Biomedical subjects

Judith A Turner

Publications and source records attributed to Judith A Turner.

At least 73 records · Page 4Linked to original sources

PubMed1996

The use of multiple-item scales for pain intensity measurement in chronic pain patients.

This study examined the relative predictive validities of several measures of pain intensity. Forty chronic pain patients completed 6-14 days worth of hourly pain ratings, which were averaged to obtain a measure of actual average pain intensity. These patients then made ratings, on 101-point numerical rating scales, of worst, least, and usual pain during the previous 2 wks, and of their current pain. A series of correlation coefficients were computed and regression analyses were performed to determine the individual or composite measures that best predicted actual average pain intensity. Consistent with previous research, the best single predictor of actual average pain intensity was patient rating of least pain in the previous 2 wks. Of all possible composites of usual, least, worst, and current pain ratings, the arithmetic mean of least and usual pain had the strongest relationship to actual average pain. The inclusion of ratings of most pain or current pain in any composite score actually weakened the relationship between the composite score and actual average pain intensity. These results suggest that, when clinicians or researchers wish to assess average pain among chronic pain patients, but cannot obtain multiple measures of pain over time, the most valid measure would be the arithmetic mean of patient-recalled least and usual pain.

Adult↗

PubMed1995

The Chronic Pain Coping Inventory: development and preliminary validation.

This paper describes the development and validation of a measure of strategies used by patients to cope with chronic pain, the Chronic Pain Coping Inventory (CPCI). A 104-item measure of pain coping responses and 3 measures of functioning were completed by 176 chronic pain patients. Two-week retest data were provided by 111 of these patients. Item and scale analyses resulted in a 65-item measure that assessed 11 pain coping dimensions. This inventory was then cross-validated in a second sample of chronic pain patients (n = 78), who also completed a measure of pain-related distress. The significant others (typically, spouses) of patients in the second sample rated patients on a significant-other version of the CPCI and on other measures of patient functioning. The results support the reliability of the CPCI scales. Four scales (Guarding, Resting, Asking for Assistance, and Task Persistence) predicted patient- and significant other-reported patient adjustment. Eight scales (Guarding, Opioid Medication Use, NSAID Use, Sedative-Hypnotic Medication Use, Resting, Asking for Assistance, and Exercise/Stretch) demonstrated moderate-to-strong relationships between patient and significant-other versions, further supporting their validity.

Adaptation, Psychological↗

PubMed1995

Chronic pain patient-spouse behavioral interactions predict patient disability.

Based on behavioral theory, it has been hypothesized that spouse solicitous responses to the pain behaviors of chronic pain patients may contribute to the maintenance of pain behaviors and disability. Self-report data support this hypothesis, but direct observational measures have not been used to study this association. In this study, 50 chronic pain patients and their spouses were videotaped while engaging in common household activities. and patient pain behaviors and spouse solicitous behaviors were coded from the tapes. Spouse solicitous responses to non-verbal pain behaviors were significant predictors of physical disability in the more depressed patients, and were significant predictors of rate of non-verbal pain behavior in patients who reported greater pain. Spouse solicitous responses did not predict psychosocial dysfunction or total self-reported pain behaviors. The result support behavioral theory and indicate the need for further study of the association between spouse solicitousness and patient pain behaviors/disability.

Adult↗

PubMed1994

Relationship of pain-specific beliefs to chronic pain adjustment.

Cognitive-behavioral models suggest that pain patients' beliefs about their pain play a critical role in their adjustment. This study sought to replicate and extend previous research that has examined the relationship between pain-specific beliefs and adjustment to chronic pain. Two hundred forty-one chronic pain patients evaluated for possible admission to an inpatient pain treatment program completed the Sickness Impact Profile (SIP) and the Survey of Pain Attitudes (SOPA), as well as measures of pain, medical services utilization and demographic characteristics. The results indicated that the beliefs that emotions affect pain, that others should be solicitous when the patient experiences pain, and (for subjects reporting low and medium levels of pain severity) that one is disabled by pain were associated positively with psychosocial dysfunction. The beliefs that one is disabled and that activity should be avoided because pain signifies damage were associated positively with physical disability. None of the beliefs assessed was significantly associated with number of physician visits in the previous 3 months, although belief in the appropriateness of medications for managing chronic pain was associated positively with pain-related emergency room visits. The results support a cognitive-behavioral model of chronic pain adjustment and suggest specific pain beliefs to target in treatment studies examining causal relationships between beliefs and adjustment.

Adaptation, Psychological↗

PubMed1994

Brief group cognitive-behavioral intervention for temporomandibular disorders.

Temporomandibular disorders (TMD) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck, and the soft tissue and bony components of the temporomandibular joint. Epidemiologic and clinical studies of TMD confirm its status as a chronic pain problem. In this report we present results from a randomized clinical trial which compared, at 3- and 12-month follow-ups, the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive-behavioral (CB) intervention delivered to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction. Patients who participated in the CB intervention followed by usual treatment showed greater long-term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment. The benefits of CB intervention were not seen when the CB and UT groups were compared at 3-month follow-up. During the 3-12-month follow-up interval, however, the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve, as hypothesized. During this same follow-up interval, the CB group also showed a strong trend toward continued improvement in pain interference. Such effects were not observed for depression, somatization, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention. Intent to treat analyses were also performed to assess generalizability of the results.

Activities of Daily Living↗

PubMed1994

What is the maximum number of levels needed in pain intensity measurement?

An important issue that has yet to be resolved in pain measurement literature concerns the number of levels needed to assess self-reported pain intensity. An examination of treatment outcome literature shows a large variation in the number of levels used, from as few as 4 (e.g., 4-point Verbal Rating scales (VRS)) to as many as 101 (e.g., 101-point Numerical Rating scales (NRS)). The purpose of this study was to provide an empirically derived guideline for determining the number of levels needed. Chronic pain patients (n = 124) provided pre- and post-treatment measures of pain intensity using 101-point NRS for least, most, current, and average pain. The patients' responses to the measures were examined closely to determine the actual number of levels used. In addition, their responses to the 101-point scales were recorded to form 7 scales of varying levels (2- to 101-point scales). The sensitivity of the 7 recorded scales was examined. The results indicated that little information is lost if 101-point scales are coded as 11- or 21-point scales. Moreover, examination of the actual responses to the 101-point measure showed that almost all patients treated it as a 21-point scale by providing responses in multiples of 5 or 10, while a substantial number of patients treated it as an 11-point scale, providing responses in multiples of 10 only. The results suggest that 10- and 21-point scales provide sufficient levels of discrimination, in general, for chronic pain patients to describe pain intensity.

Adult↗

PubMed1993

Efficacy of cognitive therapy for chronic low back pain.

The effects of outpatient group cognitive therapy, relaxation training, and cognitive therapy in combination with relaxation training on chronic low back pain and associated physical and psychosocial disability were evaluated and compared. One-hundred and two mildly disabled chronic low back pain patients were assigned randomly to a waiting-list (WL) control condition and the 3 treatments. Patient self-report and observational measures were obtained pretreatment and post-treatment for all conditions, and at 6- and 12-month follow-ups for the treatment conditions. Pain intensity decreased significantly pre- to post-treatment for patients in all 3 treatment conditions, but not the WL condition. Depressive symptoms and disability improved significantly in all conditions (including the waiting list) from pretreatment to post-treatment, with no statistically significant differences among treatments. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no statistically significant differences between treatments.

Adaptation, Psychological↗

PubMed1993

Children of chronic pain patients: risk factors for maladjustment.

Recent research has documented negative effects of chronic pain problems on patients' spouses and children. This study examined the adjustment of children of 35 chronic pain patients, compared with children of 29 healthy controls, and the relationship of specific parental characteristics to child adjustment. Pain group children had significantly more teacher-rated behavior problems and significantly lower teacher-rated social competence than did control group children. Children of male patients were rated by parents as significantly less socially competent than children of female patients. Compared with controls, pain patients and their spouses reported significantly more depression, and pain patients were significantly more disabled. Patient functional disability was significantly associated with parent-rated child behavior problems, but group membership, patient gender, patient depression, and patient marital satisfaction were not. Child social competence was predicted by patient gender, but was not predicted by patient depression or disability, group membership, or by patient marital satisfaction. The results suggest that children of chronic pain patients may be at risk for adjustment problems.

Adaptation, Psychological↗

PubMed1992

A multi-center evaluation of the McGill Pain Questionnaire: results from more than 1700 chronic pain patients.

We argue that the conflicting results reported in previous studies examining the factor structure of the McGill Pain Questionnaire Pain Rating Index (PRI) can be explained by differences in the patient samples and statistical analyses used across studies. In an effort to clarify the factor structure of the PRI, 3 different factor models were compared using confirmatory factor analysis in 2 samples of low-back pain patients (N = 1372) and in a third sample of patients suffering from other chronic pain problems (N = 423). A 4-factor model, similar to those obtained in previous studies where multiple criteria were used to determine the number of factors extracted, best explained covariation among PRI subclasses. However, relatively high interfactor correlations (approximately two-thirds of the variance explained by the best fitting factor structure was common variance) cast doubt on the discriminant validity of PRI subscales; examination of relationships between the PRI and MMPI subscales also failed to provide evidence of the discriminant validity or clinical utility of PRI subscales. Reducing the information from the 10 PRI sensory subclasses to a single subscale score may seriously limit the usefulness of the PRI. Alternate methods of using PRI data are suggested.

Adolescent↗

PubMed1992

Chronic pain, depression, and the dexamethasone suppression test.

In most healthy individuals, dexamethasone suppresses adrenal cortisol production. However, in patients with major depression, non-suppression frequently occurs and thus may be a marker for depression. The purpose of the present study was to examine the relationship of dexamethasone suppression test (DST) non-suppression to clinical variables such as major depression, site and duration of pain, prior surgery, and medication use in 81 chronic pain patients beginning inpatient pain treatment (Inpt. Pain), and 33 medication-restricted outpatients with chronic back pain and depression (Outpt. Back). In the Inpt. Pain group, the specificity of DST non-suppression for depression was 82% and for sensitivity 24%. In the Outpt. Back group, its sensitivity was 18%. Within the diverse inpatient samples, there was 69% non-suppression in patients with headache pain only, compared to 15% in patients with other sites of pain (P less than 0.01), but there was no significant difference in depression rate between these two groups. In the Inpt. Pain group, non-suppressors also had significantly less prior surgery. In the Outpt. Back group, opioid use was significantly higher in non-suppressors (33%) than in suppressors (11%). In chronic pain populations, the DST appears not to be useful clinically for the detection of depression and may be significantly affected by clinical variables other than depression.

Adult↗

PubMed1992

Validity of the Sickness Impact Profile Roland scale as a measure of dysfunction in chronic pain patients.

This study examined the reliability and validity of the Roland scale (taken from the Sickness Impact Profile: SIP) as a measure of dysfunction among chronic pain patients. One hundred forty-four subjects completed the SIP when they were screened for admission to an inpatient pain management program. One hundred sixteen subjects were subsequently re-administered the SIP at admission to inpatient treatment. A 3-month post-treatment administration of the SIP was performed for 52 of these subjects. Roland scale scores were calculated from the SIP for each patient. Test-retest stability coefficients indicated that the SIP Roland scale was generally as reliable as the SIP Total, Physical, and Psychosocial scale scores. Consistent with previous research, correlational analyses indicated that the SIP Roland scale is strongly associated with the SIP Physical but not the SIP Psychosocial scale. The SIP Roland scale and the other SIP scales demonstrated similar sensitivity to changes associated with multidisciplinary inpatient treatment for chronic pain. Finally, the pattern of relationships between the SIP Roland scale and several pain-related measures supported the concurrent validity of the SIP Roland scale. The results of the analyses were very similar for patients presenting with and without low back pain. The study supports the reliability and validity of the SIP Roland scale items for assessing dysfunction of chronic pain patients with pain in sites other than the low back as well as those with low back pain.

Adult↗

PubMed1992

The Chronic Illness Problem Inventory as a measure of dysfunction in chronic pain patients.

Assessment of physical and psychosocial dysfunction is recognized as essential in chronic pain patient evaluation. One instrument, the Sickness Impact Profile (SIP), has demonstrated good reliability and validity as a measure of dysfunction among chronic pain patients. An alternate measure, the Chronic Illness Problem Inventory (CIPI), is shorter and more easily scored than the SIP, but as yet has not been applied widely to chronic pain problems. In the present study, 95 chronic low back pain patients completed the SIP, the CIPI, activity diaries, the McGill Pain Questionnaire (MPQ), and the Center for Epidemiologic Studies-Depression scale (CES-D), before participating in a chronic pain treatment study. Overt pain behaviors were also coded from videotapes of a standardized assessment protocol. Seventy-five subjects completed the measures post-treatment. The results indicate that although the SIP and the CIPI are significantly correlated and appear to be measuring similar constructs, there is also substantial unshared variance between them, suggesting that they may tap somewhat different aspects of dysfunction in chronic pain. The CIPI shows promise as a useful alternative measure of dysfunction in chronic low back pain patients, but requires further validation for this purpose.

Back Pain↗

PubMed1992

Chronic pain coping measures: individual vs. composite scores.

Differences in the use of coping strategies have been hypothesized to explain some of the variation in adaptation among chronic pain patients. Investigators often assess coping using composite indices of different coping strategies. Although the use of composite measures has advantages, it may obscure the importance of specific coping strategies as they relate to functioning. This study compared composite with individual coping scale scores in the prediction of adjustment among chronic pain patients. One hundred and forty-one patients completed the Coping Strategies Questionnaire (CSQ) and 2 measures of adjustment (Sickness Impact Profile (SIP) and the Beck Depression Inventory (BDI)). The scales and ratings of the CSQ were factor analyzed to create composite measures, and the ability of the composite scores and individual scales to predict adjustment was compared. The results indicated that the individual scales provided more information than the composite measures regarding the relationship between coping and adjustment to chronic pain. The results also suggested that individual scale scores may be more useful than composite scores in identifying the conditions under which coping efforts have their greatest effects on adjustment.

Adaptation, Psychological↗

PubMed1991

Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment.

Recent studies suggest that coping strategies play an important role in adjustment to chronic pain. Identification of factors that influence coping could potentially help clinicians facilitate the use of adaptive coping strategies by pain patients. According to social learning theory, self-efficacy beliefs (judgments regarding one's capabilities) and outcome expectancies (judgments regarding the consequences of behaviors) are significant determinants of coping behavior. This study tested hypotheses derived from social learning theory by examining the contributions of these beliefs to the prediction of coping behavior in chronic pain patients. One hundred and fourteen chronic pain patients completed measures of health-related dysfunction, pain severity, use of 8 coping strategies, and outcome and self-efficacy expectancies regarding these coping strategies. In support of social learning theory, and consistent with research in other areas, the patients' beliefs regarding their capabilities were strongly related to reported coping efforts. Beliefs about the consequences of coping efforts and their interaction with beliefs about capabilities were generally unrelated to coping. These results suggest that treatment should emphasize the actual practice and use of adaptive coping strategies over education about their outcome.

Adaptation, Psychological↗

PubMed1991

Coping with chronic pain: a critical review of the literature.

A growing number of investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. This article reviews the empirical research which has examined the relationships among beliefs, coping, and adjustment to chronic pain. Although preliminary, some consistent findings are beginning to emerge. For example, patients who believe they can control their pain, who avoid catastrophizing about their condition, and who believe they are not severely disabled appear to function better than those who do not. Such beliefs may mediate some of the relationships between pain severity and adjustment. Although coping strategies appear to be associated with adjustment in chronic pain patients, methodological problems limit conclusions regarding the strength and nature of this association. Our recommendations for future research include the development of coping and belief measures which: (1) do not confound different dimensions (e.g., coping, beliefs, and adjustment) in the same measure; (2) assess specific (rather than composite) constructs; (3) are psychometrically sound; and (4) assess behavioral coping strategies more objectively. We also recommend a greater use of experimental research designs to examine causal relationships among appraisals, coping, and adjustment.

Adaptation, Psychological↗

PubMed1990

Dimensions of pain-related cognitive coping: cross-validation of the factor structure of the Coping Strategy Questionnaire.

Previous research has demonstrated a relationship between cognitive pain coping activity and adjustment in pain patients. The empirically derived dimensions of coping activity, as measured by scales from the Coping Strategy Questionnaire (CSQ), however, have varied across investigations. The purpose of this investigation was to determine both the content and number of dimensions of the CSQ and to explore the potential moderating influence that sociodemographic and patient history variables may have on the latent structure of the CSQ. A total of 620 patients from 5 different chronic pain patient samples were used to assess the generalizability of the dimensions across samples. Confirmatory factor analytic procedures identified a 3-factor solution in most of the samples that was robust across various demographic characteristics. Two factors appeared particularly robust: one reflected conscious use of cognitive coping strategies (with high loadings on ignoring pain and coping self-statements) and another reflected self-efficacy beliefs concerning pain (with high loadings on ability to control and decrease pain). A third factor, which was somewhat less stable, appeared to reflect avoidance of pain by attention to non-pain-related mental activity (with high loadings on diverting attention and praying and hoping). Scales reflecting catastrophizing cognitions and behavioral coping strategies did not consistently load on the above dimensions. Issues concerning the conceptualization and measurement of pain-related cognitive coping dimensions are discussed.

Adaptation, Psychological↗

PubMed1989

Sex differences in the relationship of pain patient dysfunction to spouse adjustment.

Recent studies have suggested that spouses of chronic pain patients are at risk for emotional and marital maladjustment. This study explored the role of patient and spouse gender in mediating the effects of chronic pain on the spouse's adjustment. Eight-three chronic low back pain patients and their spouses completed measures of physical and psychosocial disability, pain behaviors, marital satisfaction, and depression. The following findings characterized male but not female patient couples: (a) spouses reported significantly lower marital satisfaction than did patients; (b) lesser spouse marital satisfaction was associated with greater patient depression; and (c) greater spouse depression was associated with greater depression and lower marital satisfaction in patients. In female but not male patient couples, spouses reported significantly less depression than did patients. Significant relationships were more frequently observed between spouse-rated patient dysfunction and spouse's depression and marital adjustment in male patient couples. The results suggest a stronger relationship for female than for male spouses between the spouse's perception of patient dysfunction and the spouse's emotional and marital adjustment.

Adult↗

PubMed1986

Strategies for coping with chronic low back pain: relationship to pain and disability.

Seventy-four chronic low back pain patients in a study assessing the effectiveness of group outpatient cognitive-behavioral and operant behavioral treatment completed the Coping Strategy Questionnaire (CSQ) and measures of pain, depression, and functional disability pre- and post-treatment. The previously reported factor structure of the CSQ was generally replicated, and significant associations were found between use of ignoring and reinterpretation strategies and downtime, between use of attention diversion strategies and pain intensity, and between tendency to catastrophize and physical and psychosocial impairment. Both treatments resulted in significant changes in types of coping strategies used to deal with pain. Increased use of praying and hoping strategies was significantly related to decreases in pain intensity. Decreased catastrophizing was also significantly related to decreases in pain intensity, as well as to decreases in physical and psychosocial impairment.

Adaptation, Psychological↗