Integrating Pain Management in Clinical Practice

There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. In this paper, we briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain.     

Voluntary and involuntary attention vary as a function of impulsivity

In the present study we examined, first, whether voluntary and involuntary attention manifest differently in people who differ in impulsivity (measured with the Barratt Impulsivity Scale). For Experiment 1, we used the spatial cueing task with informative and noninformative spatial cues to probe voluntary and involuntary attention, respectively. We found that participants with high impulsivity scores exhibited larger involuntary attention effects, whereas participants with low impulsivity scores exhibited larger voluntary attention effects. For Experiment 2, we used the correlated-flanker task to determine whether the differences between groups in Experiment 1 were due to high-impulsive participants being less sensitive to the display contingencies or to high-impulsive participants having a greater spread of spatial attention. Surprisingly, high-impulsive participants showed a greater sensitivity to contingencies in the environment (correlated-flanker effect). Our results illustrate one situation in which involuntary attention associated with high impulsivity can play a useful role.     

The detection of feigned disabilities: the effectiveness of the Personality Assessment Inventory in a traumatized inpatient sample

Research on feigned mental disorders indicates that severe psychopathology coupled with significant trauma histories often complicate feigning determinations, resulting in inaccuracies on otherwise effective measures. As part of malingering assessments, the Personality Assessment Inventory (PAI) is often used because of its excellent validation and the availability of three feigning indicators (Negative Impression, Malingering Index, and Rogers Discriminant Function), which have evidenced large effect sizes and clinically useful cut scores. The current study examined the effectiveness of the PAI in a traumatized inpatient sample using a between-subjects simulation design. Although Negative Impression appeared affected by trauma--especially in conjunction with dissociative symptoms--very positive results were found for Malingering Index and Rogers Discriminant Function. They remained relatively unelevated under honest conditions, despite posttraumatic stress disorder and extensive comorbidity. Using single-point cut scores provided moderately good classification of feigned and genuine PAI profiles. For purposes of classification, the authors operationally defined small indeterminate groups that were considered too close to classify (i.e., ±5T of the cut scores). With indeterminate cases removed, the overall classification rates improved modestly. However, the more important finding involved the error rates for the indeterminate group, which exceeded 50%. Directions for further research are discussed.     

The prevalence of symptoms of Post-Traumatic Stress Disorder among soldiers with amputation of a limb or spinal injury: a report from a rehabilitation centre in Sri Lanka

Post-Traumatic Stress Disorder has been identified as one of the most commonly occurring mental illnesses in combatants. This study was conducted to determine the prevalence of Post-Traumatic Stress Disorder among soldiers who had undergone amputation of a lower or an upper limb or sustained a spinal cord injury in the battlefield, and to compare the prevalence among these categories. The research presented seeks to increase the awareness of this condition among those treating war casualties so that appropriate treatment choices could be made to address them. The study was carried out in 2009 at a rehabilitation centre for combatants of war. Data were collected from 96 male army veterans between the ages of 18-49 years using a pre-tested self-administered questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, the Impact of Event Scale and the PTSD symptom scale. Soldiers with injuries sustained at least four weeks prior to the study were selected by a convenience sampling technique. Soldiers with multiple injuries, head injuries or those diagnosed with psychiatric disorders were excluded. The results revealed that 41.7% of the study population was compatible with the diagnosis of Post-Traumatic Stress Disorder. Within the three groups, 42.5% of the lower limb amputees, 33.3% of the upper limb amputees and 45.7% of the participants with spinal cord injury had symptoms compatible with Post-Traumatic Stress Disorder. There was no difference between the prevalence among the different injury categories considered. This study highlights the need to pay more attention in providing psychological care as a part of the overall health management of injured combatants. Early preparation of soldiers for stressors of war and screening for and proper management of Post-Traumatic Stress Disorder will improve the overall outcome of rehabilitation.     

Neighborhood Determinants of Quality of Life

In this paper we analyze various dimensions of the quality of life in Uruguay. The results suggest that differences in overall happiness and in domain satisfaction can partly be explained by different levels of access to public goods. We find that the monetary equivalent value of public goods such as electricity, running water, sewage system, drainage, waste disposal system, street lighting, sidewalks in good condition, trees in the street, and the absence of air or noise pollution is considerable.     

Place and direction learning in a spatial T-maze task by neonatal piglets

Pigs are a valuable animal model for studying neurodevelopment in humans due to similarities in brain structure and growth. The development and validation of behavioral tests to assess learning and memory in neonatal piglets are needed. The present study evaluated the capability of 2-week old piglets to acquire a novel place and direction learning spatial T-maze task. Validity of the task was assessed by the administration of scopolamine, an anti-cholinergic drug that acts on the hippocampus and other related structures, to impair spatial memory. During acquisition, piglets were trained to locate a milk reward in a constant place in space, as well as direction (east or west), in a plus-shaped maze using extra-maze visual cues. Following acquisition, reward location was reversed and piglets were re-tested to assess learning and working memory. The performance of control piglets in the maze improved over time (P < 0.0001), reaching performance criterion (80 % correct) on day 5 of acquisition. Correct choices decreased in the reversal phase (P < 0.0001), but improved over time. In a separate study, piglets were injected daily with either phosphate-buffered saline (PBS; control) or scopolamine prior to testing. Piglets administered scopolamine showed impaired performance in the maze compared to controls (P = 0.03), failing to reach performance criterion after 6 days of acquisition testing. Collectively, these data demonstrate that neonatal piglets can be tested in a spatial T-maze task to assess hippocampal-dependent learning and memory.     

Genetic moderation of sensitivity to positive and negative affect in marriage

Hypothesizing that genetic factors partially govern sensitivity to interpersonal cues, we examined whether a polymorphism (5-HTTLPR) in the serotonin transporter gene would moderate spouses' sensitivity to positive and negative partner affect. Before and after marital discussions, participants from 76 couples (total n = 150) reported their affective states. Spouses carrying the short allele of the 5-HTTLPR were more responsive to their partner's preinteraction positive affect and anxiety/nervousness, compared with spouses with two long alleles. These data support the contention that the serotonin system influences affective responses to social stimuli. In contrast to the view that the 5-HTTLPR primarily affects response to adverse experiences, these results suggest that this polymorphism moderates sensitivity to positive as well as negative affect.     

Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.