Biomedical subjects

Dennis C Turk

Publications and source records attributed to Dennis C Turk.

At least 55 records · Page 3Linked to original sources

PubMed1995

Chronic pain and depression: role of perceived impact and perceived control in different age cohorts.

Chronic pain adversely affects individuals' physical as well as emotional well-being. A cognitive-behavioral model has been proposed to explain the role of cognitive appraisal variables in mediating the development of emotional distress following pain of long duration. There is little evidence linking the prevalence of depression in chronic pain patients to life stage, but there are suggestions in the literature that the link between medical illness and depression may be stronger in elderly patients. One purpose of this study was to replicate the efficacy of a previous study of the cognitive-behavioral mediation model in explaining the association between pain and depressed affect. A second purpose of this study was to extend the cognitive-behavioral model to evaluate relationships among pain, cognitive appraisal variables, and depressive affect in the elderly chronic pain population. One hundred chronic pain patients were divided into two age groups (< or = 69 years and > or = 70 years). A path analysis conducted for the total sample supported the cognitive-behavioral mediation model of depression in chronic pain, in which cognitive appraisal variables mediate the pain-depression relationship. Correlations among variables in each of the two age groups, however, revealed different patterns of association. Consistent with the cognitive-behavioral model, the younger patients demonstrated a low and non-significant correlation between pain severity and depression (r = 0.01). Conversely, a strong direct association was observed in the older patients between these variables (r = 0.51). These results suggest that the relationship between pain and depression varies substantially depending upon age cohort.

Adaptation, Physiological↗

PubMed1995

The scope and significance of anger in the experience of chronic pain.

This paper is divided into 3 sections. The first provides the conceptual framework by introducing definitions of anger and related constructs and highlighting pertinent aspects of the concept of pain. The second section examines the evidence for anger as a feature of chronic pain. The available research indicates that chronic pain patients experience anger but this may be underestimated because of denial. In fact, anger stands out as one of the most salient emotional correlates of pain, even though past research has been largely confined to the study of depression and anxiety. the third section explores the significance of anger in chronic pain, in terms of its compounding effects on pain, depression and psychosocial functioning, as well as its consequences for physical health and health habits. The impact of anger among chronic pain patients for treatment outcome is discussed. Finally, the information from these sections is integrated into a model depicting the antecedents and consequences of anger as specifically associated with the chronic pain experience.

Affective Symptoms↗

PubMed1994

Physicians' attitudes and practices regarding the long-term prescribing of opioids for non-cancer pain.

Prescribing long-term opioids for patients with chronic pain is controversial. The primary purpose of this study was to examine physicians' beliefs about and prescribing of the long-term use of opioids in the treatment of chronic pain patients. Concerns about regulatory pressure and appropriateness of education regarding opioids were also examined. The design was a stratified random sample. In the United States, 6962 physicians were randomly selected from two states in each of five regions of the country (Northeast, Midwest, Southeast, Southwest, and Pacific). Physicians from seven medical specialties (Family Practice, Internal Medicine, Physical Medicine and Rehabilitation, Rheumatology, Orthopedic Surgery, Neurosurgery, and Neurology) were surveyed and 1912 (27.46%) responded. A survey consisting of questions regarding years of practice, number of chronic pain patients treated, frequency of prescribing long-term opioids, concerns about opioids, goals of treatment, beliefs about education regarding opioids, and concerns about regulatory pressures was used. Based on the physicians who responded, it appears that prescription of long-term opioids is relatively wide-spread. Differences were noted by region, specialty, and the requirement for the use of multiple prescriptions for schedule II drugs. Physicians in the Midwestern United States were the least likely to prescribe the long-term use of opioids. Rheumatologists and general practitioners were significantly more likely to prescribe long-term opioids than were surgeons, neurologists, or physiatrists and were more likely to emphasize the importance of symptom improvement as an appropriate goal even in the absence of functional improvements.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1993

Neglected topics in chronic pain treatment outcome studies: determination of success.

Although literature on chronic pain treatment outcome has made substantial strides in improving the quality of the studies reported, there remain a number of factors that lead to qualification of the generally positive results. In the two previous papers in this series a set of migrating factors was discussed, namely, representativeness of the samples treated in these outcome studies, relapse, and non-compliance with therapeutic recommendations. Additional limitations include the lack of agreement on the criteria on which to base evaluation of the success of treatment outcome and the percentage of treated patients included in follow-up data. In this paper, the most common methods for determining success are described (group effects based on standard and quasi-standard outcome measures). The limitations of this approach are discussed and alternative strategies are presented that focus not only on traditional criteria based on group means but on additional criteria including: (a) importance of change (i.e., clinical vs. statistical significance), (b) proportion of patients who improve, (c) cost, (d) efficiency in treatment delivery, (e) and consumer acceptance and satisfaction.

Chronic Disease↗

PubMed1992

Efficacy of multidisciplinary pain treatment centers: a meta-analytic review.

Sixty-five studies that evaluated the efficacy of multidisciplinary treatments for chronic back pain were included in a meta-analysis. Within- and between-group effect sizes revealed that multidisciplinary treatments for chronic pain are superior to no treatment, waiting list, as well as single-discipline treatments such as medical treatment or physical therapy. Moreover, the effects appeared to be stable over time. The beneficial effects of multidisciplinary treatment were not limited to improvements in pain, mood and interference but also extended to behavioral variables such as return to work or use of the health care system. These results tend to support the efficacy of multidisciplinary pain treatment; however, these results must be interpreted cautiously as the quality of the study designs and study descriptions is marginal. Suggestions for improvement in research designs as well as appropriate reports of research completed are provided.

Adult↗

PubMed1991

Neglected topics in the treatment of chronic pain patients--relapse, noncompliance, and adherence enhancement.

Although published treatment outcome studies for chronic pain have provided favorable support for the efficacy of many pain clinics and the use of specific modalities such as biofeedback and relaxation, there are several factors that mitigate against euphoria. Two related factors that influence interpretation of these reported outcomes are discussed, namely, noncompliance with therapeutic recommendations during treatment and subsequent to treatment termination, and relapse. Conceptual and methodological problems for establishing the prevalence of noncompliance and relapse are reviewed. Several factors that contribute to noncompliance (individual differences, nature of disease or injury, characteristics of the prescribed treatment regimen, health-care provider-patient relationship, and contextual) are discussed. The literature reveals that noncompliance with treatment regimens is quite prevalent across diverse treatment modalities and pain syndromes. The incidence of relapse following initially successful treatment of persistent pain also appears to be high, ranging from 30% to 60%. Studies on arthritis and heterogeneous pain clinic populations suggest that noncompliance and relapse are related; however, this association is less well established for headache patients. Strategies for assessing compliance (i.e., self-report, behavioral, biochemical, and clinical outcome) and the perspectives' of patients and health-care providers on the application of self-care recommendations are discussed. Strategic planning and adherence enhancement tactics to facilitate maintenance of post-treatment gains are described.

Chronic Disease↗

PubMed1990

Neglected factors in chronic pain treatment outcome studies--referral patterns, failure to enter treatment, and attrition.

An increasing number of chronic pain treatment outcome studies have appeared in the literature. In general, these studies support the efficacy of multidisciplinary pain programs, as well as specific treatment modalities such as biofeedback and relaxation. Reviews of this literature have tended to be cautiously optimistic. Some concerns, however, have been raised about the methodological adequacy of these studies, particularly in terms of the lack of control groups, the brief duration of follow-up periods, and the vague criteria used for establishing the success of the therapeutic interventions. Other factors that mitigate conclusions regarding the generalizability of the favorable results reported need to be considered. In this paper 3 rarely discussed topics that are implicit within most treatment outcome studies and that need to be given greater attention are examined. These topics include: (1) referral patterns to pain clinics (who are referred to pain clinics, when, and how representative is the referred sample?); (2) failure to enter treatment (e.g., exclusion criteria, lack of available financial support to cover the cost of treatment, patient's refusal to accept recommendations), and consequently, the representativeness of the treated sample; and (3) patient's attrition. In this paper we discuss each of these factors as they underscore important qualifications that have to be made in evaluating treatment outcome studies.

Chronic Disease↗

PubMed1990

The robustness of an empirically derived taxonomy of chronic pain patients.

There is currently no classification system for chronic pain patients that has achieved consensus. The lack of a classification that is used consistently across settings has impaired advance of knowledge and treatment of chronic pain patients. Recently, an empirically derived multivariate classification system, the Multiaxial Assessment of Pain (MAP) patients, has been developed. In this paper, the generalizability of the MAP system was evaluated by contrasting the MAP classification of 3 common but diverse chronic pain syndromes, namely, low back pain, headache, and temporomandibular disorders. The results indicate that although the proportion of patients classified into the 3 subgroups of the MAP taxonomy differ, the profiles based on the pattern of interrelationship among the assessment scales were remarkably similar. These data suggest that the psychosocial and behavioral responses associated with chronic pain are common to diverse samples of pain patients despite differences in demographic characteristics and medical diagnosis. The implications of these results for research and clinical practice are discussed. The potential utility of a polydiagnostic approach using more traditional medically based classifications such as proposed by the IASP (Merskey, H., Pain, Suppl. 3 (1986) S1-S225) complemented by classification based on the MAP psychosocial-behaviorally based taxonomy are examined.

Adult↗

PubMed1990

Quantification of biomedical findings of chronic pain patients: development of an index of pathology.

Difficulties in assessing and quantifying the biomedical signs and symptoms that may be related to patients' reports of pain are well recognized. Although there appears to be some consensus among physicians as to the potential utility of examination and diagnostic tests frequently used to evaluate chronic pain patients, little attention has been paid to the reliability of interpreting the results of these procedures. Moreover, the integration of biomedical findings to form a general index of pathology associated with chronic pain has been a difficult problem to solve because not all biomedical procedures used to evaluate pain patients are necessarily relevant or indicated for a specific patient. Two studies are presented that were designed to evaluate the reliability of 23 biomedical procedures commonly used to evaluate chronic pain patients and to determine if findings on these procedures can effectively be combined to form a reliable index of physical pathology. The results of study 1 suggest that 17 of the 23 procedures can be applied in clinical setting with acceptable levels of reliability. Study 2 provides evidence that an innovative weighted scoring approach, based on current medical consensus, can be used to produce a reliable, general index of pathology that is independent of the number of procedures used to evaluate patients. The utility of this quantification approach to biomedical findings for clinical and research purposes is discussed.

Chronic Disease↗

PubMed1989

Relationship of pain impact and significant other reinforcement of pain behaviors: the mediating role of gender, marital status and marital satisfaction.

The operant perspective of chronic pain emphasizes the important role of reinforcement contingencies in the maintenance of pain behaviors and the experience of pain. Patients' 'significant others' are viewed as primary reinforcing agents. The relationship between pain intensity, interference, and responses by significant others in maritally distressed, maritally satisfied, and unmarried samples of male and female pain patients and their significant others was examined in this study. Results revealed that only for married male patients significant other responses explained significant proportions of the variance in the impact of pain. Significant other responses failed to explain significant proportions of the variance for male patients living with non-married significant others. By way of contrast, for female patients pain impact and reinforcement variables were less highly associated in the married as compared to the unmarried patients. For both males and females, there were significantly higher correlations between significant other responses and pain impact levels for the maritally satisfied patients. These results provide qualified support for the operant formulation of the importance of reinforcement of pain behaviors by significant others, however, these responses appear to be dependent upon gender, marital status, and marital satisfaction. Thus, clinicians need to give greater attention to these variables when designing treatment plans.

Adult↗

PubMed1989

An empirical taxometric alternative to traditional classification of temporomandibular disorders.

A number of investigators have suggested that the generic classification temporomandibular disorders (TMD) may consist of several subsets of patients. Two primary factors are to be significant in discriminating subgroups, namely, presence or absence of TM joint abnormalities and psychological characteristics such as traits, maladaptive behavioral patterns, and gross psychopathology. Few attempts, however, have been made to integrate psychosocial and behavioral parameters in order to identify a taxonomy of TMD patients and, subsequently, to examine the differentiation of subgroups on oral dysfunction/structural abnormalities (OD/SA). The primary purpose of this paper was to develop and cross-validate an empirically derived classification system of TMD patients. The first study identified three unique subgroups of TMD patients, labeled 'dysfunctional,' 'interpersonally distressed,' and 'adaptative copers.' A second study cross-validated and confirmed the uniqueness and accuracy of the taxonomy. Subsequent analyses were performed that demonstrated that these groups were not distinguishable on the basis of any measures of OD/SA. The taxonomy identified is compared and contrasted with other reported subgroups of TMD patients and the implications of this classification system for treatment of TMD patients are discussed.

Adaptation, Psychological↗

PubMed1988

The disability determination dilemma: toward a multiaxial solution.

Recently the United States Social Security Administration Commission on the Evaluation of Pain recommended that a set of criteria be developed that could be used to determine 'impairment due primarily to pain.' The intention was to provide a specific and equitable system for determination of disability of social security claimants who alleged that they were disabled primarily by pain. In this paper, the social security disability determination process is described, criteria for the proposed listing of 'impairment due primarily to pain' are reviewed, and a multiaxial taxometric system for determining disability due primarily to pain is described. The social implications of the proposed listing as well as a multiaxial taxometric approach for the social security disability system are described. Impediments to solutions to the disability determination problems confronting the Social Security Administration are discussed, and a scientific approach is contrasted with the current legal decision making process, as it relates to the awarding of Social Security disability benefits.

Disability Evaluation↗

PubMed1988

Differential utility of medical procedures in the assessment of chronic pain patients.

Physicians are frequently called upon to evaluate patients with chronic pain to (1) establish the etiology, (2) determine the extent of impairment and disability, and (3) prescribe treatment. In many cases, there is little agreement as to what evaluation procedures should be used or how to weight and integrate these findings. Two studies were conducted to determine the domain of procedures pain specialists believe are most important in evaluation and the clinical utility of each. A survey of 75 physicians specializing in the treatment of chronic pain was conducted. Coefficients of concordance indicated that physicians displayed substantial agreement as to the differential utility of 18 physical examination and diagnostic procedures. The relevance of each of these procedures in the assessment of 100 pain patients was evaluated. Differential weights for each procedure derived from the survey were highly correlated with clinical practice. The results of the present studies provide a basis for development of a standardized assessment procedure that incorporates statistically derived weights to quantify medical findings.

Attitude of Health Personnel↗

PubMed1988

Chronic pain and depression: toward a cognitive-behavioral mediation model.

Although considerable attention has recently been devoted to explaining why depression is a frequent concomitant of chronic pain, little empirical work has been conducted to test predictions based on these models. The present study was designed to test a cognitive-behavioral mediation model of pain and depression that proposes perceived reduction in instrumental activities along with a decline in perceptions of control and personal mastery are necessary prerequisites for the development of depressive symptomatology in pain patients. According to this model, in contrast to alternative models, the presence of pain is not sufficient condition for the subsequent development of depression. This model was tested and confirmed through the application of structural modeling with latent variables. Specifically, the direct link between pain and depression was found to be non-significant, however, measures of perceived life interference and self-control were found to be significant intervening variables between pain and depression. These results provide the first empirical demonstration that psychological mediators may be involved in the development of depression secondary to chronic pain. The findings of this study are contrasted with single-factor models that postulate both chronic pain and depression as resulting from a common cause.

Adult↗

PubMed1987

Pain and families. I. Etiology, maintenance, and psychosocial impact.

This is the first part of a two-part extended review on the interdependency between chronic pain and families. This paper will address the role of the family in the etiology and maintenance of chronic pain and will describe the reciprocal impact of chronic pain on families. Different conceptualizations of the role of the family and the available empirical evidence related to 3 central questions, namely, 'do families play an etiological role in chronic pain?,' 'does the family maintain the chronic pain problem?,' and 'is there a negative impact of chronic pain on the family?' will be critically examined. The second, companion paper will address the issue of the inclusion of family members in the assessment and treatment of chronic pain. Finally, recommendations for future research will be made.

Adaptation, Psychological↗

PubMed1987

Pain and families. II. Assessment and treatment.

This is the second part of an extended review on pain and families. The first paper dealt with the role of the family in the etiology and maintenance of chronic pain and discussed the impact of chronic pain on families. The paper will examine the role of the family in the assessment and treatment of chronic pain. Finally, problems of the theoretical models and empirical studies reviewed will be discussed and suggestions for future research will be presented.

Adaptation, Psychological↗

PubMed1987

Pain greater than pain behaviors: the utility and limitations of the pain behavior construct.

A great deal of attention has been given to the importance of learning factors in communications of pain and suffering--pain behaviors. The concept of pain behaviors has served a heuristic function, however, there remain a number of important questions to be answered regarding the assessment and conceptual limitations of the construct. These concerns and questions must be acknowledged if the construct is to be of use in enhancing our understanding of chronic pain syndromes and to be employed in treatment. Current conceptualizations of pain behaviors are examined and methods of assessing pain behaviors are evaluated. The validity and utility of the construct and its limitations are discussed. It is concluded that failure to consider psychosocial, psychophysiological, and medical-physical factors may lead to an inadequate understanding of the patient and results in inappropriate treatment interventions. Suggestions for refined understanding of the scope of the construct are provided.

Chronic Disease↗

PubMed1987

IASP taxonomy of chronic pain syndromes: preliminary assessment of reliability.

Communication and consequently advancement of knowledge in understanding and treatment of chronic pain has been hindered by the absence of a taxonomy of chronic pain syndromes. Recently the IASP Subcommittee on Taxonomy proposed a classification method based on a multiaxial system. In the present study the interjudge reliability of 2 of the 5 axes, body location and presumed etiology are evaluated. Overall, axis I demonstrated good reliability, however, the reliability of several categories contained within this axis were low enough to suggest minor changes to this axis may increase its clinical utility. Axis V was found to have only fair reliability and many of the categories comprising this axis were demonstrated to have reliabilities that are not clinically acceptable. The implications of these results for future development and refinement of the IASP taxonomy are discussed.

Chronic Disease↗