Utility of selected MMPI-2 scales in the outcome prediction for patients with chronic back pain.

The predictive utility of selected scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher et al, 1989) was examined in relation to a number of physical and psychosocial measures of treatment outcome in patients reporting chronic back pain. MMPI-2 scales assessing manifestations of emotional distress were considered: anxiety (Scale 7 [Pt]: Anxiety [ANX] and Obsessiveness [OBS]), depression (Scale 2 [D]: Depression [DEP]), and somatic discomfort (Scale 1 [Hs]: Lassitude-Malaise [Hy3], Somatic Complaints [Hy4], and Health Concerns [HEA]). The outcome results at 6-month follow-up for 120 patients who participated in a 4-week outpatient multimodal treatment program were examined. Results showed several of the selected scales to be predictive of less improvement, depending on the outcome measures used. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived self-efficacy and outcome expectancies in coping with chronic low back pain

RNA free energy landscapes are analysed by means of "time-series" that are obtained from random walks restricted to excursion sets. The power spectra, the scaling of the jump size distribution, and the scaling of the curve length measured with different yard stick lengths are used to describe the structure of these "time series". Although they are stationary by construction, we find that their local behavior is consistent with both AR(1) and self-affine processes. Random walks confined to excursion sets (i.e., with the restriction that the fitness value exceeds a certain threshold at each step) exhibit essentially the same statistics as free random walks. We find that an AR(1) time series is in general approximately self-affine on timescales up to approximately the correlation length. We present an empirical relation between the correlation parameter rho of the AR(1) model and the exponents characterizing self-affinity.     

Active and passive coping strategies in chronic pain patients

This study assessed the validity of active and passive coping dimensions in chronic pain patients (n = 76) using the Coping Strategies Questionnaire and the Vanderbilt Pain Management Inventory. The validity of active and passive coping dimensions was supported; passive coping was strongly related to general psychological distress and depression, and active coping was associated with activity level and was inversely related to psychological distress. In addition, the Coping Strategies Questionnaire was found to be a more psychometrically sound measure of active and passive coping than the Vanderbilt Pain Management Inventory.     

Assessment of chronic back pain patient characteristics using factor analysis of the MMPI-2: which dimensions are actually assessed?

Guided by the study of Deardorff et al. (Pain, 54 (1993) 153-158), the MMPI-2 data from 240 chronic back pain patients were factor-analyzed in an attempt to discern the most important dimensions for this patient population. Principal components analysis with an oblique rotation revealed four underlying factors: Psychological disturbances, Extraversion-introversion, Passivity, and Somatic complaints. The factor structure reported by Deardorff et al. was thus successfully replicated. The stability of the factors was also supported using random split subsamples. External measures relevant to pain were used to investigate the external validity of Somatic complaints in a subsample of patients (n=93). Relations were found to number of painful sites, Waddell signs, fear of movement (maximal isometric flexion and extension performance by dynamometry, and cardiovascular fitness (VO2-max). Substantial differences emerged across genders. The derived MMPI-2 dimensions appear to constitute important characteristics associated with chronic pain. It is concluded that MMPI-2 research into chronic pain may become more productive when the instrument and its clinical correlates are examined within a clear conceptual framework of distress and personality relevant for chronic pain and its treatment.     

Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: A test of mediation and moderation models.

Symptom-specific reactivity to stress (lower paraspinal muscle reactivity) among chronic low back pain (CLBP) patients may exacerbate chronic pain. It was hypothesized that among CLBP patients (N?=?107) only stress-induced lower paraspinal reactivity, and not reactivity in other indexes, would predict pain severity (PS), and that lower paraspinal reactivity would mediate or moderate links between depression and PS. Electromyogram readings from lower paraspinal and trapezius muscles, systolic and diastolic blood pressures, and heart rate were collected during mental arithmetic (MA) and an anger recall interview. The moderator hypothesis was supported: Only lower paraspinal reactivity during MA was related significantly to PS, but only among patients with high levels of depression. Thus, a profile of lower paraspinal hyperreactivity plus depressed affect may aggravate CLBP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance user MMPI-2 profiles: predicting failure in completing treatment

Induced pathogenicity in animals and humans differs considerably. This review is devoted to the relations between Brucella spp. and professional phagocytes, particularly macrophages and macrophagic cell lines in vitro. Although numerous studies have been reported, the type of ingestion by macrophages, the receptor involved, and the molecular mechanisms, are poorly understood. The ability of most Brucella species to actively inhibit their ingestion by neutrophils or macrophages has been proposed as an explanation for the poor rate of in vitro phagocytosis and in vivo alteration of the phagocytic cells. Oxidative burst plays a significant role in the antibacterial processes of phagocytic cells. The effects of whole or fractioned B. abortus on the ability of neutrophils to induce an oxidative burst in response to stimulation with opsonized zymosan particles were examined. Besides oxygen-based killing, the phagocytic cells have developed other types of defence, including hydrolytic enzymes and reactive halides. Inside the cell, the bacteria encounter new environmental conditions. Their survival is conditioned by an adaptation to this new situation. Pathogens that have acquired the ability to multiply within macrophages should synthesize products specifically interacting with the host cell defence system. Survival of intracellular pathogens is closely linked to the mechanisms of evasion from cellular defences. Brucellae stay in membrane bound vacuoles called phagosomes, but the exact nature and the maturation pathway of this compartment have not yet been understood. Macrophages play a central role in the evolution of brucellosis; this first interaction between the pathogens and the cell will determine the course of the disease. There are natural differences between brucellae species regarding macrophage response to the bacteria.     

Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with chronic back pain and previously asymptomatic low-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: The role of previously asymptomatic low-grade isthmic spondylolisthesis in chronic adult low back pain is unclear. Operative intervention in this setting is controversial. METHODS: Twenty-four consecutive adult patients with chronic low back pain and low-grade isthmic spondylolisthesis first detected during routine work-up of new onset low back pain underwent spinal fusion with or without decompression. The influence of active worker's compensation or litigation claims, radicular pain, concomitant laminectomy, age, gender, fusion to L4, intervertebral disc bulge, and pseudarthrosis were investigated. RESULTS: All 13 patients involved in worker's compensation claims or pending litigation had fair or poor results. Nine of 11 patients without such issues had good or excellent results. Although the strong association of worker's compensation with poor results made it difficult to assess the importance of other risk factors, the data suggest that good results may be more likely in patients with radiculopathy who undergo laminectomy. CONCLUSIONS: This investigation, although limited by a number of factors including small sample size and retrospective, unblinded review, suggests that active worker's compensation and litigation issues are associated strongly with poor results of operative management for chronic low back pain in adult patients with low-grade spondylolisthesis.     

Assessment of stress-related psychophysiological reactions in chronic back pain patients.

Compared the relationship of paraspinal EMG reactivity to personally relevant and general stress among 17 chronic back pain (CBP) patients, 17 non-back-pain patients, and 17 healthy controls. The 3 experimental groups were matched according to sex, age, marital status, education, and employment level. 78% of the Ss were male; 72% were married. The Ss ranged in age from 23 to 73 yrs. Ss participated in a psychophysiological assessment that included 4 trials (discussions of personal stress and pain, mental arithmetic, and reciting the alphabet). Paraspinal and frontalis EMG, heart rate, and skin resistance were recorded continuously. Psychological variables (e.g., depression and perceived control) were also assessed. Results indicate that CBP Ss displayed elevations and delayed return to baseline only in their paravertebral musculature and only when discussing personally relevant stress. Neither of the other groups displayed similar response patterns. Abnormal muscular reactivity was best predicted by depression and manner of coping with pain rather than by organic variables. These results suggest that the assessment of stress-related responses may be important in the evaluation and treatment of CBP. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Avoidance and confrontation of painful, back-straining movements in chronic back pain patients

Avoidance of painful activities has been proposed to be an important risk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants were first classified as avoiders or confronters. In comparison with confronters, avoiders reported greater frequency and duration of pain, higher fear of pain and injury, more disability in daily living, and more attention to back sensations. Finally, avoiders reported more fear of (re)injury during the behavioral test and had a worse performance than confronters. The results suggest a close link between the fear of pain/(re)injury on one hand and avoidance behavior and physical deconditioning on the other hand.     

The comparability of MMPI and MMPI-2 scales and profiles.

The revised form of the Minnesota Multiphasic Personality Inventory (MMPI-2) incorporates a number of changes that necessitate an investigation into the comparability of its scale scores and clinical profile to those of the original MMPI. In the current study, differences between scores obtained by 189 college students who completed both the original and revised forms of the MMPI were compared with differences between scores obtained by 188 other students who were administered the original form twice. Results indicated substantial congruence between the cross-administration stability of scores and profiles obtained by the two groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lumbar strengthening in chronic low back pain patients. Physiologic and psychological benefits

The effects of exercise for isolated lumbar extensor muscles were examined in 54 chronic low-back pain patients. Subjects were randomly assigned to a 10-week exercise program (N = 31) or a wait-list control group (N = 23). Results indicated a significant increase in isometric lumbar extension strength for the treatment group and a significant reduction in reported pain compared with the control group (P 0.05). Treated subjects reported less physical and psychosocial dysfunction whereas the control group increased in pain, and physical and psychosocial dysfunction. There were no concomitant changes in reported daily activity levels. These results show that lumbar extension exercise is beneficial for strengthening the lumbar extensors and results in decreased pain and improved perceptions of physical and psychosocial functioning in chronic back pain patients. However, these improvements were not related to changes in activities or psychological distress.     

MMPI-2 profiles of motivated fakers given specific symptom information: A comparison to matched patients.

Two groups of normal adults were given specific symptom information on posttraumatic stress disorder (PTSD) and paranoid schizophrenia, respectively, and instructed to simulate these disorders on the MMPI-2. Monetary prizes were offered for successful faking. To determine whether symptom information helped Ss produce responses that closely resembled patients' profiles, scores from fakers were compared with scores from patients with these disorders, using a 2?×?2 (Disorder?×?Response Style) ANOVA. Results showed significant differences for response style, with fakers in both groups producing lower scores on K and higher scores on F, Fb, F–K, Ds, as well as on all 10 clinical scales, than patients. The findings suggest that having specific information about the symptoms of psychological disorder does not enable fakers to avoid detection and/or produce profiles equivalent to those produced by patients with the disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients.

Anger may have greater effects on chronic pain severity than other negative emotions and may do so by increasing muscle tension near the site of injury (symptom-specific reactivity). For patients with chronic low back pain (CLBP), relevant muscles are lower paraspinals (LP). Ninety-four CLBP patients and 79 controls underwent anger and sadness recall interviews. EMG and cardiovascular activity were recorded. Patients exhibited greater LP tension increases during anger and slower recovery than controls. Only patients showed greater LP reactivity during anger than sadness. For both groups, trapezius reactivity during anger and sadness did not differ. LP reactivity to anger correlated with everyday pain severity for patients. Anger-induced symptom-specific LP reactivity may be linked to chronic pain aggravation among CLBP patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregiver models of self and others, coping, and depression: Predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed, and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

有氧运动对治疗慢性下背痛的疗效

目的:探索有氧运动对治疗慢性下背痛疗效的影响.方法:选择社区医疗服务中心40例病史3个月以上的下背痛患者,采用电脑随机方法将受试者分为两组:一组为实验组,进行有氧训练;另一组为对照组,不接受任何训练计划.对照组和实验组分别在干预介入前与介入后进行下背痛失能程度量表和疼痛评分(Visual Analogue Scale,VAS).结果:治疗12周后,发现实验组在治疗后欧式下背痛失能程度显著小于对照组,且VAS评分结果显著优于对照组.结论:有氧运动可以改善慢性下腰痛患者的疼痛程度及改善其失能状况.     

Role of self-efficacy in rehabilitation outcome among chronic low back pain patients.

Examined the role of self-efficacy beliefs in the rehabilitation of 45 low back pain patients participating in a 3-wk rehabilitation program. Increments in self-efficacy beliefs during the rehabilitation program were not associated with improved patient functioning at discharge from the program. However, in support of the theorized role of self-efficacy in behavior change, these increments in self-efficacy significantly predicted better patient functioning and less reported pain at the 6-mo follow-up assessment. Implications of these findings for the rehabilitation of low back pain patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI-2 profiles of women differing in sexual abuse history and sexual orientation

Four groups of women (N = 115) self-identified as having histories of childhood sexual abuse or no such histories and self-identified as either heterosexual or lesbian were compared using a questionnaire and the MMPI-2. Subjects ranged in age from 21-60 years with 60% between ages 30-50 years. Results of a Three-Way MANOVA for abuse history and sexual orientation repeated across MMPI-2 clinical scales showed a between-subjects effect for abuse, and within-subjects effects for orientation and abuse. T scores of women with abuse histories were significantly higher than those of women without abuse histories on Hs, D, Pd, Pa, Pt, Sc, and Ma scales of the MMPI-2. Profiles indicated an 8-4 codetype and a Scarlett O'Hara V configuration for the group with abuse history. Heterosexual women obtained significantly higher t scores than did lesbians on the Depression scale. Results show that the MMPI-2 can be used to help detect lesbian as well as heterosexual adults who were sexually molested as children.     

Cross-Cultural Equivalence and Validity of the Vietnamese MMPI-2: Assessing Psychological Adjustment of Vietnamese Refugees.

The cross-cultural equivalence and validity of the Vietnamese translation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were examined in a sample of 1st-generation Vietnamese refugees in the United States (N = 143). Respondents completed the Vietnamese MMPI-2, the Harvard Trauma Questionnaire, a measure of acculturation, and a demographic questionnaire. An inspection of MMPI-2 mean profiles and items showing extreme endorsement rates suggested that certain symptom tendencies and cultural values may be reflected in responses to some MMPI-2 items. Older age, lower acculturation, greater experienced premigration-postmigration traumas, and military veteran status were all associated with elevated MMPI-2 profiles, suggesting that the MMPI-2 functions in a reasonably equivalent and valid way in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between isoinertial lumbar dynamometry parameters and demographic parameters in chronic low back pain patients

The purpose of this study was to investigate which demographic parameters are most important in relation to lumbar dynamometry performance in patients with chronic low back pain (LBP). Forty-five chronic LBP patients participated in this study. Gender, age, weight and height were determined and a lumbar dynamometry measurement was carried out, using the Isostation B200. Student's t-test, ANOVA techniques and correlation coefficients were used to investigate the relationships between each demographic parameter and lumbar dynamometry performance. Stepwise multiple linear regression analyses were performed afterwards to determine which demographic parameters are most important in relation to lumbar dynamometry performance. Results indicate significant relationships (1) between gender, height, weight and all lumbar dynamometry parameters and (2) between age and three of the six isometric torque parameters. No significant relationship was found between age and maximum velocity parameters. Results of the stepwise multiple linear regression analyses show that the demographic parameters explain 27-47% of the variance in maximum isometric strength parameters and 19-25% of the variance in maximum velocity parameters. Gender is the most important demographic parameter, being related to nearly all maximum isometric torque parameters (percentage explained variance 6-37%) and height is the only important demographic parameter related to the velocity parameters (percentage explained variance 19-25%). Weight and age account for only a small amount of variance in lumbar dynamometry parameters (percentage explained variance 5-7%), meaning that these parameters are non-relevant predictors.