Pain-related correlates of MMPI profile subgroups among back pain patients.

96 17–80 yr old male and 218 16–83 yr old female outpatients at a back pain clinic were administered the Cornell Medical Index, the Minnesota Multiphasic Personality Inventory (MMPI), the McGill Pain Assessment Questionnaire—Revised, and the Shipley Institute of Living Scale. Analysis showed greater disruption of daily activities and affective disturbance and poorer adjustment to pain among subgroups with elevated neurotic scales. Results are consistent with those of similar studies of chronic pain patients showing that MMPI profile subgroups may be identified that are associated with relatively unique pain-related correlates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musculoskeletal status and disability of MMPI profile subgroups among patients with low back pain.

Studied Minnesota Multiphasic Personality Inventory (MMPI) profiles of 362 patients with acute and chronic low back pain (LBP) for replicable homogeneous subgroups using 3 cluster-analysis procedures. Two normal and 3 clinically elevated profile subgroups were identified. The 2 normal subgroups were characterized by relatively normal musculoskeletal condition and were least disabled but differed from each other in duration of pain, presence of physical abnormalities, and daily functioning. The most pathologic profile subgroup consisted largely of acute-pain patients whose musculoskeletal condition and daily functioning were similar to those of the normal subgroups. Patients in the 3 abnormal MMPI subgroups were exposed to more LBP physical-risk factors in the workplace. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically derived MMPI profile clusters and characteristics of low back pain patients.

Analysis of the MMPI scores of 401 low-back-pain patients (average age 45 yrs) by a multivariate clustering procedure produced 5 homogeneous subgroups. Three groups with elevated MMPI profiles and 2 unelevated groups showed differences in age, employment, marital status, pretreatment pain intensity, and activity limitations. Follow-up comparisons at 6-mo and 1-yr intervals revealed that the elevated subgroups had a poorer response to treatment. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of MMPI short forms with psychiatric patients.

Compared the use of 2 MMPI short forms, the MMPI-168 and the Mini-Mult, with the complete MMPI using 2,721 psychiatric inpatients and 634 outpatients. Estimated Full Scale MMPI scores for both short forms showed very high relationships with actual Full Scale scores, and the degree of profile agreement for the 3 highest scales was also quite high, although comparisons of the MMPI-168 and Mini-Mult demonstrated a number of significant differences which affect profile interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic comparability of the MMPI in pain patients

The MMPI basic validity and clinical scales' patterns of 295 White-, African- and Latino-American pain patients were compared. Mean group differences across ethnic groups on scales L, F, K, Mf, and Si were revealed in multivariate analysis of covariance for females, while differences across ethnic groups on scales F, K, Mf, Sc, Ma, and Si were revealed for males. In the univariate follow-up analyses of covariance, significant main effects were obtained for ethnicity along with education and (occasionally for males) duration of pain. Various high-point, two-point, and other profile patterns were examined and notable gender/ethnic group differences were found. The pattern of intercorrelations of the MMPI scales mean T scores with various demographic and clinical characteristics suggested some notable divergence across subgroups on certain correlates of the pain experience.     

MMPI scales as predictors of pain-coping strategies preferred by patients with chronic pain.

Correlated pain-coping strategies preferred by 300 patients with chronic pain with their MMPI scores. Data from 2 samples of patients indicated that self-management and social support were related to good adjustment and that helplessness and medical remedies were related to poor adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The MMPI and chronic pain.

112 chronic pain patients (mean age 48.4 yrs) completed the MMPI upon entering either an anesthesiologic or a psychiatric treatment program. Pretreatment MMPI performance was found to be successful in predicting patient outcome an average of 20 mo following treatment, with the K (Test-Taking Attitude), Hypochondriasis, Hysteria, and Masculinity and Femininity scales accounting for most of the variance. The strength of this relationship varied as a function of the measure of outcome and type of treatment received. Substantial MMPI differences were found when Ss with only one part of their body in pain were compared with those with multiple pain complaints. Significant MMPI differences were also found in comparisons based on Ss' sex, type of pain (e.g., head vs back), and type of treatment for which was referred (i.e., psychiatric vs anesthesiologic). Clinical implications of the observed MMPI differences are discussed. Results are seen as demonstrating the value of the MMPI as a clinical and research instrument within this population. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk of long-term disability among patients with back pain

This follow-up study was designed to identify the differences between the TMJ movements of individuals undergoing orthognathic surgery, with and without positioning of the mandibular proximal segment. A further aim was to assess the location of the terminal hinge axis before and after surgery regarding variations due to mandibular advancement or set back, respectively combined two jaw osteotomy. Mechanical axiographic tracings were documented in 14 patients undergoing orthognatic surgery without positioning of the mandibular proximal segment. The terminal hinge axis position was marked by a tattoo. After surgery two more axiographic tracings were recorded over a follow-up period of 24 months. Changes to the terminal hinge axis position were also documented. Condylar guidance angles showed no differences, whereas Bennett angles decreased by an average of 25%. Subjective or objective TMJ symptoms after surgery could be observed in 64% of the patients, compared to 50% before surgery. Considerable variations in the position of the terminal hinge axis were observed nine months after surgery, especially in the two jaw group. In Class II individuals the terminal hinge axis was found in a cranial position both after 9 and 24 months. Class III individuals with two jaw surgery also gained a long term cranial localisation, whereas Class III patients with mandibular setback only demonstrated a hinge axis position inferior and anterior compared to the preoperative reference. No statistically significant differences were apparent between the axiographic condylar movement parameters in the present group as compared to data published employing condylar positioning.     

Evaluating back pain in older patients

Low back pain in the elderly has a much wider range of possible causes than in younger patients. In addition to nonspecific mechanical causes, malignancy presenting as back pain occurs more often in older patients. Other systemic and visceral causes of back pain such as polymyalgia rheumatica, aortic aneurysm, Paget disease, Parkinson disease, and osteoporosis with compression fracture occur almost exclusively in persons over age 50. Keys to diagnosis and management of low back pain in older patients are presented.     

Evaluating the child with back pain

The most common causes of serious low back pain in children include spondylolysis, Scheuermann disease and musculoligamentous injury. Questions should be asked about the mechanism of onset and exacerbating factors, and the frequency, duration and severity of the pain. The examination should check gait and alignment, flexibility, strength and reflexes, and localize and evaluate the pain. Warning signs of serious problems include constant pain in a child younger than 11 years of age that lasts for several weeks or occurs spontaneously at night, repeatedly interferes with school, play or sports, or is associated with marked stiffness and limitation of motion, fever or neurologic abnormalities. Pain at the lumbosacral junction may suggest spondylolysis or spondylolisthesis. Scheuermann disease is diagnosed by the observance of wedging, irregularity or growth disturbance of three successive vertebrae. Musculoligamentous pain may result from injury to or overuse of muscles or joints of the back. Rare causes include discitis, tuberculosis, bone or spinal cord tumor, pyelonephritis and retroperitoneal infection.     

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)     

Short forms of individual intelligence tests.

The literature on short forms of individual intelligence tests—Wechsler's scales in particular—is critically reviewed. The review is structured around four choice-points faced by those who study short forms: how to abbreviate the original scale, what kind of subject sample to use, how to estimate IQs on the original scale, and what criteria to apply in evaluating a short form. The review concludes with some reflections based on more than 20 years of research on short forms and the posing of two questions about which little is yet known. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Equivalence of the MMPI-2 with the MMPI in psychiatric patients.

Psychiatric patients were administered the MMPI, its revision (MMPI-2), or both, in a counterbalanced repeated-measures design. MMPI-2 T scores were found to be significantly lower than MMPI T scores on several of the clinical scales. S rank order on T scores and dispersion of the basic clinical scales did not differ between the tests, and measures of profile similarity indicated congruence between the 2 instruments. Among Ss who completed both the MMPI and the MMPI-2, code-type concordance was not significantly lower than stability rates of the tests. Results support the assignment of 65T as the lower boundary of clinical elevation on the MMPI-2 and the psychometric equivalence of the MMPI-2 and the MMPI with respect to mean T scores, score rankings, and measures of score distribution. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients with low back pain

OBJECTIVES: The aim of this study was to examine the clinical utility of low-dose oral prednisone in preventing severe paclitaxel-associated arthralgias and myalgias. METHODS: Patients treated with paclitaxel in the gynecologic oncology program of the Cleveland Clinic Foundation who developed arthralgias/myalgias which were uncontrolled through the use of nonsteroidal anti-inflammatory medications received low-dose oral prednisone (10 mg B.I.D. starting 24 h after the completion of chemotherapy and continuing for a total of 5 days) with their next paclitaxel course. RESULTS: Of 46 patients meeting the criteria for treatment with the oral prednisone regimen (i.e., subjective feeling of unacceptable discomfort despite the use of nonsteroidal anti-inflammatory agents), 39 (85%) experienced substantial relief of symptoms. All but one of the responding patients requested continuation of the oral prednisone regimen with subsequent paclitaxel treatment cycles. There were no significant toxicities noted in any patient receiving prednisone. CONCLUSION: This low-dose oral prednisone regimen results in substantial improvement in the majority of patients experiencing significant paclitaxel-associated arthralgias/myalgias.     

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)     

Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain

OBJECTIVE: We suggested fibromyalgia (FM) is a disorder associated with an altered functioning of the stress-response system. This was concluded from hyperreactive pituitary adrenocorticotropic hormone (ACTH) release in response to corticotropin-releasing hormone (CRH) and to insulin induced hypoglycemia in patients with FM. In this study, we tested the validity and specificity of this observation compared to another painful condition, low back pain. METHODS: We recruited 40 patients with primary FM (F:M 36:4), 28 patients (25:3) with chronic noninflammatory low back pain (LBP), and 14 (12:2) healthy, sedentary controls. A standard 100 microg CRH challenge test was performed with measurement of ACTH and cortisol levels at 9 time points. They were also subjected to an overnight dexamethasone suppression test, followed by injection of synthetic ACTH1-24. At 9 AM, the patients divided in 2 groups, received either 0.025 or 0.100 microg ACTH/kg body weight to test for adrenocortical sensitivity. Basal adrenocortical function was assessed mainly by measurement of 24 h urinary excretion of free cortisol. RESULTS: Compared to the controls, the patients with FM displayed a hyperreactive ACTH release in response to CRH challenge (ANOVA interaction effect p = 0.001). The mean ACTH response of the patients with low back pain appeared enhanced also, but to a significantly lesser extent (p = 0.02 at maximum level) than observed in the patients with FM. The cortisol response was the same in the 3 groups. Following dexamethasone intake there were 2 and 4 nonsuppressors in the FM and LBP groups, respectively. The very low and low dose of exogenous ACTH1-24 evoked a dose and time dependent cortisol response, which, however, was not significantly different between the 3 groups. The 24 h urinary free cortisol levels were significantly lower (p = 0.02) than controls in both patient groups; patients with FM also displayed significantly lower (p < 0.05) basal total plasma cortisol than controls. CONCLUSION: The present data validate and substantiate our preliminary evidence for a dysregulation of the HPA axis in patients with FM, marked by mild hypocortisolemia, hyperreactivity of pituitary ACTH release to CRH, and glucocorticoid feedback resistance. Patients with LBP also display hypocortisolemia, but only a tendency toward the disrupted HPA features observed in the patients with FM. We propose that a reduced containment of the stress-response system by corticosteroid hormones is associated with the symptoms of FM.     

The MMPI and chronic pain: A cross-cultural view.

The MMPI scores were studied for 430 male and 180 female Australian chronic pain patients. Analysis revealed mean MMPI profiles (i.e., elevated Hypochondriasis, Hysteria, and Depression clinical scales) and 3 cluster-analytically derived profile types that corresponded closely to findings in the literature on US chronic pain patients. Further, at least some of the behavioral correlates associated with MMPI performance among US pain patients were also found for the Australian pain patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.