation Measure of Pain Behavior, Revised Coping Strategies Questionnaire, and Chronic Disease Index. The Dysfunctional subgroup reported significantly more pain behavior, disability, affective distress, and catastrophizing than either the Interpersonally Distressed subgroup or Adaptive Copers, but were not significantly different on measures of adaptive coping strategies. The percentage of dropouts from treatment was significantly less among Adaptive Copers (11%) than among the Dysfunctional (33%) or Interpersonally Distressed (47%) subgroups. Differences in affective distress found among the MPI subgroups at baseline were not evident at the posttreatment assessment. The present findings support the use of MPI psychosocial subgroup analysis to enhance our understanding of differential response to chronic pain and pain management intervention.     

Family environment and its relation to adolescent personality factors

Investigated the relationship between family social climate characteristics and adolescent personality functioning. The High School Personality Questionnaire (HSPQ) was administered to 80 high school students. These students and their parents also completed the Family Environment Scale (FES). Results of a stepwise multiple regression analysis indicated that one or more HSPQ scales had significant associations with each FES scale. Significant variance in child behavior was attributed to family social system functioning; however, no single family variable accounted for a major portion of the variance to the exclusion of other factors. It was concluded that child behavior varies with total system functioning, more than with separate system factors.     

Problem-Solving Appraisal and Psychological Adjustment of Persons with Chronic Low-Back Pain

To examine the role of self-appraised problem-solving ability in the prediction of psychosocial impairment, depression, hopelessness, average pain unpleasantness, and current pain ratings among persons with chronic low-back pain. A second purpose was to enhance theoretical understanding of the mechanisms by which problem-solving appraisal influences adjustment. Correlational and regression procedures were used to test the hypothesized relations procedures between elements of self-appraised problem-solving ability and each criterion variable. Seventy-eight persons enrolled in an inpatient multidisciplinary chronic pain management program. The psychosocial subscale of the Sickness Impact Profile, the Beck Depression Inventory, the Beck Hopelessness Scale, the McGill Pain Questionnaire, and Visual Analogue Scales of Pain Sensory Intensity and Affective Response were the main outcome measures. After first controlling demographic characteristics, elements of self-appraised problem-solving ability assessed by the Problem-Solving Inventory were significantly predictive of depression, hopelessness, psychosocial impairment, and average pain unpleasantness (accounting for 20, 26, 29, and 11% of the respective variance in these constructs). Results indicate complex relations among the elements of problem-solving appraisal, suggesting that the Approach–Avoidance link to psychological adjustment was mediated by Problem-Solving Confidence. Comprehensive problem-solving interventions may be beneficial to persons with chronic pain     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

The Role of Self-Efficacy and Fear-Avoidance Beliefs in the Prediction of Disability

Both self-efficacy and fear-avoidance beliefs have been shown to be predictors of the level of disability in low back pain suffers. What is not clear from the literature, however, is whether the two constructs are differentially predictive of disability. The aim of this study was to investigate the relationship between pain self-efficacy and fear-avoidance beliefs and to determine whether they can explain unique variance in disability scores. One hundred and twenty-one people over the age of 18, suffering from chronic low back pain and receiving workers' compensation, completed the Pain Self-Efficacy Scale (PSEQ), the Fear Avoidance Beliefs questionnaire (FABQ), the Quebec Back Pain Disability Scale and a visual analogue scale for pain. The results show that, after controlling for pain, self-efficacy explained 24% of the variance in disability scores, and fear avoidance only a further 3.1%.     

Factor analysis of the WISC-R and the Adaptive Behavior Scale-School Edition for a referral sample

The purpose of this study was to determine if a common factor structure was evident in the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the Adaptive Behavior Scale-School Edition (ABS-SE) for a sample of 171 children referred for evaluation of learning and behavior problems. The WISC-R subtests (excluding Mazes) and the ABS-SE factor domain scores (Personal Self-Sufficiency, Community Self-Sufficiency, Personal-Social Responsibility, Social Adjustment, and Personal Adjustment) were subjected to an exploratory principal-components factor analysis with varimax rotation. ANOVAs were conducted on each of the derived factors to determine race and sex effects. The results indicated no common factor structure in the instruments, the Verbal Comprehension, Perceptual Organization, Independent Functioning, Maladaptive Behavior, and Freedom From Distractibility factors being extracted. The derived factors were very similar to those identified in standardization data and other studies. Perceptual Organization and Social Adjustment showed sex and race effects, respectively, although each model accounted for only about 7% of the variance.     

Factor analysis of the frontal systems behavior scale (FrSBe)

The Frontal Systems Behavior Scale (FrSBe), formerly called the Frontal Lobe Personality Scale (FLOPS), is a brief behavior rating scale with demonstrated validity for the assessment of behavior disturbances associated with damage to the frontal-subcortical brain circuits. The authors report an exploratory principal factor analysis of the FrSBe-Family Version in a sample including 324 neurological patients and research participants, of which about 63% were diagnosed with neurodegenerative diseases (Huntington's, Parkinson's, and Alzheimer's diseases). The three-factor solution accounted for a modest level of variance (41%) and confirmed a factor structure consistent with the three subscales proposed on the theoretical basis of the frontal systems. Most items (83%)from the FrSBe subscales of Apathy, Disinhibition, and Executive Dysfunction loaded saliently on three corresponding factors. The FrSBe factor structure supports its utility for assessing both the severity of the three frontal syndromes in aggregate and separately.     

Anxiety Sensitivity Taxonicity: a Concurrent Test of Cognitive Vulnerability for Post‐Traumatic Stress Symptomatology Among Young Adults

This study evaluated the anxiety sensitivity taxon using the 16‐item Anxiety Sensitivity Index in relation to 2 criteria relevant to post‐traumatic stress disorder; post‐traumatic stress disorder symptom severity as indexed by the Post‐Traumatic Diagnostic Scale, and post‐traumatic cognitions as indexed by the Post‐Traumatic Cognitions Inventory. Taxometric analyses of data collected from 331 young adults indicated that the latent structure of anxiety sensitivity was taxonic with an estimated base‐rate range of 11–12%. As predicted, an 8‐item Anxiety Sensitivity Index Taxon Scale accounted for significant variance above and beyond that accounted for by negative affectivity and the full‐scale Anxiety Sensitivity Index total score in terms of both criteria. Moreover, after accounting for variance explained by the full‐scale Anxiety Sensitivity Index total score and negative affectivity, the sum score for the 8 Anxiety Sensitivity Index items not included in the Anxiety Sensitivity Index Taxon Scale was associated with significant variance in these same dependent measures, but the relation was in the opposite direction to that predicted by theory. These findings are discussed in terms of theoretical and clinical implications for the study of anxiety sensitivity and post‐traumatic stress disorder vulnerability.     

AFRICAN AMERICAN COLLEGE WOMEN'S BODY IMAGE

The purpose of this study was to examine general and cultural factors associated with body image perceptions of African American women college students. A total of 124 African American college women attending a historically Black college completed the following scales: African Self-Consciousness (ASC) scale, the Skin Color Satisfaction Scale (SCSS), the Body Mass Index (BMI), and several body image measures. Results from simultaneous multiple regression analyses suggest that all three factors collectively accounted for a significant amount of variance in dimensions of body image satisfaction. Specifically, SCSS accounted for a significant amount of variance in three body image dimensions (i.e., appearance evaluation, satisfaction with specific body areas, internalization of social cultural messages of appearance), suggesting that the greater satisfaction with one's skin color was associated with more positive, internal perspectives of one's body image. The BMI accounted for a significant amount of variance in measures of appearance evaluation and satisfaction with body areas, such that greater BMI scores were related to a less positive evaluation of overall appearance but more satisfaction with specific body areas. Implications of the findings and suggestions for future research are discussed.     

Stage of Chronicity and Cognitive Correlates of Pain-Related Disability

The present research examined the functional relations between the different dimensions of catastrophic thinking and pain-related disability, as a function of stage of chronicity. In the present study, 150 patients with chronic pain were grouped to form 3 different levels of chronicity: Group A (6 months to 2 years, n = 44); Group B (2-4 years, n = 55); and Group C (more than 4 years, n = 51). The 3 subscales of the Pain Catastrophizing Scale (Rumination, Magnification, Helplessness) were used as predictors of disability. Disability was assessed with the Pain Disability Index and pain was assessed with the McGill Pain Questionnaire. For Group A, regression analysis revealed that none of the PCS subscales predicted disability beyond the variance accounted for by sex, age and pain. Rumination was a significant predictor of disability in Group B, and both rumination and helplessness predicted disability in Group C. These findings provide preliminary evidence that stage of chronicity is an important moderator of psychological vulnerability for pain-related disability. Discussion addresses how the impact of pain management programs might be increased by tailoring interventions to specific patient needs.     

General self-efficacy,dental anxiety and multiple fears among 20-year-olds in Norway

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.     

Quality of Well-Being Scale and Chronic Low Back Pain

Outcome measures that assess quality of life for use in health policy decisions need to be investigated in chronic pain patients. In the present study, the validity of the Quality of Well-Being Scale (QWB) was evaluated on 67 adult chronic low back pain (CLBP) patients who were enrolled in a 12-week multidisciplinary pain treatment program. Participants completed the QWB, a battery of pain measures, a behavioral observation task, and a medical exam. The findings indicated that CLBP patients have a low level of functioning or quality of life (M = .567, SD = .08) compared with persons with life-threatening diseases. The QWB score was significantly correlated with observational measures of pain behavior and pain-related coping strategies. Multivariate analysis indicated that interference in daily activities, distorted ambulation, affective distress, pain duration, and guarding were the most significant predictors of quality of well-being (multiple R = .84, p < .0001). Patients with medically incongruent physical signs had significantly lower QWB scores than patients with congruent signs. Overall, the data supported the validity of the QWB in a sample of CLBP patients.     

Perception of parents'' behavior, familial satisfaction, and sense of coherence in hyperactive children

The aim of the study was to compare the perceptions of hyperactive children with those of a nonhyperactive matched control group on the following dependent variables: (a) sense of coherence, (b) life satisfaction, and (c) perceptions of parental roles. Eighty-four children divided into two equal groups (27 boys and 15 girls in each group) were studied, by means of a short form of the Cornell Parent Behavior Inventory (PBI), the Sense of Coherence Scale, and a global measure of the Life Satisfaction Scale. The teachers rated each child on the Conners Abbreviated Symptom Questionnaire (ASQ), the Aggressive Behavior Scale, and a global evaluation of academic status. The data were analyzesd by multivariate analysis of variance, step-wise multiple regression, and Pearson correlation. The hyperactive children demontrated lower levels of sense of coherence: their environment seemed to them to be less ordered, to less manageable, and to bear less meaning. Study of the pereption of familial interactions highlighted the significance of the father's role for life satisfaction of the hyperactive children, and supportive behavior was perceived as contributing more than disciplinary acts to life satisfaction.     

Relationship between the Millon Behavioral Health Inventory and the minnesota multiphasic personality inventory (MMPI) in low-back pain patients

The Millon Behavioral Health Inventory (MBHI) is being used with increasing frequency for the assessment of chronic pain, although there is a relative lack of evidence as to its utility, and prior studies have not examined low back pain. This investigation compared the MBHI to the MMPI in a sample of low-back pain patients and analyzed subgroups of pain patients based upon their MBHI responses. Subjects were 60 patients who had been admitted to outpatient multidisciplinary pain clinics of two Chicago-area hospitals. Patients completed both the MMPI and the MBHI and provided demographic information. Results of correlational analyses indicated strong relationships between the MBHI psychogenic attitude, psychosomatic correlate, and prognostic index scales and the validity scales of the MMPI. The MBHI Pain Treatment Responsivity scale (PP) correlated with 16 of the other 19 MBHI scales. PP did not demonstrate specificity with low back pain patients. The results of both the scale comparisons and the exploratory two-group cluster subgroup analysis support the notion that responses to the MBHI are largely affected by the respondent's tendency to deny psychopathology or to admit emotional distress.     

Correlations for perceived family environmental factors with substance use among adolescents in South Africa

Perceived family environmental factors were used to predict self-reported use of substances (drugs or alcohol) among adolescents in South Africa. 435 high school students (ages 15 to 19 years, M=17.2 yr., SD=1.34) answered a questionnaire which included questions on demographic variables, the Family Environmental Scale, and questions on substances used (drugs or alcohol). Logistic regression analysis indicated that scores on family conflict and low family moral-religious emphasis were significantly associated with drug use (57.9% of the variance was accounted for) and use of alcohol (62.3% of the variance was accounted for). Programmes for the reduction of substance use among adolescents should include activities designed to reduce family conflict and strengthen family moral-religious emphasis.