Biomedical subjects

Judith A Turner

Publications and source records attributed to Judith A Turner.

At least 55 records · Page 3Linked to original sources

PubMed2004

Screening for psychosocial risk factors in patients with chronic orofacial pain: recent advances.

BACKGROUND: The authors compiled information about recent advances in screening for psychosocial risk factors considered to be yellow flags for potentially poor outcomes among patients with chronic orofacial pain (most commonly temporomandibular disorders). TYPES OF STUDIES REVIEWED: The authors conducted MEDLINE searches for the period 1995 through 2002 using the terms "temporomandibular disorders," "assessment" and "psychological," as well as "primary care," "screening" and "psychological disorders." They also searched personal files for relevant articles. RESULTS: Psychosocial dysfunction is prevalent among patients with chronic orofacial pain. Yellow flags include high levels of disability; psychological disorders; and prolonged or excessive use of opiates, benzodiazepines, alcohol or other drugs. The authors identified several reliable, valid and brief patient self-administered questionnaires that can be used to screen for these yellow flags. Some of these are the Research Diagnostic Criteria/ Temporomandibular Disorders Axis II, Alcohol Use Disorders Identification Test and Patient Health Questionnaire. CLINICAL IMPLICATIONS: Dentists can improve the quality of care for patients with chronic orofacial pain by screening for psychosocial risk factors and by referring patients with risk factors for psychological or psychiatric assessment and treatment.

Activities of Daily Living↗

PubMed2004

Policy-relevant research: when does it matter?

Evidence-based medicine is most meaningful to policy makers when research questions are clearly informed by strategic health policy questions. In Washington State workers' compensation, key structural characteristics allow for the conduct of effective policy-relevant research. These include clear authority and a stable funding stream, a formal relationship between a policy agency and a University, development of appropriate research capacity, development of research questions related to strategic goals, and a robust data source. The research conducted relies on computerized medical bills and work disability records, medical records, structured telephone surveys to collect data on pain, functional status, quality of life, and computerized data on employment status. The types of policy-relevant research include identification of factors leading to preventable disability, outcomes research of specific procedures, technology assessment, and "real-time" research that addresses rapidly emerging questions. Health policy changes implemented from research have been substantial in Washington State workers' compensation, including: 1) noncoverage or partial coverage decisions for emerging technologies not proven to be of value to injured workers, 2) formal treatment guidelines and utilization review criteria for invasive, expensive, or marginally effective procedures, 3) disability prevention efforts, and 4) relatively rapid changes in policy as emerging patterns suggest harmful outcomes from existing treatments (e.g., schedule II opioids). Key structural characteristics must be in place to conduct policy-relevant research effectively. The workers' compensation system in Washington State is a single-payer system with other unique properties that have allowed the emergence of these structural characteristics and the conduct of research linked to the strategic goals of policy makers.

Adult↗

PubMed2004

Short-term clinical outcomes and patient compliance with temporomandibular disorder treatment recommendations.

AIMS: To evaluate short-term patient compliance with 5 conservative temporomandibular disorder (TMD) treatments (jaw relaxation, jaw stretching, heat application, cold application, and occlusal splint use) and the association of compliance with changes in pain intensity, pain-related activity interference, and jaw use limitations. METHODS: Eighty-one TMD patients were given 1 to 5 treatment recommendations as part of usual care in a TMD specialty clinic. Compliance with each recommendation and pain, pain-related activity interference, and jaw use limitation measures were calculated from electronic interviews conducted 3 times daily for 2 weeks. RESULTS: Median compliance with individual treatment modalities ranged from 7.7% for heat application to 92.7% for jaw relaxation; median overall compliance was 54.8%. Participants with higher initial pain intensity and jaw use limitations were significantly more compliant with their recommended treatment regimen (P < .05). The authors controlled for age, gender, education, and initial jaw use limitations. Overall compliance was associated significantly and positively with 2-week jaw use limitations (P = .03). A trend toward a statistically significant positive association was found between compliance and 2-week pain intensity (P = .09). CONCLUSION: Compliance varied widely across patients and therapies. Patients with higher initial pain and jaw use limitation levels were more compliant with treatment recommendations. Although compliance was associated with slight increases in pain and jaw use limitations in this preliminary study, further research is needed to evaluate the longer-term effects of compliance with recommended therapies.

Adult↗

PubMed2003

Comparison of the Roland-Morris Disability Questionnaire and generic health status measures: a population-based study of workers' compensation back injury claimants.

STUDY DESIGN: Workers' compensation back injury claimants completed baseline and follow-up telephone interviews in a prospective population-based cohort study. OBJECTIVE: To compare the Roland-Morris Disability Questionnaire (RDQ) to widely used generic health status measures in a sample of workers with recent work-related back injuries in terms of validity, reliability, responsiveness to change, and floor and ceiling effects. SUMMARY OF BACKGROUND DATA: Little research has directly compared the validity and responsiveness of the RDQ to that of the Short-Form 12 or Short-Form 36 health status measures among individuals with back pain. Furthermore, there is little information concerning the validity, reliability, and responsiveness of the RDQ as a measure of functional outcomes for workers with back injuries. METHODS: Approximately 8 weeks (median) after filing low back injury claims, 309 workers completed the RDQ, Short-Form 12, and Short-Form 36 scales and gave information about their work status in computer-assisted telephone interviews. An average of 5 months later, 284 workers (91.9%) completed the measures again. RESULTS: The RDQ demonstrated excellent internal consistency and validity through correlations with other measures of physical functioning, ability to discriminate between those working and those not working, and much more responsiveness to change than the Short-Form 12 and Short-Form 36 scales. However, 15% of the sample did not answer one or more RDQ items. CONCLUSIONS: The RDQ is a valid measure of physical disability among workers with back injuries. Its greater responsiveness to change suggests its superiority to the Short-Form 12 and Short-Form 36 as an outcome measure in this population.

Adolescent↗

PubMed2003

The Chronic Pain Coping Inventory-42: reliability and validity.

Coping responses have been shown to be associated with physical and psychological functioning in patients with chronic pain. Assessment of coping strategies has received increasing attention, with several measures of cognitive and behavioral coping showing promise. One such instrument is the Chronic Pain Coping Inventory (Pain 60 (1995) 203), a 65-item measure of behavioral and cognitive pain coping strategies often targeted as part of multidisciplinary pain treatment. Initial research has supported the reliability and validity of the CPCI. This article describes the development of an abbreviated (42-item) CPCI. The results demonstrate very high correlations between the original and abbreviated CPCI scales, as well as comparable internal consistency, test-retest stability, and validity coefficients. The findings support the reliability and validity of the abbreviated CPCI, and suggest that it could be substituted for the CPCI without sacrificing reliability and validity in situations where a briefer measure of coping with chronic pain is preferable.

Adaptation, Psychological↗

PubMed2003

One- and two-item measures of pain beliefs and coping strategies.

Pain-related beliefs and pain coping strategies are central components of current cognitive-behavioral models of chronic pain, and have been found in numerous studies to be associated significantly with psychosocial and physical disability. However, the length of most measures of pain-related beliefs and coping restricts the ability of clinicians and researchers to perform a thorough assessment of these variables in many situations. The availability of very brief versions of existing scales would make possible the assessment of a range of important pain beliefs and coping strategies in settings where subject or patient assessment burden is an issue. In this study, one- and two-item versions of the subscales of several commonly used measures of pain beliefs and coping strategies were developed using both rational and empirical procedures. The findings support the validity of these brief subscales. The appropriate use and limitations of these measures are discussed.

Adaptation, Psychological↗

PubMed2003

Readiness to self-manage pain is associated with coping and with psychological and physical functioning among patients with chronic pain.

A patient's readiness to adopt a self-management approach to pain has been suggested as a construct that may explain differences among patients in coping, adjustment, and response to multidisciplinary pain treatment. The pain stages of change questionnaire (PSOCQ; Pain, 72 (1997) 227) was designed to assess four components of this construct. The current study tested the following two hypotheses in two different samples of persons with chronic pain. PSOCQ scales are associated with (1) coping strategies used to manage pain and (2) patient disability and depression. The findings supported the first hypothesis and provided mixed support for the second. The implications of the findings for understanding the readiness to self-manage pain construct and the validity of the PSOCQ for assessing this construct are discussed.

Adaptation, Psychological↗

PubMed2003

Social environment moderates the association between catastrophizing and pain among persons with a spinal cord injury.

Catastrophizing, or exaggerating the negative consequences of a situation, is associated with higher pain intensity, emotional distress, and functional disability among persons with chronic pain. According to the 'communal coping' model, catastrophizing in persons with pain may function as a social communication directed toward obtaining social proximity, support, or assistance. We tested the hypothesis, based on this model, that social factors would moderate the association between catastrophizing and sensory and affective pain. Seventy-four persons with a spinal cord injury and chronic pain completed measures of catastrophizing, solicitousness, depression, and sensory and affective pain before beginning a randomized controlled medication trial. Catastrophizing was significantly associated with solicitousness and pain reports. The association between catastrophizing and sensory pain scores was stronger for those who lived with a spouse or partner than for those who lived with someone else. In addition, there was a stronger association between catastrophizing and affective pain for those who reported greater solicitousness in their relationship. The results provide partial support for the communal coping model of catastrophizing.

Adaptation, Psychological↗

PubMed2003

Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls.

PURPOSE: Previous reports have identified bacteria in the prostate of men with chronic pelvic pain syndrome. To examine whether prostatic bacteria are more prevalent among patients with chronic pelvic pain syndrome than among those without pelvic pain, we compared 4-glass urine test and prostate biopsy results. MATERIALS AND METHODS: A total of 120 patients with types IIIa and IIIb chronic pelvic pain syndrome and 60 asymptomatic controls underwent a standard 4-glass urine test, examination of expressed prostatic secretion leukocytes by hemocytometer and transperineal, digitally guided prostate biopsies. Tissue was cultured for aerobes, anaerobes, Trichomonas vaginalis, Chlamydia trachomatis and herpes simplex virus. Skin cultures were performed on a subset of patients and controls. RESULTS: Positive prostate biopsy cultures were obtained from patients and controls. Bacteria were found in 45 of 118 pain patients (38%) and in 21 of 59 controls (36%) (p = 0.74). Older men were more likely to have positive cultures. Men with type IIIa chronic pelvic pain syndrome were more likely than those with type IIIb to have positive prostate biopsy cultures. CONCLUSIONS: Bacteria cultured from transperineal prostatic biopsies do not differ between men with and without chronic pelvic pain syndrome. Prostatic bacteria obtained by biopsy are probably not etiologically related to the symptoms in the majority of men with chronic pelvic pain syndrome.

Adolescent↗

PubMed2003

Validity and responsiveness of the national institutes of health chronic prostatitis symptom index.

PURPOSE: The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was validated in a sample of men with longstanding prostatitis but it has not been validated in primary care samples or assessed for responsiveness to change. We assessed its reliability, validity and responsiveness to change in a sample of men with pelvic pain visits to health maintenance organization primary care and urology clinics. MATERIALS AND METHODS: A total of 261 men with recent primary care or urology clinic visits for pelvic pain and no evidence of specific disease completed the NIH-CPSI and validated generic pain and health-related quality of life measures (Graded Chronic Pain Scale, Short-Form 36 and Short-Form 12 scales) in a telephone interview approximately 1 month after the visit, of whom 230 (88%) completed the measures again 3 months later. RESULTS: Validity was demonstrated for the NIH-CPSI pain and quality of life scales through their moderate correlations with other validated measures of these constructs. The NIH-CPSI total scale but not the subscales showed high internal consistency. The pain, quality of life and total scores were moderately responsive to change (effect size -0.57 to -0.60), but the urinary symptoms scale was less responsive (effect size -0.18). CONCLUSIONS: The NIH-CPSI total score appears to be a valid, reliable, responsive measure of prostatitis symptoms in primary and secondary care patients. The findings support the use of the total score as an outcome measure. It may be useful to supplement it with valid, reliable measures of pain intensity and activity interference.

Adolescent↗

PubMed2003

Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: a case-control study.

PURPOSE: Men with chronic pelvic pain syndrome (CPPS) type III experience pelvic pain of uncertain etiology. Pain has been attributed to prostatic, bladder and muscular origins. Few studies have documented pelvic and abdominal muscle function in men with CPPS or compared their muscular examination to that of men without pain. We hypothesized that the musculoskeletal examinations of men with CPPS types IIIA and IIIB would show more spasm, tenderness and dysfunction than in men without CPPS. MATERIALS AND METHODS: A total of 62 men with CPPS and 89 healthy men without pelvic pain underwent a standardized musculoskeletal examination by a licensed physical therapist. RESULTS: Controls and patients with pain showed a significant difference in muscle spasm, increased muscle tone, pain with internal transrectal palpation of the pelvic muscles, and increased tension and pain with palpation of the levator ani and coccygeus muscles (p <0.001). Patients with pain also had significantly greater pain and tension with palpation of the psoas muscles and groin. Patients and controls did not differ significantly in strength testing of the lower abdominal and oblique muscles. CONCLUSIONS: Men with CPPS have more abnormal pelvic floor muscular findings compared with a group of men without pain. Abnormalities of the pelvic muscles may contribute to this pain syndrome.

Abdominal Muscles↗

PubMed2002

Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial.

Chronic pain in persons with spinal cord injury (SCI) is a difficult problem for which there is no simple method of treatment. Few randomized controlled trials of medications for pain in persons with SCI have been conducted. This study was designed to determine whether amitriptyline, a tricyclic antidepressant, is efficacious in relieving chronic pain and improving pain-related physical and psychosocial dysfunction in persons with SCI. Eighty-four participants with SCI and chronic pain were randomized to a 6-week trial of amitriptyline or an active placebo, benztropine mesylate. All pre- and post-treatment assessments were conducted by evaluators blind to the allocation. Regression analyses were conducted to examine whether there was a medication group effect on the primary (average pain intensity) and secondary outcome measures. No significant differences were found between the groups in pain intensity or pain-related disability post-treatment, in either intent-to-treat analyses or analyses of study completers. These findings do not support the use of amitriptyline in the treatment of chronic pain in this population, but we cannot rule out the possibility that certain subgroups may benefit.

Adult↗

PubMed2002

Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury.

Little research has examined the role of patient cognitive and behavioral responses, including catastrophizing, in adjustment to chronic pain associated with spinal cord injury (SCI). The objective of this study was to examine the associations of catastrophizing and specific pain coping strategies with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain and SCI, after controlling for important demographic and SCI-related variables that might affect outcomes. Participants in this study were 174 community residents with SCI and chronic pain who completed a mailed questionnaire that included the SF-36 Mental Health scale, Coping Strategies Questionnaire, and Graded Chronic Pain Scale. The pain coping and catastrophizing measures explained an additional 29% of the variance in pain intensity after adjusting for the demographic and SCI variables (P<0.001). The coping and catastrophizing scales accounted for an additional 30% of the variance in psychological distress (P<0.001) and 11% of the variance in pain-related disability (P<0.001), after controlling for pain intensity and demographic and SCI variables. Catastrophizing, but not any other single pain coping strategy, was consistently strongly and independently associated with the outcome measures. Potentially, the assessment and treatment of catastrophizing may reduce psychological distress and pain-related disability among individuals with chronic pain and SCI.

Adaptation, Psychological↗

PubMed2002

Blinding effectiveness and association of pretreatment expectations with pain improvement in a double-blind randomized controlled trial.

Patient, provider, and clinical investigator expectations concerning treatments are believed to play important roles in patient response. This study examined the association of patient and research nurse/physician pretreatment expectations of pain relief with actual pain relief, the accuracy of patient and research nurse guesses about patient medication assignment, and changes in research nurse and patient pain relief expectations over the course of a randomized double-blind trial of amitriptyline versus an active placebo for patients with chronic pain and spinal cord injuries (SCI). Patient expectations of pain relief with amitriptyline were associated significantly with actual pain decrease for patients in the amitriptyline, but not placebo, condition. Research nurse/physician expectations did not predict patient pain relief. Both patients and the research nurse were able to guess patient medication assignment at a rate significantly greater than chance. The research nurse's, but not the patients', expectations of pain relief with amitriptyline decreased significantly over the course of the study. These findings have implications for future randomized controlled trials. Fully double-blind conditions are very difficult to achieve, and it is informative to assess patient and research clinician expectations and guesses regarding medication assignment.

Adult↗

PubMed2002

Classification of chronic pain associated with spinal cord injuries.

OBJECTIVES: To determine interrater reliability of a classification system for chronic pain in persons with spinal cord injury (SCI) and to determine the frequency and characteristics of various pain types as categorized by this system. DESIGN: Independent categorization (based on questionnaires; for 15 persons, questionnaires plus personal interviews) by 2 investigators. SETTING: Community. PARTICIPANTS: A total of 163 individuals aged >or=18 years with SCI and pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain categories, Short-Form McGill Pain Questionnaire, and Chronic Pain Grade questionnaire. RESULTS: Among 41 (25%) questionnaires categorized independently by 2 investigators, strength of agreement in categorizing 68 pain problems was substantial (kappa=.68). For 15 persons whose pain was categorized in person by 2 investigators, strength of agreement was also substantial (kappa=.66). Among 163 survey respondents with pain, the most common worst pain was SCI pain (31.9%). Mean characteristic pain intensity +/- standard deviation for worst pain, regardless of type, was 61.02+/-18.5 on a scale from 0 to 100. On average, for worst pain, respondents reported moderate pain-related disability (43.70+/-29.4; scale range, 0-100). Although certain pain descriptors were more often associated with a specific type of pain, none was pathognomonic. CONCLUSIONS: Substantial interrater reliability was achieved in determining pain categories by use of responses to a questionnaire with a classification system based on presumed pathology. Adding interviews with patients increased our ability to classify pain but did not improve overall interrater reliability.

Adult↗

PubMed2002

Primary care and urology patients with the male pelvic pain syndrome: symptoms and quality of life.

PURPOSE: We assessed symptoms and health related quality of life in men who received prostatitis-prostatodynia diagnoses at primary care and urology visits, and compared those in whom pain-discomfort had versus had not resolved approximately 1 month later. MATERIALS AND METHODS: Telephone interviews were done with 357 men an average of 1 month after a prostatitis-prostatodynia diagnosis was made at a health maintenance organization visit. The interview included the National Institutes of Health Chronic Prostatitis Symptom Index, and pain and health related quality of life measures. RESULTS: The most common pain location was the pubic-bladder area. Mean scores on most health related quality of life measures were below average, and higher pelvic pain and urinary symptom scores were associated with worse quality of life. This episode of pelvic pain was the first lifetime episode in fewer urology (22%) than primary care (38%) patients (p = 0.02). Urology patients had longer symptom episodes (p = 0.000), more days with pain in the last month (p = 0.002) and higher National Institutes of Health Chronic Prostatitis Symptom Index pain scores (p = 0.002). Men with pain in the testicles, penis or between the rectum and testicles at the visit, and with longer symptom duration before the visit were significantly more likely to have continued pain between the visit and interview. CONCLUSIONS: Pelvic pain is often a persistent, recurrent condition that can have a significant negative impact on quality of life. The average symptom severity in men with pelvic pain in primary care and urology settings is lower than that in tertiary care samples.

Adolescent↗

PubMed2002

A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders.

AIMS: To test the usefulness of tailoring cognitive-behavioral therapy (CBT) for patients with temporomandibular disorders (TMD) who demonstrated poor psychosocial adaptation to their TMD condition, independent of physical diagnosis. METHODS: A randomized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists. For study inclusion, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Axis II criteria, were used to target patients with elevated levels of TMD pain-related interference with daily activities, independent of physical diagnosis (i.e., Axis I). RESULTS: At the post-treatment assessment, about 4 months after the baseline evaluations, the comprehensive care group, when compared to the usual treatment group, showed significantly lower levels of characteristic pain intensity, significantly higher self-reported ability to control their TMD pain, and a strong trend (P = .07) toward lower pain-related interference in daily activities. From post-intervention to 1-year follow-up, all subjects showed improvement. At the 1-year follow-up, the comprehensive care group, while not losing any of its early gains, was not significantly different from the usual care group with regard to reported levels of pain, ability to control pain, and levels of interference in activities. For many of these psychosocially disabled TMD patients, pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate randomized clinical trial on the basis of better psychosocial adaptation. CONCLUSION: The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment, but was too brief an intervention to result in further improvement after the sessions ended. Patient ratings of treatment satisfaction and helfulness were high for both groups, but they were significantly higher for the comprehensive care group.

Activities of Daily Living↗

PubMed2000

Further evaluation of the pain stages of change questionnaire: is the transtheoretical model of change useful for patients with chronic pain?

Patient readiness to adopt new beliefs and coping responses to pain may predict response to multidisciplinary or cognitive-behavioral pain treatments that emphasize changes in beliefs and coping behaviors. According to the transtheoretical model of change, individuals go through specific stages in the process of changing maladaptive behaviors. Based on this model, Kerns et al. (1997) (Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornthwaite J. Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain 1997;72:227-234) developed a measure of readiness to adopt a self-management approach to pain problems (the Pain Stages of Change Questionnaire; PSOCQ) and provided preliminary data supporting the validity of the measure. The current study sought to further evaluate the PSOCQ by determining the generalizability of these preliminary findings and the ability of the PSOCQ to classify persons with chronic pain into specific stages of readiness to self-manage pain. One hundred ten patients with diverse chronic pain problems, and 119 patients with fibromyalgia completed the PSOCQ and two measures of pain-related beliefs and coping prior to entry into two separate multidisciplinary pain programs. The internal consistency and concurrent validity of the PSOCQ subscales were largely replicated, supporting the validity of the subscales as measures of readiness to self-manage pain. However, the PSOCQ demonstrated less utility as a tool for classifying individuals into one of four specific stages of readiness to adopt a self-management approach. This result may be due to the classification procedure used in the current study, the characteristics of the samples in the study, specific limitations of the measure, and/or limitations in the applicability of the transtheoretical model of change to patients with chronic pain.

Adaptation, Psychological↗