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Biomedical subjects

D S Ciccone

Publications and source records attributed to D S Ciccone.

8 recordsLinked to original sources
PubMed2001

Pain expectancy and work disability in patients with acute and chronic pain: a test of the fear avoidance hypothesis.

According to the fear avoidance model, prolonged disability among patients with chronic nonmalignant pain is due, in part, to an exaggerated fear of pain. At issue in the present study was an attempt to refine the fear-avoidance hypothesis by eliciting estimates of anticipated pain as well as anticipated injury. Along with scores on the Fear Avoidance Beliefs Questionnaire-Work (FABQ-W), a validated measure of fear avoidance, pain and injury expectancies were used as predictors of work disability in a hierarchical regression model. We also examined the possibility that fear avoidance might be confined to patients with chronic pain and thus fail to account for work impairment after the onset of acute injury or illness. Samples of patients with acute (N = 47) and chronic (N = 56) pain completed a battery of psychological tests. Pain and injury expectancies collectively explained 40% to 35% of the variance in work disability compared with 12% to 10% explained by the FABQ-W for the acute and chronic samples, respectively. After controlling for pain duration, depression, somatization, and current pain severity, pain expectancy alone accounted for 16% of the variance in patients in the chronic group (P < .001) and 33% of the variance in patients in the acute group (P < .001). Both pain and injury expectancies were associated equally with work disability for patients in the acute group (P < .001), but only pain expectancy accounted for variance in the chronic group (P < .001). Fear-avoidance beliefs, in the form of cognitive expectancies, may have as much influence on the duration of disability in patients with acute pain as they do in patients with chronic pain.

Journal Article↗
PubMed2000

Psychological correlates of opioid use in patients with chronic nonmalignant pain: a preliminary test of the downhill spiral hypothesis.

There is still controversy surrounding the use of opioid medication for patients with chronic nonmalignant pain. Schofferman has argued that long-term opioid use leads to a "downhill spiral" associated with loss of functional capacity and a corresponding increase in depressed mood. The present study was a retrospective comparison of opioid users vs. non-users to determine whether: (a) users have higher levels of disability, medical visitation, depression, and pain; (b) the behavioral problems associated with opioid use persist after controlling for the influence of other medication; (c) opioid use is in fact a predictor of illness behavior; and (d) higher levels of opioid consumption are associated with higher levels of disability and depression. A consecutive series of 243 patients with nonmalignant pain about to enroll at a tertiary clinic were retrospectively assigned to either an Opioid User (n = 87) or Non-User (n = 156) group. Compared to Non-Users, Opioid Users were more likely to be physically disabled ( P <0.05) and depressed ( P<0.05), as well as more likely to report pain at higher levels (P<0.001) and in more locations ( P<0.05). Despite the appearance of a downhill spiral, we were unable to demonstrate an association between opioid use and any measure of illness behavior after controlling for benzodiazepine use (with the possible exception of domestic disability). Instead, we found that benzodiazepine use was significantly associated with activity level ( P<0.05), medical visitation ( P<0.01), domestic disability ( P<0.01), depression ( P <0.01), and to a lesser degree, disability days (P<0.1). Using somatization as a reference variable, we found that opioid use failed to explain a comparable amount of variance in illness behavior. Finally, there was no evidence that higher levels of opioid use were associated with higher levels of disability or depression.

Chronic Disease↗
PubMed1999

Effects of qigong on late-stage complex regional pain syndrome.

CONTEXT: Despite the growing popularity of qigong in the West, few well-controlled studies using a sham master to assess the clinical efficacy of qigong have been conducted. OBJECTIVE: To study the effect of qigong on treatment-resistant patients with late-stage complex regional pain syndrome type I. DESIGN: Block-random placebo-controlled clinical trial. SETTING: Pain Management Center at New Jersey Medical School. PATIENTS: 26 adult patients (aged 18 to 65 years) with complex regional pain syndrome type I. INTERVENTIONS: The experimental group received qi emission and qigong instruction (including home exercise) by a qigong master. The control group received a similar set of instructions by a sham master. The experimental protocol included 6 forty-minute qigong sessions over 3 weeks, with reevaluation at 6 and 10 weeks. Assessment included comprehensive medical history, physical exam, psychological evaluation, necessary diagnostic testing. Symptom Check List 90, and the Carleton University Responsiveness to Suggestion Scale. MAIN OUTCOME MEASURES: Thermography, swelling, discoloration, muscle wasting, range of motion, pain intensity rating, medication usage, behavior assessment (activity level and domestic disability), frequency of pain awakening, mood assessment, and anxiety assessment. RESULTS: 22 subjects completed the protocol. Among the genuine qigong group, 82% reported less pain by the end of the first training session compared to 45% of control patients. By the last training session, 91% of qigong patients reported analgesia compared to 36% of control patients. Anxiety was reduced in both groups over time, but the reduction was significantly greater in the experimental group than in the control group. CONCLUSIONS: Using a credible placebo to control for nonspecific treatment effects, qigong training was found to result in transient pain reduction and long-term anxiety reduction. The positive findings were not related to preexperimental differences between groups in hypnotizability. Future studies of qigong should control for possible confounding influences and perhaps use clinical disorders more responsive to psychological intervention.

Adolescent↗
PubMed1997

Psychological dysfunction in patients with reflex sympathetic dystrophy.

Patients with reflex sympathetic dystrophy (RSD) often present with pain and disability that cannot be explained on the basis of objective physical findings. This has led some to speculate that RSD may be caused or mediated by non-organic factors. Unfortunately, there have been few studies using standardized measures of mood and illness behavior that have compared patients with RSD to patients with other chronic pain disorders. The goal of the present study, therefore, was to compare the pattern of psychological dysfunction in patients with RSD to the pattern of dysfunction in patients with chronic back pain and local neuropathic pain. Patients with back pain resemble those with RSD in that both may report symptoms that cannot be reconciled with objective physical findings. Patients with local neuropathy, by contrast, report pain that is both circumscribed and consistent with a known organic cause. The records of 253 patients attending a tertiary pain service were retrospectively reviewed and three distinct (non-overlapping) diagnostic groups were formed: 25 were assigned to the RSD group; 44 to the back pain group; and 21 to the local neuropathy group. Using a set of stringent criteria to diagnose RSD and an analysis of covariance to control for differences in symptom duration and age, the present study found no evidence to suggest that patients with RSD were psychologically unique. Instead, RSD patients were remarkably similar to those with local neuropathy in terms of their symptom reporting, illness behavior, and psychological distress. The only exception was that RSD patients had more disability days during the preceding 6 months than those with local neuropathy (P < 0.05). The back pain group, on the other hand, presented with more diffuse pain complaints (P < 0.05) and had a greater number of non-specific medical symptoms (P < 0.05) compared to either the RSD or local neuropathy group. In contrast to previous research using less stringent diagnostic criteria, there was no evidence of higher pain scores or lower levels of psychological distress among patients with RSD. In addition, a validated survey of childhood trauma found that sexual abuse, physical abuse, emotional abuse, and cumulative trauma were evenly distributed among all three diagnostic groups. The burden of proof would appear to be upon those who advocate the non-organic hypothesis to provide credible evidence of psychological involvement in the etiology of RSD.

Adaptation, Psychological↗
PubMed1996

Non-organic symptom reporting in patients with chronic non-malignant pain.

Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physical disease [corrected]. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale (Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.

Adult↗
PubMed1984

Cognitive dimensions of chronic pain.

Behavioral interventions have now found widespread acceptance in the treatment of chronic benign pain. Among those with demonstrated therapeutic efficacy are operant conditioning, biofeedback and cognitive-behavior therapy. Since these interventions are based on different assumptions about the etiology of chronic pain, behavioral clinicians are often in the position of using different causal models to justify the use of different treatment procedures. In an effort to address this problem, the present paper proposes an explanatory framework based on the principles of cognitive psychology. Such a framework is parsimonious, empirically-based and offers an internally-consistent approach to understanding the development and maintenance of chronic pain symptoms. An important implication of this approach is that all behavioral interventions may exert an influence on chronic pain through a common mechanism, namely by changing the way clients think about their pain. Specific patterns of dysfunctional thinking are proposed to account for each of the major symptoms of chronic pain. These cognitive patterns include: awfulizing; low frustration tolerance; self-downing; and overgeneralizing. A conceptual analysis of biofeedback and operant conditioning found no evidence to suggest that either modality can effect changes in clients through noncognitive means. It was concluded that behavioral interventions are effective because they facilitate the development of new thinking skills that explicitly challenge the cognitive causes of chronic pain.

Behavior Therapy↗
PubMedDate not supplied

A comparison of economic and social reward in patients with chronic nonmalignant back pain.

OBJECTIVE: Patients with chronic nonmalignant back pain are often exposed to multiple sources of economic and social reward. At issue in the present study was whether these rewards are 1) correlated with similar or dissimilar outcome variables and 2) able to account for unique variance in regression models of illness behavior. METHODS: A 2 x 2 factorial design was used in which patients were retrospectively assigned to one of four independent groups: low economic/low social reward, low economic/high social reward, high economic/low social reward, and high economic/high social reward. Of 265 consecutive patients enrolled at a tertiary pain service, 75 met eligibility criteria and had chronic nonmalignant back pain. RESULTS: Preexisting differences in health status were not associated with differences in illness behavior or pain ratings. With social reward held constant, patients in the high economic reward group missed more days from work (p < .005), had more domestic disability (p < .05), and were more depressed (p < .05) than patients in the low economic reward group. With economic reward held constant, patients in the high social reward group missed more days from work (p < .05), had more domestic disability (p < .01), and were more depressed (p < .01) than patients in the low social reward group. Unlike patients in the high economic reward group, however, patients in the high social reward group had higher levels of pain (p < .05) and more nonspecific medical complaints (p < .01). CONCLUSIONS: Economic and social rewards were both associated with increased disability and depression, but only social rewards were associated with increased symptom reporting. Exposure to economic and social rewards may account for unique variance in illness behavior that cannot be explained by differences in medical diagnosis, symptom duration, pain intensity, depression, or somatization.

Adult↗