Musculoskeletal status and disability of MMPI profile subgroups among patients with low back pain

The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 205 male and 157 female patients with acute and chronic low back pain (LBP) were studied for replicable homogeneous subgroups using three cluster-analysis procedures. Two normal and three clinically elevated profile subgroups were identified. The two normal subgroups were characterized by relatively normal musculoskeletal condition and were least disabled, but they differed somewhat from each other in duration of pain, presence of physical abnormalities, and daily functioning. The third subgroup had the following characteristics: an elevated neurotic triad, greatest duration of symptoms, most abnormal physical findings, greatest limitation of motion, most pain complaints during physical examination, and the fewest number of intact functional activities. The fourth subgroup, with an elevated neurotic triad plus subclinical elevations on other scales, had somewhat less musculoskeletal impairment but had extensive work disability, financial compensation, and previous surgeries. The fifth and most pathologic profile subgroup surprisingly consisted largely of acute-pain patients whose musculoskeletal condition and daily functioning were similar to those of the normal subgroups. Patients in the three abnormal MMPI subgroups were exposed to more LBP physical-risk factors in the workplace. Implications for psychological treatment with these different profile types are discussed.     

Alexithymia among empirically derived subgroups of chronic back pain patients

A seeded cluster analysis procedure was applied to the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 102 male and 63 female back-pain patients. For both men and women, the resulting subgroups were found to correspond closely to similar subgroups obtained in several previous investigations. New data on the psychometric properties of the MMPI Alexithymia scale (Kleiger & Kinsman, 1980) are presented. Significant differences in alexithymia among empirically derived MMPI subgroups were found in the male sample only.     

Factorial analysis of the MMPI profiles of low back pain patients

To examine the interrelationships of MMPI scale scores among low back pain patients, 50 profiles were scored on the traditional 13 scales, Hanvik's Lb scale and seven subscales derived from Scales 1 and 3. The profiles were randomly divided into two equal samples and factor analyzed. Comparison of the two samples yielded three common factors. The first factor measured severity of the symptoms, the second assessed the level of anger and aggression and the third assessed the psychogenic components of the syndrome. The implications of the factors are discussed.     

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.     

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.     

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.     

MMPI-2 subgroups in a sample of chronic pain patients

MMPI-2 scores of 307 female and 161 male chronic pain patients were analyzed by gender using a multivariate clustering method. Two subgroups were found for both sexes replicating previous results. The major subgroup corresponded to the classical "Conversion V" and the minor corresponded to the "Generally elevated" profile. The results also indicated a satisfactory internal consistency and a high discriminant validity of the Swedish version of the MMPI-2.     

Use of verbal pain measurement in the detection of hidden psychological morbidity among low back pain patients with objective organic findings

Abstract

Patients with positive physical findings to explain low back pain arc believed lo belong to two organic subgroups. One group has organic disease alone: in the other, organic disease is accompanied by psychological disturbance. Separation of patients with medical findings into groups with varying levels of psychological disturbance is difficult, because emotional disturbance is often hidden. In this study, the pain report of 124 patients with organic findings alone, and 50 patients with organic and psychological findings was examined to determine whether pain measurement could he used to identify accurately patients belonging 10 the two groups. the pain groups differed in the use of 43 pain words from the Low Back Pain Symptom Check List. Using a set of weights derived From discriminant analysis. the 33 pain words predicted 99.2% of the patients with organic disease alone and 86.0% of the patients with organic disease and psychological disturbance. The results were replicated in a new sample of 140 patients. Cross-validation shrinkage in accuracy was 8.3%. The results of the two studies suggest that pain measurement may he a useful clinical indicator of psychological disturbance in patients with organic findings.     

Neuropsychological and MMPI correlates of patients' future employment characteristics

Previous research has suggested that patients' neuropsychological test scores correlate not only with neurologic status but also with their success in coping with some of the demands of daily living. This study investigated the utility of such laboratory test scores in predicting several vocational variables. Patients who had recieved neuropsychological evaluations were recontacted and questioned about their employment over the previous 6 mo. Of the 78 individuals who participated, 25 had been chronically unemployed. The remaining 53 were asked about job stability, hours worked, and wages earned, and were administered the Minnsota Job Requirements Questionnaire. Patients' scores on the Halstead-Reitan Battery, the WAIS and the MMPI were highly correlated with employment status (employed or chronically unemployed), income, and skills required on the jobs held. The results suggest that these tests may have clinical utility in assessing patients' employability, as well as the types of jobs for which they are suited.