Rorschach and pain characteristics of patients with low back pain and "conversion V" MMPI profiles

Two studies examined the relationship between Rorschach determinants, MMPI scale scores, and pain reports in order to clarify the meaning of the MPI "conversion V" pattern among patients with low back pain. Study I showed that patients without demonstrable organic disease of the back produce Rorschach response summaries marked by lower F+%, lower Sum C, and higher F% than patients with demonstrable organic disease. Study 2 showed that only the increase in F% was associated with significant elevations of the MMPI Hs and Hy scales. The results suggest that elevated MMPI "conversion V" profiles are indicative of psychological disturbance among patients with low back pain. It is unlikely, however, that the disturbance is hysterical. Instead, the psychopathology is probably marked by tension and constraint rather than the over-reactivity of hysteria. The implications of these findings for diagnosis are discussed.     

Chronic pelvic pain: A meta-analytic review

Abstract

Chronic pelvic pain (CPP) in women of reproductive age is a common complaint; for many women no identifiable pathology can be found. Research has suggested that women who have chronic pelvic pain without obvious pathology differ on a range of psychological characteristics, such as anxiety and depression, compared with those with identified pathology. A meta-analysis of 22 studies was undertaken to clarify these issues. Results showed that there were no significant differences on a range of psychological variables between women who were identified, via laparoscopy and clinical judgement, as having organic disorders and those who were not so identified. When women with chronic pelvic pain were compared with pain-free groups a profile of elevated depression, anxiety, neuroticism and psychopathology was found which is consistent with findings from studies of other painful conditions.     

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 relationship between pain and coping styles among hiv-positive men and women

Abstract

Pain in HIV/AIDS patients is associated with compromised quality of life and emotional adjustment. Although previous findings support a relationship between coping styles and subjective pain for various groups of chronically-ill persons, little research has examined the associations between coping and pain in HIV-positive or AIDS patients. The purpose of this study was to explore the relationship between pain and coping styles among 105 HIV-positive participants (32 women and 73 men) in a randomized clinical trial designed to examine the effect of group psychotherapy on quality of life and health behavior. Participants completed the Brief COPE, the pain scale from the Medical Outcomes Study-HIV, and a demographic and medical questionnaire. Multiple regression analysis, with pain as the dependent variable, showed that participants who reported coping through denial reported greater pain severity (p < 0.0001). These results suggest that denial as a coping strategy appears to be signficantly associated with pain for persons with HIV/AIDS. However, further research is necessary to determine the causal relationship between pain and coping through denial. These findings also point to the possibility of psychological intervention in order to modify maladaptive coping styles and to ameliorate pain in this population.     

Medical help-seeking by different types of chronic pain patients

Abstract

This paper reports on a study of the use of health services by different types of patients with chronic benign pain. The purpose of the study was to identify differences in medical consumption between different types of pain patients. In the course of one year 586 patients were selected by 45 general practitioners: they included patients who had had almost daily chronic pain symptoms for at least six months, without a medical diagnosis (such as cancer or arthritis) to explain the pain. Patients were categorized according to the Multidimensional Pain Inventory which distinguishes four categories: the dysfunctional, who perceive severe pain and gain social support; the interpersonally distressed, who combine pain with affective and relational distress; adaptive copers, who cope with their pain in a number of ways; the average type, with characteristics of all three other types. It was hypothesised that adaptive copers would make less use of health services and would be more involved in self-help activities than dysfunctional or interpersonally distressed patients. Frequent use of psychological services by the interpersonally distressed group was expected. It was predicted that difference in health services use would continue during the subsequent year.

No differences were found between the four groups in location, temporal characteristics, or possible medical causes of the pain symptoms. Dysfunctional patients used more services than the others. Adaptive copers used the least. The four groups did not differ in self-care activities. Group-membership as well as pain severity are related to the use of health services. None of the groups showed a significant decline in the use of health services during the year. It is concluded that chronic pain is invalidating, but that not all patients are equally excessive in their use of medical services.     

Exploring the associations shared by mood,pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample

Objective: Sleep disturbance in chronic pain is common, occurring in two-thirds of patients. There is a complex relationship between chronic pain and sleep; pain can disrupt sleep and poor sleep can exaggerate pain intensity. This may have an impact on both depressive symptoms and attention to pain. This study aims to evaluate the relationship between chronic pain and sleep, and the role of mood and attention.

Methods: Chronic pain patients, recruited from a secondary care outpatient clinic, completed self-report measures of pain, sleep, depressive symptoms and attention to pain. Hierarchical regression and structural equation modelling were used to explore the relationships between these measures. Participants (n = 221) were aged between 20 and 84 (mean = 52) years.

Results: The majority of participants were found to be ‘poor sleepers’ (86%) with increased pain severity, depressive symptoms and attention to pain. Both analytical approaches indicated that sleep disturbance is indirectly associated with increased pain severity Instead the relationship shared by sleep disturbance and pain severity was further associated with depressive symptoms and attention to pain.

Conclusions: Our results indicate that sleep disturbance may contribute to clinical pain severity indirectly though changes in mood and attention. Prospective studies exploring lagged associations between these constructs could have critical information relevant to the treatment of chronic pain.     

The utility of McGill pain questionnaire subscales for discriminating psychologica disorder in chronic pain patients

Abstract

The practice of separately scoring the sensory, affective and evaluative suhscules of the McGill Pain Questionnaire has not bccn unequivocally supported hy rcsearch, While there is moderate support for the three-factor Structure of this scale, recent studies have revealed strong intercorrelations among these factors and have not supported thcir differential predictive ahility. Present factor analytic results provide support for solutions involving a global factor in conjunction with either two or three subscale factors. The differential relationships of the sensory and affective factors to the Minnesota Multiphasic Personality Inventory and Zung Dcpression Inventory demonstrate support for the validity of separately scoring the two factors in chronic pain patients. Preliminary guidelines are provided for the clinical use of the MPQ to discriminate psychological disorder in chronic pain 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.     

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.     

Effects of different psychological interventions on neck,shoulder and low back pain in female hospital staff

Abstract

One hundred and eleven females volunteered to take part in this intervention study of musculoskeletal pain. They all completed a survey of pain among five hundred and eighty-six female hospital staff and presented mild to severe pain in the neck, shoulder and/or low back. They were randomly assigned to one of the following groups; Focus on job-stress and psychosocial coping (Cognitive), relaxation training (Relaxation), the combination of the two (Combined) or to a control group (Control). Musculoskeletal pain (intensity and duration) was assessed by self-report prior to interventions, immediately after interventions, and at a four months follow-up. Results from multivariate analyses of variance as well as covariance (pre-intervention levels of pain as covariate) showed that magnitude of pain reduction was dependent upon the interaction between area of the back and type of intervention. These trends were more significant for intensity than for duration scores. They were due to reductions of pain in (1) neck and shoulders for the Cognitive and Combined groups and (2) in the low back and shoulders for the Relaxation group. The four month follow-up assessment revealed a significant risk of relapse only for duration of low back pain among subjects in the Combined group. Results from the Cognitive approach to intervention may reflect a causal role for ability to cope with psychosocial job stress in the development of neck and shoulder pain in female hospital staff.     

The role of additional information in the compliance,satisfaction, psychological,and emotion responses of non-surgical patients with low back pain: An exploratory investigation

Abstract

Noncompliance and the psychological and emotional states of patients with low back pain are major concerns for health professionals. The current study evaluated whether amount of information available to patients enhanced compliance to a medical regimen and whether it reduced negative emotions in patients with low back pain. Forty-five orthopaedic non-surgical patients with low back pain were randomly assigned to one of three information presentation conditions: 1) Standard, 2) Pre-examination, and 3) Post-examination. Patients were also separated by compensation and noncompensation within each information group. Patients completed questionnaires at their initial visit and at their follow-up which evaluated their: levels of compliance to a prescribed treatment program, psychological, and emotional states. Results indicated that some patients benefitted from receiving additional information as the Pre-examination and Post-examination groups demonstrated superior comprehension and recall as well as higher levels of compliance to a physical therapy program. In addition, compensation patients complained of more negative psychological and emotional behaviors in comparison to noncompensation patients. Implications of the research and future research considerations were discussed.     

Defensive high-anxious individuals with chronic back pain demonstrate different treatment choices and patient persistence

The aim of this study is to determine whether the experience of, and response to chronic back pain was different for defensive high-anxious individuals than other personality types (defensive high-anxious, high-anxious, repressor and low-anxious). Participants (n = 111) were recruited from a heterogeneous sample of individuals who had reported back pain within the last 6 months. Self-report measures of trait anxiety and defensiveness were used to determine personality type. In addition, pain, treatment history, disability, depression and satisfaction with treatment were recorded. Despite reporting similar levels of pain to other personality groups, defensive high-anxious individuals reported significantly greater disability and depression (p < 0.01). Of the defensive high-anxious individuals, 92% sought more than one intervention. In comparison, repressors predominantly self-managed their pain with only 10% utilising more than one intervention. Surprisingly, there were no differences in treatment satisfaction between the four groups. The present study suggests that personality type is an important factor influencing patients’ treatment options, with defensive high anxious individuals substantially more likely to seek multiple interventions and remain within the care system. The present study provides a basis for future research into the role of personality type in the management of chronic pain.     

Predicting behavioral outcomes with two psychological assessment methods in an outpatient pain management program

Abstract

In research with pain patients, the determination of psychological variables that can predict physiological gains would be helpful for practitioners doing assessments on pain patients. The present study used the Millon Behavioral Health Inventory (MBHI) and the Minnesota Multiphasic Personality Inventory (MMPI) to assess whether gains in time sitting, time standing, number of stairs climbed, time on a treadmill, treadmill speed, grip strength in both hands, and a composite score of these variables could be successfully predicted for patients at a 20-day outpatient multidisciplinary pain rehabilitation program. Discriminant analyses demonstrated that both the MBHI and the MMPI were successful in this prediction. Advantages for using the two instruments singly and together in assessment procedures and suggestions for future research are made.     

The impact of experiential avoidance on the relations between illness representations,pain catastrophising and pain interference in chronic pain

Objective: The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients’ illness representations to pain interference, through pain catastrophising

Design and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSS

Results: After controlling for patient and illness-related variables and pain severity, the ‘illness representations–pain catastrophising–pain interference’ pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant.

Conclusion: The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.     

The role of the patient in the management of post surgical pain

Abstract

An experiment was conducted to test the idea that patients do not have the necessary knowledge about pain relief to contribute effectively to their own pain management through such strategies as being more assertive in requesting analgesia. When patients were provided with video-taped information about available pain control techniques, together with a rationale for the minimisation of pain and encouragement to request analgesia as required, they did not achieve significantly less pain than control groups. Since patients were well satisfied with pain levels substantially greater than zero, it is argued that the conventional wisdom that high pain scores indicate that post surgical pain is badly treated should be re-assessed.     

Measuring clinical pain

There are two goals in attempts to measure, the intention to describe and the intention to compare. These two functions work hand in hand and are brought to fruition in psychological and educational testing only by psychometrics that can produce person-free item calibrations and item-free person measures. The only such psychometrics that currently exist is that based on George Rasch's work. One of the consequences of using the tools Rasch left us is the Pain Scale, a rating scale that asks the person in pain to compare the intensityof his/her own pain with that he/she imagines is described by some 25 adjectives. Analyses of the responses of 53 people with chronic lower back pain to the Pain Scale using the Rasch partial-credit latent-trait model show that they were very much in agreement about the amount of hurt implied by each of the adjectives. An examination of person fit to the partial-credit model gave no hint of a response set in the data but two people did differ very much from their peers in their operational definitions of back pain and were studied separately. The evidence from these two people suggested that they either could not understand the task before them or could not get enough perspective on their pain to describe its intensity.I would like to thank Benjamin Wright and Geoff Masters for their help with this research. Drs. David J. Smith and James B. Boscardin were the first to bring my attention to the problem of measuring pain and were generous in their financial support of this work.     

Time perspective,socioeconomic status,and psychological distress in chronic pain patients

Time perspective (TP) is a fundamental dimension of the psychological construction of time. It refers to a subjective experience and can be defined as the relationship that individuals and groups have with the present, past, and future. Studies have shown that it is interesting to take into account TP in the field of health, especially for the study of the psychological distress (PD) of individuals faced with aversive situations. We conducted a research, which aimed to explore the relationship between TP and PD in patients with chronic pain. A total of 264 first-time patients (72.3% women; mean age = 49 years) at CHU Timone (Marseille) pain center answered a questionnaire included TP, socioeconomic status, pain beliefs (PB), pain characteristics, and sociodemographic characteristics. Using hierarchical regression analyses adjusted to the characteristics of pain, sociodemographic characteristics, and PB, we can observe significant relationships between different components of TP, socioeconomic status, and PD. These results emphasize the importance of TP as psychosocial variable in the analysis of PD in patients with chronic pain. These results also lead us to point out the role of the socioeconomic status that predicts levels of PD.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.