Biomedical subjects

Stephen Morley

Publications and source records attributed to Stephen Morley.

31 records · Page 2Linked to original sources

PubMed2002

Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief.

A systematic review and subset meta-analysis of published randomised controlled trials of psychological therapies for children and adolescents with chronic pain is reported. A search of four computerised abstracting services recovered 123 papers from which 28 potential trials were identified. Eighteen met the criteria for inclusion in the review. The majority of these papers reported brief behavioural and cognitive behavioural interventions for children with headache and many were conducted in community (i.e. school) settings. Meta-analysis was applicable for 12 headache trials and one trial of recurrent abdominal pain using the Pain Index. The odds-ratio for a 50% reduction in pain was 9.62 and the number needed to treat was 2.32, indicating that the psychological treatments examined are effective in reducing the pain of headache. The quality of the 18 trials retrieved is narratively reviewed and suggestions for the development of trials in this field are made.

Abdominal Pain↗

PubMed2002

A confirmatory factor analysis of the Beck Depression Inventory in chronic pain.

The Beck Depression Inventory (BDI) is widely used to assess depression in chronic pain despite doubts about its structure and therefore its interpretation. This study used a large sample of 1947 patients entering chronic pain management to establish the structure of the BDI. The sample was randomly divided to conduct separate exploratory (EFA) and confirmatory factor analyses (CFA). EFA produced many satisfactory two-factor solutions. The series of CFA generated showed reasonable fit for ten of those solutions. All included a first factor identified as negative view of the self (items: failure, guilt, self-blame, self-dislike, punishment and body image change), and a second factor identified as somatic and physical function (items: work difficulty, loss of appetite, loss of libido, fatigability, insomnia and somatic preoccupation). The remaining items (suicidal ideation, social withdrawal, dissatisfaction, sadness, pessimism, crying, indecisiveness, weight loss, irritability) loaded infrequently or not at all in the CFA solutions. They did not form a coherent factor but comprised items associated with negative affect. When compared with published data from samples of depressed patients drawn from mental health settings the mean item scores for items reflecting the negative view of the self were consistently statistically lower that that observed in samples; there was no consistent difference between the samples on the items reflecting somatic and physical function; but the mean scores for the remaining affect items were significantly greater in the mental health samples. This version of depression is strikingly different from the psychiatric model of depression (e.g. DSM-IV or ICD-10), which is primarily defined by affective disturbance, and secondarily supported by cognitive and somatic symptoms. The finding is consistent with a reconsideration of what constitutes depression in the presence of chronic pain. It also has important clinical implications: it may provide a way to distinguish depressed patients with typical cognitive biases, who require specific treatment for depression alongside pain management.

Chronic Disease↗

PubMed2001

The Development of a Method to Assess Patients' Cognitive Representations of Epilepsy.

Objective. The study describes the development of a new method for assessing cognitive representations of epilepsy.Methods. The study was a cross-sectional design contrasting the cognitive representations of three groups of epilepsy patients, varying in recency of onset (acute vs chronic) and the location of medical management (hospital vs community). A total of 94 patients were studied: 21 recent onset, 47 patients with chronic epilepsy attending the clinic and 26 patients with chronic epilepsy seen by general practitioners. An interview that combined open questions and structured questionnaire items was devised to assess six illness representation components; identity, beliefs about symptoms; causal beliefs; timeline, beliefs about temporal course; consequences, beliefs about the implications of epilepsy; control beliefs; and self-illness relationship, or the impact of epilepsy on patients' self perceptions.Results. The scales formed by the questionnaire items had satisfactory internal consistency. Further, the scales demonstrated logical interrelationships, and significant differences were found between the scales on group difference tests.Conclusions. Overall, the data provide support for the approach of administering quantitative illness representation scales within a brief structured interview format. The measure provides a way to elicit the health beliefs that determine patients' psychosocial reactions to epilepsy. Such insights are important in the development of effective psychological interventions.

Journal Article↗

PubMed1995

The Pain Beliefs and Perceptions Inventory: a British replication.

The factorial structure, reliability, and validity of the Pain Beliefs and Perceptions Inventory (PBPI) was investigated in a sample of 84 pain patients drawn from a pain clinic in the United Kingdom. The recovered factorial structure replicated that of a previous study. The 4 derived subscales, Mysteriousness, Self-Blame, Pain Constancy and Pain Permanence, had excellent reliability (internal consistency); Chronbach's alpha was greater than 0.80. However, the construct validity of the PBPI, assessed by examining the association between the subscales and the Coping Strategies Questionnaire (CSQ), was not supported. The results are discussed with particular reference to the interpretative issues concerning 2 of the subscales and their relation to the concept of the 'time line' component of illness representation.

Adaptation, Psychological↗

PubMed1995

Scaling the affective domain of pain: a study of the dimensionality of verbal descriptors.

This study evaluated the multidimensional structure of affective verbal descriptors and investigated individual differences in the scaling of the descriptors. Patients with chronic low back pain, chronic headache and rheumatoid arthritis (25 per group) and 25 control subjects, matched for age and sex, made similarity judgements of a set of 12 verbal descriptors, e.g., awful, miserable. They also completed the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, McGill Pain Questionnaire Short Form, and a measure of verbal intelligence. The similarity data were subjected to individual differences multidimensional scaling (ALSCAL) and the resulting subject weights were related to group membership and the questionnaire data. The multidimensional nature of affective descriptors was confirmed. A 4-dimensional solution was identified: the first 3 dimensions were comparable with previous findings and labeled Tolerability, Focus of Attention and Minor Emotional Reaction. The 4th dimension was enigmatic and attributable to the back pain group. There were significant differences between the groups in their weighting of the dimensions and in their self-reported coping strategies. The results are discussed with reference to an earlier study and the degree of consistency across the studies is noted. Implications of the results for the conceptualisation and measurement of the affective domain of pain report are outlined.

Adaptation, Psychological↗

PubMed1993

Memory for acute pain experience is specifically inaccurate but generally reliable.

Sixty patients having their wisdom teeth removed under general anaesthetic were tested immediately after surgery and 2 weeks later. Subjects completed versions of the McGill Pain Questionnaire (MPQ) and the UWIST Mood Adjective Checklist (UMACL). At the second test they were randomly assigned to 1 of 3 groups and either cued for their mood experience, cued for their pain experience or asked to recognise those words which they had chosen on the first occasion. Forty-nine patients completed the study. Accuracy of remembering was measured using Cohen's kappa (kappa) as a measure of agreement over the 2 tests. In general, accuracy of remembering was only 'fair' for both mood and pain (kappa = 0.5). Contrary to expectation cueing did not improve specific recognition, e.g., cueing for pain did not improve memory for pain words. However, there was evidence that memory of mood was more accurate when patients were cued to remember their pain. There was also evidence of a shift in the hedonic tone of the remembered mood; patients remembered their mood as being more negative than it actually was.

Adolescent↗

PubMed1993

Vivid memory for 'everyday' pains.

A 2-part study in which memory for everyday pains was investigated is reported. The first part compared ratings of vivid, 'flashbulb' memories of pain and non-pain events. Memories of pain events were rated as having been more surprising, having induced more negative emotional change, and having provoked greater change in ongoing activity than their non-pain event counterparts. In the second part of the study the relationship between remembering the pain event, experiencing the pain and re-experiencing the sensory qualities was examined. No subject reported sensory re-experiencing and 41% of subjects were unable to recall the sensory quality of the pain experience memory. Elements of pain experience (recalled intensity, distress and sensory quality) were differentially associated with components of pain event memory. Distress was associated with the reported frequency with which the pain event was rehearsed and with ratings of emotional and activity change induced by the pain event. In contrast, ratings of the intensity and sensory quality of the pain were associated with the reported vividness of the pain event memory. It is concluded that memories of painful events are readily retrievable and that the memory for a pain event, the sensory and affective qualities of pain experience and somatosensory component of pain are separated in their encoding and/or retrieval. The possible mechanisms whereby pain memories are encoded and retrieved are discussed. The clinical implications of the data concerning how judgements of past pain are made and the possible role of memory in coping are also noted.

Adolescent↗

PubMed1990

Memory for pain: a review.

This paper reports a qualitative review of the literature on memory for pain. Most research has focused on the accuracy of memory for pain intensity. There is some evidence that recall is moderately accurate but this conclusion is tentative because of significant methodological problems. There is also some evidence that recall of acute pain is more accurate than recall of chronic pain and we make some suggestions as to why this difference might occur. We conclude that further research on memory for pain should be informed by reference to methodological practices developed in cognitive psychology and embedded within an appropriate theoretical framework.

Acute Disease↗

PubMed1989

The development of a self-administered psychophysical scaling method: internal consistency and temporal stability in chronic pain patients.

Twenty chronic pain patients carried out a self-administered cross-modal matching task to scale pain intensity and unpleasantness descriptors on 2 occasions separated by 2-3 weeks. Measures of psychological distress (HAD and GHQ) and verbal intelligence (Mill Hill Synonym Test) were also taken. On the 2 occasions 65% and 70% of patients were able to scale intensity words with an internal consistency of r greater than or equal to 0.90. Eleven (55%) patients met this criterion on both occasions. The percentage of patients meeting the internal consistency criterion for unpleasantness descriptors was much lower, 25% and 40% on the 2 occasions. For patients who met the internal consistency criterion for intensity words there was very high test-retest stability for the group scale values of the intensity words. There was no evidence that the level of psychological distress was associated with ability to scale unpleasantness words. Intelligence was positively related to the ability to scale intensity descriptors.

Adult↗

PubMed1989

The dimensionality of verbal descriptors in Tursky's pain perception profile.

In the first part of the study 20 subjects (11 headache, 9 normals) free-sorted descriptors from the intensity and affect scales of the Tursky pain perception profile (PPP) into groups on the basis of similar meaning. In part 2 they made similarity ratings of all pairs of words within the intensity and affect scales. In the third part of the study subjects completed a cross-modal matching task to scale the intensity and affect words. Data from the first 2 parts of the study were examined with multidimensional scaling (MDS) and hierarchical cluster analyses. Free-sorting the descriptors did not produce 2 groups corresponding to the intensity and affect descriptors described in the Tursky PPP. The descriptors were arranged in 6 groups described by subjects as reflecting increasing painfulness. An MDS analysis showed that the groups could be located in 2-dimensional space in which the dimensions of intensity and affective distress could be easily discerned. When the descriptors from the intensity and affect scales were rated within each scale, a second MDS analysis showed that, whereas the intensity descriptors could be fitted by a 1-dimensional representation, the affect descriptors required a 3-dimensional model. There was evidence that subjects with extensive pain experience placed greater weight on the second and third affective dimensions compared with relatively pain-free subjects.

Adolescent↗

PubMed1989

An experimental investigation of the construct validity of the McGill Pain Questionnaire.

In order to circumvent problems with self-report measures of pain we conducted an experimental analysis of MPQ pain descriptors using a Stroop task. In this task subjects are asked to name the colours in which stimulus words are written. Previous research has demonstrated that words with emotional significance interfere (indexed by increased latencies to respond) with a person's ability to name the colour. We predicted that: (1) chronic pain patients, compared with normal controls, would show more interference to words drawn from the MPQ, and (2) affective/evaluative descriptors would produce greater interference than sensory descriptors. There was support for the first hypothesis but not the second. Possible reasons for these findings are discussed.

Adult↗

PubMed1988

The development of a self-administered psychophysical scaling method: range effects.

101 subjects engaged in a self-administered cross-modal matching task to scale descriptors of pain intensity and unpleasantness. The correlation between the two responses was used to determine reliability (internal consistency). When r greater than or equal to 0.90 was set as a criterion about 3% of the subjects were unable to calibrate standard stimuli reliability, 6% were unable to calibrate intensity descriptors and 60% were unable to calibrate unpleasantness descriptors reliably. When the criterion reliability was set at r greater than or equal to 0.85 all subjects successfully scaled the intensity descriptors. Further relaxation of the criterion to r greater than or equal to 0.80 reduced the 'failure' rate for unpleasantness descriptors to 24%. These data compare favourably with other published results from non-chronic and chronic pain patients. The provision of a fixed reference value produced range effects in the resulting scale but do not severely attenuate the range of the scale as has been previously suggested. It is concluded that a self-administered version of the task is feasible. Reasons for the poor performance with the unpleasantness descriptors are discussed.

Adult↗

PubMedDate not supplied

Cognitive-behavioral treatments for chronic pain: what works for whom?

Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. Despite these achievements, there is still room for improvement. First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest. Third, there is little evidence for differential outcomes for different treatment methods. Fourth, there still is relatively little known about the specific biobehavioral mechanisms that lead to chronic pain and pain disability. One direction is to better match treatment programs to patients' characteristics. This can be done according to an "Aptitude X Treatment Interaction" framework, or from the perspective of the Moderator-Mediator distinction. In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.

Chronic Disease↗