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.     

Timing multimodal events in pigeons

The peak procedure was used in two experiments to study pigeons' ability to time multimodal events. In the first experiment, birds were trained to time a single event consisting of a 9-s tone or light followed by a 21-s fixed interval associated with a signal of light or tone (signal of the other modality). On occasional empty trials, different lengths of the first signal were followed by a long period of the second signal. Peak response times as a function of the duration of the first signal were linear and had a slope of close to one in all birds. This indicates that the birds were timing only the second signal. In a second experiment, two complex events were used in training. One consisted of a 9-s tone or light followed by a 21-s fixed interval associated with a light or tone. The other consisted of a 21-s tone or light followed by a 9-s fixed interval associated with a light or tone. Different durations of the first signal were again used on empty trials. Peak response times as a function of the duration of the first signal were again linear in all birds. The slope of the function was less than one but greater than zero for 3 birds. This indicates that these birds were partly timing the entire complex event of 30-s duration and partly timing only the second signal of the event. A model is proposed in which the bird takes as a criterion for timing a weighted average of different target criteria. Comparisons with the performance of rats are made.     

Money versus pain: experimental study of a conflict in humans.

Ten healthy human males volunteered to be subjects in an experiment in which they were to be paid to endure a painful sensation. This sensation was produced by isometric muscular contraction in the thighs. For each of six sessions the subjects received either a payment that was changed for each session (0.2, 0.5, 1.25, 3.125, 7.8125 French francs per 20 s) or a lump sum. At the beginning of a session, the subjects assumed a seated position against a wall, but without a seat, and the duration for which they could hold this position was the chief variable measured. Heart rate, blood pressure, and magnitude estimation of pain were also recorded periodically throughout each session. Pain was reported after a mean delay of 15 +/- 7 s (SE), and the magnitude estimates then increased linearly with time. The duration of maintaining the painful position increased linearly in relation to the logarithm of the increase in the amount of payment. Thus, utility of money decreased when pitted against pain.     

Cognitive Behavioral Therapy for Postamputation Chronic Pain: A Case Report

Limb amputation has a significant impact on an individual, not only physically but emotionally. Consequences of both traumatic and atraumatic amputations are vast and can result in functional disability, impaired emotional functioning, and changes in overall quality of life. These consequences may be further complicated by the development of chronic pain. Traditional management of postamputation chronic pain often involves invasive procedures and pharmacotherapy. While research notes behavioral interventions, such as cognitive-behavioral therapy (CBT) as a viable treatment alternative for chronic pain, there is no literature supporting CBT for postamputation chronic pain. In this case report, we present a 63-year-old male lower limb amputee complicated with chronic pain who experienced pain reduction and improved quality of life following manualized treatment with CBT for chronic pain. Treatment took place over 12 sessions with fidelity (93%) being measured throughout to ensure accurate utilization of the treatment manual. As part of the treatment manual, self-report measures (Pain Rating Scale, Pain Catastrophizing Scale, Pain Outcomes Questionnaire, and subjective units of distress) were used throughout to track patient progress. All measures showed improvement with the biggest gains being seen in pain ratings and pain catastrophizing.     

Penalized optimal scaling for ordinal variables with an application to international classification of functioning core sets

Ordinal data occur frequently in the social sciences. When applying principal component analysis (PCA), however, those data are often treated as numeric, implying linear relationships between the variables at hand; alternatively, non-linear PCA is applied where the obtained quantifications are sometimes hard to interpret. Non-linear PCA for categorical data, also called optimal scoring/scaling, constructs new variables by assigning numerical values to categories such that the proportion of variance in those new variables that is explained by a predefined number of principal components (PCs) is maximized. We propose a penalized version of non-linear PCA for ordinal variables that is a smoothed intermediate between standard PCA on category labels and non-linear PCA as used so far. The new approach is by no means limited to monotonic effects and offers both better interpretability of the non-linear transformation of the category labels and better performance on validation data than unpenalized non-linear PCA and/or standard linear PCA. In particular, an application of penalized optimal scaling to ordinal data as given with the International Classification of Functioning, Disability and Health (ICF) is provided.     

Pain in the eye of the beholder: Variations in pain visual representations as a function of face ethnicity and culture

Pain experienced by Black individuals is systematically underestimated, and recent studies have shown that part of this bias is rooted in perceptual factors. We used Reverse Correlation to estimate visual representations of the pain expression in Black and White faces, in participants originating from both Western and African countries. Groups of raters were then asked to evaluate the presence of pain and other emotions in these representations. A second group of White raters then evaluated those same representations placed over a neutral background face (50% White; 50% Black). Image-based analyses show significant effects of culture and face ethnicity, but no interaction between the two factors. Western representations were more likely to be judged as expressing pain than African representations. For both cultural groups, raters also perceived more pain in White face representations than in Black face representations. However, when changing the background stimulus to the neutral background face, this effect of face ethnic profile disappeared. Overall, these results suggest that individuals have different expectations of how pain is expressed by Black and White individuals, and that cultural factors may explain a part of this phenomenon     

Internal consistency and reliability of alternate short forms of the college women's assertion sample: Clinical and research implications

Assertive behavior is most often assessed with self-report or role-play measures. The latter modality is preferred because it provides for the sampling of the structure of behavior and for the consideration of the situational context. MacDonald (1978) has developed such an assessment device but it is limited by the length of time for administration and scoring. Two studies were conducted to reconstruct reliable alternate short forms. The first study describes the selection of items and demonstrates the internal consistency of the alternate forms. The second study demonstrates the alternate form and retest reliability and provides normative statistics. We conclude that reliable alternate short forms have been constructed to be used in research in clinical applications.This research was supported by the Marie Wilson Howells Fund.Alternate short forms of the CWAS may be obtained from the first author.     

Linear Analogue Self-Assessment and Procrustean Measurement: A Critical Review of Visual Analogue Scaling in Pain Assessment

Visual analogue scales (VASs) are one of the most widely used self-report measures of clinical pain. This article reviews the empirical literature on linear analogue self-assessment (LASA) and critically examines the features that appear to have made it such an attractive measurement option in pain assessment. It is concluded that analogue scaling does not withstand critical scrutiny as a primary measure of either pain intensity or pain affect and that, in most circumstances, the overall clinical utility of VASs is inferior to that of more structured pain indices.     

Concordance Between Mothers' and Children's Reports of Somatic and Emotional Symptoms in Patients with Recurrent Abdominal Pain or Emotional Disorders

Mother–child concordance regarding children's somatic and emotional symptoms was assessed in children with recurrent abdominal pain (n = 88), emotional disorders (n = 51), and well children (n = 56). Children between 6 and 18 years of age and their mothers completed questionnaires assessing the children's somatic symptoms, functional disability, and depression. Mothers of children with recurrent abdominal pain reported more child somatic and depressive symptoms than did their children, and mothers of children with emotional disorders reported more child depressive symptoms than did their children. Higher levels of maternal distress were associated with greater mother-child discordance in the direction of mothers reporting more child symptoms than did their children. No significant child age or sex differences were found in concordance patterns.