Comment on Nicholas and Asghari: Pain 2006;124:269-79.
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Adaptation, Psychological↗
Biomedical subjects
L M McCracken
Publications and source records attributed to L M McCracken.
Multimethod assessment of treatment process in chronic low back pain: comparison of reported pain-related anxiety with directly measured physical capacity.
Although cognitive behavioural treatments (CBT) have proven efficacy in improving symptom management, pain-related distress, physical performance and return to work. few studies have examined the relationship between changes in behavioural process variables during treatment and improvement in outcome variables following treatment. We designed a multimethod assessment strategy to test the relative contribution of changes in physical capacity and pain-related anxiety to treatment outcome variables. Low back pain patients (n = 59) were treated with an intensive programme of physical exercise and CBT. Comparisons from pre- to post-treatment showed significant improvement in pain severity, interference, affective distress, activity level, and depression. Improvements in pain-related anxiety were associated with improvements in all outcome variables except interference. Of three physical capacity composite scores, improvement in only one (lumbar extension and flexion capacity) was associated with improvements in all outcome variables except interference. Further analyses demonstrated that the relationship between changes in pain-related anxiety and treatment outcome were independent of changes in physical capacity performance. Changes during treatment in pain-related anxiety may be more important than changes during treatment in physical capacity when predicting the effect of treatment on behavioural outcome measures. These results are discussed in the context of how to improve assessment of the chronic pain patient and improve the effectiveness of multidisciplinary CBT.
Adult↗
Predicting complaints of impaired cognitive functioning in patients with chronic pain.
Patients with chronic pain often complain of difficulties with cognitive functioning. Previous studies suggest that these occur with no history of head trauma or neurological disease. This study examined potential predictors of cognitive complaints in 275 consecutive patients referred to a university pain management center. Patients completed a brief set of self-report measures of problems with cognitive functioning, biographical information, pain severity, pain location, depression, anxiety, sleep quality, medication use, and litigation status during their first visit to the clinic. The most frequently reported cognitive complaints included forgetfulness (23.4%), minor accidents (23.1%), difficulty finishing tasks (20.5%), and difficulty with attention (18.7%). Fifty-four percent of patients reported at least one problem with cognitive functioning. Correlation analyses showed that using antidepressants, pain severity, pain-related anxiety, and depression were moderately associated with total cognitive complaints. Regression analyses showed that depression accounted for the largest unique proportion of variance in cognitive complaints (DeltaR2 = 29%). Given the high frequency of complaints of impaired cognitive functioning, this realm of functioning deserves routine assessment. When these complaints are encountered, a careful evaluation considering a range of neurological, social, and emotional influences is in order.
Adult↗
A comparison of blacks and whites seeking treatment for chronic pain.
OBJECTIVE: Most conceptualizations of chronic pain acknowledge the importance of culture and social circumstances. Cultural and social influences may differ for persons of different racial or ethnic groups, and this circumstance may lead them to experience and adjust differently to pain. The current study compared adjustment to chronic pain by blacks and whites seeking treatment for chronic pain. SUBJECTS AND MEASURES: Fifty-seven black and 207 white patients completed measures of anxiety, depression, disability, pain, and physical symptoms during their initial visit to a university pain clinic. RESULTS: Comparisons showed that the groups did not differ with regard to age, sex, education, chronicity of pain, pain location, work status, previous surgeries, medical diagnosis, medication, wage replacement, or involvement in litigation. However, the black group reported higher pain severity, more avoidance of activity, more fearful thinking, more physical symptoms, and greater physical and psychosocial disability. The groups remained significantly different with regard to avoidance, fearful thinking, and physical symptoms after pain severity was statistically controlled for; however, they did not remain different on disability. CONCLUSIONS: These results show that blacks and whites with chronic pain experience pain differently. Several factors may underlie these differences, including family situation, health care experiences, or other unmeasured behavioral, environmental, or social influences. Other investigators should attempt to replicate these findings and more closely examine variables that may explain them.
Adaptation, Psychological↗
Assessing depression in systemic lupus erythematosus: determining reliable change.
Systemic lupus erythematosus (SLE) can follow an unpredictable course. Clinicians and researchers use various self-report inventories to track aspects of the patient's functioning during the course of the illness (e.g. health status, pain, fatigue, quality of life and psychological status). These self-report inventories are used to measure improvement or deterioration as a function of the natural history of the disease process, or as a function of response to treatment. Proper interpretation of scores derived from these inventories requires an understanding of their psychometric properties, in particular, their reliability. It is important to calculate reliable change difference scores for tests commonly used in rheumatology so clinicians can determine if a change score is a reliable indicator of improvement or deterioration in individual patients (i.e. the change score is not likely to be due to measurement error). The purpose of this article is to illustrate the use of the reliable change difference scores when assessing depression in patients with SLE using the Beck Depression Inventory (BDI).
Depression↗
Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older.
BACKGROUND: This study examined screening utilization at least once and regular adherence to mammography, clinical breast exam, and breast self-exam among older Chinese-American women. METHOD: One hundred women were recruited from senior centers in two metropolitan cities. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, breast cancer screening, common and cultural barriers to screening, and acculturation. RESULTS: Logistic regression models found insurance coverage for mammography and acculturation to be significant predictors of having had a mammogram at least once. Low perceived need/lack of physician recommendation and recency of physical examination were significant predictors of having had a mammogram in the past year. Acculturation and modesty were significant predictors of having had a clinical breast exam at least once, while recency of physical examination was a significant predictor of having had a clinical breast exam in the past year. Reliance on medial professionals for screening and forgetting were significant predictors of having performed breast self-exam at least once, and forgetting was a significant predictor of regular performance of breast self-exam. CONCLUSIONS: These findings suggest that both common and cultural barriers play a role in breast cancer screening among older Chinese-American women, with cultural factors being more influential in the initiation of cancer screening behavior.
Acculturation↗
Sex-specific and general roles of pain-related anxiety in adjustment to chronic pain: a reply to Edwards et al.
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Adaptation, Psychological↗
Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance.
Through empirical methods we now characterize patients with chronic pain as either dysfunctional, interpersonally distressed, or adaptive copers. Studying factors that differentiate these groups may reveal the behavioral processes that determine adjustment to pain. Subjects for this study were 190 patients referred for treatment of chronic pain. They were classified as dysfunctional (n = 41), interpersonally distressed (n = 28) or adaptive copers (n = 59) based on the Multidimensional Pain Inventory (Kerns, R.D., Turk, D.C. and Rudy, T.E., The West Haven-Yale Multidimensional Pain Inventory (WHYMPI), Pain, 23 (1985) 345-356) and compared on measures of pain-related anxiety and pain acceptance. Our analyses showed that the dysfunctional group reported greater pain-related anxiety and less acceptance of pain than the other groups. Additional analyses, statistically controlling for pain severity and depression, showed that the patient subtypes continued to differ on pain-related anxiety and acceptance. Discriminant function analyses including pain-related anxiety and acceptance correctly classified 72.5% of dysfunctional and 90.9% of adaptive copers. Again, anxiety and acceptance contributed uniquely to classification independent of depression and pain intensity. Pain-related anxiety and acceptance of pain appear to be unique behavioral dimensions of adjustment to chronic pain. Decreasing anxiety and increasing acceptance may 'move' patients with chronic pain from the dysfunctional to the adaptive coper category.
Adaptation, Psychological↗
Living forensics: a natural evolution in emergency care.
'Throughout history, health care professionals have been called upon to assist the legal system in the prosecution of cases where patient care overlaps with the law and physiological realities collide' (Lynch 1995). Working for the last 21 years in the Accident & Emergency setting, the author is dedicated to increasing the awareness and assisting in the establishment of basic forensic evidence collection guidelines for the emergency care provider. Due to the nature of the clientele and setting, emergency personnel will inevitably care for 'victims of violence'. Domestic violence injuries, abuse and neglect in the elderly and young, the addictive client seeking emergency care, the sexual assault victim, and sufferers of occupational injuries, are but a few of the cases that would be classified in the forensic arena. Holistic care dictates looking after the patient as a whole. The nurse must meet the patient's physical and psychosocial needs. The forensic nurse ensures that the patient's civil and constitutional rights are also met. This forensic health care role can be achieved and strengthened by recognizing potential evidence and maintaining a 'chain of custody' of this evidence.
Data Collection↗
Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory?
Overlap between depression scale item content and medical symptoms may exaggerate depression estimates for patients with multiple sclerosis (MS). We reconsider Mohr and co-workers' (1997) recommendation to omit Beck Depression Inventory (BDI) items assessing work ability (item 15), fatigue (17), and health concerns (20) for MS patients. Subjects were medical patients with either MS (n = 105) or a medical disorder for which the BDI is empirically supported [diabetes mellitus (DM), n = 71; chronic pain (CP), n = 80], psychiatric patients with depressive disorder (MDD; n = 37), and healthy controls (HC; n = 80). Relative scores for the eight "somatic" BDI items were analyzed by multivariate analysis of variance with demographic variables and BDI total as covariates. The only significant difference was MS > HC (item 15). On raw scores, MS patients exceeded HCs on items 15 and 21 (sexual disinterest), but this was attributable to the low HC item endorsement. There were no other differences on somatic items or item-total correlations. Scale consistency was good across groups, regardless of item omission. Somatic items were unassociated with major MS parameters. We thus encourage continued application of the full BDI for assessing depressive symptoms in patients with MS.
Adult↗
Cardiac exposure history as a determinant of symptoms and emergency department utilization in noncardiac chest pain patients.
Although comparative studies differentiate noncardiac chest pain (NCCP), panic disorder, and coronary artery disease (CAD), little research has examined the defining features of NCCP, such as cardiac complaints, medical utilization, and learning history. We administered self-report measures to 80 Emergency Department (ED) patients with a primary complaint of chest pain who were subsequently found to not have CAD. Forty-eight percent of the ED utilization variance was accounted for by NCCP duration, age, cardiac distress symptoms, and prior exposure to both siblings' and friends' cardiac distress symptoms. In turn, 67% of the variance in cardiac distress symptoms was explained by education, age, NCCP duration, number of illnesses, noncardiac panic symptoms, prior exposure (friends), and prior observation of others' cardiac distress. No effects emerged for gender, ethnicity, avoidance, or depression. Results suggest that beyond the effects of age and distress intensity, prior exposure to other people's cardiac distress may influence NCCP.
Adult↗
Pain-related anxiety predicts non-specific physical complaints in persons with chronic pain.
Persons with chronic pain often report a range of physical symptoms beyond their primary pain complaint itself. We predicted that non-specific physical symptom complaints would correlate more strongly with pain-related distress than with general measures of distress, and that they would contribute directly to disability. Results from 210 adults with chronic pain showed that collateral physical complaints are common in persons with chronic pain. Correlational analyses showed that greater reporting of physical complaints was associated with reports of higher pain severity, higher levels of depression, more cognitive, escape/avoidance, fearful appraisal, and physiological symptoms of pain-related anxiety and more physical and psychosocial disability. Regression analyses showed that, with pain-related anxiety variables entered either before or after depression, physiological symptoms of pain-related anxiety significantly predicted physical complaints. In comparison with cognitive and somatic depression symptoms physiological symptoms of pain-related anxiety were the stronger predictor.
Adult↗
Coping with pain produced by physical activity in persons with chronic low back pain: immediate assessment following a specific pain event.
Coping with chronic pain during exposure to pain produced by activity was examined in 30 patients with chronic low back pain referred to a university pain management center. Patients' range of motion, autonomic responses, and anticipatory anxiety ratings before exposure and ratings of pain and anxiety after exposure were assessed, and the number of repetitions of the activities that produced the pain was recorded. Analyses showed that using coping self-statement was associated with lower skin conductance during anticipation and greater range of motion. Praying, hoping, and catastrophizing were associated with greater anticipatory anxiety, greater anxiety during the painful activity, and less range of motion from the onset of increased pain to the point of pain tolerance. Praying and hoping were associated with higher pain ratings and fewer repetitions of the activity. Assessment of coping during an incident of pain and multiple methods to measure pain and distress provided convincing evidence that patients' self-management responses influence the consequences of pain exposure.
Adaptation, Physiological↗
Assessment of satisfaction with treatment for chronic pain.
The purpose of this study was to develop an instrument to assess satisfaction with treatment of chronic pain, evaluate the reliability and validity of this instrument, and then examine predictors and consequences of satisfaction. The Pain Service Satisfaction Test (PSST) is the result of this effort. Fifty adult patients receiving services for chronic pain in a university pain clinic completed the PSST as part of a survey mailed to their homes. Findings supporting the validity of the PSST included significant positive correlations with a general measure of treatment satisfaction, patient ratings of global treatment satisfaction and effects of treatment, and physician ratings of patient satisfaction with treatment. Regression analyses of predictors of satisfaction highlighted significant contributions of confidence and trust in the provider, pain reduction, and waiting in the clinic. These predictors together accounted for 60% of satisfaction with treatment. Treatment satisfaction was negatively correlated with depression, reported number of physicians consulted, and number of physician visits for pain in the past 12 months; and there was a trend toward a negative correlation with disability. Results of the present study support the importance of satisfaction with treatment as a predictor and possible determinant of later health, function, and service utilization.
Chronic Disease↗
'Postconcussive' symptoms in persons with chronic pain.
The purpose of this study was to examine the base rate of cognitive and neurobehavioural complaints in patients with chronic pain (N = 170) who had not sustained a head injury. The patients completed a packet of questionnaires that contained numerous questions regarding physical, cognitive, and psychological symptoms. The 'postconcussive-like' symptoms were selected and analysed. Specific symptom endorsement rates ranged from 5% to 76.5%. Disturbed sleep, fatigue, and irritability were reported by the majority of chronic pain patients. Cognitive complaints relating to forgetfulness (29%), difficulty maintaining attention (18%), and difficulty with concentration or thinking (16.5%) were endorsed by a significant minority of patients. Most patients (80.6%) endorsed three or more symptoms from Category C of the DSM-IV Postconcussional Disorder research criteria. This study further illustrates that postconcussive-like symptoms are not unique sequelae of mild head injury, and the presence of chronic pain should be considered when interpreting patients' physical, cognitive, and psychological complaints following closed head injury.
Adult↗
Cross-sectional and longitudinal analyses of coping responses and health status in persons with systemic lupus erythematosus.
The authors investigated the relations of coping with psychological adjustment and functional status in 46 adults with systemic lupus erythematosus (SLE). The participants completed questionnaires that measured coping with SLE, depression, and functional impairment. A subgroup (n = 22) completed the same questionnaires an average of 7.7 months later. Correlational and regression analyses revealed that, at Time 1, passive coping strategies (eg, avoidance, wishful thinking, blaming self) were significantly related to poorer psychological adjustment and functional status. Problem-focused coping was significantly associated with less depression. Longitudinal analyses showed that using wishful thinking and seeking social support at Time 1 were significant predictors of adjustment at Time 2. These findings are compared with findings from studies of other population groups with chronic illnesses.
Activities of Daily Living↗
Research methods for investigating causal relations between SLE disease variables and psychiatric symptomatology.
People with systemic lupus erythematosus (SLE) frequently experience psychiatric problems. Some researchers and clinicians presume that these psychiatric problems are a direct manifestation of the disease, while others suggest that psychosocial and environmental factors have greater etiological significance. The majority of the studies addressing these issues in patients with SLE are too methodologically limited to make confident conclusions regarding etiology. More methodologically sound research in this area is needed. This article describes some of the limitations in past research in the areas of sampling, measurement, research design, data analyses and data presentation. Suggestions for improved methodology in future research are offered.
Humans↗
Application of a forced-choice memory procedure designed to detect experimental malingering.
The detection of dissimulated cognitive deficits is an important issue in many clinical assessment situations. Specific procedures designed to aid in this detection can be useful additions to standard assessment protocols. The present study investigates the potential utility of a modification of the forced-choice, symptom validity paradigm to the assessment of memory deficits. Previous research indicated that the procedure could discriminate between college students instructed to malinger memory impairment and college students instructed to perform at their best ability. The present study administered a forced-choice memory assessment instrument to 60 psychiatric patients, 60 normal community volunteers, and 60 neuropsychological patients. Thirty psychiatric patients and 30 community volunteers were given instructions to malinger. Discriminant function analyses yielded an overall correct group classification rate of 90.6%, with 5% of the nonmalingering subjects and 18.3% of the experimental malingerers incorrectly classified.
Journal Article↗