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Biomedical subjects

Dennis C Turk

Publications and source records attributed to Dennis C Turk.

68 records · Page 4Linked to original sources
PubMed1986

Long-term efficacy of EMG biofeedback for chronic rheumatic back pain.

Short-term effects of EMG biofeedback for chronic rheumatic back pain have been documented, however, the long-term efficacy of this treatment modality has not yet been established. Twenty-two patients of an original sample of 24 patients who participated in a treatment outcome study [6] were followed up 2.5 years after they had been treated with either EMG biofeedback, pseudotherapy, or conventional medical treatment alone. The results indicate that patients treated with EMG biofeedback maintained beneficial effects and differ significantly from the control groups both on behavioral and cognitive responses to the pain, but not global pain intensity ratings. These data support the long-term utility of biofeedback for chronic rheumatic back pain.

Adult↗
PubMed1985

The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).

The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.

Chronic Disease↗
PubMed1985

The McGill Pain Questionnaire reconsidered: confirming the factor structure and examining appropriate uses.

A major problem in the understanding and psychological treatment of chronic pain patients is the inadequacy of available assessment procedures. Currently, the most frequently used instrument is the Pain Rating Index (PRI) of the McGill Pain Questionnaire, designed to assess 3 components of pain (i.e., sensory, affective, and evaluative) postulated by the Gate Control Theory. The PRI has been used in many studies to make differential diagnoses, to describe different groups of pain patients, and to identify the factor composition of the instrument itself. To date, however, no study has appropriately tested the a priori structure of the PRI or cross-validated it. Confirmatory factor analytic procedures employed in the present study supported Melzack's postulated tri-component structure of the PRI in 2 diverse samples of pain patients from different hospitals. However, the 3 components were found to be highly intercorrelated. Subsequent analyses revealed that the 3 components of the PRI do not display adequate discriminant validity. The current use of 3 subscales to establish differential diagnoses or patterns of different pain syndromes may lead to inappropriate classification and treatment decisions. The major conclusion of these findings is that use of only the total score of the PRI is appropriate for pain assessment.

Chronic Disease↗
PubMed1984

Etiological theories and treatments for chronic back pain. II. Psychological models and interventions.

This is the second part of an extended review of the etiology and treatment of chronic back pain (CBP). The first paper dealt with somatic factors and interventions, this paper will examine psychological theories on the etiology of CBP and psychological treatments for CBP. Finally common problems of both the somatic and the psychological approaches will be discussed and suggestions for treatment and research will be made.

Back Pain↗
PubMed1983

Efficacy of EMG biofeedback, pseudotherapy, and conventional medical treatment for chronic rheumatic back pain.

Twenty-four patients suffering from chronic rheumatic back pain were treated with EMG biofeedback, a credible pseudotherapy, or conventional medical treatment alone during a 4 week inpatient stay at a Rheumatology Clinic. At the end of the treatment phase and at the 4 month followup the patients in the biofeedback group showed significant improvements in the duration, intensity, and quality of their back pain as well as their EMG levels, negative self-statements, and utilization of the health care system. In contrast, the pseudotherapy group showed minimal, but non-significant improvements, and the medically treated group remained unchanged.

Adult↗
PubMedDate not supplied

Cognitive-behavioral approach to the treatment of chronic pain patients.

BACKGROUND AND OBJECTIVES: Chronic pain is both prevalent and costly. Despite advances in understanding the anatomy, physiology, and biochemistry of nociception and development of potent analgesic agents and advanced technology, a significant number of people continue to experience pain and related disability. The perception of and response to pain are influenced by cognitive, affective, and behavioral factors as well as physical pathology. In this article, a selective review of research supporting the important contributions of psychologic factors is provided, a cognitive-behavioral perspective to understanding pain is presented, an integrative treatment and rehabilitation approach based on this perspective is described, and some of the evidence supporting the effectiveness of this treatment approach is summarized. CONCLUSION: Chronic pain by definition persists over a long period-it is a chronic disease. Even the most sophisticated treatments are incapable of eliminating all pain for all pain sufferers. There is also tremendous variation in how patients respond to treatments provided and prescribed. Better treatment outcomes are likely to occur when the psychologic contributors and the physical factors involved are addressed. Moreover, a treatment approach based on the cognitive-behavioral perspective should help patients adapt to residual pain that remains after currently available treatments are undertaken. Thus cognitive-behavioral treatments should be viewed as important complements to more traditional pharmacological, physical, and surgical interventions.

Chronic Disease↗
PubMedDate not supplied

Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain.

OBJECTIVE: Chronic pain is a prevalent and costly problem. This review addresses the question of the clinical effectiveness and cost-effectiveness of the most common treatments for patients with chronic pain. DATA SOURCES: Representative published studies that evaluate the clinical effectiveness of pharmacological treatments, conservative (standard) care, surgery, spinal cord stimulators, implantable drug delivery systems (IDDSs), and pain rehabilitation programs (PRPs) are examined and compared. The cost-effectiveness of these treatment approaches is also considered. DATA SYNTHESIS: Outcome criteria including pain reduction, medication use, health care consumption, functional activities, and closure of disability compensation cases are examined. In addition to clinical effectiveness, the cost-effectiveness of PRPs, conservative care, surgery, spinal cord stimulators, and IDDSs are compared using costs to return a treated patient to work to illustrate the relative expenses for each of these treatments. CONCLUSIONS: There are limitations to the success of all the available treatments. The author urges caution in interpreting the results, particularly in comparisons between treatments and across studies, because there are broad differences in the pain syndromes and inclusion criteria used, the drug dosages, comparability of treatments, the definition of "chronic" used, the outcome criteria selected to determine success, and societal differences. None of the currently available treatments eliminates pain for the majority of patients. Pain rehabilitation programs provide comparable reduction in pain to alternative pain treatment modalities, but with significantly better outcomes for medication use, health care utilization, functional activities, return to work, closure of disability claims, and with substantially fewer iatrogenic consequences and adverse events. Surgery, spinal cord stimulators, and IDDSs appear to have substantial benefits on some outcome criteria for carefully selected patients. These modalities are, however, expensive. Pain rehabilitation programs are significantly more cost effective than implantation of spinal cord stimulators, IDDSs, conservative care, and surgery, even for selected patients. Research is needed to identify which patients are most likely to benefit from the available treatments and to study combinations of the available treatments since none of them appear capable of eliminating pain or significantly improving functional outcomes for all treated.

Chronic Disease↗
PubMedDate not supplied

Comparison of the redundancy, reliability, and responsiveness to change among SF-36, Oswestry Disability Index, and Multidimensional Pain Inventory.

OBJECTIVE: To compare the Medical Outcomes Trust Short-Form-36 (SF-36), the Multidimensional Pain Inventory (MPI), and the Oswestry Disability Index (ODI) measures on internal consistency, domain overlap, and responsiveness in detecting changes following multidisciplinary pain treatment. METHODS: 424 patients with chronic pain referred to a multidisciplinary pain center were assessed. Of these, 87 patients were assessed prior to and following treatment. Cronbach's alphas were calculated for each SF-36 and MPI domain, and for the ODI. Canonical correlation and regression analyses (R2) described overlap. Responsiveness to change was computed from treatment effect size and significance. RESULTS: Cronbach's alpha ranged from 0.69-0.92 for MPI domains, from 0.79-0.91 for SF-36 domains, and was 0.86 for the ODI. Three domains overlapped but several were unique (eg, the MPI "significant other" domains; R2 range 0.03-0.16). Significant changes following treatment were observed for the MPI Pain Severity, Interference and Outdoor Work Activities, the SF-36 Physical and Social Functioning, Bodily Pain, and the ODI. CONCLUSION: The MPI, SF-36, and ODI each have good psychometric properties. Three domains overlapped between the MPI and the SF-36: pain, Interference/Social functioning, and mental health. The MPI and the SF-36 each contributed unique domains such as the SF-36 General Health and Vitality domains and the MPI "significant other" and physical activity domains. Several of the MPI domains were among the most sensitive to change. Because of its large normative sample and samples of patients with diverse medical disorders, the SF-36 may be particularly useful to compare chronic pain patients to those with other medical conditions. The ODI has the lowest respondent burden. The MPI and SF-36, although containing much overlapping information, both make unique and complementary contributions to assessing patients with chronic pain.

Adult↗
PubMedDate not supplied

Psychosocial profiles of people with pain associated with spinal cord injury: identification and comparison with other chronic pain syndromes.

OBJECTIVES: The objectives of the study were to: (1) identify psychosocial profiles of people with pain associated with spinal cord injuries (SCI), and (2) compare the psychosocial profiles with other chronic pain syndromes. METHODS: History questionnaires and the Multidimensional Pain Inventory (MPI) were mailed to 159 persons with chronic pain and SCIs (SCICP) and 120 (75.5%) agreed to participate. RESULTS: Cluster analysis of MPI scores identified 2 subgroups of SCICP. One (42.5%) was characterized by high Pain Severity (PS), Affective Distress (AD), Life Interference (LI), and low Life Control (LC) similar to a previously identified cluster labeled Dysfunctional. The second (57.5%) was characterized by low PS, AD, LI, and high levels of LC and activity (GA), similar to the Adaptive Copers (AC) cluster identified in previous studies with the exception that the scores were lower on Support (S), Solicitous Responses (SR), and Negative Responses (NR) and higher on Distracting Responses (DR). Both subgroups were similar to those observed in other chronic pain syndromes (CPSs). People with SCIs differed significantly from heterogeneous chronic pain and chronic headaches in that they indicated less inference of pain with activities. They also scored lower on S. SCICP reported comparable levels of LI, LC, AD, S, SR, but greater levels of PS compared with a group of people with post-polio syndrome. DISCUSSION: The similarities and differences between SCI and other CPSs suggest that although a general measure assessing psychosocial impact can be used across pain syndromes, it is important to use different norms for comparison of particular pain syndromes. The failure to identify a subgroup of patients characterized by low levels of S and high levels of NR, and the low SR and DR for SCICP compared with other CPSs warrants examination.

Adaptation, Psychological↗
PubMedDate not supplied

The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting.

A large and diverse number of treatments have been shown to be effective in reducing pain and other symptoms for a minority but statistically significant number of patients in different chronic pain syndromes. The means by which such different treatments achieve similar outcomes is not well understood. In this paper, the importance of considering patient heterogeneity for those who may be diagnosed with the same medical syndrome is discussed. The author suggests that the lack of satisfactory treatment outcomes for the treatments of chronic pain syndromes may be accounted for by the patient homogeneity myth--the assumption that all patients with the same medical diagnosis are similar on all important variables. The importance of subdividing (splitting) patients into meaningful groups is described. Studies presenting data on the identification of patient subgroups based on psychosocial and behavioral characteristics and the reliability and validity of this approach are presented. Some initial attempts to demonstrate the potential for matching treatments to patient subgroups are described.

Chronic Disease↗
PubMedDate not supplied

The effect of fear of movement on muscle activation in posttraumatic neck pain disability.

Studies using surface electromyography have demonstrated a reorganization of muscle activation patterns of the neck and shoulder muscles in patients with posttraumatic neck pain disability. The neurophysiologically oriented "pain adaptation" model explains this reorganization as a useful adaptation to prevent further pain and injury. The cognitive-behavioral-oriented "fear avoidance" model suggests that fear of movement, in addition to the effects of pain, modulates the muscle activation level. We analyzed the extent to which pain and fear of movement influenced the activation patterns of the upper trapezius muscle during the transition from acute to chronic posttraumatic neck pain. Ninety-two people with an acute traumatic neck injury after a motor vehicle accident were followed up for 24 weeks. Visual analog scale ratings of pain intensity, response on the Tampa Scale of Kinesophobia--fear of movement, and surface electromyography of the upper trapezius muscles during a submaximal isometric physical task were obtained at 1, 4, 8, 12, and 24 weeks after the motor vehicle accident. Multilevel analysis revealed that an increased level of both fear of movement (t value=-2.19, P=0.030) and pain intensity (t value=-2.94, P=0.004) were independently associated with a decreased level of muscle activation. Moreover, the results suggest that the association between fear of movement and lower muscle activity level is stronger in patients reporting high pain intensity (t value=2.15, P=0.033). The contribution of pain intensity to the muscle activation level appeared to decrease over time after the trauma (t value=2.58, P=0.011). The results support both the "pain adaptation" and the "fear avoidance" models. It is likely that the decrease in muscle activation level is aimed at "avoiding" the use of painful muscles.

Accidents, Traffic↗
PubMedDate not supplied

Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables.

OBJECTIVE: The prevalence as well as predictors of psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] axis I and II) in patients with fibromyalgia syndrome (FMS) was evaluated. METHOD: One-hundred fifteen patients with FMS participated in the Structured Clinical Interview for DSM-IV to assess current mental disorders. In addition, patients completed standardized questionnaires regarding pain, pain impact, anxiety, depression, posttraumatic stress disorder-like symptoms, and sexual and physical abuse. RESULTS: Patients were grouped into one of three psychosocial subgroups based on responses to the Multidimensional Pain Inventory (MPI)-Dysfunctional (DYS), Interpersonally Distressed (ID), and Adaptive Copers (AC). Axis I diagnoses were present in 74.8% of the participants overall with the DYS subgroup mainly reporting anxiety and the ID group mood disorders. The AC group showed little comorbidity. Axis II diagnoses were present in only 8.7% of the FMS sample. CONCLUSION: These results suggest that FMS is not a homogeneous diagnosis, but shows varying proportions of comorbid anxiety and depression dependent on psychosocial characteristics of the patients. The results demonstrate the importance of not treating patients with FMS as a homogeneous group. Assessment should not only examine the presence of widespread pain and the number of tender points, but also the presence of affective distress. Treatment should focus both on physical and emotional dysfunction.

Adult↗