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Biomedical subjects

Michael E Geisser

Publications and source records attributed to Michael E Geisser.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain.

STUDY DESIGN: Longitudinal masked, double-controlled cohort study. OBJECTIVES: To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA: The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS: Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS: Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION: Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

Aged↗
PubMed2006

Comparing pain severity and functional status of older adults without spinal symptoms, with lumbar spinal stenosis, and with axial low back pain.

BACKGROUND: Functional status has been quantified in the adult low back pain (LBP) population, but has not been characterized for older adults with spinal symptoms. OBJECTIVES: To compare pain severity and functional status of older adults with and without spinal symptoms, and to determine what factors are associated with quality of life in the spinal stenosis and axial LBP groups. METHODS: In 24 subjects greater than 55-years old with lumbar spinal stenosis, 12 with LBP, and 12 without spinal symptoms, obtain the following: pain severity with 10-cm visual analog scale (VAS), 15-minute walk test, 7-day walking distance, Quebec Back Pain Disability Scale (QBPDS), and Pain Disability Index (PDI). RESULTS: The mean scores were worst for the stenosis group, were intermediate for the LBP group, and were the best for the asymptomatic group. Analysis of variance showed that the pain VAS (p < 0.001), 15-minute walk test (p = 0.01), 7-day walk (p = 0.02), QBPDS (p < 0.001), and PDI (p < 0.001) were different between at least two groups. All the variables in the stenosis group were worse than in the asymptomatic group, but only the pain VAS, QBPDS, and PDI in the LBP group were worse than in the asymptomatic group. In both the stenosis and LBP group the QBPDS and PDI were only related to pain VAS. CONCLUSION: Seniors with spinal stenosis and LBP have more disability than asymptomatic seniors. The 15-minute walking test with the stenosis group was slower than with the asymptomatic seniors. However, they compensate so that their 7-day walking distance is not as significantly decreased.

Activities of Daily Living↗
PubMed2006

The Spine Team Assessment for chronic back pain disability. Part 1: basic protocol and performance in 500 patients.

PURPOSE: For persons with chronic back pain disability, customized, effective, and efficient treatment depends on the initial assessment. Functional capacity evaluations and intake screenings for particular programs are not independent or goal-directed. This paper describes a standardized independent multidisciplinary assessment for treatment planning, and characteristic findings in a population of chronically disabled persons. METHODS: The Spine Team Assessment (STA), a (1/2)-day assessment including extensive intake information, evaluations by therapists and counselors, a team meeting with a physician, and a comprehensive report, was performed on 500 consecutive persons with chronic back pain. RESULTS: Representative findings included maximum cardiac performance of 5.33 (+/-4.08 SD) METS; Progressive Isoinertial Lifting Evaluation floor-to-waist of 36.4% (+/-23.9% of norms, and CESD depression scores of 24.7 (+/-13.5 SD). Fear and avoidance and poor physiologic effort were common. CONCLUSION: Deconditioning, psychosocial factors and functional deficits are common, complex, and variable among chronic back pain patients. This description of the STA provides a potentially reproducible standard for research into individualized treatment. The work provides benchmark data for independent multidisciplinary assessments.

Adult↗
PubMed2006

The Spine Team Assessment for chronic back pain disability. Part 2: team decision making and a preliminary outcome study.

PURPOSE: Back pain disability is complex, involving medical, physical, functional, social, and financial issues. This study aims to develop the first codified decision making process for individualized treatment planning. METHODS: In a multidisciplinary assessment protocol for chronic low back pain disability, the Spine Team Assessment (see Part I), a 'case law' qualitative approach to decision making began with a basic framework. Details were established over 103 cases at a community hospital. Through 500 more cases, a university spine program developed new exceptions, definitions, and rule clarifications. RESULTS: The final framework includes physical deconditioning, psychosocial factors, and potential for cure, with dozens of subcategories. Seventeen different combinations of therapy were recommended. Of 68 persons referred to one multidisciplinary treatment protocol, at 6 - 12 months the 17 completers had less work disability (31 vs. 62%, p = 0.032) and tended towards fewer subsequent diagnostic tests (17.6 vs. 34.7%) and less surgery (0 vs. 4). CONCLUSIONS: The data suggests that the process is complex, that customization did occur, and that at least one team decision led to better outcomes. While derived qualitatively, this decision-making tree provides a road map for less experienced teams and a precedent for researchers who wish to study individualized treatment.

Adult↗
PubMed2006

The association between experimental and clinical pain measures among persons with fibromyalgia and chronic fatigue syndrome.

Evoked or experimental pain is often used as a model for the study of clinical pain, yet there are little data regarding the relationship between the two. In addition, there are few data regarding the types of stimuli and stimulus intensities that are most closely related to clinical pain. In this study, 36 subjects with fibromyalgia (FM), chronic fatigue syndrome (CFS), or both syndromes were administered measures of clinical pain and underwent a dolorimetry evaluation. Subjects also underwent experimental pain testing utilizing heat and pressure stimulation. Stimulation levels evoking low, moderate and high sensory intensity, and comparable levels of unpleasantness, were determined for both types of stimuli using random staircase methods. Clinical pain was assessed using visual analogue ratings and the short form of the McGill Pain Questionnaire (MPQ). Ratings of heat pain sensation were not significantly associated with clinical pain ratings, with the exception of unpleasantness ratings at high stimulus intensities. Pain threshold and tolerance as assessed by dolorimetry were significantly associated with average measures of clinical pain. Both intensity and unpleasantness ratings of pressure delivered using random staircase methods were significantly associated with clinical pain at low, moderate and high levels, and the strength of the association was greater at increasingly noxious stimulus intensities. These findings suggest that random pressure stimulation as an experimental pain model in these populations more closely reflects the clinical pain for these conditions. These findings merit consideration when designing experimental studies of clinical pain associated with FM and CFS.

Adult↗
PubMed2006

Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression.

OBJECTIVE: To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians. DESIGN: Prospective, masked, double-controlled trial. SETTING: University spine center. PARTICIPANTS: One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer. INTERVENTIONS: Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI. MAIN OUTCOME MEASURE: Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician. RESULTS: Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P = .80 vs asymptomatic, P = .99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P = .14 vs asymptomatic, P = .09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data. CONCLUSIONS: The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.

Activities of Daily Living↗
PubMed2006

Psychometric properties of the mood and anxiety symptom questionnaire in patients with chronic pain.

OBJECTIVE: Previous studies have demonstrated that the Mood and Anxiety Symptom Questionnaire is able to discriminate between depressive and anxious symptoms. Factor analysis of the scale has revealed 3 factors: general distress, positive affect, and physiological hyper-arousal. However, the properties of the Mood and Anxiety Symptom Questionnaire have not been extensively examined in medical populations, in which the measurement of depressive and anxious symptoms is complicated by the presence of comorbid physical symptoms such as pain. Therefore, the purpose of the present study was to evaluate the psychometric properties of the Mood and Anxiety Symptom Questionnaire in patients with chronic pain. MATERIALS AND METHODS: A total of 230 persons with chronic musculoskeletal pain were recruited from a multidisciplinary pain clinic (n=110) and a large urban community (n=120). Participants completed the Mood and Anxiety Symptom Questionnaire and were interviewed for the presence of depressive disorders using the Structured Clinical Interview for the DSM-IV. Factor analyses, scale reliability analyses, and discriminative function analyses were performed on the data. RESULTS: Utilizing principal factor analysis and orthogonal rotation, the factor structure of the Mood and Anxiety Symptom Questionnaire in both chronic pain samples was similar to previously reported factor analyses. Three factors emerged: positive affect, general distress, and physiological hyper-arousal. Coefficients of congruence calculated from the factor structures of each subsample of persons with chronic pain suggested that the factors were highly similar (0.83-0.93). Given that the factor structures were comparable in both populations, a final analysis was conducted on the entire sample. Again, this analysis revealed a 3-factor solution. Examination of the factor loadings and item-to-total correlations revealed that some of the original scale items failed to load on or correlate with a specific factor, or correlated highly with 2 or more factors (thus lacking discriminatory power). A revised scale, eliminating items with low factors loadings and/or high cross loadings, was examined. Reliabilities for the subscales were high, and the subscales demonstrated the ability to predict clinical diagnoses of depression in a hypothesized fashion. DISCUSSION: The results support the utility of the Mood and Anxiety Symptom Questionnaire with samples of patients with chronic pain and provide further support for the tripartite model of anxiety and depression.

Adult↗
PubMed2006

Ability of early response to predict discharge outcomes with physical therapy for chronic low back pain.

OBJECTIVE: To determine how well early responses to physical therapy for chronic low back pain predict outcomes at discharge. METHODS: A prospective single cohort study of chronic low back pain patients seen at a university spine physical therapy clinic. Self-reported pain severity on a 100-mm visual analog scale was measured before each physical therapy visit. The predictive variables were the change in pain score at the second, third, and fourth visits. The first outcome variable was discharge change in pain severity for a correlation analysis. The second outcome variable was a dichotomous variable of whether the subjects had achieved at least a 30% reduction in pain severity at discharge for a discriminant analysis. RESULTS: Spearman's rank order correlation coefficient showed that early responses at the second (r = 0.324, P = 0.02) third (r = 0.342, P = 0.01), and fourth visits (r = 0.615, P < 0.001) were all significantly correlated with discharge change in pain. The discriminant analysis showed that early responses from the second to fourth visits were able to correctly predict 80.4% of the discharge outcomes (P < 0.001). CONCLUSIONS: Early responses with physical therapy help predict discharge outcomes for chronic low back pain.

Adult↗
PubMed2005

The sensitivity and specificity of electrodiagnostic testing for the clinical syndrome of lumbar spinal stenosis.

STUDY DESIGN: Prospective, masked, double controlled diagnostic trial. OBJECTIVES: To determine the sensitivity and specificity of electrodiagnostic consultation (EDX) for the clinical syndrome of lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: EDX has been used for more than 50 years to diagnose spinal disorders but has not met the new standards of evidence-based medicine. METHODS: A total of 150 subjects (asymptomatic volunteers and patients with MRIs suggesting back pain or spinal stenosis; 55-80 years of age) underwent physiatrist history and physical examination, MRI, and review of this data by a neurosurgeon, with each clinician masked to any outside information, leading to a unanimous consensus on diagnosis in 55. After masked EDX testing, 7 subjects with undiagnosed neuromuscular disease were discovered. EDX findings were related to "clinical gold standard" diagnoses in 48 persons. RESULTS: Paraspinal mapping EMG score of >4 had 100% specificity and 30% sensitivity for stenosis compared with either the back pain or asymptomatic groups (each, P < 0.04). A composite limb and paraspinal fibrillation score had a sensitivity of 47.8% and specificity of 87.5% (P = 0.008), and H-wave sensitivity was 36.4, specificity 91.3 (P = 0.026) for stenosis versus all controls. CONCLUSIONS: This first masked study in the 60-year history of needle electromyography also introduces anatomically validated needle placement, quantified and reproducible examination of the paraspinal muscles, and dual control populations to EDX research in spinal disorders. EDX has statistically significant, clinically meaningful specificity for spinal stenosis and detects neuromuscular diseases that may masquerade as stenosis.

Aged↗
PubMed2005

The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort.

OBJECTIVE: Individuals with chronic pain frequently display comorbid depression, but the impact of symptoms of depression on pain processing is not completely understood. This study evaluated the effect of symptoms of depression and/or clinically diagnosed major depressive disorder (MDD) on pain processing in patients with fibromyalgia (FM). METHODS: Results of quantitative sensory testing and neural responses to equally painful pressure stimuli (measured by functional magnetic resonance imaging [fMRI]) were compared with the levels of symptoms of depression and comorbid MDD among patients with FM. RESULTS: Neither the level of symptoms of depression nor the presence of comorbid MDD was associated with the results of sensory testing or the magnitude of neuronal activation in brain areas associated with the sensory dimension of pain (primary and secondary somatosensory cortices). However, symptoms of depression and the presence of MDD were associated with the magnitude of pain-evoked neuronal activations in brain regions associated with affective pain processing (the amygdalae and contralateral anterior insula). Clinical pain intensity was associated with measures of both the sensory dimension of pain (results of sensory testing) and the affective dimension of pain (activations in the insula bilaterally, contralateral anterior cingulate cortex, and prefrontal cortex). CONCLUSION: In patients with FM, neither the extent of depression nor the presence of comorbid major depression modulates the sensory-discriminative aspects of pain processing (i.e., localizing pain and reporting its level of intensity), as measured by sensory testing or fMRI. However, depression is associated with the magnitude of neuronal activation in brain regions that process the affective-motivational dimension of pain. These data suggest that there are parallel, somewhat independent neural pain-processing networks for sensory and affective pain elements. The implication for treatment is that addressing an individual's depression (e.g., by prescribing an antidepressant medication that has no analgesic properties) will not necessarily have an impact on the sensory dimension of pain.

Adult↗
PubMed2005

Momentary relationship between cortisol secretion and symptoms in patients with fibromyalgia.

OBJECTIVE: To compare the momentary association between salivary cortisol levels and pain, fatigue, and stress symptoms in patients with fibromyalgia (FM), and to compare diurnal cycles of cortisol secretion in patients with FM and healthy control subjects in a naturalistic environment. METHODS: Twenty-eight patients with FM and 27 healthy control subjects completed assessments on salivary cortisol levels and pain, fatigue, and stress symptoms, 5 times a day for 2 consecutive days, while engaging in usual daily activities. Only those participants who adhered to the protocol (assessed via activity monitor) were included in the final analyses. RESULTS: Twenty FM patients and 16 healthy control subjects adhered to the protocol. There were no significant differences in cortisol levels or diurnal cortisol variation between FM patients and healthy controls. Among women with FM, a strong relationship between cortisol level and current pain symptoms was observed at the waking time point (t = 3.35, P = 0.008) and 1 hour after waking (t = 2.97, P = 0.011), but not at the later 3 time points. This association was not due to differences in age, number of symptoms of depression, or self-reported history of physical or sexual abuse. Cortisol levels alone explained 38% and 14% of the variation in pain at the waking and 1 hour time points, respectively. No relationship was observed between cortisol level and fatigue or stress symptoms at any of the 5 time points. CONCLUSION: Among women with FM, pain symptoms early in the day are associated with variations in function of the hypothalamic-pituitary-adrenal axis.

Adult↗
PubMed2005

Cognitive complaints are associated with depression, fatigue, female sex, and pain catastrophizing in patients with chronic pain.

OBJECTIVE: To examine the relation between demographic, pain-related, psychosocial, affective, and treatment factors and complaints of cognitive dysfunction among patients with chronic pain. DESIGN: Cross-sectional survey. SETTING: A university hospital outpatient multidisciplinary chronic pain program. PARTICIPANTS: Chronic pain patients (N=222; 135 women, 87 men) completed a battery of psychometric questionnaires as part of an initial evaluation on referral to the program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cognitive impairment was assessed with items from the Brief Symptom Inventory; measures of depressive symptoms, pain intensity, posttraumatic stress disorder (PTSD), and pain catastrophizing were obtained from the Beck Depression Inventory (negative affect, negative self, somatic/physical function), McGill Pain Questionnaire, Modified Posttraumatic Chronic Pain Test, and Coping Strategies Questionnaire, respectively; and measures of subjective sleep disturbance, fatigue, opiate use, compensation/litigation status, pain location, and relevant demographic data were obtained from an open-ended questionnaire. RESULTS: Correlational analysis indicated that female sex, pain intensity, PTSD symptoms, depressive symptoms, catastrophizing, pain location (neck), and fatigue were all positively related to cognitive complaints. Simultaneous regression analysis showed that all factors combined accounted for 52% of the variance in self-report of cognitive difficulties and that 6 variables had a significant unique contribution to the report of cognitive complaints in the following order of importance: depression-negative affect (beta=.28, P <.05), fatigue (beta=.17, P <.05), depression-somatic/physical function (beta=.16, P <.05), depression-negative self (beta=.14, P =.05), pain catastrophizing (beta=.12, P =.08), and female sex (beta=.12, P <.05). CONCLUSIONS: Complaints of cognitive impairment among chronic pain patients appear to be associated with multiple factors, with particular attention to depressive symptoms, fatigue, and catastrophizing. Our results also suggest that women with chronic pain are particularly vulnerable to cognitive dysfunction.

Adaptation, Psychological↗
PubMed2005

Factors associated with marital satisfaction and mood among spouses of persons with chronic back pain.

UNLABELLED: Few studies have examined the impact of chronic pain on the spouse. In this study the impact of pain and disability as rated by both the patient and the spouse on spouse marital satisfaction and affective distress was examined in 110 couples. Zero-order correlations indicated that absolute ratings of perceived disability by the spouse, rather than discrepancies between spouse and patient ratings, were most highly associated with spouse marital dissatisfaction and affective distress. Predictors of spouse marital satisfaction and distress were examined by using simultaneous multiple regression. Spouse ratings of greater physical disability were significantly related to greater spouse affective distress. Spouse ratings of higher psychosocial disability, lower spouse marital satisfaction, and being a patient of male gender were marginally related to higher spouse affective distress. Spouse marital dissatisfaction was significantly associated with patient ratings of greater psychosocial disability and lower pain. Spouse-rated psychosocial disability and affective distress were also marginally related to spouse marital satisfaction. These findings highlight the importance of patient disability, particularly limitations in function as perceived by the spouse, on spouse adjustment. PERSPECTIVE: The impact of chronic pain on the spouse of the person with pain has received little empirical attention. The present study examines the relationship between patient and pain-related factors and psychosocial adjustment in the spouse.

Activities of Daily Living↗
PubMed2005

A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls.

UNLABELLED: Significant differences in surface electromyography (SEMG) have been reported between persons with low back pain (LBP) and normal, healthy controls. This manuscript presents a systematic meta-analytic review of studies examining SEMG differences between these groups. Forty-four articles were identified using MEDLINE and a review of reference lists in articles. For static SEMG, the largest effect size was observed for SEMG while standing, with subjects having LBP demonstrating higher SEMG. The effect size for flexion/relaxation measures was found to be very high (d = -1.71). Studies examining SEMG during isometric exercise or muscle recovery following exercise produced inconsistent findings. Sensitivity and specificity of SEMG for dynamic SEMG measures averaged 88.8% and 81.3%. Most classification schemes were statistically determined and utilized a combination of measures. Only one published study prospectively validated a classification scheme. SEMG measures of flexion-relaxation appear to distinguish LBP subjects from controls with good accuracy, and the sensitivity and specificity of SEMG can be increased by using multiple measures. Further research is needed to determine the combination of measures that are cost-effective, reliable, valid and discriminate with a high degree of accuracy between healthy persons and those with LBP. PERSPECTIVE: SEMG is a simple and noninvasive measure of muscle activity. SEMG measures hold promise as an objective marker of LBP.

Action Potentials↗
PubMed2003

Alcohol use self report in chronic back pain--relationships to psychosocial factors, function performance, and medication use.

BACKGROUND CONTEXT: Alcohol consumption is a known risk factor for spinal disability, but there is no data on the relationship between reported alcohol consumption and behaviours in persons who are disabled. PURPOSE: To determine the interaction between reported alcohol consumption, physical performance, and medication use in this group. To determine psychosocial correlates of reported alcohol consumption in this group. METHODS: A retrospective review 147 men and 136 women with more than 3 months disability who underwent a multidisciplinary physical, functional and psychosocial Spine Team Assessment. Questions about alcohol consumption were related to outcome measures. RESULTS: None of the women reported more than 5 drinks/week. Ten men reported more than 12 drinks per week. These performed significantly better on the Progressive Isoinertial Lifting Evaluation (PILE) low lift and the Functional Assessment Screening Test (FAST) 5 minute twisting test, and trended towards better performance on all other tests (the PILE high lift, all 4 other FAST components, Sorenson trunk extension test, and bicycle ergometer submaximal stress test). They had less back pain disability (Quebec p = 0.061), but no difference in depression (CESD), pain (visual analog scale) or fear (Tampa). They used fewer Non-steroidal medications, but similar narcotic medications as the others. No significant differences in the SF-36 were noted. CONCLUSIONS: This first assessment of the relationship of alcohol consumption with back pain disability suggests that women with chronic back pain disability seldom report heavy alcohol consumption. Men with back pain disability who consume large amounts of alcohol have less physical disability despite similar pain. Despite potential interactions, heavy drinkers with pain do not use fewer narcotic analgesics than light drinkers.

Adult↗
PubMed2003

Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing.

Recent studies have demonstrated that persons with fibromyalgia display abnormal processing of different types of painful stimulation, suggesting the disorder is characterized by a central pain-processing deficit not limited specifically to muscle pain. In the present study, 20 women with fibromyalgia and 20 normal, healthy women were compared on measures of pressure pain stimulation and response to contact thermal heat at both noxious and innocuous intensities. Women with fibromyalgia displayed significantly lower pressure pain thresholds at 18 tender point locations as defined by the American College of Rheumatology criteria, as well as lower pressure pain thresholds at five control sites. Women with fibromyalgia had significantly lower heat pain thresholds and tolerances when stimulated on the volar surface of the left forearm. When examining visual analog ratings of intensity and unpleasantness to constant stimuli, a multivariate analysis of variance performed on these ratings indicated that there were significant main effects of level of stimulation and group. Individual analysis of variances at each temperature revealed significant differences between the groups in pain intensity and unpleasantness ratings at both noxious and innocuous temperatures. Multiple regression analyses indicated that greater pain catastrophizing and diagnosis of fibromyalgia were associated with decreased pain thresholds and tolerances in the entire sample, whereas, self-report of depressive symptoms was associated with increased thresholds and tolerances. Self-report of somatic symptoms was not associated with these measures. These findings indicate that persons with fibromyalgia display altered perception of both pressure and thermal stimulation, even at innocuous levels. They also suggest that catastrophic thoughts about pain may play a role in increased pain perception in this population.

Adult↗
PubMed2003

The effect of order of testing in functional performance in persons with and without chronic back pain.

Batteries of individually standardized physical and functional tests are commonly used to assess persons with chronic back pain disability. The order of testing may affect performance on later tests. One hundred and fifty patients with > 3 months of back pain disability underwent a multidisciplinary Spine Team Assessment involving Physical Therapy, Occupational Therapy, Pain Psychology, and Vocational Rehabilitation Counselor assessments at a university spine clinic. Seventeen back healthy volunteers performed the physical component of the assessment. For the volunteers the order of testing was randomized to OT tests first or PT test first, with 0.5 h rest between the tests. For patients the order of testing was arbitrarily set by an alternating schedule, with 1 h psychological testing between the two components. For both the patients and volunteers, among the 14 test components, there was no significant difference (p > 0.05) in performance with order of testing. This held true for the subgroup of patients who put out good cardiac effort. Volunteers performed better than patients on all individual tests (p < 0.001). Results suggest that the order of physical testing during a Spine Team Assessment does not affect test performance either in chronic low back disabled patients or in volunteers.

Adult↗