The West Haven-Yale Multidimensional Pain Inventory (WHYMPI)

The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.

Chronic pain: a multiple-setting comparison of patient characteristics

Chronic pain patients attending four different pain management programs (N = 160) were compared on multiple variables encompassing demographics, the nature of the pain problem, and treatment history. Programs were selected because they differed on several dimensions (e.g., geographic location, general hospitals vs those serving veterans of Armed Services, university affiliated vs nonaffiliated) believed potentially to interact with treatment outcome. Results indicated differences between hospital programs serving veterans and general hospital programs (serving nonveterans) in terms of patients' age, percentage married, disability compensation, duration of pain symptoms, and treatment history. In addition, findings indicated that covariance among pain variables was dissimilar across the four types of pain programs, making it difficult to generalize from one type of setting to another regarding issues such as choice of optimal treatment.

An empirical examination of the "pain-behavior" construct

Observable means of communicating pain and suffering, "pain behaviors," have been postulated to comprise an important construct relevant in both the development and the maintenance of chronic pain [Fordyce, W.E. (1976). Behavioral Methods for Chronic Pain and Illness, C.V. Mosby, St. Louis, Mo.]. Two groups of professionals who have direct contact with chronic-pain patients (i.e., physicians and psychologists) participated in a study designed (a) to identify the latent or underlying characteristics of pain behaviors and (b) to assess the degree of agreement of these characteristics between health professionals with very different training. Multi-dimensional scaling and hierarchical clustering statistical techniques were employed to identify the latent structure of pain behaviors. Two primary pain behavior dimensions were identified, namely, audible-visible and affective-behavioral. Four clusters of pain behaviors were identified and labeled distorted ambulation or posture, negative affect, facial/audible expressions of distress, and avoidance of activity. The two samples of health-care providers identified virtually equivalent latent characteristics of pain behaviors. The data suggest that there is consistency in the pain-behavior construct and that the latent structure is generally congruent with Fordyce's original conceptualization. The results provide an empirically derived basis for the assessment of pain behaviors.

Conceptual issues in the assessment of clinical pain

A number of approaches to the clinical assessment of pain are examined. Emphasis is placed on the importance of matching assessment procedures with specific research or referral questions being addressed. The importance of a comprehensive approach in which cognitive, affective, and behavioral, as well as sensory-physiological dimensions are assessed is discussed drawing on three case examples. Methodological and conceptual issues of pain assessment are examined and guidelines for comprehensive pain assessment are offered.

Lack of stimulation by high amphetamine doses following a low dose of spiperone

The locomotor stimulant and stereotypic effects of amphetamine were investigated in rats pretreated with the specific dopaminergic blocker spiperone (0.25 mg/kg). Amphetamine doses from 8.0 to 64.0 mg/kg failed to stimulate behavior significantly and consistently after spiperone treatment. These results suggest the possibility of non-competitive antagonism by spiperone at dopaminergic synapses.

Support, stress, and recovery from coronary heart disease: a longitudinal causal model

Measures of support, stress, distress, and cardiac symptoms were obtained from a cohort of 73 male cardiac patients at hospitalization and at 3, 6, and 12 months thereafter. Sets of general and alternative hypotheses regarding the direction of causality among these variables were drawn from the literature on cardiac rehabilitation, stress, and support. Structural equation modeling was used to evaluate the stability and duration of these hypotheses over three time-lags. The results showed strong support for the general hypotheses and minimal support for the alternative hypotheses. Support ameliorated the subsequent experience of stress and distress and had opposing effects to these variables on cardiac symptoms. Support was more influential in the first half of the year than it was in the second half, however, whereas stress was predominant causally in the second half. Implications of this pattern for clinical intervention are drawn and directions for further research are proposed.