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.     

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.     

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.     

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.     

Coping with health problems: Developing a reliable and valid multidimensional measure.

Current conceptions relating psychological variables to health recognize the key role of coping processes as mediating variables between stress and illness, yet few reliable and valid instruments exist for the assessment of coping with physical health problems. A self-report instrument, the Coping With Health Injuries and Problems Scale (CHIP) was developed identifying 4 basic coping dimensions for responding to health problems: distraction, palliative, instrumental, and emotional preoccupation coping. The CHIP's factor structure, established with a large derivation sample of adults, is cross-validated in a heterogenous group of general medical patients and a homogeneous group of patients being treated for lower back pain. Preliminary construct validity data are presented by comparing the coping behaviors of patients with chronic and acute illnesses and by comparing CHIP scores with basic coping styles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in pain perception after treatment for chronic pain

Pain threshold, sensitivity, response bias and ability to discriminate were measured before and after treatment for 15 improved and 15 unimproved chronic pain patients diagnosed as having myofascial pain dysfunction (MPD) syndrome, There were no differences between the groups before treatment. After treatment, the improved group showed an increase in pain threshold, sensitivity and ability to discriminate between different levels of painful stimulation and a decrease in response bias to report pain. The unimproved group showed no changes.     

Prayer as a coping strategy for chronic pain patients.

Prayer as a coping mechanism was examined in a group of 105 persons (average age 45 yrs) experiencing chronic pain for an average of 4.3 yrs. Previous research suggested that prayer may actually be associated with increased disability among individuals who develop a permanent, painful condition of 6 mo duration or longer. Assessment instruments included the Medical Coping Modes Questionnaire and 2 subscales of the West Haven-Yale Multidimensional Pain Inventory; prayer was measured by the Diverting Attention/Praying-Hoping Subscale of the Coping Strategies Questionnaire. Consistent with previous research, individuals who endorsed a greater use of prayer to cope with their pain also reported a greater degree of disability. Follow-up statistical analyses suggested that prayer was associated with avoidance suggestive of a passive coping response. Additional research is needed to clarify the relationship of prayer to avoidance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain coping strategies in osteoarthritis patients.

The present study investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic knee pain. Fifty-one patients completed the Coping Strategies Questionnaire (CSQ), the McGill Pain Questionnaire, the Arthritis Impact Measurement Scale (AIMS), and the Symptom Checklist-90 Revised (SCL-90R). Medical status variables included roentgenograph (x-ray) findings, obesity measures, disability status, and chronicity of pain. Factor analysis of the CSQ revealed two factors (Coping Attempts, Pain Control and Rational Thinking) that accounted for 60% of the variance in CSQ responses. Regression analyses controlling for demographic and medical variables identified the Pain Control and Rational Thinking factor as a significant predictor of the outcome measures. Patients scoring high on this factor had lower pain levels, better health status, and lower levels of psychological distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain.

66 chronic low back pain sufferers (aged 20–65 yrs) were randomly divided into 3 equal groups. Ss completed a psychological test battery that included the Beck Depression Inventory and the State-Trait Anxiety Inventory; pain monitoring measures, including the McGill Pain Questionnaire (MPQ); and measurement of paraspinal electromyogram (EMG). One group then received paraspinal EMG biofeedback, 1 group received placebo treatment, and the 3rd group received no intervention. All Ss were reassessed immediately after treatment and at 3-mo follow-up. Results show that all groups showed significant reductions in pain, anxiety, depression, and paraspinal EMG following treatment and at follow-up, but there were no differences between groups. A regression analysis failed to identify Ss' characteristics that predicted positive outcome in the biofeedback group. However, high scores on the Evaluative scale of the MPQ and high hypnotizability were significant predictors of positive outcome for the placebo group. It is concluded that paraspinal EMG biofeedback is not a specific treatment for chronic low back pain in a nonhospitalized population. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child and parent reports of childhood anxiety: differences in coping styles

This study compares children anxious only on parent report (PR) with those anxious on self-report (SR) and self- and parent report (SPR) to examine the reasons for the reporting differences. Sixty-five children aged 7-12 years who met criteria for one or more Axis I anxiety disorders (25% with comorbid nonanxiety diagnoses) completed standardized measures of anxiety, depression, and coping style. Parents completed measures of child psychopathology and adult coping style. Assessing clinicians completed the Global Assessment of Functioning. All parents endorsed anxiety in their children. Based on their responses on standardized self-report measures of anxiety, children were classified as endorsing anxiety (SPR group) or not endorsing anxiety (PR group). Multivariate analysis of variance revealed that children in the SPR group endorsed more depression and employed a greater variety of coping strategies than children in the PR group. The two groups did not differ on parent or clinician measures. These findings suggest that reporting differences may be related to differences in coping styles in anxious children. SPR children may over report anxiety symptoms due to feelings of decreased self-worth associated with depressive thinking, whereas PR children may be able to distract themselves from their anxieties. The lack of difference in functioning between the two groups suggests that self-report anxiety questionnaire scores are not necessarily indicative of severity.     

The pain drawing and Waddell's nonorganic physical signs in chronic low-back pain

Pain drawings were obtained from a group of 651 patients who had chronic low-back pain. Pain drawings were rated in four grades according to the degree of organic and nonorganic pain. Experienced and inexperienced evaluators were used. The reliability was excellent with an interevaluator reliability between 73% and 78%. A correlation between pain drawings and Waddell's nonorganic physical signs demonstrated that a large proportion of patients with high Waddell scores had nonorganic pain drawings. No significant differences were noted in the distribution of Waddell scores and pain drawings based on patient gender or payment status (i.e., medicolegal or workers' compensation). Pain drawings afford an important adjunct in the physician's assessment of chronic low-back pain.     

Comparison of group progressive-relaxation training and cognitive-behavioral group therapy for chronic low back pain.

36 20–63 yr old chronic low-back-pain outpatients were randomly assigned to group progressive-relaxation training, cognitive-behavioral group therapy, or waiting list/attention conditions. Both relaxation-training and cognitive-behavioral-therapy Ss improved significantly on self-report measures of pain, depression, and disability (e.g., Sickness Impact Profile, Beck Depression Inventory) and on a significant-other-rated measure of physical and psychosocial dysfunction pre- to posttreatment, whereas waiting-list Ss did not. Posttreatment, cognitive-behavioral-therapy Ss did not differ from relaxation-training Ss on most variables, but they did rate themselves as having improved more in ability to tolerate pain and participate in normal activities. At 1-mo follow-up, relaxation-training Ss showed no significant further improvement and had a significant increase in pain. Cognitive-behavioral-therapy Ss demonstrated further improvement at 1-mo follow-up on several measures of pain, depression, and disability. A 1?–2 yr mail follow-up indicated a marked reduction in health-care use for Ss in both treatments, and the cognitive-behavioral-therapy Ss had improved markedly in time spent working. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relaxation for the relief of chronic pain: a systematic review

The effectiveness of relaxation techniques in the management of chronic pain was determined in this systematic review of published randomized controlled trials. Reports were sought by searching MEDLINE, psycLIT, CINAHL, EMBASE and the Oxford Pain Relief Database. Studies were included in this review if they were randomized controlled trials of relaxation techniques in chronic pain. Studies which investigated the effects of relaxation in combination with other interventions were not considered. Nine studies involving 414 patients met the predefined inclusion criteria and are critically appraised in this review. Meta-analysis was not possible, due to lack of quantitative data in the primary studies. Studies involved patients with a range of chronic pain conditions. The McGill Pain Questionnaire was the most common pain outcome used. Whilst four studies were able to show a significant difference for the pain outcomes in favour of relaxation for the pre- and post-treatment assessments, few statistically significant differences were reported in favour of relaxation when between treatment comparisons were used. Only three studies reported statistically significant differences in favour of relaxation (judged as a significant difference for at least 1 of the pain outcomes) compared to the other treatment groups. In rheumatoid arthritis the McGill Pain Questionnaire scores were significantly lower for patients receiving relaxation compared to those who were in the routine treatment control group. In ulcerative colitis significant differences were reported for six of seven different pain outcome measures in favour of progressive muscle relaxation compared to patients in the waiting list control group. In one of the two cancer pain studies, relaxation taught by nurses produced significantly lower pain sensation scores compared to the control group. Two studies reported significant differences in favour of the experimental control groups rather than for relaxation. There is insufficient evidence to confirm that relaxation can reduce chronic pain. Many of the studies both positive and negative suffer methodological inadequacies. Recommendations for future research into the effectiveness of relaxation techniques for chronic pain are made.     

A fourth empirically derived cluster of chronic pain patients based on the Multidimensional Pain Inventory: Evidence for repression within the dysfunctional group.

The authors proposed that chronic pain patients with repressive defenses are not represented in current 3-cluster solutions of the Multidimensional Pain Inventory and that such a group can be distinguished by using a measure of defensiveness together with subscales of the MPI. For 178 pain patients, hierarchical cluster analyses were performed on the MPI and Balanced Inventory of Desirable Responding. Profile analysis of validation measures showed that repressors scored comparably with dysfunctional patients on somatic symptoms of depression, pain severity, and perceived disability but significantly higher on these factors than the adaptive copers. Repressors scored comparably with adaptive copers on cognitive-affective symptoms of depression, anxiety, and anger but significantly lower on these variables than dysfunctional patients. Repressors also reported greater pain severity and perceived disability relative to their reports of negative affect, whereas dysfunctional and adaptive coper groups exhibited no such disparities. Without a measure of defensiveness, the MPI may misclassify a distinct group of patients as dysfunctional, but who readily endorse physical symptoms yet report low levels of emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A single centre experience with allogeneic stem cell transplantation for severe aplastic anaemia in childhood

BACKGROUND: The purpose of this study was to investigate the barriers to receiving analgesics for cancer pain in Taiwanese patients. METHODS: The sample consisted of 128 hospitalized patients. All of the subjects were receiving analgesics. Three questionnaires entitled "Barriers Questionnaire-Taiwan Form (BQT)", "Brief Pain Inventory Short Form", and "Pain Management Index (PMI)" were used in this study. Data were analyzed using Student's t-test and Pearson correlation. RESULTS: The results showed that most of BQT subscales including disease progression, time interval, tolerance, injection, addiction, fatalism and side effects were approaching toward the moderate or high end of the scale. 42.1% (n = 54) of the patients had negative PMI scores indicating that they were using less than adequate analgesics for pain. There was a significant difference between those who had adequate medication and those who did not, in terms of disease progression score and the total BQT score. CONCLUSIONS: Overall the result revealed that pain management in these cancer patients was inadequate. Misconceptions on the part of patients still exist. Educational intervention could be an effective means for overcoming such barriers in Taiwanese patients who received analgesics for cancer pain.     

Development and validation of the pain response inventory for children.

The Pain Response Inventory (PRI) was developed as a multidimensional instrument to assess children's coping responses to recurrent pain. The PRI assesses 3 broad coping factors—Active, Passive, and Accommodative—each with subscales representing specific strategies for coping with pain. Confirmatory factor analysis was used to derive and cross-validate the factor structure of the PRI in 3 different samples of children and adolescents: 688 9–16 yr olds in general population, 120 8–18 yr old abdominal pain patients who also completed followup interviews 2-wks and 6 mo after initial interview, and 224 11–23 yr old former abdominal pain and well patients. The subscales were found to be internally consistent and reasonably stable. Validity of the subscales was assessed by examining the relations of particular coping strategies to various outcome indicators, including functional disability, somatization symptoms, and depressive symptoms. Results indicated that different types of health outcome were predicted by different patterns of PRI coping strategies, thus supporting the utility of a multidimensional approach to the assessment of coping responses to pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-report evaluation of health behavior, stress vulnerability, and medical outcome of heart transplant recipients

OBJECTIVE: The purpose of this study was to explore the value of patient self-report assessment in heart transplant candidacy evaluation, utilizing the Millon Behavioral Health Inventory (MBHI). Patient's MBHI measures were related to important pretransplant patient characteristics and posttransplant measures of health behavior, medical morbidity, and mortality. METHOD: Ninety heart patients with end-stage cardiac disease completed the MBHI during pretransplant candidacy evaluations, and also were interviewed concerning their coping effectiveness, support resources, and compliance history. Postransplant follow-up of 61 living and 29 deceased patients included measures of survival time, postsurgical medical care, rejection and infection episodes, and nurse ratings of medication compliance and problematic interpersonal health behaviors. RESULTS: The MBHI coping scales were found to significantly discriminate good and poor pretransplant compliance, and interview judgments of good and poor coping and support resources, with modest accuracy. The MBHI also was superior to these interview judgments in predicting posttransplant survival time and medical care used. Certain scales were also positively associated with physical parameters of pretransplant and posttransplant status. CONCLUSIONS: Patient self-report with the MBHI can contribute to identification of patients at risk for a problematic outcome with transplant, by providing information pertinent to clinical decision making and outcome management analysis with this special population of cardiac patients.     

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)     

Monitoring and blunting: Validation of a questionnaire to assess styles of information seeking under threat.

Subjects were divided into information seekers (high monitors)/information avoiders (low monitors) and distractors (high blunters)/nondistractors (low blunters) on the basis of their scores on a self-report scale to measure coping styles, the Miller Behavioral Style Scale (MBSS). In Experiment 1, subjects were faced with a physically aversive event (the prospect of electric shock). High monitors and low blunters chose to seek out information about its nature and onset whereas low monitors and high blunters chose to distract themselves. This effect was strongest with the blunting dimension. High monitoring and low blunting were also accompanied by sustained high anxiety and arousal. In contrast, low monitors and high blunters were able to relax themselves over time. In Experiment 2, subjects worked on a series of tests that presumably predicted success in college. They could attend as often as they wished to a light that signaled how well they were performing. Results showed that coping-style scores accurately predicted informational strategy, particularly with the monitoring dimension: High monitors tended to look at the light whereas low monitors tended to ignore it. Thus the MBSS measure of coping styles appears to be a valid instrument for predicting behavioral strategies in response to both physical and psychological stressors. The theoretical and practical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)