Reliability and standardization in the assessment of self-reported headache pain

The efficacy of a treatment intervention for head pain is typically evaluated by self-reported data. Self-monitoring schedules used to collect these data vary extensively across studies. The present article reviews conceptual and methodological problems with these self-report inventories. In addition, the most promising procedure was implemented in a study designed to measure the reliability of self-reported headache pain levels. One-hundred twenty-four college students self-monitored headache pain over an 8-week period. Three objective procedures were used to detect inaccurate recording. Subjects were also asked, in a post-experimental questionnaire, to subjectively rate the degree to which they complied with the experimenters' instructions regarding the self-monitoring procedures. Forty percent of the subjects were found to be noncompliant based on the detection techniques. However, responses to the postexperimental questionnaire indicated this to be a conservative estimation of noncompliance. There was no consistent difference between the postexperimental questionnaire for the subjects detected and those not detected. Results are discussed with relation to the need for researchers to adopt a standard methodology for (1) measuring self-reported headache pain and (2) reporting reliability data.Portions of these data were presented at the meeting of the Association for Advancement of Behavior Therapy, Chicago, November 1978.     

Facial expressions of pain in muscle-contraction headache patients

Using a judgment and component analysis of facial actions, 14 muscle-contraction headache (MCH) patients were videotaped in headache and nonheadache states. In addition, patients were also required to undergo a resting physiological assessment (frontalis electromyography, temporal blood volume pulse, and heart rate), reaction-time task, and complete self-report measures of pain state and mood. Headache and nonheadache state of MCH patients were reliably identified by 20 observers. Characteristics of facial expressions that occurred most frequently in the headache state included furrowed eyebrows, closed eyes, slow eye blinks, lip pursuing, facial grimacing, and flat facial affect. Headache state was also associated with increased latency to respond to an auditory tone and mood disturbances, but no differences in baseline physiological activity were observed. Our findings provide support for the utility and clinical relevance of judgment and component analysis of facial actions in MCH patients.     

The pain behavior scale: Modification and validation for outpatient use

The present study investigated the validity of an inpatient pain behavior rating scale modified for outpatient use. A series of 43 consecutive outpatients referred for evaluation of chronic pain was examined using the Pain Behavior Scale (PBS) and other psychometric instruments. Analyses revealed significantly higher Pain Behavior Scale scores for low back and multiple pain-site groups. The results also indicated a high degree of internal consistency of the scale. A multiple regression analysis, predicting observed pain behavior from reported pain behavior, indicated that decreased activity accounted for 32% of the variance in the PBS score. A similar regression for pain experience found that the pain level and the sensory scale score on the McGill Pain Questionnaire accounted for 39% of the PBS variance. Psychological characteristics including disease conviction, self-control, depression, and anxiety explained 45% of the variability in the PBS score. Thus, the scale is related to pain intensity, interference with activities, and a variety of psychological characteristics. The scale provides a measure of observable pain behavior that is also relatively independent of these clinical data sources. The Pain Behavior Scale as modified for outpatient use provides a brief index of pain behavior with potential use in the comprehensive evaluation of the pain patient.     

Delayed temporal discrimination in pigeons: A comparison of two procedures

A within-subjects comparison was made of pigeons' performance on two temporal discrimination procedures that were signaled by differently colored keylight samples. During stimulus trials, a peck on the key displaying a slanted line was reinforced following short keylight samples, and a peck on the key displaying a horizontal line was reinforced following long keylight samples, regardless of the location of the stimuli on those two choice keys. During position trials, a peck on the left key was reinforced following short keylight samples and a peck on the right key was reinforced following long keylight samples, regardless of which line stimulus appeared on the correct key. Thus, on stimulus trials, the correct choice key could not be discriminated prior to the presentation of the test stimuli, whereas on position trials, the correct choice key could be discriminated during the presentation of the sample stimulus. During Phase 1, with a 0-s delay between sample and choice stimuli, discrimination learning was faster on position trials than on stimulus trials for all 4 birds. During Phase 2, 0-, 0.5-, and 1.0-s delays produced differential loss of stimulus control under the two tasks for 2 birds. Response patterns during the delay intervals provided some evidence for differential mediation of the two delayed discriminations. These between-task differences suggest that the same processes may not mediate performance in each.     

Anxiety sensitivity and its impact on pain experiences and conditions: A state of the art

This paper serves as an introduction to the special issue of Cognitive Behaviour Therapy devoted to the topic of anxiety sensitivity (AS) and its impact on pain experiences and conditions. We provide a historical overview of relevant cognitive behavioural models of chronic pain, summarize recent models incorporating the AS construct, and introduce the papers in the special issue. These papers are organized into two sets – basic laboratory‐based investigations and relatively more applied studies. We attempt to highlight some of the most important findings from each of these investigations and studies, in turn. Then, we consider several important conclusions derived from the set of special issue papers and the implications of these for the practice of cognitive‐behavioural interventions with pain populations. Finally, we make several suggestions for directions for future investigations in this burgeoning area of cognitive behavioural research and practice.     

A comparison of two procedures for calculating discriminant function coefficients

Alternative procedures for calculating discriminant function coefficients have been illustrated in reported research. One method proceeds from data which has been expressed in deviation score units, whereas the other method implies that the data has been expressed in standard units. It is shown algebraically that both procedures yield identical discriminant function coefficients, and therefore, the method involving less mathematical manipulation and computation is preferable.     

A comparison of two multicomponent procedures to increase food consumption

We compared two procedural variations of response cost (RC) of preferred materials to increase mouth clean in a five‐year‐old boy diagnosed with autism. Noncontingent presentation of preferred materials (NCR) was compared to differential reinforcement of alternative behavior (DRA) when returning preferred materials once they have been removed for refusal or expulsion of food. Results indicated that both procedures increased swallowing and reduced problem behavior; however, NCR + RC was superior to DRA + RC with respect to overall mean and initial treatment measures. Copyright © 2005 John Wiley & Sons, Ltd.     

A comparison of pain management outcomes for disability compensation and non-compensation patients

Abstract

In this study, 50 men in an in-patient comprehensive rehabilitation program receiving disability compensation were compared with 25 non-recipients with respect to pre-and post-program measures of personality functioning. physical functioning and reported pain. On the pre-program measures. the only significant difference emerging between the two groups was found on the Mf scale of the MMPI, with the compensation group showing a slightly lower mean score. The two groups responded equally well on virtually all outcome measures. One interesting exception was found on the subjective measure of pain. which showed the compensation group reporting a higher level of subjective pain, and the non-compensation group a lower level than would be predicted on the basis of pre-program scores. Overall. and contrary to popular belief. the results suggest that compensation recipients can derive considerable benefit from pain management interventions despite the ostensible reinforcement provided by disability payments.     

The development of the multidimensional locus of pain control questionnaire (MLPC): Factor structure,reliability, and validity

This study was conducted to develop a comprehensive Multidimensional Locus of Pain Control questionnaire (MLPC) and to examine how locus of pain control is related to pain appraisals, pain coping strategies, and adjustment to chronic pain. Subjects were 170 chronic headache patients. By means of factor analysis, four subscales were derived: an Internal, a Chance, a Physician, and a Medication locus of pain control orientation scale. The reliability and validity of the subscales appeared to be satisfactory. The results of the present study indicate that the locus of pain control orientation is significantly related to pain appraisals such as perceived pain control and catastrophizing and, to a lesser degree, to coping strategies as measured by the Coping Strategies Questionnaire (CSQ). However, almost no relationship was observed between locus of pain control and adjustment to pain. Further research with the MLPC in different chronic pain populations is warranted in order to investigate whether the results found in this study can be generalized to chronic pain patients in general.     

Assessing pain behaviour of low-back pain patients in real time: concurrent validity and examiner sensitivity

Several systems for measuring pain behaviour have been developed for clinical settings. The present study reports on a real-time system for coding five categories of pain behaviour for low-back pain patients: guarding, touching, sounds, words, and facial expression. Unique features of the system are the use of refined measures of facial expression and integration of the measurements with a standardized physical examination. 176 sub-acute and chronic low-back pain patients underwent a physical examination while their pain behaviour was coded. Concurrent measures of subjective pain, medically-incongruent signs, and independent global ratings of pain behaviour were taken. Analyses indicated that the pain behaviours, particularly guarding and facial expression, varied systematically with the alternative measures, supporting the concurrent validity of the behaviour observation system. While pain behaviours, especially use of words and facial expressions, were significantly associated with the examiners' independent ratings, the strength of the associations suggested that, in the absence of direct training, examiners' performance was relatively poor. Implications for training of clinicians in detecting pain behaviour are discussed.     

A comparison of two college classroom testing procedures: required remediation versus no remediation

Forty one subjects from a 10-week introductory course in Educational Psychology were randomly divided into two experimental groups. All students took weekly quizzes over content material. Members of one group received little or no academic credit if they performed at less than 90% on a weekly quiz, but could earn additional credit by taking a weekly remedial quiz. Members of the second group also took the initial weekly quizzes, but retained their raw scores and were not permitted to take the weekly remedial quizzes. Performance on a 100-item multiple-choice comprehensive final revealed a statistically significant and educationally important difference between the two groups, the required-remediation group scoring an average of one-half letter grade higher.     

The automatic recording of aggression in pigeons: A comparison of two methods with live targets

Three pigeons were exposed to a fixed-time response independent food-delivery schedule and a live target pigeon restrained in a holder mounted on a spring and microswitch assembly. This common method of recording aggression was compared with a photocell system, and both were evaluated by observation of video-tape recordings. Dependent variables included the number of interfood intervals with an attack, attacks per minute, and attack duration. The photocell proved more reliable than the microswitch and correlated highly with observations of both the number of interfood intervals with an attack for three subjects and attack duration for two. Neither apparatus provided accurate information about the rate of attacks. The microswitch apparatus was not sensitive to changes in the subject’s attack topography, while both recording devices were susceptible to activation by responses in the attacking pigeon other than discrete pecks or physical blows. In view of these findings, attacks per minute may not be an appropriate measure of aggression in studies using such devices.     

Neural basis of affective touch and pain: A novel model suggests possible targets for pain amelioration

Pain is one of the most common health problems and has a severe impact on quality of life. Yet, a suitable and efficient treatment is still not available for all patient populations suffering from pain. Interestingly, recent research shows that low threshold mechanosensory C-tactile (CT) fibres have a modulatory influence on pain. CT-fibres are activated by slow gentle stroking of the hairy skin, providing a pleasant sensation. Consequently, slow gentle stroking is known as affective touch. Currently, a clear overview of the way affective touch modulates pain, at a neural level, is missing. This review aims to present such an overview. To explain the interaction between affective touch and pain, first the neural basis of the affective touch system and the neural processing of pain will be described. To clarify these systems, a schematic illustration will be provided in every section. Hereafter, a novel model of interactions between affective touch and pain systems will be introduced. Finally, since affective touch might be suitable as a new treatment for chronic pain, possible clinical implications will be discussed.     

Response elimination: A comparison of four procedures

Four procedures for eliminating an operant response were compared within a multiple schedule. Response reduction was most rapid when reinforcement was provided for a specific alternative response. The decline in responding produced by extinction and differential reinforcement of other behavior was similar. Responding initially increased and then gradually decreased when reinforcers were delivered independently of responding at fixed times. Removal of reinforcement from the alternative-response and DRO procedures did not result in recovery of the target response. However, the shift from response-independent dilivery of reinforcers to extinction caused an initial increase in responding.     

Vibrotactile masking: A comparison of psychophysical procedures

The amounts of ipsilateral and contralateral masking obtained with a modified psychophysical procedure were compared for vibratory stimuli presented to different body loci. Results of a combined forced-choice localization task and a forced-choice detection task were similar to the results obtained in previous investigations which employed method of limits and two-alternative, temporal forced-choice procedures, respectively. Ipsilateral maskers produced similar amounts of masking in both the detection and localization tasks for fingertip and arm test sites. Contralateral maskers resulted in considerably more masking in the localization task than in the detection task for both fingertip and arm test sites. When large longitudinal distances were introduced between the test stimulus and masker, little masking was evident in either the localization or detection task. It was concluded that the differences in the amount of ipsilateral and contralateral masking obtained with different psychophysical procedures reflect different effects of a masker on the detectable attributes of a test stimulus. Implications of these results for the study of multiple tactile perception were discussed.     

The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity: A moderated mediation model

Objectives: This study investigated the mediating role of pain behaviours in the association between pain catastrophising and pain intensity and explored the moderating role of family caregivers’ responses to pain in the link between pain behaviours and pain intensity.

Methods: The sample consisted of 154 chronic pain patients and their family caregivers. Patients completed questionnaires regarding pain intensity, pain catastrophising, pain behaviours and their caregivers’ responses to their pain. Family caregivers reported their responses to the patients’ pain.

Results: Pain catastrophising was associated with pain intensity (r = 0.37) and pain behaviours partly mediated this association. The positive association between pain behaviours and pain intensity was significant only if patients reported that their family caregivers showed high levels of solicitous (effect = .49) and distracting responses (effect = .58), and if caregivers reported to show high levels of solicitous responses (effect = .51). No support was found for negative responses as a moderator neither based on patients’ perception of negative responses nor based on caregivers’ perception of negative responses.

Conclusions: The findings are in line with the idea that family caregivers’ solicitous and distracting responses convey to patients that their condition is serious, which may reinforce patients’ pain and pain behaviours, especially in those who catastrophise.     

Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

Reliability and validity of children's reports of migraine headache symptoms

The present study was concerned with whether children's responses to a questionnaire correspond with parents' reports of the child's headache symptoms and whether these responses correlate with self-monitored headache activity. Twenty-eight children, ages 7 years–16 years, participated in the study. Using a questionnaire format, data on a wide variety of headache characteristics were gathered from parents and children. During the subsequent 4 weeks, children monitored their headache activity and medication usage. Results were generally supportive of the validity and reliability of children's reports via a questionnaire format. The responses to the frequency of headache and medication usage were found to predict the responses over the next month, whereas the response on the duration of headache did not. Significant correlations for most headache-symptom items indicated that children and parents agree on their presence and severity. This investigation is the first step in developing a systematic assessment procedure for childhood headache.