The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Quality of Life in Patients with Chronic Pain- A Study in Indian Population Using European Organization for Research and Treatment of Cancer(EORTC) Questionnaire

Quality of life in chronic pain Health-related quality of life was compared in patients of chronic pain with that of general population.We designed this study as a prospective, observational trial in a tertiary care centre. Quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The EORTC QLQ-C30 is a valid alternative to the SF-36 in the assessment of QOL in patients with chronic pain especially when a broader assessment of symptoms is desired. All participants completed a set of questionnaires on demographic variables, cause, pain intensity (VAS) and quality of life (EORTC qlq c30). A total of two hundred participants were enrolled including 100 patients with chronic pain. Chronic pain was defined as one which is persisting beyond 3 months. The study revealed significantly decreased quality of life in patients with chronic pain as compared to general population (p?<?0.001). Patients with chronic pain had significantly decreased score in Physical functioning, Role functioning, emotional and social functioning on functional scales and increased scores of pain, fatigue, sleep disturbances and financial difficulties on symptom scales. The study revealed sex-related differences on the QoL with females having a lower global QOL. It is thus concluded that patients with chronic pain especially females have decreased quality of life as compared to general population     

Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.     

Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.     

Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.     

Sex differences and similarities in job attribute preferences: a meta-analysis

Many researchers have studied sex differences in job attribute preferences. The authors meta-analyzed 242 samples collected from 321,672 men and boys and 316,842 women and girls in the United States between 1970 and 1998. Findings indicated significant (p < .05) sex differences on 33 of 40 job attribute preferences examined. The effect sizes were small. Of the 33 significant differences, 26 had average effect sizes of magnitude .20 or less. The directions of the differences were generally consistent with gender roles and stereotypes. Many job attributes became relatively more important to women and girls in the 1980s and 1990s compared with the 1970s, indicating that women's aspirations to obtain job attributes rose as gender barriers to opportunity declined.     

Infant Distress During Immunization: A Multimethod Assessment

The purpose of this study was to comprehensively describe infant procedural distress and pain across assessment modalities, and to compare similarities and differences across measures. A multimethod assessment of distress was conducted to investigate infants (N = 37) undergoing routine immunizations. Measures of infant distress included Parent report, nurse report, infant heart rate, and an observational measure of infant distress. Parents rated their infant's distress and pain significantly higher than did nurses. Observational and physiological ratings of infant distress were found to vary significantly by phase, and there were no correlations between adult ratings of pain and distress and physiological ratings. Findings suggest that infant procedural distress can be assessed in a number of manners. The discordance between these measures emphasizes the need for multimethod assessment of pediatric procedural distress in both research and clinical settings. Given the differences between parent and nurse ratings, clinicians should be aware that different assessment methods might lead to different conclusions about infant procedural distress.     

GENDER DIFFERENCES IN SELF-REPORTED POSTTRAUMATIC GROWTH: A META-ANALYSIS

A meta-analysis was conducted to examine the direction and magnitude of gender differences in self-reported posttraumatic growth. Results from 70 studies ( N  = 16,076) revealed a small to moderate gender difference ( g  = .27, 95% CI = .21 −.32), with women reporting more posttraumatic growth than men. Moderator analyses were then conducted to identify possible sources of these differences. The following moderators were examined: mean age of sample, measure used, nature of the stressful event, language of the measure, and type of sample (i.e., community samples, college students, or mixed). The only significant moderator was age, with women reporting incrementally more posttraumatic growth as the mean age of the sample increased ( B  = .004,  p  < .01,  SE  = .001,  Q  = 9.13). To check for publication bias, effect sizes were compared across published and unpublished research. The size of the gender difference was not significantly different between published ( g  = .30, 95% CI = .23 − .38) and unpublished ( g  = .22, 95% CI = .12 −.31) studies. The present findings indicate that modest, but reliable gender differences exist in posttraumatic growth even when unpublished data are included in the analyses. Possible explanations for these findings and suggestions for future research are discussed.     

Gender differences in moral orientation: a meta-analysis

C. Gilligan's (1982) critique of L. Kohlberg's theory of moral reasoning and her assertion that two modes of moral reasoning (justice and care) exist have been the subject of debate within the field of psychology for more than 15 years. This meta-analysis was conducted to review quantitatively the work on gender differences in moral orientation. The meta-analysis revealed small differences in the care orientation favoring females (d = -.28) and small differences in the justice orientation favoring males (d = .19). Together, the moderator variables accounted for 16% of the variance in the effect sizes for care reasoning and 17% of the variance in the effect sizes for justice reasoning. These findings do not offer strong support for the claim that the care orientation is used predominantly by women and that the justice orientation is used predominantly by men.     

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.     

Does performance on the standard antisaccade task meet the co-familiality criterion for an endophenotype?

The “co-familiality” criterion for an endophenotype has two requirements: (1) clinically unaffected relatives as a group should show both a shift in mean performance and an increase in variance compared with controls; (2) performance scores should be heritable. Performance on the antisaccade task is one of several candidate endophenotypes for schizophrenia. In this paper we examine whether the various measures of performance on the standard version of the antisaccade task meet the co-familiality criterion for an endophenotype. The three measures of performance—reflexive saccade errors, latency of correct antisaccades, and gain—show a wide range of effect sizes and variance ratios as well as evidence of significant or near significant heterogeneity. The estimated mean effect sizes [Cohen’s d: error rate: 0.34 (SD: 0.29); latency: 0.33 (SD: 0.30); gain: 0.54 (SD: 0.38)] are significantly greater than 0, but the magnitude of the departures from 0 is relatively small, corresponding to modest effect sizes. The width of the 95% confidence intervals for the estimated effect sizes (error rate: 0.2–0.49; latency: 0.17–0.50; gain: 0.23–0.85) and the coefficients of variation in effect sizes (error rate: 85.3%; latency: 90.9%; gain: 68.4%) reflect heterogeneity in effect sizes. The effect sizes for error rate showed statistically significant heterogeneity and those for latency (P = .07) and gain (P = .09) showed a trend toward heterogeneity. These results indicate that the effect sizes are not consistent with a single mean and that the average effect size may be a biased estimate of the magnitude of differences in performance between relatives of schizophrenics and controls. Relatives of schizophrenics show a small but significant increase in variance in error rate, but the confidence interval is broad, perhaps reflecting the heterogeneity in effect size. The variance ratios for latency and gain did not differ in relatives of schizophrenics and controls. Performance, as measured by error rate, is moderately heritable. The data do not provide compelling support for a consistent shift in mean or variance in relatives of schizophrenia patients compared with nonpsychiatric controls, both of which are required for a major gene involved in co-familial transmission. This set of findings suggests that although intra-familial resemblance in antisaccade performance is due in part to genetic factors, it may not be related to a schizophrenia genotype. Based on the current literature, it would be premature to conclude that any of the measures of antisaccade performance unambiguously meets the co-familiality criterion for an endophenotype.     

Gender differences in mathematics performance: a meta-analysis

Reviewers have consistently concluded that males perform better on mathematics tests than females do. To make a refined assessment of the magnitude of gender differences in mathematics performance, we performed a meta-analysis of 100 studies. They yielded 254 independent effect sizes, representing the testing of 3,175,188 Ss. Averaged over all effect sizes based on samples of the general population, d was -0.05, indicating that females outperformed males by only a negligible amount. For computation, d was -0.14 (the negative value indicating superior performance by females). For understanding of mathematical concepts, d was -0.03; for complex problem solving, d was 0.08. An examination of age trends indicated that girls showed a slight superiority in computation in elementary school and middle school. There were no gender differences in problem solving in elementary or middle school; differences favoring men emerged in high school (d = 0.29) and in college (d = 0.32). Gender differences were smallest and actually favored females in samples of the general population, grew larger with increasingly selective samples, and were largest for highly selected samples and samples of highly precocious persons. The magnitude of the gender difference has declined over the years; for studies published in 1973 or earlier d was 0.31, whereas it was 0.14 for studies published in 1974 or later. We conclude that gender differences in mathematics performance are small. Nonetheless, the lower performance of women in problem solving that is evident in high school requires attention.     

Sex differences in pain

Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, some painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is "learned" and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production.     

“I Have Not a Want But a Hunger to Feel No Pain” Mexican Immigrant Women with Chronic Pain: Narratives and Psychotherapeutic Implications

We present a foundation for psychotherapy for Mexican immigrant women with chronic pain. We describe research on health care and the multiple identities that influence health behavior, including identity as Mexican, as immigrant, as Mexican woman, and as Christian. The importance of situating the pain narrative within the client’s life narrative is illustrated by interviews with five Mexican immigrant women with moderate to severe chronic pain. Emergent themes revealed the profound impact of culture and gendered imperatives: matriarch, worker, sufferer, stoic. Suggestions for psychotherapy are provided, guided by awareness of core value systems, socioeconomic impact on access to care, and experiences as immigrant.     

Cognitive–Behavioral-Interpersonal Scenarios: Interformulator Reliability and Convergent Validity

Although a clinical case formulation can help focus treatment, little is known about the reliability and convergent validity of independently generated, cognitive–behavioral or cognitive–interpersonal formulations. Using videotapes of a semi-structured interview, pairs of clinicians independently formulated 2–3 cognitive–behavioral–interpersonal scenarios (CBISs) on each of 4 women with mood or comorbid mood and anxiety disorders. Ten licensed psychologists then rated each CBIS on 15 dimensions involving cognition, affect, symptoms, and interpersonal functioning. Reliability of the mean ratings (aggregated over the 10 raters) was >.83 for all dimensions. The set of CBISs formulated by a clinician for a patient generally demonstrated good convergent (same patient/different formulator) and discriminant (different patient/same or different formulator) validity on three factor-analytically derived general dimensions of depression, anxiety, and interpersonal functioning. Within each of three patients, pairs of formulators generally agreed on the situational components of the CBISs and demonstrated adequate to very good convergent validity of corresponding CBIS content. These results contribute to accumulating evidence for the reliability and validity of clinical scenarios as an idiographic, situation-level case formulation. Such formulations can help identify multiple cognitive, behavioral, or interpersonal intervention points in the causal chain leading to distress or dysfunction.     

A critical analysis of students' teacher ratings

Analysis of data obtained from 258 second-year undergraduate students revealed that sex differences are not associated with differences in students' teacher ratings. Significant differences in ratings were found to be associated with differences in academic performance and with differences in preference for anonymity when submitting ratings. These findings suggest that students' ratings of teaching performance suffer from significant validity problems and that such ‘performance indicators’ are likely to provide misleading information.     

Sex differences in response to an observational fear conditioning procedure

The present study evaluated sex differences in observational fear conditioning using modeled “mock” panic attacks as an unconditioned stimulus (UCS). Fifty-nine carefully prescreened healthy undergraduate participants (30 women) underwent 3 consecutive differential conditioning phases: habituation, acquisition, and extinction. It was expected that participants watching a confederate display mock panic attacks (UCS) paired with a previously neutral stimulus (CS⁺) would learn to respond fearfully to the CS⁺, but not to the CS⁻ (i.e., a stimulus never associated with displays of panic). Women also were expected to report more distress and ratings of panic to the CS⁺ than the CS⁻ compared to men, but no sex differences were anticipated on autonomic indices of conditioning (i.e., electrodermal responses). Consistent with expectation, aversive conditioning was demonstrated by greater magnitude electrodermal and verbal-evaluative (e.g., subjective units of distress scale, panic ratings) responses to the CS⁺ over the CS⁻, with women reporting more distress to the CS⁺ over the CS⁻, but not greater autonomic conditioning, compared to men. Overall, the results support the notion that modeled panic attacks can serve as a potent UCS for both men and women. Discussion focuses on sex differences in observational fear conditioning and its relation to the clinical presentation of anxiety disorders.