Older spouses' perceptions of partners' chronic arthritis pain: Implications for spousal responses, support provision, and caregiving experiences.

This study of older patients with osteoarthritis and their spouses examined concordance between patients' and spouses' reports of patients' pain severity and the association of concordance with support and caregiving outcomes. Patients and spouses independently viewed videotapes of the patient performing simulated household tasks and provided ratings of patients' pain. Spousal overestimation of patients' pain was the most common type of nonconcordance. Spouses who were accurate in their perceptions of their partner's level of pain during a log-carrying task responded less negatively and provided emotional support that was more satisfying to patients. In addition, spouses who were accurate in their perceptions of their partner's pain during the log-carrying task reported less stress from providing support and assistance. Future research that uses such observational methods may be highly useful for understanding the effects of chronic illness on older couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perfectionism and relationship adjustment in pain patients and their spouses.

The authors assessed whether social facets of perfectionism were associated with indexes of dyadic and family adjustment. A sample of 83 pain patients and their spouses completed the Multidimensional Perfectionism Scale, Dyadic Adjustment Scale, Family Assessment Device, Beck Depression Inventory, and Multiaxial Pain Inventory. After controlling for depression, the authors found that pain patients' relationship adjustments were associated with their spouses' other-oriented perfectionism. Also, pain patients rated their other-oriented perfectionistic spouses as less supportive. Spouses' reports of poor dyadic and family adjustment were associated with their own socially prescribed perfectionism. The findings suggest that social aspects of perfectionism contribute to poor family adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spouses' provision of health-related support and control to patients participating in cardiac rehabilitation.

The authors examined spouses' provision of health-related support and control as predictors of health behavior and mental health among patients participating in cardiac rehabilitation (N = 94 couples). Cross-sectional analyses revealed that spouses' support was positively associated with patient health behavior. Prospective analyses of change over 6 months (N = 65 couples) revealed that spouses' support predicted increased patient mental health, whereas spouses' control predicted decreased patient health behavior and mental health. Findings suggest that spouses' efforts to facilitate patients' healthy lifestyle behaviors are associated with patients' health behavior and mental health, but not always as spouses might intend. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Life task appraisals, spouse involvement in strategies, and daily affect among short- and long-term married couples.

The purpose of this study was to examine predictors and consequences of spouses' involvement in each others' strategies for pursuing important personal goals called life tasks. Husbands and wives within 39 short- and long-term marriages described five life tasks and provided appraisals of whether each was shared with their spouse. Participants later completed 14 consecutive diary entries recording daily life task pursuit strategies, the extent of spouse involvement in each, and measures of positive and negative affect. Results indicated that interdependence in life task appraisals prospectively predicted greater spouse involvement, and greater spouse involvement was associated with more positive affect for that day. Life task appraisals may provide avenues for understanding couples' strategies for dealing with goals or stressors and how those strategies affect mood. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Momentary Mood and Coping Processes in TMD Pain.

Temporomandibular dysfunction (TMD) pain, like many chronic pain problems, appears to be multiply determined. Patients with TMD pain of at least 6 months duration (N = 30) were administered questionnaires measuring dispositional coping styles and appraisals to explore the dynamic interactions of the pain and coping process. Patients were then issued handheld computers that prompted them to record their momentary pain and coping processes 4 times per day for 7 days. Hierarchical linear regression models using both the dispositional and momentary predictors indicated that momentary pain was a function both of dispositional tendency to catastrophize and of momentary measures of catastrophization, self-efficacy, and mood states. Results were seen as supporting a situational model of intervention for chronic TMD pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

Objective: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. Design: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. Main Outcome Measures: Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. Results: Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. Conclusion: Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and physiological antecedents of threat and challenge appraisal.

Cognitive appraisal theories of stress and emotion propose that cognitive appraisals precede physiological responses, whereas peripheralist theories propose that physiological arousal precedes cognitive processes. Three studies examined this issue regarding threat and challenge responses to potential stress. Study 1 supported cognitive appraisal theory by demonstrating that threat and challenge cognitive appraisals and physiological responses could be elicited experimentally by manipulating instructional set. Studies 2 and 3, in contrast, found that manipulations of physiological response patterns consistent with challenge and threat did not result in corresponding changes in cognitive appraisal. Appraisals in Study 3, however, were related to subjective pain independent of the physiological manipulation. These studies suggest a central role for cognitive appraisal processes in elicitation of threat and challenge responses to potentially stressful situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological factors in chronic pain: Evolution and revolution.

Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronic pain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronic pain patients have received empirical support. The authors describe a biopsychosocial model of chronic pain and provide an update on research implicating the importance of people's appraisals of their symptoms, their ability to self-manage pain and related problems, and their fears about pain and injury that motivate efforts to avoid exacerbation of symptoms and further injury or reinjury. They provide a selected review to illustrate treatment outcome research, methodological issues, practical, and clinical issues to identify promising directions. Although there remain obstacles, there are also opportunities for psychologists to contribute to improved understanding of pain and treatment of people who suffer from chronic pain. The authors conclude by noting that pain has received a tremendous amount of attention culminating in the passage of a law by the U.S. Congress designating the period 2001-2011 as the "The Decade of Pain Control and Research." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Provider role attitudes, marital satisfaction, role overload, and housework: A dyadic approach.

Treating the marital dyad as the unit of analysis, this study examined the within-couple patterning of 272 dual-earner spouses' provider role attitudes and their longitudinal associations with marital satisfaction, role overload, and the division of housework. Based on the congruence of husbands' and wives' provider role attitudes, couples were classified into one of four types: (a) main-secondary, (b) coprovider, (c) ambivalent coprovider, and (d) mismatched couples. Nearly half of all spouses differed in their attitudes about breadwinning. A series of mixed model ANCOVAs revealed significant between- and within-couple differences in human capital characteristics, spouses' perceptions of marital satisfaction and role overload, and the division of housework across 3 years of measurement. Coprovider couples reported higher levels of marital satisfaction and a more equitable division of housework than the other couple groups. Wives in the ambivalent coprovider couples' group reported higher levels of role overload than their husbands to a greater extent than was found in the other couple groups. As the first study to adopt a dyadic approach that considers the meanings that both spouses in dual-earner couples ascribe to paid employment, these findings advance understanding of how dual-earner spouses' provider role attitudes serve as contexts for marital quality, behavior, and role-related stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceiving control, construing benefits, and daily processes in rheumatoid arthritis.

Examined the influence of perceived pain control (PPC) and pain benefit appraisals (PBAs) on adjustment to rheumatoid arthritis (RA) in a 75-day study of 54 RA patients. After completing measures of dispositional optimism (M. Scheier and C. Carver; see record 1986-19862-001) and appraisals of control over, and benefits from, their chronic pain, Ss reported each day their pain intensity, mood, and activity limitations due to pain. Controlling for disease activity and dispositional optimism, Ss high in PPC at the outset of the study experienced less daily pain. Daily pain also moderated the relation between control beliefs and adjustment as well as the relation between PBA and adjustment. With increased pain, greater PPC was associated with less positive mood. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitions in marriage: The relationship between standards and attributions.

The current investigation explored the relation between (a) spouses' standards for their marriages and (b) attributions for relationship problems and reported emotional and behavioral responses. Three dimensions of relationship standards were assessed: boundaries, distribution of power between partners, and demonstrated investment in the relationship. Findings indicate it is not the levels of boundaries, power, and investment reflected in spouses' standards that were related to their attributions, emotions, and self-reported behavioral responses to relationship problems. Instead, negative causal attributions; attributions to boundary, power, and investment issues; negative emotional responses to relationship problems; and reported active-destructive behavioral responses to relationship problems were associated with (a) spouses' unmet standards and (b) how upset spouses became when their relationship standards were not met. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of an audiovisual taxonomy of pain behavior: Reliability and discriminant validity.

Developed a pain behavior taxonomy derived from patients', spouses', and health care providers' nominations of pain behaviors. 71 chronic low back pain patients and 40 controls (Ss' mean age 38.25 yrs) were videotaped while undergoing a sequence of movements involving sitting, standing, walking, bending, and exercising, and a brief standardized interview component. Two observers rated each S's videotape employing a 16-category observational rating system that included verbal and nonverbal pain behaviors. Seven of the pain behavior categories, including guarding, bracing, position shifts, partial movement, grimacing, limitation statements, and sounds, had acceptable reliabilities and frequencies and were selected for inclusion in a discriminant analysis. Ss were randomly divided into 2 groups, and analysis on the 1st subsample indicated that partial movement, limitation statements, sounds, and position shifts accounted for 75% of the variance in group membership and correctly classified 94.4% of the patients and 95.2% of the controls. On cross-validation, the same 4 categories identified in the initial discriminant function correctly classified 88.9% of the Ss in the 2nd subsample. The utility of this pain behavior observational recording system is discussed in reference to both patient assessment and treatment outcome research. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative emotions, pain, and functioning.

We used linear structural equations (path model analysis) to examine associations among negative emotions, pain, and functioning in a large sample (N = 511) of veterans with chronic pain. We postulated and tested a model where pain and functioning affect negative emotions and where negative emotions affect pain and functioning. The findings confirm a strong relationship between negative emotions, pain, and functioning in our sample, particularly as the variable Pain Interference affects Depression. In a significant but weaker relationship, we also found that Anxiety has a direct effect on patients' perception of their Disability. Specifically, the data support a model where increased Pain Interference, Pain Severity, Depression and Anxiety all lead to increased Disability. Findings that Pain Interference and Depression appear to play a major role in the relationships between pain and negative emotions support the need for experimental studies to understand the causal impact of these variables on patient functioning. In the meantime, the findings suggest that Pain Interference, Depression, and Anxiety, in addition to Pain Severity, should all be targets of chronic pain treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain.

To evaluate and compare the efficacy of two widely used behavioral approaches for the treatment of chronic pain, 81 mildly dysfunctional chronic low back pain patients were randomly assigned to operant behavioral (OB) treatment, cognitive-behavioral (CB) treatment, or a waiting-list (WL) control condition. Both treatments, which were conducted in eight-session outpatient groups, resulted in decreased physical and psychosocial disability. The OB patients showed greater pre- to posttreatment improvement as rated by patients and their spouses than did the CB patients. Generally, the OB patients showed a leveling off in improvement at 6- and 12-month follow-ups, whereas the CB patients generally continued to improve over the 12 months following treatment. At 12-month follow-up, patients in both treatments remained significantly improved, with no significant differences between conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positively biased appraisals in everyday life: When do they benefit mental health and when do they harm it?

To promote optimal mental health, is it best to evaluate negative experiences accurately or in a positively biased manner? In an attempt to reconcile inconsistent prior research addressing this question, we predicted that the tendency to form positively biased appraisals of negative experiences may reduce the motive to address those experiences and thereby lead to poorer mental health in the context of negative experiences that are controllable and severe but lead to better mental health in the context of controllable negative experiences that are less severe by promoting positive feelings without invoking serious consequences from unaddressed problems. In 2 longitudinal studies, individuals in new marriages were interviewed separately about their ongoing stressful experiences, and their own appraisals of those experiences were compared with those of the interviewers. Across studies, spouses' tendencies to form positively biased appraisals of their stressful experiences predicted fewer depressive symptoms over the subsequent 4 years among individuals judged to be facing relatively mild experiences but more depressive symptoms among individuals judged to be facing relatively severe experiences. Furthermore, in Study 2, these effects were mediated by changes in those experiences, such that the interaction between the tendency to form positively biased appraisals of stressful experiences and the objectively rated severity of initial levels of those experiences directly predicted changes in those experiences, which in turn accounted for changes in depressive symptoms. These findings suggest that cognitive biases are not inherently positive or negative; their implications for mental health depend on the context in which they occur. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Knowledge and beliefs of dentists regarding temporomandibular disorders and chronic pain

To assess the knowledge and beliefs of practicing dentists regarding temporomandibular disorders and chronic pain, a random sample of dentists in the Kansas City metropolitan area was surveyed. A survey instrument examining knowledge and beliefs in four domains (psychophysiological, psychiatric disorders, chronic pain, and pathophysiology) was used. The responses of the practicing dentists were compared to the responses of panels of experts. Results indicated that dentists generally agreed with experts in the psychophysiological and psychiatric disorders domains but disagreed with the experts in the chronic pain and pathophysiology domains. Specialists and general dentists did not differ from one another in their responses. The findings partially replicate an earlier, similar survey of dentists in the Seattle, Washington, area. The findings suggest that the role of psychiatric disorders and psychophysiologic factors in the etiology of temporomandibular disorders is widely acknowledged by practicing dentists. However, there is considerable discrepancy between practicing dentists and temporomandibular disorder experts on the pathophysiology of temporomandibular disorders and how best to diagnose and treat these chronic conditions.     

Control of pain initiation by endogenous cannabinoids

The potent analgesic effects of cannabis-like drugs and the presence of CB1-type cannabinoid receptors in pain-processing areas of the brain and spinal cord indicate that endogenous cannabinoids such as anandamide may contribute to the control of pain transmission within the central nervous system (CNS). Here we show that anandamide attenuates the pain behaviour produced by chemical damage to cutaneous tissue by interacting with CB1-like cannabinoid receptors located outside the CNS. Palmitylethanolamide (PEA), which is released together with anandamide from a common phospholipid precursor, exerts a similar effect by activating peripheral CB2-like receptors. When administered together, the two compounds act synergistically, reducing pain responses 100-fold more potently than does each compound alone. Gas-chromatography/mass-spectrometry measurements indicate that the levels of anandamide and PEA in the skin are enough to cause a tonic activation of local cannabinoid receptors. In agreement with this possibility, the CB1 antagonist SR141716A and the CB2 antagonist SR144528 prolong and enhance the pain behaviour produced by tissue damage. These results indicate that peripheral CB1-like and CB2-like receptors participate in the intrinsic control of pain initiation and that locally generated anandamide and PEA may mediate this effect.     

Reconstructing memory for emotions.

This research assessed the stability of peoples' memory for their past emotions over time and the role of changing appraisals in accounting for biases in emotion recall. Following Ross Perot's abrupt withdrawal from the presidential race in July 1992, supporters (N?=?227) rated their initial emotional reactions and described their interpretations of the event. After the elections in November, supporters (N?=?147) again recalled their initial emotional reactions and described their current appraisals of Perot. In contrast to some current models, memories for past emotions were not indelible, and a general tendency to overestimate the intensity of past emotions was not observed. Rather, systematic distortions in emotion recall were found in the direction of consistency with current appraisals. These findings support the conclusion that memories for emotional responses are partially reconstructed or inferred on the basis of current appraisals of events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing the reliability and validity of pain intensity measurement in chronic pain patients

This study examined the effects of increasing the number of assessments on the reliability and validity of measures of average pain intensity. Two hundred chronic pain patients completed 2 weeks of hourly pain ratings. A series of regression analyses were performed, and test-retest stability, internal consistency and validity coefficients were computed to address 4 questions. (1) Are chronic pain patients' reports of pain similar from one day to another? (2) What is the reliability and validity of a single rating of pain intensity when used as an indicant of average pain? (3) How many assessments (data points) are required to obtain estimates of average pain intensity with adequate to excellent psychometric properties? (4) How important is it to sample pain from different days? The results were consistent with predictions based on patients' self-reports of their pain and on psychometric theory. First, the majority of patients did not report similar levels of pain from one day to another, and average pain scores calculated from ratings obtained from a single day were less stable than those calculated from ratings obtained from multiple days. Also, and as expected, the results indicate that a single rating of pain intensity is not adequately reliable or valid as a measure of average pain. However, a composite pain intensity score calculated from an average of 12 ratings across 4 days demonstrated adequate reliability and excellent validity as a measure of the average pain in this sample of chronic pain patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases

The placebo effect will have a growing importance in the field of nuclear medicine as the potentials for palliative therapy with internal sources are realized. It is important for nuclear medicine physicians and their colleagues to be familiar with the role of placebo responses in clinical trials, especially when such trials involve the subjective assessment of pain. A summary of the literature on the placebo effect in pain studies is presented in which traditional values for placebo responses are contrasted with more current thinking in the field. The few published double-blind studies of pain relief after treatment with radiotherapeutic agents are summarized specifically with respect to their cited placebo response.