Depression, alexithymia, and pain prone disorder: a Rorschach study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p less than .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.     

Depression,Alexithymia, and Pain Prone Disorder: A Rorschach Study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p < .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.     

The MMPI in evaluation of functional versus organic low back pain

This paper reviews the research literature on MMPI assessment of functional versus organic low back pain (LBP). Research is described in three categories: (a) the relationship between psychopathology as measured by the MMPI and low back pain, (b) MMPI speciality scales, and (c) surgical outcomes. Research, to date, has suffered from methodological problems which has limited generalizations to clinical population. It is suggested, however, that the MMPI can be effectively used with LBP patients, but should not be the only data used in such assessments. Cautions are noted regarding use of the speciality scales.     

The reluctance to generalize corrective experiences in chronic low back pain patients: a questionnaire study of dysfunctional cognitions

The present study investigated whether pain catastrophizing and pain-related fear is related to a reluctance to generalize an experience of lesser pain than expected to other similar situations. Eighty-five patients with chronic low back pain (40 males; 45 females; age range=21-63 years) completed a series of vignettes assessing catastrophizing, overgeneralization, personalization and selective abstraction related to general life experiences and to low back pain (LBP) experiences. Three vignettes also assessed the lack of generalization of corrective experiences related to LBP. Our results showed that dysfunctional cognitions related to general life experiences were the strongest predictor of the self-denigration subscale of the Beck Depression Inventory (BDI), whereas only dysfunctional cognitions related to LBP had a unique contribution in the prediction of the somatic and physical function subscale of the BDI. Furthermore, dysfunctional cognitions related to LBP were significantly correlated with interference with daily life due to pain. As predicted, pain catastrophizing and pain-related fear had a unique contribution in predicting the lack of generalization of corrective experiences, over and above sociodemogaphic variables, pain severity and pain duration.     

Walking breaks can reduce prolonged standing induced low back pain

Standing is commonly recommended to reduce sedentary behavior in the workplace; however, constrained prolonged standing has also been linked to musculoskeletal symptoms, such as low back pain (LBP). Light physical activity breaks, such as walking, may change lumbar spine posture enough to reduce LBP during standing. This study assessed the effectiveness of inserting 5-minute walking breaks every 25 min for reducing prolonged standing-induced LBP development. Nineteen participants completed two bouts of standing lasting 2 h – one with a 5-minute walking break every 25 min and one with no breaks. Pain measures were completed throughout the trial to categorize participants as pain developers (PDs) or non-pain developers (non-PDs). Lumbar region kinematics angle and range of motion were measured continuously. In standing, 58% (11/19) of participants were PDs, compared to just 26% when walking breaks were inserted. Seventy-three percent (8/11) were categorized as non-PDs with walking breaks. Median lumbar flexion increased during walking compared to standing. Lumbar region range of motion in the coronal and transverse planes also increased during walking. The intermittent lumbar flexion may help decrease LBP during prolonged standing. These results demonstrate that walking breaks may help promote lumbar movement and reduce prolonged standing-induced LBP.     

Health Locus of Control Beliefs in Low Back Pain Patients

Abstract

Associations between health locus of control (HLC) beliefs, illness characteristics, psychological distress and self-care behaviour were studied in a group of subjects (n=459) aged 35 to 54 years suffering from chronic or recurrent low back pain (LBP). The results showed that younger subjects and men were more internal in their beliefs, and that duration and severity of LBP, psychological distress, and back care were associated with the individual's beliefs in his/her control over illness. The associations found were, however, of a low magnitude. More conclusive evidence on the development and modification of HLC beliefs are required before practical applications are possible.     

Chronic absence,eighth-grade achievement,and high school attainment in the Chicago Longitudinal Study

Although not as commonly reported as average daily attendance, chronic absence data may be of significant importance for understanding student success. Using data from 1148 participants in the Chicago Longitudinal Study, we assessed the associations of chronic absence in the early middle grades, grades fourth through sixth, with eighth-grade achievement and three measures of high school attainment including four-year graduation by diploma, graduation by diploma by age 21, and any high school completion by age 21. The rate of chronic absenteeism, defined here as students missing approximately 14 days of school or more in a year, was 15%. Using Ordinary Least Squares, probit regression, and inverse-probability-weighting regression-adjustment methods (IPWRA), results indicated that chronic absence in the early middle grades was negatively associated (d = − 0.17) with eighth-grade math achievement and reduced the probability of four-year graduation by diploma by 18 percentage points, graduation by diploma by age 21 by 17 percentage points, and any high school completion by age 21 by 11 percentage points. IPWRA yielded similar estimates. Coefficients varied by subgroup with males and children of mothers who completed high school experiencing more detrimental effects. Associations of chronic absence with outcomes are important to understand because school interventions and practices which begin early can be effective in reducing the prevalence of absenteeism.     

Effect of Nonspecific Chronic Low Back Pain on Walking Economy: An Observational Study

The authors investigated the effects of chronic low back pain (LBP) and walking speed (WS) on metabolic power and cost of transport (CT). Subjects with chronic nonspecific LBP (LBP group [LG]; n = 9) and healthy (control group [CG]; n = 9) were included. The test battery was divided into 3 blocks according to WS as follows: preferred self-selected speed (PS), and lower and higher than the PS. In each block, the volunteers walked 5 min, during which oxygen consumption was measured. Although without differences between groups, the LG had CT lower in slower speeds than in faster speeds. Walking speed affected CT only in the LG, which the group had the greatest walking economy at slower speeds.     

“Posture first”: Interaction between posture and locomotion in people with low back pain during unexpectedly cued modification of gait initiation motor command

The ability to adapt anticipatory postural adjustments (APAs) in response to perturbations during single-joint movements is altered in people with chronic low back pain (LBP), but a comprehensive analysis during functional motor tasks is still missing. This study aimed to compare APAs and stepping characteristics during gait initiation between people with LBP and healthy controls, both in normal (without cue occurrence) condition and when an unexpected visual cue required to switch the stepping limb. Fourteen individuals with LPB and 10 healthy controls performed gait initiation in normal and switch conditions. The postural responses were evaluated through the analysis of center of pressure, propulsive ground reaction forces, trunk and whole-body kinematics, and activation onsets of leg and back muscles. During normal gait initiation, participants with LBP exhibited similar APAs and stepping characteristics to healthy controls. In the switch condition, individuals with LBP were characterized by greater mediolateral postural stability but decreased forward body motion and propulsion before stepping. The thorax motion was associated with forward propulsion parameters in both task conditions in people with LBP but not healthy controls. No between-group differences were found in muscle activation onsets. The results suggest that postural stability is prioritized over forward locomotion in individuals with LBP. Furthermore, the condition-invariant coupling between thorax and whole-body forward propulsion in LBP suggests an adaptation in the functional use of the thorax within the postural strategy, even in poor balance conditions.     

Job demands and job resources as predictors of absence duration and frequency

This study among 214 nutrition production employees uses the Job Demands-Resources (JD-R) model to predict future company registered absenteeism. According to this model, job demands are primarily responsible for health impairment, whereas job resources lead primarily to increased motivation and attachment to work and the organization. Consistent with hypotheses derived from the JD-R model and the absenteeism literature, results of structural equation modeling analyses show that job demands are unique predictors of burnout (i.e., exhaustion and cynicism) and indirectly of absence duration, whereas job resources are unique predictors of organizational commitment, and indirectly of absence spells. These findings have implications for individual and organizational interventions aimed at reducing absenteeism.     

Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain

The aim of this investigation was to examine the effectiveness of a graded exposure in vivo treatment with behavioural experiments as compared to usual graded activity in reducing pain-related fears, catastrophising and pain disability in chronic low back pain patients reporting substantial fear of movement/(re)injury. Included in the study were four consecutive CLBP patients who were referred for outpatient behavioural rehabilitation, and who reported substantial fear of movement/(re)injury (Tampa Scale for Kinesiophobia score>40). A replicated single-case cross-over design was used. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In intervention A, patients received the exposure first, followed by graded activity. In intervention B, the sequence of treatment modules was reversed. Sixty-three daily measures of pain-related cognitions and fears were recorded with visual analogue scales. Before and after the treatment, the following measures were taken: pain-related fear, pain catastrophising, pain control and pain disability. Using time series analysis on the daily measures of pain-related cognitions and fears, we found that improvements only occurred during the graded exposure in vivo, and not during the graded activity, irrespective of the treatment order. Analysis of the pre-post treatment differences also revealed that decreases in pain-related fear concurred with decreases in pain catastrophising and pain disability, and in half of the cases an increase in pain control. This study shows that the external validity of exposure in vivo also extends to the subgroup of chronic low back pain patients who report substantial fear of movement/(re)injury.     

Employee absenteeism: A review of the literature

The purpose of this paper is to review the literature on employee absenteeism as a form of withdrawal behavior apart from turnover. Studies examining the psychometric properties of absence measures are reviewed, along with the relationship between absenteeism and personal, attitudinal, and organizational variables. Studies exploring the relationship between absenteeism and turnover are examined according to the unit of analysis studied in the research. Programmatic efforts to reduce employee absenteeism are also reviewed. Throughout the paper emphasis is placed on the indices used by investigators to measure absenteeism, and the problems that have arisen in the literature through the use of multiple indicators of absenteeism. The review concludes with suggestions for research that are of both theoretical and practical concern.     

A reevaluation of the absenteeism-job satisfaction relationship

Previous reviews of the relationship of employee absenteeism to job satisfaction have largely neglected the size of the relationships reported and the artifacts that can affect statistical tests of significance. This paper applies the F. L. Schmidt-J. E. Hunter (1977, Journal of Applied Psychology, 62, 529-540) model of validity generalization in assessing the nature and strength of the relationship of absence to attitudes. Issues concerning the reliability and validity of absence measures are addressed, correlations between absence and job satisfaction are compiled and summarized, and an agenda for future research is set out. Considering the reliability estimates reported for the Frequency, Attitudinal, and Time Lost indices, the Time Lost Index was found to be the most reliable (r xx = .66, SD = .28). Factor analyses of intercorrelations among absence measures provided tentative support for a voluntary-involuntary absenteeism distinction. Combining all measures of satisfaction and all measures of absences, the mean correlation between absence and attitudes is -.09 (SD = .13). In addition to more comprehensive theory-guided multivariate research, future studies should aim toward a reconceptualization of absenteeism as a construct to take into consideration the perceptions of the workers themselves.     

Coping Styles,Pain Expressiveness,and Implicit Theories of Chronic Pain

Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain.     

Differences in timing and magnitude of lumbopelvic rotation during active and passive knee extension in sitting position in people with and without low back pain: A cross-sectional study

Repetitive lumbopelvic rotation (LPR) during active limb movements has been indicated as a factor that contributes to low back pain (LBP). Prior studies suggest that people with LBP demonstrate greater and earlier LPR during limb movements in prone.We examined timing and magnitude of LPR during sitting active knee extension in people with and without LBP. We also investigated differences of LPR during active and passive knee extension in LBP group. 38 men (mean age: 38.4)10.6) years) with chronic mechanical LBP and 38 matched healthy men (mean age: 36.6(8.4) years) were examined. Kinematic data were collected by motion capture system and analyzed using OpenSim software. The difference between the start time of knee extension and start time of LPR was calculated and was normalized to knee extension movement time. Maximum angular displacement for LPR was also calculated across time.People with LBP demonstrated earlier LPR during knee extension than healthy subjects (P < 0.01). There was, however, no difference in maximum LPR between groups. LBP group also demonstrated greater and earlier LPR during active than during passive knee extension (P < 0.01).Earlier LPR during limb movements in sitting may be related to LBP. Quadriceps muscle activity and inefficient trunk muscles activation may contribute to early LPR in LBP group. A greater understanding of the factors that may contribute to early LPR during daily activities can provide information to guide rehabilitation treatment for people with LBP.     

Cognitive Behavioral Therapy for Postamputation Chronic Pain: A Case Report

Limb amputation has a significant impact on an individual, not only physically but emotionally. Consequences of both traumatic and atraumatic amputations are vast and can result in functional disability, impaired emotional functioning, and changes in overall quality of life. These consequences may be further complicated by the development of chronic pain. Traditional management of postamputation chronic pain often involves invasive procedures and pharmacotherapy. While research notes behavioral interventions, such as cognitive-behavioral therapy (CBT) as a viable treatment alternative for chronic pain, there is no literature supporting CBT for postamputation chronic pain. In this case report, we present a 63-year-old male lower limb amputee complicated with chronic pain who experienced pain reduction and improved quality of life following manualized treatment with CBT for chronic pain. Treatment took place over 12 sessions with fidelity (93%) being measured throughout to ensure accurate utilization of the treatment manual. As part of the treatment manual, self-report measures (Pain Rating Scale, Pain Catastrophizing Scale, Pain Outcomes Questionnaire, and subjective units of distress) were used throughout to track patient progress. All measures showed improvement with the biggest gains being seen in pain ratings and pain catastrophizing.     

Sex Differences in Clinical Pain: A Multisample Study

A recent meta-analysis of the experimental pain literature revealed effect sizes of .55 for pain threshold and .57 for pain tolerance, indicating a moderate difference in pain perception between men and women, with women reporting an increased sensitivity to pain. The current study investigated the relationship between sex and clinical pain ratings, in patients seeking care at a tertiary care facility. Five samples of chronic pain patients were recruited from several diverse clinics associated with the University of Florida. Analyses of clinical pain ratings revealed similar effect sizes for all samples, ranging from –.07 to –.25, indicating small differences, with women reporting higher levels of clinical pain. This is the first paper to report effect sizes for differences in report of pain in samples of chronic pain patients presenting for treatment at a tertiary care facility.     

Age-related differences in employee absenteeism: a meta-analysis

Meta-analyses were performed on 34 samples that included correlations of the age and employee absenteeism relationship. Samples were categorized into 2 groups for voluntary absenteeism and involuntary absenteeism based on the frequency index and the time-lost index, respectively. Results indicated that both voluntary and involuntary absence are inversely related to age. Unexplained variance remained for each of the absence measures after variance due to sampling error and measurement unreliability was statistically estimated. Work demand was negatively associated with age, but not in the expected direction. Work demand did not moderate the age-absence relationship for either voluntary or involuntary absence. Sex moderated the relationship between age and voluntary absenteeism only. For men, the relationships were negative; for women, they did not differ significantly from 0. Implications for research and human resource management practices regarding aging and absenteeism are discussed.