Specificity of Stroop interference in patients with pain and PTSD.

The authors investigated processing of threat words in motor vehicle accident survivors using a modified Stroop procedure. Three samples were included: 28 participants with comorbid posttraumatic stress disorder (PTSD) and pain, 26 participants with pain without PTSD, and 21 participants without pain or any psychiatric conditions. Four word categories were used: (a) accident words, (b) pain words, (c) positive words, and (d) neutral words. This study examined whether processing biases would occur to accident words only in participants with PTSD or if these biases would also be noted in the No PTSD/Pain sample. Additionally, this study examined whether processing biases would be noted to pain words in the 2 pain samples, irrespective of PTSD. Overall, color naming was significantly slower in the PTSD/Pain group in comparison with the other groups. As well, the PTSD/Pain sample showed significant response delays to both accident and pain-related words, whereas patients with No PTSD/Pain showed delays to pain stimuli only. (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)     

Brief Symptom Inventory norms for spinal cord injury.

Investigated the effects of spinal cord injury (SCI) upon a person's response to the Brief Symptom Inventory (BSI) by analyzing differences across item-response distributions from 225 Ss with SCI (aged 17–68 yrs) vs a nonpatient normative sample of 719 Ss. The study also developed more appropriate BSI normative data for persons with SCI. Because Ss' time since injury varied at time of BSI administration, normative scores were provided within 3 groupings: at discharge from the hospital; 0–24 mo post-discharge; and beyond 24 mo. Results show that SCI Ss had higher BSI scores when compared with Ss in the normative sample. These differences were particularly significant across 8 BSI items that reflected actual SCI physical and psychosocial symptoms. SCI Ss reported more distress during the period immediately following discharge to 24 mo. Overall, BSI scores tended to be lower at discharge and after 24 mo post-discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between the MMPI-2 and psychosocial measures in a heterogeneous pain population.

Objective: A prior study demonstrated the utility of an MMPI-2 profile pattern, formerly known as the "Floating Profile," for identifying treatment complications in the context of pain management. Retermed the "Disability Profile" (DP), this profile comprised a large proportion of the chronic musculoskeletal pain sample studied, and it was associated with several negative treatment outcomes. Method: This current study was designed to further evaluate the DP, but within a more heterogeneous pain population, while also comparing 3 other MMPI-2 profile patterns and 5 specific pain categories on behavioral and psychosocial measures administered at an initial intake evaluation. A total of 755 participants were evaluated. Results: Results clearly demonstrated the utility of the DP, with its association with significant impairment and disability in the pain population at the intake evaluation. Conclusions: A heterogeneous pain population is likely to include a number of individuals who demonstrate a pattern of behavior consistent with the initial findings of the DP characteristics. Those participants demonstrating a DP appear to have more complications during treatment and will likely require more thorough interventions at multiple points during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General health factors and denture function in patients with burning mouth syndrome and matched control subjects

A total of 30 denture-wearing patients with burning mouth syndrome (BMS) referred to a Pain Clinic Unit and 26 age- and sex-matched control subjects were examined and compared with respect to general health factors and denture function. The study demonstrated a significantly higher frequency of multiple chronic diseases, psychosocial stress factors, and tenderness/pain in masticatory, neck, shoulder, and suprahyoid muscles in patients with BMS. Denture function differed also between the two groups as patients with BMS had significantly less daily use of dentures, reduced tongue space, incorrect placement of occlusal table and increased vertical dimension. Pain interview with the use of the McGill Pain Questionnaire demonstrated that pain in parts of the body other than the oral cavity were reported more frequently and that the intensity of past pain experiences was not rated higher except for pain in the head in patients with BMS. The results suggested a complex interaction between several general health factors, psychosocial stressors and denture dysfunction in order to explain an idiopathic burning pain in the anterior part of the oral cavity. The existence of demonstrable load factors does not seem to support the suggestion that BMS is primarily a psychogenic disorder.     

Psychological interventions for arthritis pain management in adults: A meta-analysis.

Context: The psychosocial impact of arthritis can be profound. There is growing interest in psychosocial interventions for managing pain and disability in arthritis patients. Objective: This meta-analysis reports on the efficacy of psychosocial interventions for arthritis pain and disability. Data Sources: Articles evaluating psychosocial interventions for arthritis were identified through Cochrane Controlled Trials, EMBASE, Ovid MEDLINE, and Ovid PsycINFO data sources. Study Selection: Randomized controlled trials testing the efficacy of psychosocial interventions in arthritis pain management were reviewed. Data Extraction: Twenty-seven randomized controlled trials were analyzed. Pain intensity was the primary outcome. Secondary outcomes included psychological, physical, and biological functioning. Data Synthesis: An overall effect size of 0.177 (95% CI = 0.256-0.094) indicated that patients receiving psychosocial interventions reported significantly lower pain than patients in control conditions (combined p = .01). Meta-analyses also supported the efficacy of psychosocial interventions for the secondary outcomes. Conclusions: These findings indicate that psychosocial interventions may have significant effects on pain and other outcomes in arthritis patients. Ample evidence for the additional benefit of such interventions over and above that of standard medical care was found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of psychosocial features of employment status on emotional distress in chronic pain and healthy comparison samples

This study examined the extent to which measures of psychosocial features of employment status predict emotional distress in chronic pain (n = 83) and healthy comparison (n = 88) samples. Participants completed measures of emotional distress, pain severity, psychosocial features of employment status, and demographic data. After controlling for length of current unemployment, number of pain sites, and level of current pain severity, psychosocial measures (structured and purposeful time use, perceived financial security, skill use, social support form formal sources) were significant predictors of emotional distress in the chronic pain sample. Similar results were obtained for the healthy comparison sample. Structured and purposeful time use emerged as the most significant individual predictor of emotional distress for both samples. Findings are discussed in terms of their potential implications for treating chronic pain patients and the need to develop multidimensional measures that assess features of employment status within chronic pain samples.     

A high-risk method for studying psychosocial antecedents of chronic pain: The prospective investigation of herpes zoster.

Although patients with chronic pain (CP) are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of CP or whether it is caused by the experience of living with CP. This investigation aimed to develop a method that would allow individuals who are at risk for the development of CP to be studied before the pain has become chronic. Patients with acute herpes zoster (HZ) were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 wks and 3, 5, 8, and 12 mo after these initial assessments. There were no significant differences between Ss who developed short-term HZ pain and Ss who did not develop short-term pain for any of the measures at the initial assessment, except for 1 measure of pain intensity. Ss who developed HZ CP, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than Ss who did not develop CP. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating Ss who did and did not develop CP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial and Ethnic Disparities in the Evaluation and Treatment of Pain: Psychological Perspectives.

Pain is the medical symptom that most often propels people to seek medical care. Because psychosocial problems often complicate treatment, patients in pain frequently require psychological care as well. Recent evidence demonstrates that the standard of care for racial-ethnic minorities is inferior to that for Caucasians. This article reviews the literature regarding disparities in pain treatment from patient, provider, and public health perspectives. Psychologists, both academic and clinical, are uniquely positioned to clarify factors that underlie disparities and to offset inequities in clinical settings. If racial-ethnic disparities in pain treatment are to be eliminated, psychologists must take an active role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of pain interference in multiple sclerosis.

Objectives: To describe pain interference and explore its associations with several indexes of health and psychosocial functioning among veterans with multiple sclerosis (MS). Study Design: Cohort study linking computerized medical records and survey questionnaire. Participants: Four hundred fifty-one veterans with MS. Outcome Measures: Pain Effects Scale, Patient Health Questionnaire, Modified Social Support Survey, items from the Short Form Health Survey and the North American Research Consortium on MS Registry Survey (NARCOMS) Performance Scales. Results: Participants reported a moderate level of overall pain interference. Increased fatigue, poorer general health, and greater depression symptom severity each were significantly associated with higher levels of pain interference. Conclusions: Pain interference in MS is associated with a variety of other clinically meaningful indexes of functioning. Pain in MS should be treated aggressively to minimize functional impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An examination of the co-morbidity between chronic pain and posttraumatic stress disorder on U.S. Veterans.

The purpose of this study was to assess the comorbidity between chronic pain and posttraumatic stress disorder (PTSD) and examine the extent to which PTSD is associated with changes in the multidimensional experience of pain in a sample of Veterans with chronic pain. It was hypothesized that Veterans with comorbid chronic pain and PTSD would report significantly higher scores on measures of pain intensity, pain behaviors, pain-related disability, and affective distress than Veterans with pain alone. Data were obtained from 149 Veterans who completed self-report questionnaires as part of their participation in a Psychology Pain Management program at a northeastern Department of Veterans Affairs health care facility. Analyses indicated that 49% of the sample met criteria for PTSD. A multivariate analysis of covariance was conducted with age, sex, pain duration, and depressive symptom severity as covariates. In partial support of our hypothesis, the presence of PTSD was found to contribute significantly to measures of affective distress, even after controlling for the effects of depressive symptom severity. The implications of these data are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain

OBJECTIVE: To examine in a prospective manner the long-term safety and efficacy of chronic intrathecal morphine in patients with severe, nonmalignant pain refractory to less invasive modalities. METHODS: Forty patients with severe, chronic nonmalignant pain poorly managed by systemic medications were identified as candidates for intraspinal trial of morphine. Thirty participants reported successful pain relief during trial and were implanted with an intraspinal delivery system. Standardized measures of pain and functional status were assessed before treatment was begun and at defined intervals during the subsequent 24 months. Intrathecal opioid use and pharmacological and device-related complications were also monitored. RESULTS: The participants had a mean age of 58 +/- 13 years and a mean pain duration of 8 +/- 9 years. Fifty-three percent of the study participants were women. Pain type was characterized as mixed neuropathic-nociceptive (15 of 30 patients, 50%), peripheral neuropathic (10 of 30 patients, 33%), deafferentation (4 of 30 patients, 13%), or nociceptive (1 of 30 patients, 3%). Forty-seven percent of the patients were diagnosed with failed back surgery syndrome. Significant improvement over baseline levels of visual analog scale pain was measured at each follow-up examination after implant. Overall, 50% (11 of 22 patients) of the population reported at least a 25% reduction in visual analog scale pain after 24 months of treatment. In addition, the McGill Pain Questionnaire, visual analog scale measures of functional improvement and pain coping, and several subscales of the Chronic Illness Problem Inventory showed improvement throughout the follow-up period. Pharmacological side effects were managed medically by morphine dose reduction, addition of bupivacaine, or replacement of morphine with hydromorphone. Device-related complications requiring repeat operations were experienced by 20% of the patients. CONCLUSION: Continuous intrathecal morphine can be a safe, effective therapy for the management of severe, nonmalignant pain among a carefully selected patient population and can result in long-term improvement in several areas of daily function.     

Detection of IgA anti-PGL-I specific antigen to Mycobacterium leprae in mangabey monkeys inoculated with M. leprae

OBJECTIVE: This study examined the reliability of the three-cluster model for chronic low back pain patients found using the Integrated Psychosocial Assessment Model (IPAM). A replication study using a sample of patients from a different country was completed. PATIENTS: Seventy patients (average age = 47.05 years, SD = 16.11) with chronic low back pain of noncancer origin participated in the study. Sixty-two of these patients were attending The Auckland New Zealand Regional Pain Service, while a further eight were attending a private practice pain service in Auckland. OUTCOME MEASURES: Subjects were assessed on the IPAM, which measures pain intensity, disability, coping strategies, attitudes towards and beliefs about pain, depression and illness behaviour, the Medical Examination and Diagnostic Information Coding System, and the Multidimensional Pain Inventory. RESULTS: Cluster analyses using the kappa-means algorithm were performed on the IPAM data. The three-cluster solution was preferred according to both the Variance Ratio Criterion and cluster interpretability. Two of the three clusters correlated highly with clusters retrieved in the original study (r = 0.78, r = 0.71), while the third cluster showed partial resemblance (correlation of r = 0.31). Clusters were named "In Control," "Depressed and Disabled," and "High Deniers and Somatizisers." No differences were found on the physical pathology scores between clusters. Decision rules for cluster assignation resulted in 68% of the sample being correctly assigned. CONCLUSIONS: Support for this cluster model from two countries suggests its value in providing a multidimensional picture of patients with chronic low back pain. The possibility of using such cluster groups for determining treatment type is discussed.     

Transition to chronic pain in men with low back pain: Predictive relationships among pain intensity, disability, and depressive symptoms.

Pain intensity, disability, and depressive symptoms are hallmarks of chronic pain conditions, but little is known about the relationships among these symptoms in the transition from acute to chronic pain. In this study, an inception cohort of men with low back pain (N?=?78) was assessed at 2, 6, and 12 months after pain onset. At 6 months, pain intensity, disability, and depressive symptoms were predicted only by their respective levels at 2 months after pain onset. At 12 months, pain intensity and depressive symptoms were predicted by heightened disability at 6 months after pain onset; 12-month depressive symptoms also were predicted by 2-month disability. Pain intensity was not predictive of changes in disability or depressive symptoms. These findings suggest that functional disability plays a more prominent role than pain intensity in the transition from acute to chronic pain. A "failure to adapt" conceptual model is presented to account for these results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Variable Responding Scale for detection of random responding on the Multidimensional Pain Inventory.

This study developed a scale for detecting random responding on the Multidimensional Pain Inventory (MPI). Ninety-five undergraduates (derivation sample) completed the MPI randomly, as did 2 cross-validation samples, 34 chronic pain patients (pain) and 115 health care professionals (health care). Up to 71% of random profiles appeared valid. For comparison in validity scale development, a clinical MPI sample (N?=?507) was split into derivation and cross-validation samples. Given that responses to similar items should be consistent in nonrandom protocols, 8 pairs of highly intercorrelated items were selected. Absolute differences between pairs were summed into a variable responding (VR) scale; scores were contrasted across clinical and random groups. On the basis of derivation sample results, VR scale cut scores (from 12 to 17) were tested and found to discriminate accurately (p?     

A randomized controlled trial of hypnosis for burn wound care.

Purpose/Objective: There have been few randomized controlled studies on the effectiveness of clinical hypnotic analgesia. The authors' goal was to improve on previous methodologies and gain a better understanding of the effects of hypnosis on different components of pain in a clinical setting. Research Method/Design: This study used a randomized controlled design in which the nurses and data collectors were unaware of treatment condition to compare hypnotic analgesia with an attention-only placebo for burn pain during wound debridements. Data were analyzed on a total of 46 adult participants. Results: The authors found that the group receiving hypnosis had a significant drop in pain compared with the control group when measured by the McGill Pain Questionnaire but not when measured by other pain rating scales. Conclusion: The McGill Pain Questionnaire total score reflects multiple pain components, such as its affective component and various qualitative components, and is not merely a measure of pain intensity. Thus, the findings suggest that hypnosis affects multiple pain domains and that measures that assess these multiple domains may be more sensitive to the effects of hypnotic analgesia treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported suicidal ideation in adolescent psychiatric inpatients.

In an investigation of the psychosocial correlates of suicidal ideation in adolescent inpatients, the Beck Scale for Suicide Ideation (BSI) was administered to 108 inpatients between 12 and 17 yrs of age who were diagnosed with mixed psychiatric disorders. A series of multiple regression analyses that controlled for gender, ethnicity, age, diagnosis of a mood disorder, and a history of a past suicide attempt were then used to examine the relationships of the Beck Depression Inventory, Anxiety Inventory, and Hopelessness Scale (BHS) with the BSI. Regardless of the series, the BHS contributed unique variance to the explanation of the BSI scores. The results are discussed as supporting the use of the BSI with adolescent inpatients and indicating that hopelessness is related to suicidal ideation when depression is controlled for. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The chronology and sequence of eruption of human permanent teeth in Northern Ireland

OBJECTIVE: To investigate the use of pain coping strategies by community-living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability. METHODS: A group of 157 people with pain "in the last month" was identified. Coping with pain was assessed with the Pain Coping Inventory, physical disability with the Sickness Impact Profile, and household and sport activities with a validated structured interview method. RESULTS: People with chronic pain used relatively more "resting," and "reducing demands" as pain coping strategies. Pain chronicity made a significant contribution to physical disability; however, when corrected for other variables in a regression model, no significant partial correlation was found. CONCLUSION: We conclude that pain coping has a mediating role in the relationship between pain chronicity and physical disability. Less use of "resting" and a physically active lifestyle are independently associated with less physical disability.