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Biomedical subjects

Dennis C Turk

Publications and source records attributed to Dennis C Turk.

At least 37 records · Page 2Linked to original sources
PubMed2004

Exacerbation of chronic pain following spinal cord injury.

Because of the high prevalence and the refractory nature of pain following spinal cord injury (SCI), it is important to increase the understanding of what factors aggravate different types of pain. This information is related to pain generating mechanisms and may thus be useful in the diagnosis and management of these difficult pain conditions. The aims of the present study were to (1) identify variables (factors) that exacerbate chronic pain associated with SCI and (2) define the relationships among these patterns of pain exacerbation, specific pain characteristics, and psychological features. A sample out of 159 (75.5%) people with SCI and chronic pain, volunteered to participate in a mail survey. Over 50% of the sample indicated that prolonged sitting, infections, fatigue, muscle spasms, cold weather, and sudden movements exacerbated their pain. A principal components analysis detected five sets of factors that were reported to magnify pain: negative mood, prolonged afferent activity (bowel, bladder, somatic), weather, voluntary physical activity, and transient somatic afferent activity. Negative mood and prolonged afferent activity were frequently and significantly associated with both pain characteristics and psychosocial issues. A multiple regression analysis revealed that a combination of decreased activity levels due to pain (t = 3.54; p < 0.001), pain located in the frontal aspects of torso (including genitals) (t = 2.29; p < 0.05), "burning" (t = 2.26; p < 0.05), or "electric" (t = 2.09; p < 0.05) pain, and a limited perception of life control (t = -2.16; p < 0.05) was significantly associated with a high extent of pain aggravation (R2 = 0.39; p < 0.000).

Adult↗
PubMed2004

Pain, impairment, and disability in the AMA guides.

Physicians use the American Medical Association's Guides to the Evaluation of Permanent Impairment, 5th edition to evaluate millions of disability applicants each year. As major contributors to the chapter in the Guides devoted to assessing impairment associated with pain, we confronted the difficulties of incorporating pain into the Guides' overall evaluation system. Analysis of these difficulties is complicated by the paucity of research on the Guides, and by ambiguities and contradictions that pervade it. We propose that the ambiguities can be reduced if impairment is consistently defined in terms of organ or body part derangement, and disability in terms of activity limitations at the level of the whole person. We also propose a distinction between objective factors that may influence a person's ability to perform activities following injury. We suggest that when physicians examine disability applicants, they should evaluate both objective measures of organ or body part dysfunction and subjective reports of applicants -- especially ones regarding pain. We conclude that a comprehensive medical evaluation of disability applicant encompasses more than an impairment assessment.

Activities of Daily Living↗
PubMed2003

Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations.

Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism-based approach.

Analgesics↗
PubMed2003

Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.

OBJECTIVE: To provide recommendations for the core outcome domains that should be considered by investigators conducting clinical trials of the efficacy and effectiveness of treatments for chronic pain. Development of a core set of outcome domains would facilitate comparison and pooling of data, encourage more complete reporting of outcomes, simplify the preparation and review of research proposals and manuscripts, and allow clinicians to make informed decisions regarding the risks and benefits of treatment. METHODS: Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 27 specialists from academia, governmental agencies, and the pharmaceutical industry participated in a consensus meeting and identified core outcome domains that should be considered in clinical trials of treatments for chronic pain. CONCLUSIONS: There was a consensus that chronic pain clinical trials should assess outcomes representing six core domains: (1) pain, (2) physical functioning, (3) emotional functioning, (4) participant ratings of improvement and satisfaction with treatment, (5) symptoms and adverse events, (6) participant disposition (e.g. adherence to the treatment regimen and reasons for premature withdrawal from the trial). Although consideration should be given to the assessment of each of these domains, there may be exceptions to the general recommendation to include all of these domains in chronic pain trials. When this occurs, the rationale for not including domains should be provided. It is not the intention of these recommendations that assessment of the core domains should be considered a requirement for approval of product applications by regulatory agencies or that a treatment must demonstrate statistically significant effects for all of the relevant core domains to establish evidence of its efficacy.

Chronic Disease↗
PubMed2003

Chronic neck pain disability due to an acute whiplash injury.

Several theories about musculoskeletal pain syndromes such as whiplash-associated disorder (WAD) suggest that pain and muscle activity interact and may contribute to the chronicity of symptoms. Studies using surface electromyography (sEMG) have demonstrated abnormal muscle activation patterns of the upper trapezius muscles in the chronic stage of WAD (grade II). There are, however, no studies that confirm that these muscle reactions are initiated in the acute stage of WAD, nor that these muscle reactions persist in the transition from acute neck pain to chronic neck pain disability. We analyzed the muscle activation patterns of the upper trapezius muscles in a cohort of 92 subjects with acute neck pain due to a motor vehicle accident (MVA). This cohort was followed up in order to evaluate differences in muscular activation patterns between subjects who have recovered and those subjects who have not recovered following an acute WAD and developed chronic neck pain. sEMG parameters were obtained at 1, 4, 8, 12, and 24 weeks after an MVA. The level of muscle reactivity (the difference in pre- and post-exercise EMG levels) and the level of muscle activity during an isometric and a dynamic task were used as EMG parameters. The results revealed no elevated muscle reactivity either in the acute stage, or during the follow-up period. The results of both the isometric and dynamic task, showed statistically significant different EMG levels between four neck pain disability subgroups (analysis of variance reaching P-levels of 0.000), with an inverse relationship between the level of neck pain disability and EMG level. Furthermore, follow-up assessments of the EMG level during these two tasks, did not show a time related change. In conclusion, in subjects with future disability, the acute stage is characterized by a reorganization of the muscular activation of neck and shoulder muscles, possibly aimed at minimizing the use of painful muscles. This change of motor control, is in accordance with both the (neurophysiological) 'pain adaptation model' and (cognitive behavioral) 'fear avoidance model'.

Accidents, Traffic↗
PubMed2002

Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble?

STUDY DESIGN: One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repeat examination was performed 3 months later, when return-to-work status was determined. OBJECTIVE: To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status. SUMMARY OF BACKGROUND DATA: A systematic review of the work disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables. METHODS: Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physiotherapists). Return-to-work status was measured 3 months later, and predictive validity was evaluated using logistic regression modeling. RESULTS: Medical variables (, medical history subscales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants. CONCLUSIONS: Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables that would account for significant proportions of variance in return to work. The weight of evidence obtained in this study suggests that injured workers' subjective interpretations and appraisals may be more powerful predictors of the course of postinjury recovery than exclusively medical assessments.

Back Injuries↗
PubMed2002

Behavioral and cognitive-behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process.

STUDY DESIGN: A literature review was conducted. OBJECTIVE: To examine the outcome of behavioral (BT) and cognitive-behavioral treatment (CBT), collectively referred to as BT-CBT, for chronic pain, to identify the predictors of treatment outcome, and to investigate the change processes associated with these treatments. SUMMARY OF BACKGROUND DATA: Numerous controlled clinical trials of BT-CBT for chronic pain, alone or more commonly in multidisciplinary treatment contexts, suggest that these treatments are effective. However, further study is needed to examine which outcome variables change, when, for whom, and how. METHODS: Published literature was gathered from Medline, PsychLit, and searches of relevant journals. RESULTS: Overall, BT-CBT for chronic pain reduces patients' pain, distress, and pain behavior, and improves their daily functioning. Differences across studies in sample characteristics, treatment features, and assessment methods seem to produce varied treatment results. Also, some patients benefit more than others. Highly distressed patients who see their pain as an uncontrollable and highly negative life event derive less benefit than other patients. Decreased negative emotional responses to pain, decreased perceptions of disability, and increased orientation toward self-management during the course of treatment predict favorable treatment outcome. CONCLUSIONS: Current BT-CBT helps many patients with chronic pain. Continuing clinical research should improve the matching of treatments with patient characteristics and refine the focus of treatments on behavior changes most associated with positive outcome. Further study of fear, attention, readiness to adopt self-management strategies, acceptance of pain, and new combinations of interdisciplinary treatments may lead to improved interventions.

Behavior Therapy↗
PubMed2002

Cervical muscle dysfunction in chronic whiplash-associated disorder grade 2: the relevance of the trauma.

STUDY DESIGN: Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain. OBJECTIVE: To determine the etiologic relation between acceleration-deceleration trauma and the presence of cervical muscle dysfunction in the chronic stage of whiplash-associated disorder. SUMMARY OF BACKGROUND INFORMATION: From a biopsychosocial perspective, the acceleration-deceleration trauma in patients with whiplash-associated disorder is not regarded as a cause of chronicity of neck pain, but rather as a risk factor triggering response systems that contribute to the maintenance of neck pain. One of the contributing factors is dysfunction of the cervical muscles. Considering the limited etiologic significance of the trauma, it is hypothesized that in patients with neck pain, there are no differences in muscle activation patterns between those with and those without a history of an acceleration-deceleration trauma. METHODS: Muscle activation patterns, expressed in normalized smooth rectified electromyography levels of the upper trapezius muscles, in patients with whiplash-associated disorder Grade 2 were compared with those of patients with nonspecific neck pain. The outcome parameters were the mean level of muscle activity before and after a physical exercise, the muscle reactivity in response to the exercise, and the time-dependent behavior of muscle activity after the exercise. RESULTS: There were no statistical significant differences in any of the outcome parameters between patients with whiplash-associated disorder Grade 2 and those with nonspecific neck pain. There was only a tendency of higher muscle reactivity in patients with whiplash-associated disorder Grade 2. CONCLUSIONS: It appears that the cervical muscle dysfunction in patients with chronic whiplash-associated disorder Grade 2 is not related to the specific trauma mechanism. Rather, cervical muscle dysfunction appears to be a general sign in diverse chronic neck pain syndromes.

Adult↗
PubMed2002

Psychological evaluation of patients diagnosed with fibromyalgia syndrome: a comprehensive approach.

Symptoms of FMS are extremely distressing, and currently there is no cure or any treatment capable of substantially reducing all symptoms for all patients. Rehabilitation goals include improving emotional functioning, physical functioning, and quality of life. In light of these goals, psychological screening is an essential component of any comprehensive FMS evaluation. In many cases, the high levels of emotional distress, disability, and reduced quality of life noted in these patients warrants a more thorough psychological evaluation [11]. A comprehensive psychological evaluation is complex, involves exploration of a broad range of areas, and should be administered by an experienced health psychologist. The primary objective of this evaluation is to delineate emotional, cognitive, and behavioral factors involved in persistent pain, suffering, and disability, with an emphasis on the prescription of appropriate interventions for altering maladaptive patterns. The results of the psychological evaluation involve a synthesis of information and should assist in developing a list of behavioral problems that contribute to the maintenance and exacerbation of [table: see text] suffering and disability. Information obtained should facilitate treatment planning, specifically the matching of treatment components to the needs of individual patients.

Fibromyalgia↗
PubMed2002

Cancer patients in pain: considerations for assessing the whole person.

Pain is a subjective perception that is influenced by psychosocial and behavioral factors and physical pathology. In cancer, the source of the pain may be the disease itself, the treatment, or co-occurring pain syndromes. Often, cancer is a progressive disease, and pain may be marked by exacerbations, additional treatment, and remissions. Thus, pain assessment must become part of routine care. Ratings of pain should be performed on a regular basis, just as vital signs are taken on a regular basis. Unlike the other vital signs, however, pain can only be assessed by the patients' verbal and nonverbal behavior. Therefore, it is necessary to actively involve the patient in the assessment process. In deciding what to assess about the pain and how, the clinician needs to balance the purposes of the evaluation with the patient's capacity. During initial assessment it may be possible to include a more comprehensive evaluation of the patient and his or her pain. Relatively brief measures may be used on a routine ongoing basis. When a new type of pain or exacerbation of pain is identified, additional attention beyond pain severity and location may be appropriate. For the very ill patient, it may be possible only to ask a few questions and to observe his or her behavior. In some circumstances, such as when patients are unwilling or unable to report on their pain, it is useful to gather information from caretakers. At a minimum, the severity, location, and pattern of pain and patients' functional activity and mood should be assessed. Timely, appropriate, and thorough assessment and treatment of cancer patients experiencing pain should reduce their suffering and improve the quality of their lives.

Activities of Daily Living↗
PubMed2002

Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal pain disorder characterized by diffuse pain and associated psychophysiological symptoms. Despite extensive research in the past 3 decades, the etiology and pathophysiology of FMS and effective treatment approaches are yet to be delineated. Recently, it has been suggested that FMS may be related to hypofunctional stress systems, particularly in the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. Studies have demonstrated that patients with FMS exhibit lowered sympathoadrenal reactivity to stress. These findings seem to be consistent with the large volume of research indicating the inverse relationship between pain sensitivity and sympathetic reactivity. In this paper, we discuss the role of stress in the pain experience in general, stress in patients with FMS, and review the studies evaluating the ANS and HPA functions in response to various stressors.

Fibromyalgia↗
PubMed2002

Psychological factors in chronic pain: evolution and revolution.

Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronic pain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronic pain patients have received empirical support. The authors describe a biopsychosocial model of chronic pain and provide an update on research implicating the importance of people's appraisals of their symptoms, their ability to self-manage pain and related problems, and their fears about pain and injury that motivate efforts to avoid exacerbation of symptoms and further injury or reinjury. They provide a selected review to illustrate treatment outcome research, methodological issues, practical, and clinical issues to identify promising directions. Although there remain obstacles, there are also opportunities for psychologists to contribute to improved understanding of pain and treatment of people who suffer from chronic pain. The authors conclude by noting that pain has received a tremendous amount of attention culminating in the passage of a law by the U.S. Congress designating the period 2001-2011 as the "The Decade of Pain Control and Research."

Adaptation, Psychological↗
PubMed2002

Assessment of the impact of pain and impairments associated with spinal cord injuries.

OBJECTIVES: To determine the adequacy of the Multidimensional Pain Inventory (MPI) for assessing pain impact after spinal cord injury (SCI) and to determine whether the impact of pain can be separated from other consequences of SCI. DESIGN: Postal survey. SETTING: General community. PARTICIPANTS: Of the 159 subjects contacted who experienced chronic pain, 120 (75.5%) participated. INTERVENTIONS: Subjects were mailed the original MPI and a set of additional items specific to SCI. MAIN OUTCOME MEASURE: The MPI. RESULTS: Confirmatory (CFA) and exploratory factor analyses were performed for each section of the MPI. Elimination of several items, including those related to work in section 1 (pain impact), improved the goodness-of-fit index (GFI). A CFA for section 2 (response of significant other) resulted in acceptable GFI after 2 items were deleted. Decrease in activity levels (section 3) because of other consequences of injury was significantly greater after tetraplegia than after paraplegia. In contrast, pain-related reduction in activities was not associated with injury level. Although other consequences of SCI may have greater impact on activities than pain, severe pain is likely to affect activity levels significantly. CONCLUSION: The MPI appears to be appropriate for use in a SCI population when modified to eliminate questions related to work and to supplement the activity scale with items addressing decreased activity levels due to pain.

Adult↗
PubMed2002

A diathesis-stress model of chronic pain and disability following traumatic injury.

One of the perplexing features of pain is the wide variability in patients' responses to ostensibly the same extent of physical pathology. A range of cognitive, affective and behavioural factors are related to the perception of pain, maintenance of pain and disability, exacerbation of pain and response to treatment. Moreover, there is some evidence that individual differences and prior learning history also have a significant influence on the experience of pain and related disability. The role of these psychological factors in the maintenance of disability following traumas such as motor vehicle accidents and work-related injuries has generated considerable interest. This paper provides a brief overview of a set of predisposing factors, cognitive processes and behavioural principles that appear to be particularly important in the maintenance of disability following trauma. In particular, anxiety sensitivity, anticipation and avoidance of fear or harm, catastrophizing ideation, causal attributions for symptoms, self-efficacy and operant conditioning are discussed. Each of these factors is integrated in a diathesis-stress model that emphasizes the interaction of predisposing factors with a trauma, setting in motion a cascade of interpretive cognitive processes and reinforcement contingencies that maintain disability following the trauma. This model proposes a sequential process to explain the variation observed among people following a relatively minor trauma. The model is intended to be heuristic. It may be a useful conceptualization that can serve to guide prevention efforts and the development of treatment interventions.

Chronic Disease↗
PubMed1999

Does sex make a difference in the prescription of treatments and the adaptation to chronic pain by cancer and non-cancer patients?

The literature suggests that the sex of patients is an important factor in understanding how they are treated by health care professionals and how they adapt to their symptoms. In two groups of patients with chronic pain (n = 428 non-cancer (Study 1) and n = 143 cancer-related (Study 2)), men and women were compared on medications prescribed, treatment history, and coping and adaptation. In Study 1 with the non-cancer pain patients, there were no significant differences between the sexes in past treatments, current analgesic use, pain, or disability. Women were significantly more depressed and were more likely to receive antidepressants than men. Subgrouping patients on the basis of pain-adaptation responses yielded groups with distinct psychosocial and behavioral characteristics. In Study 2 with the cancer pain patients, men and women did not show significant differences on any variables. Consistent with the results of Study 1, however, psychological subgroups differed significantly in pain severity, mood and disability regardless of sex. The results of both studies suggest that the role of patients' sex in chronic pain may be less important than their psychosocial and behavioral responses. Thus, it appears that knowing the psychological characteristics of patients may be more important than their sex.

Adaptation, Psychological↗
PubMed1995

Differential treatment responses of TMD patients as a function of psychological characteristics.

A number of studies have reported that psychological factors play a significant role in TMD. Several studies have identified subgroups of patients based on their responses to psychological assessments; however, none of these studies have reported on the clinical utility of classifications of TMD patients on these various measures. In this study, the differential response of 133 TMD patients classified within 3 psychosocial-behaviorally based subgroups to a conservative, standardized treatment was examined. The treatment consisted of the combination of an intra-oral appliance, biofeedback, and stress management. Follow-up assessments were conducted 6 months after treatment termination. The results demonstrated that overall as a group patients significantly improved and maintained improvements on physical, psychosocial, and behavioral measures (P < 0.0001). Comparisons across patient subgroups, however, revealed differential patterns of improvement on the outcome measures. Most notably, reliable change indices demonstrated that the patients classified into a subgroup characterized by the greatest degree of psychological distress (Dysfunctional) demonstrated significantly greater improvements on measures of pain intensity (P < 0.001), perceived impact of TMD symptoms on their lives (P < 0.001), depression (P < 0.01), and negative thoughts (P < 0.001), compared with groups characterized by greater interpersonal problems (Interpersonally Distressed) and those patients who appeared to be the least disabled by TMD (Adaptive Copers). These data provide support for the clinical utility of a psychosocial-behavioral classification system and suggest that in future research individualizing treatments and outcome measures based on patient characteristics may improve treatment efficacy and outcome evaluation.

Adaptation, Physiological↗