Biomedical subjects

J Epker

Publications and source records attributed to J Epker.

4 recordsLinked to original sources

PubMed2001

Presurgical psychological screening in back pain patients: a review.

OBJECTIVE: The objective of this article is to provide a brief overview of the major psychosocial risk factors impacting recovery from spine surgery. RESULTS: Numerous personality, cognitive, behavioral and historical factors affecting surgical recovery are reviewed. Among the most significant issues that have been found to have an adverse influence on outcome are Minnesota Multiphasic Personality Inventory scale elevations associated with pain sensitivity, depression, anger and anxiety. Maladaptive pain coping strategies, litigation, workers' compensation and reinforcement of pain behavior by the spouse also have been found to reduce spine surgery results. A number of other factors are reviewed, including pre-existing psychological problems, sexual and physical abuse, marital distress and substance abuse. CONCLUSIONS: Presurgical psychological screening should be included in the medical diagnostic process of spine surgery candidates, especially when the major goal is pain reduction, or when the surgeon recognizes the existence of psychosocial risk factors. Suggestions for future directions in the development of presurgical psychological screening procedures are also given.

Back Pain↗

PubMed2000

Prediction of treatment-seeking behavior in acute TMD patients: practical application in clinical settings.

AIMS: To determine potential differences in predictive models of acute temporomandibular disorder (TMD) patients divided into groups based on the physiologic characteristics of their TMD. METHODS: One hundred seventy-seven acute TMD patients were evaluated with an extensive battery that included biologic and psychosocial measures. Subjects were separated into 3 groups based on a physical exam using the Research Diagnostic Criteria for TMD (RDC): those with a myofascial pain diagnosis, those with either a disc displacement or other joint condition, and those who reported pain but did not receive an RDC Axis I diagnosis. Six months later, it was determined whether patients had sought additional treatment for relief of their symptoms. Treatment-seeking and non-treatment-seeking groups were compared for significant differences, and predictive models were generated to determine the array of variables that best predicted treatment-seeking behavior among each of the 3 classifications of TMD patients used in this study. RESULTS: Among patients with a diagnosis of myofascial pain, gender, Multidimensional Pain Inventory (MPI) interference score, and MPI affective distress score accurately predicted treatment-seeking behavior in 76.1% of the sample. For patients with a diagnosis of disc displacement, arthralgia, arthritis, or arthrosis, the following variables predicted treatment utilization behavior in 93.6% of the sample: race, RDC graded chronic pain, and the introversion scale of the Minnesota Multiphasic Personality Inventory-2. For patients with no RDC Axis I disorder, 80.5% of the sample was accurately classified with regard to treatment-seeking behavior through the use of only the characteristic pain intensity score (i.e., mean of visual analog scale scores for "pain right now," "worst pain," and "average pain"). CONCLUSION: The factors that predict which acute TMD patients are most likely to seek additional treatment vary depending on the physiologic basis of their TMD. This suggests that acute TMD patients may benefit from different modalities of treatment, depending on the type of TMD with which they present.

Acute Disease↗

PubMed1999

A model for predicting chronic TMD: practical application in clinical settings.

BACKGROUND: Substantial cost is associated with the treatment of chronic temporomandibular disorders, or TMDs, and patients with TMDs often experience significant psychosocial distress. Early intervention based on identified risk factors has potential financial and functional benefits. METHODS: Two hundred four patients with acute TMD were evaluated via an assessment battery that included physical, psychological and social measures. All participants were diagnosed as having TMD on the basis of the research diagnostic criteria for TMD, Axis I. At the six-month follow-up assessment, patients were considered to have chronic TMD if they continued to have TMD pain. This resulted in 144 of the patients being classified in the chronic group and 60 being classified in the nonchronic group. RESULTS: A comparison of the acute TMD data demonstrated that the group that went on to develop chronic TMD and the group that did not differed significantly in their scores on numerous biopsychosocial indexes. Although several biopsychosocial measures were found to differentiate these two groups before the onset of chronic TMD, logistic regression analysis demonstrated that a two-variable predictive model consisting of the presence of a muscle disorder and characteristic pain intensity (that is, the mean of these three ratings: patient's report of current pain, worst pain in the last three months and mean pain in the last three months) accurately classified 91 percent of the subjects who went on to develop chronic TMD. CONCLUSIONS: During the acute phase of TMD, two variables allowed for an accurate prediction rate of 91 percent among patients who went on to develop chronic TMD. CLINICAL IMPLICATIONS: This model provides clinicians with the opportunity to identify at-risk patients early and initiate adjunctive or alternative treatments, thus reducing the likelihood of the development of TMD chronicity.

Acute Disease↗

PubMedDate not supplied

Coping profile differences in the biopsychosocial functioning of patients with temporomandibular disorder.

OBJECTIVE: The objective of this study was to evaluate whether biopsychosocial functioning differences exist between samples of patients with temporomandibular disorder (TMD) who differ in coping profiles as assessed by the Multidimensional Pain Inventory. METHODS: A total of 322 patients who presented with TMD were administered a comprehensive biopsychosocial assessment battery, and the acute or chronic status of their disorder was determined. A follow-up evaluation was conducted 6 months later to determine the status of their pain. RESULTS: TMD patients with dysfunctional and interpersonally distressed coping profiles demonstrated more acute and chronic psychosocial difficulties than patients with adaptive coper profiles. The data also suggest that having a dysfunctional/distressed coping profile on the Multidimensional Pain Inventory has some predictive value in determining the likelihood of developing chronicity in the absence of treatment. CONCLUSIONS: The presence of a dysfunctional/distressed coping profile in patients with TMD is likely to provide clinicians with important information about the biopsychosocial functioning of those patients, which, in turn, will help to determine the most effective treatment modalities to use with TMD patients.

Acute Disease↗