51
|
|
52
|
Eccleston C, Jordan AL, Crombez G. The Impact of Chronic Pain on Adolescents: A Review of Previously Used Measures. J Pediatr Psychol 2005; 31:684-97. [PMID: 16150880 DOI: 10.1093/jpepsy/jsj061] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To review the use of instruments to assess the impact of adolescent chronic pain, focussing on the development of instruments, the domains covered, psychometric properties, and published use with adolescent chronic pain patients. METHODS Systematic literature searching recovered 706 articles, yielding 116 relevant articles, employing a total of 43 separate measurement instruments, which were subjected to content analysis. RESULTS Most instruments were in the psychological domain (n = 22), with a self-report format (n = 36). Thirty instruments were specifically developed for adolescent populations; only 12 instruments had psychometric evaluation with adolescent chronic pain patients. The median use of any one instrument in published studies was two. Clinically relevant psychometric data were missing for many instruments. CONCLUSIONS There is a diversity of instrumentation with some pockets of depth of use, but some domains of chronic pain experience with no routine assessment. Further development of the knowledge base of measurement of the impact of chronic adolescent pain is necessary.
Collapse
|
53
|
Goubert L, Crombez G, Danneels L. The reluctance to generalize corrective experiences in chronic low back pain patients: a questionnaire study of dysfunctional cognitions. Behav Res Ther 2005; 43:1055-67. [PMID: 15967176 DOI: 10.1016/j.brat.2004.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Revised: 07/15/2004] [Accepted: 07/29/2004] [Indexed: 10/26/2022]
Abstract
The present study investigated whether pain catastrophizing and pain-related fear is related to a reluctance to generalize an experience of lesser pain than expected to other similar situations. Eighty-five patients with chronic low back pain (40 males; 45 females; age range=21-63 years) completed a series of vignettes assessing catastrophizing, overgeneralization, personalization and selective abstraction related to general life experiences and to low back pain (LBP) experiences. Three vignettes also assessed the lack of generalization of corrective experiences related to LBP. Our results showed that dysfunctional cognitions related to general life experiences were the strongest predictor of the self-denigration subscale of the Beck Depression Inventory (BDI), whereas only dysfunctional cognitions related to LBP had a unique contribution in the prediction of the somatic and physical function subscale of the BDI. Furthermore, dysfunctional cognitions related to LBP were significantly correlated with interference with daily life due to pain. As predicted, pain catastrophizing and pain-related fear had a unique contribution in predicting the lack of generalization of corrective experiences, over and above sociodemogaphic variables, pain severity and pain duration.
Collapse
Affiliation(s)
- Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | | | | |
Collapse
|
54
|
Yong HH. Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance and functional interference in chronic pain patients? Eur J Pain 2005; 10:399-407. [PMID: 15972262 DOI: 10.1016/j.ejpain.2005.05.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Accepted: 05/12/2005] [Indexed: 11/26/2022]
Abstract
The aims of the present study were (a) to examine the relationship between age, attitudes and self-reported pain and suffering in a sample of chronic pain patients and (b) to determine the extent to which attitudes of stoicism and cautiousness might mediate between age and chronic pain experience. Psychometric measures were administered to 338 chronic pain patients. The results indicate that there were significant relationships between both age and attitudes with measures of pain, mood disturbance and functional interference. Attitudes were found to provide either a full or partial mediation of the relationship between age and various measures of chronic pain experience, thus emphasizing the importance of including these cognitive variables for clinical assessment. It appears that attitudes of stoicism may be more important than age as a predictor of self-reported pain severity. However, with respect to mood and functional disturbance, age and perhaps, other age-related factors, remain important additional predictors.
Collapse
Affiliation(s)
- Hua-Hie Yong
- National Ageing Research Institute, Parkville, Vic., Australia.
| |
Collapse
|
55
|
Abstract
OBJECTIVES A large percentage of employees experience persistent pain while at work. This situation can become costly to employers with large amounts of lost production-time, absenteeism, and long-term disability. The link or transition between working through (ignoring) pain and disabling pain is unknown. This paper presents the results of a controlled study examining the impact of persistent pain on performance in a working population. Benefits of early detection are discussed. METHODS This was a controlled, repeated measures study using 3 types of measures: questionnaires (pain, pain anxiety, daily memory, and attention mistakes); actigraphic monitoring to assure the absence of sleep deprivation; and the Performance Assessment Battery, a computer-based series of tests. Participants were studied during 3 time periods (9:00 AM, 3:00 PM, and 9:00 PM). RESULTS Forty participants (20 pain, 20 controls) were studied. For all tasks, pain participants were slower than controls with significant findings on 2 tasks and less accurate with significant differences on 1 task. DISCUSSION Unlike other studies that either induced pain or used persons with complex pain conditions, this study used participants with a low level of pain intensity and had a majority still engaged in full-time employment. Our results found that people with persistent low-level pain demonstrate a reduction in performance compared with controls. Our study revealed that using a sensitive tool to detect minor performance deficits could indicate pain interference. The early detection of pain interference would provide an opportunity for prevention programs to have a pre-emptive effect on work-related musculoskeletal disorders.
Collapse
Affiliation(s)
- Katherine Harman
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | |
Collapse
|
56
|
Taylor R, Lovibond PF, Nicholas MK, Cayley C, Wilson PH. The utility of somatic items in the assessment of depression in patients with chronic pain: a comparison of the Zung Self-Rating Depression Scale and the Depression Anxiety Stress Scales in chronic pain and clinical and community samples. Clin J Pain 2005; 21:91-100. [PMID: 15599136 DOI: 10.1097/00002508-200501000-00011] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of somatic items in the assessment of depression in chronic pain. METHODS The Self-Rating Depression Scale was administered to 398 individuals with chronic pain, 313 psychology clinic patients with similar overall levels of depression, and a general population sample of 491. All three samples were also administered the Depression Anxiety Stress Scales. RESULTS Confirmatory factor analysis of pooled Self-Rating Depression Scale and Depression Anxiety Stress Scales items revealed that Self-Rating Depression Scale items denoting diurnal variation, decreased appetite, weight loss and constipation failed to contribute to depression in all 3 samples. Items denoting tachycardia and irritability also failed to discriminate between depression and a combined anxiety/stress factor in all 3 samples. The chronic pain sample endorsed somatic items, in particular psychomotor retardation, sleep disturbance, constipation, and fatigue, more strongly than the other samples relative to their endorsement of nonsomatic depression items. CONCLUSIONS It was concluded that depression measures that give emphasis to somatic symptoms provide poor measures of depression severity in any individuals and in patients with chronic pain may lead to an overestimation of the severity of depression. More recently developed instruments avoid these limitations and are also better able to discriminate depression from related states such as anxiety and tension/stress.
Collapse
Affiliation(s)
- Renae Taylor
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | | | | | | |
Collapse
|
57
|
Shafer AB. Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol 2005; 62:123-46. [PMID: 16287149 DOI: 10.1002/jclp.20213] [Citation(s) in RCA: 526] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Four separate metaanalyses of factor analyses were conducted for the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HRSD), and the Zung Self-Rating Depression Scale (SDS). The total number of participants (N) and studies (k) included in each of the metaanalyses were the following: BDI (N = 13,643, k = 33), CES-D (N = 22,340, k = 28), HRSD (N = 2,606, k = 17), and SDS (N = 12,621, k = 13). Metaanalysis results suggest that the specific depression symptom factors within each test appear to be relatively robust and well established and match fairly closely previously hypothesized factor structures. A general Depression Severity factor and a small Somatic Symptoms factor are found in all four tests and two tests had a small Positive Affect factor. There were fewer common specific depression symptom factors across tests than expected.
Collapse
Affiliation(s)
- Alan B Shafer
- Texas Department of Mental Health and Mental Retardation, USA.
| |
Collapse
|
58
|
Baker TA, Green CR. Intrarace Differences Among Black and White Americans Presenting for Chronic Pain Management: The Influence of Age, Physical Health, and Psychosocial Factors. PAIN MEDICINE 2005; 6:29-38. [PMID: 15669948 DOI: 10.1111/j.1526-4637.2005.05014.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Emerging comparative literature documents significant racial differences in the chronic pain experience in terms of physical, psychological, and social well-being. However, the intrarace differences of chronic pain among black Americans and white Americans has not been extensively investigated. The purpose of this investigation was to examine the potential within-race-group differential effects and the psychosocial aspects of chronic pain in black and white Americans across age groups. DESIGN A retrospective study of patients presenting for chronic pain management. SETTING A tertiary care multidisciplinary pain center. PATIENTS Patients were younger (<50 years) (mean +/- SD: 36.7 +/- 8.4) and older (> or =50 years) (60 +/- 9.3) black Americans (N = 525), and younger (36.6 +/- 8.1) and older (63 +/- 9.8) white Americans (N = 5,298). OUTCOME MEASURES Participants were measured on depressive symptoms, social functioning, pain intensity, pain-related disability, and physical comorbidities. RESULTS Younger black Americans reported more depressive symptoms, pain intensity, and were less successful at coping with pain when compared to older black Americans. Similar within-group differences were also observed for reports of depressive symptoms, pain intensity, and coping abilities among white Americans. Results further showed that younger white Americans also experienced more symptoms related to post-traumatic distress than older white Americans. CONCLUSION Examining within-race-group variability suggests that chronic pain differentially affects the quality of life and health status of black Americans and white Americans across age groups. This study emphasizes the need for further chronic pain studies examining pain indicators within defined racial and ethnic groups.
Collapse
Affiliation(s)
- Tamara A Baker
- University of South Florida, School of Aging Studies, Tampa, Florida, USA
| | | |
Collapse
|
59
|
Abstract
Chronic pain is one of the clearest examples of the complex relationship between the mind, body, spirit, and environment. After decades of research, a growing body of evidence supports the importance of certain psychological factors in the chronic pain experience. This article reviews research related to evaluating the role of depression, personality factors, pain-related beliefs, trauma, and coping style in the chronic pain experience. Understanding and using the findings of this research can improve nursing care of persons with chronic pain.
Collapse
Affiliation(s)
- Wendy Lewandowski
- College of Nursing, 113 Henderson Hall, Kent State University, Kent, OH 44242, USA.
| |
Collapse
|
60
|
Pincus T, Williams ACDC, Vogel S, Field A. The development and testing of the depression, anxiety, and positive outlook scale (DAPOS). Pain 2004; 109:181-8. [PMID: 15082140 DOI: 10.1016/j.pain.2004.02.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2003] [Revised: 02/02/2004] [Accepted: 02/03/2004] [Indexed: 01/09/2023]
Abstract
Measurement of depression and other mood states in pain patients has been criticised in recent years on the grounds that most questionnaires were not developed in pain populations and suffer from criterion contamination by somatic items. In addition, there is no accepted measurement for positive emotions which are more than the absence of depression. The aim of this study was to develop a reliable and brief tool to assess mood in pain patients. Non-somatic items concerning depression, anxiety and positive outlook were extracted using exploratory factor analysis from commonly used instruments (the Beck Depression Inventory and the Hospital Anxiety and Depression Scale) completed by over 900 chronic pain patients. Confirmatory factor analysis was used to test the internal structure of the final item set. Items were then reworded and presented as a new questionnaire (the Depression, Anxiety and Positive Outlook Scale: DAPOS) to two new samples: patients attending pain management and patients attending osteopathy. The new questionnaire was compared with several well-known questionnaires (SF36, BDI, PCS). The structure was calibrated and tested using confirmatory factor analysis on both samples. Finally, a subset of patients carried out a sorting task to test for face validity. The DAPOS performed well, indicating that it is a reliable measure of the three mood states with good initial evidence of validity in these samples.
Collapse
Affiliation(s)
- Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK.
| | | | | | | |
Collapse
|
61
|
Smith MT, Perlis ML, Haythornthwaite JA. Suicidal ideation in outpatients with chronic musculoskeletal pain: an exploratory study of the role of sleep onset insomnia and pain intensity. Clin J Pain 2004; 20:111-8. [PMID: 14770051 DOI: 10.1097/00002508-200403000-00008] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Sleep disturbance, depression, and heightened risk of suicide are among the most clinically significant sequelae of chronic pain. While sleep disturbance is associated with suicidality in patients with major depression and is a significant independent predictor of completed suicide in psychiatric patients, it is not known whether sleep disturbance is associated with suicidal behavior in chronic pain. This exploratory study evaluates the importance of insomnia in discriminating suicidal ideation in chronic pain relative to depression severity and other pain-related factors. METHODS Fifty-one outpatients with non-cancer chronic pain were recruited. Subjects completed a pain and sleep survey, the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, and the Multidimensional Pain Inventory. Subjects were classified as "suicidal ideators" or "non-ideators" based on their responses to BDI-Item 9 (Suicide). Bivariate analyses and multivariate discriminant function analyses were conducted. RESULTS Twenty-four percent reported suicidal ideation (without intent). Suicidal ideators endorsed higher levels of: sleep onset insomnia, pain intensity, medication usage, pain-related interference, affective distress, and depressive symptoms (P < 0.03). These 6 variables were entered into stepwise discriminant function analyses. Two variables predicted group membership: Sleep Onset Insomnia Severity and Pain Intensity, respectively. The discriminant function correctly classified 84.3% of the cases (P < 0.0001). DISCUSSION Chronic pain patients who self-reported severe and frequent initial insomnia with concomitant daytime dysfunction and high pain intensity were more likely to report passive suicidal ideation, independent from the effects of depression severity. Future research aimed at determining whether sleep disturbance is a modifiable risk factor for suicidal ideation in chronic pain is warranted.
Collapse
Affiliation(s)
- Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | |
Collapse
|
62
|
Abstract
BACKGROUND There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described. METHODS This prospective cohort study of 205 Canadian hemodialysis (HD) patients describes the prevalence, cause, severity, and management of pain in this population. A chart review for demographic and clinical data was conducted, and patients completed a questionnaire that incorporated the Brief Pain Inventory, followed by the McGill Pain Questionnaire. RESULTS One hundred three patients (50%) reported a problem with pain. Patients with pain had been on HD therapy longer (52.2 months) than those without pain (37.7 months). Causes of pain were diverse, and 18.4% of patients had more than a single cause of their pain. Musculoskeletal pain was most common (50.5%) and equal in severity to pain associated with peripheral neuropathy and peripheral vascular disease. Fifty-five percent of patients with pain rated their worst episode in the previous 24 hours as severe. Thirty-two percent of patients with pain were administered no analgesics, 29.1% were administered nonopioid analgesics, 26.2% were administered weak opioids, and 9.7% were administered strong opioids. The Pain Management Index describes the effectiveness of pain management and was negative in 74.8% of patients, indicating ineffective management. CONCLUSION Pain is a significant problem in more than 50% of HD patients and is not being effectively managed. The development of effective pain management strategies, underpinned by appropriate training and education, is necessary to improve the quality of life for dialysis patients.
Collapse
Affiliation(s)
- Sara N Davison
- Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
63
|
Pearce S, Koutantji M. Psychological Factors in Measurement of Pain. Pain 2003. [DOI: 10.1201/9780203911259.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
64
|
Green CR, Baker TA, Sato Y, Washington TL, Smith EM. Race and chronic pain: A comparative study of young black and white Americans presenting for management. THE JOURNAL OF PAIN 2003; 4:176-83. [PMID: 14622701 DOI: 10.1016/s1526-5900(02)65013-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic pain is a debilitating problem for many Americans. It affects physical, social, and emotional health. This study addresses the potential differential effects of chronic pain cross-culturally in younger Americans. A retrospective analysis of persons younger than 50 years of age presenting for chronic pain management in a multidisciplinary pain center was done. White and black American adults aged 18 to 50 years (N = 3669) were compared to determine whether there were differences in (1) psychologic functioning, (2) pain characteristics, (3) pain disability, and (4) comorbidities. Our results suggest that black Americans had more depressive symptoms and symptoms consistent with post-traumatic stress disorder when compared to white Americans. These results showed that on initial assessment, black Americans with chronic pain report significantly more pain and sleep disturbance as well as more symptoms consistent with post-traumatic stress disorder and depression than white Americans. They also experience a higher prevalence of self-identified comorbidities, including dizziness, chest pain, and high blood pressure. In conclusion, considerable diminution in the overall physical and emotional health of black Americans 18 to 50 years of age with chronic pain was noted. These data support the need for further study of the chronic pain experiences of racial and ethnicity minority persons.
Collapse
Affiliation(s)
- Carmen Reneé Green
- Department of Anesthesiology, Multidisciplinary Pain Center, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
| | | | | | | | | |
Collapse
|
65
|
Rothrock NE, Lutgendorf SK, Kreder KJ. Coping strategies in patients with interstitial cystitis: relationships with quality of life and depression. J Urol 2003; 169:233-6. [PMID: 12478143 DOI: 10.1016/s0022-5347(05)64075-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Previous research has demonstrated that interstitial cystitis patients experience depressive symptoms and decrements to quality of life. However, to our knowledge the extent to which patients may be able to influence quality of life and depressive symptoms through coping strategies has not been investigated in this population. In a number of other chronic conditions specific coping strategies have been associated with the degree of impairment beyond disease severity. Therefore, the association of coping strategies with depressive symptoms, quality of life and self-reports of pain was assessed in patients with interstitial cystitis. MATERIALS AND METHODS A total of 64 females with interstitial cystitis were recruited from a urology clinic at a tertiary medical center. Questionnaires assessing depression, quality of life, coping and symptom severity were completed and returned at a clinic appointment. Depression was also measured through a standardized semi-structured interview (Hamilton Rating Scale for Depression). All analyses controlled for age. RESULTS Patients coping by greater catastrophizing reported greater impairments in various domains, including depressive symptoms, general mental health, social functioning, vitality and pain. Greater venting was associated with greater depressive symptoms and poorer mental health. Seeking instrumental social support was associated with fewer depressive symptoms. CONCLUSIONS These findings suggest that maladaptive coping strategies are associated with higher levels of depressive symptoms and quality of life decrements in patients with this condition. Psychosocial interventions aimed at increasing adaptive coping may positively impact the female experience with interstitial cystitis.
Collapse
Affiliation(s)
- Nan E Rothrock
- Departments of Psychology and Urology, University of Iowa, Iowa City, IA, USA
| | | | | |
Collapse
|
66
|
The Use of a Standard Measure of Emotional Distress to Evaluate Early Counseling Intervention in Patients with Amputations. ACTA ACUST UNITED AC 2003. [DOI: 10.1097/00008526-200301000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
67
|
Coping Strategies in Patients with Interstitial Cystitis: Relationships with Quality of Life and Depression. J Urol 2003. [DOI: 10.1097/00005392-200301000-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
68
|
Morley S, Williams ACDC, Black S. A confirmatory factor analysis of the Beck Depression Inventory in chronic pain. Pain 2002; 99:289-98. [PMID: 12237207 DOI: 10.1016/s0304-3959(02)00137-9] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Stephen Morley
- Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, Leeds, LS2 9 JT, UK.
| | | | | |
Collapse
|
69
|
Abstract
OBJECTIVES Insomnia and depression are common problems for people with chronic pain, and previous research has found that each is correlated with measures of pain and disability. The goal of this study was to examine the combined impact of major depression and insomnia on individuals with chronic pain. METHODS The participants were patients with chronic musculoskeletal pain who underwent evaluation at an interdisciplinary treatment center. On the basis of semistructured interviews, participants were classified in three groups depending on whether they: (1) met criteria for major depression with insomnia (n = 38); (2) had insomnia without major depression (n = 58); or (3) had neither insomnia nor major depression (n = 47). The groups were then compared on self-report measures that included the McGill Pain Questionnaire, the Beck Depression Inventory, and the Multidimensional Pain Inventory. RESULTS Participants with major depression and insomnia reported the most difficulty on measures of affective distress, life control, interference, and pain severity, although the insomniac patients without major depression also had elevated scores on some measures. In regression analyses, insomnia severity ratings did not contribute uniquely to the prediction of psychosocial problems when depression was controlled, but they did contribute to the prediction of pain severity. CONCLUSIONS These results suggest that patients with chronic pain and concurrent major depression and insomnia report the highest levels of pain-related impairment, but insomnia in the absence of major depression is also associated with increased pain and distress.
Collapse
Affiliation(s)
- Keith G Wilson
- Institute for Rehabilitation Research and Development, The Rehabilitation Center, Ottawa, Ontario, Canada.
| | | | | | | | | |
Collapse
|
70
|
Zlot SI, Herrmann M, Hofer-Mayer T, Adler M, Adler RH. A comparison of self-concept and personality disorders in women with pain accounted for by psychological factors, women with major depression, and healthy controls. Int J Psychiatry Med 2002; 31:61-71. [PMID: 11529391 DOI: 10.2190/1120-85ja-aamg-ltke] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Do patients with pain accounted for by psychological factors (P) differ in their self-concept and personality disorders from patients with major depression (D) and healthy controls (C)? METHOD Thirty hospitalized P-patients (DSM-IV, 307.80) and 30 hospitalized D-Patients (DSM-III-R) were given the Beck Depression Inventory on admission (BDI-1) and at discharge (BDI-2). Together with BDI-2, patients filled out the Personality Disorder Questionnaire for DSM-III-R (PDQR) and the Frankfurt Self-Concept Scales (FSKN). Thirty-two healthy comparisons (C) completed the same questionnaires. RESULTS BDI-2 showed no significant differences between groups P and D, a prerequisite for the comparison of psychological traits. PDQR differed in the three groups. D showed more dependent, obsessive-compulsive, and histrionic personality features than group P. The three groups differed in FSKN total score and all 10 subscales (C (healthiest self-concept) > P > D). Groups P and D were different (P > D) in total score and subscales: performance, problem coping, confidence in behavior and decision taking, and self-esteem. Ten P-patients with pathological BDI-2 (P(D)) had significantly more disturbed PDQR and FSKN scores than the non-depressed (P(ND)), and closely resembled the D-patients. CONCLUSIONS Personality disorders and self-concept are not homogenous in female patients with P. Subgroup P(ND) differs from patients with depression (fewer personality disorders, better self-concept), whereas subgroup P(D) closely resembles them.
Collapse
Affiliation(s)
- S I Zlot
- University of Geneva, Switzerland
| | | | | | | | | |
Collapse
|
71
|
Skevington SM, Carse MS, Williams AC. Validation of the WHOQOL-100: pain management improves quality of life for chronic pain patients. Clin J Pain 2001; 17:264-75. [PMID: 11587119 DOI: 10.1097/00002508-200109000-00013] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study aimed to validate a new, multidimensional, multilingual instrument (the WHOQOL-100) for assessing QOL in chronic pain patients. METHODS Chronic pain patients (N = 106) who agreed to participate in an established pain management program (PMP) were assessed for quality of life (QOL) before and one month after the intervention. The WHOQOL-100 is a generic profile containing 25 facets of QOL organized in 6 domains. It was administered concurrently with the MOS Short Form-36, the Beck Depression Inventory, and measures of pain intensity, duration, disruption and distress. RESULTS The patients were outpatients and inpatients with a mean age of 44 years and mean pain duration of 8 years. The sample included 70 (66%) women. After the PMP, QOL had significantly improved generally. and in the physical, psychological and independence domains, as well as in 10 facets of QOL including pain and discomfort. Good QOL is consistently associated with low levels of pain severity and pain distress and little pain disruption. Overall internal consistency reliability was good and for most facets and domains but marginal for the pain facet. When compared with the SF-36. the WHOQOL-100 shows good concurrent validity, greater comprehensiveness and very good responsiveness to clinical change. DISCUSSION The WHOQOL-100 indicates significant improvements to QOL for those entering a PMP and is validated for the clinical assessment of chronic pain patients and for use in multi-national clinical trials, clinical governance and audit.
Collapse
Affiliation(s)
- S M Skevington
- WHOQOL Centre for the Study of Quality of Life, Department of Psychology, University of Bath, UK.
| | | | | |
Collapse
|
72
|
Abstract
Do patients with chronic pain selectively process pain- and illness-related stimuli? The evidence with regard to attention, interpretation, and recall biases is critically reviewed. A model is proposed to account for the findings in which it is suggested that biases in information processing in chronic pain are the result of overlap between 3 schemas: pain, illness, and self. With frequent repeated or continued experience of pain, the pain schema becomes enmeshed with illness and self-schemas. The extent of the enmeshment and the salient content of the schema determine the bias. A fundamental assumption is that all patients with pain selectively process sensory-intensity information. A clinical implication of the results is that processing biases that extend beyond this healthy and adaptive process to enmesh the self-schema with pain and illness schemas could maintain and exacerbate distress and illness behavior in patients with chronic pain.
Collapse
Affiliation(s)
- T Pincus
- Department of Psychology, Royal Holloway, University of London, Egham, United Kingdom.
| | | |
Collapse
|
73
|
Burns JW, Kubilus A, Bruehl S, Harden RN. A fourth empirically derived cluster of chronic pain patients based on the multidimensional pain inventory: evidence for repression within the dysfunctional group. J Consult Clin Psychol 2001; 69:663-73. [PMID: 11550732 DOI: 10.1037/0022-006x.69.4.663] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors proposed that chronic pain patients with repressive defenses are not represented in current 3-cluster solutions of the Multidimensional Pain Inventory (MPI; R. D. Kerns, D. C. Turk, & T. E. Rudy, 1985) and that such a group can be distinguished by using a measure of defensiveness together with subscales of the MPI. They expected these patients to be described both by high defensiveness and by elevated pain and disability but minimal emotional distress. For 178 pain patients, hierarchical cluster analyses were performed on the MPI and Balanced Inventory of Desirable Responding (D. L. Paulhus, 1984). A 3-cluster solution replicated past findings in identifying dysfunctional, interpersonally distressed, and adaptive coper groups. A 4-cluster solution fit the data better, with a repressor group described by high pain, low activity and low distress emerging from the dysfunctional group. Profile analysis of validation measures showed that repressors scored comparably with dysfunctional patients on somatic symptoms of depression, pain severity, and perceived disability but significantly higher on these factors than the adaptive copers. Repressors scored comparably with adaptive copers on cognitive-affective symptoms of depression, anxiety, and anger but significantly lower on these variables than dysfunctional patients. Repressors also reported greater pain severity and perceived disability relative to their reports of negative affect, whereas dysfunctional and adaptive coper groups exhibited no such disparities. Without a measure of defensiveness, the MPI may misclassify a distinct group of patients as dysfunctional, but who readily endorse physical symptoms yet report low levels of emotional distress.
Collapse
Affiliation(s)
- J W Burns
- Department of Psychology, Finch University of Health Sciences/The Chicago Medical School, Illinois 60064, USA.
| | | | | | | |
Collapse
|
74
|
Réthelyi JM, Berghammer R, Kopp MS. Comorbidity of pain-associated disability and depressive symptoms in connection with sociodemographic variables: results from a cross-sectional epidemiological survey in Hungary. Pain 2001; 93:115-121. [PMID: 11427322 DOI: 10.1016/s0304-3959(01)00301-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate the prevalence of pain symptoms causing disabilities in every-day activities and their possible connection to depressive symptomatology. A representative sample of 12640 adults from the Hungarian population participated in a door-to-door survey about demographic variables, pain-associated disability, and depressive symptomatology. The overall prevalence of pain-associated disability was 32.7%, significantly lower in men, showing a significant increasing trend with age. A decreasing tendency in prevalence rates was observed in connection with higher educational and occupational status. Results revealed a 30.2% prevalence of depressive symptomatology among interviewees reporting pain-associated disabilities. The co-prevalence of depressive symptoms revealed a significant increasing trend with age and lower educational level. No significant gender difference was found in the co-occurrence of depressive symptoms. This survey concludes that pain symptoms constitute a substantial public health problem in the Hungarian population in forms of emerging disabilities and depression. Epidemiological studies offer a better understanding of sociodemographic differences in health status, and serve the better allocation of professional and economic resources.
Collapse
Affiliation(s)
- János M Réthelyi
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | | | | |
Collapse
|
75
|
Wilson KG, Mikail SF, D'Eon JL, Minns JE. Alternative diagnostic criteria for major depressive disorder in patients with chronic pain. Pain 2001; 91:227-234. [PMID: 11275378 DOI: 10.1016/s0304-3959(00)00440-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic pain is associated with high rates of major depressive disorder (MDD), but somatic symptoms caused by pain may complicate the diagnosis of MDD. Different methods to address this issue include the adoption of an inclusive approach to diagnosis (i.e. including all symptoms when assessing MDD, regardless of their presumed cause), an etiologic approach (i.e. disregarding symptoms that are caused by medical problems), and a substitutive approach (i.e. replacing somatic symptoms with non-somatic alternatives). In this study, 129 patients with chronic pain (56 men and 73 women) underwent semi-structured interviews addressing 23 individual symptoms of MDD. Detailed probing was undertaken into patients' perceptions of the causes of those symptoms that could potentially be brought on by pain. We found that the prevalence of MDD was highest with the inclusive diagnostic method (35.7%), lowest with an etiologic approach that discounted symptoms based on patient attributions (19.4%), and intermediate with the substitutive method (30.3%). Although some symptoms, such as insomnia, fatigue, and difficulty concentrating, were reported by 34--53% of the patients who did not meet criteria for MDD, they were still more common among those who did (85--94%, P<0.001). Patients who met criteria for MDD with the inclusive method, but who did not meet criteria using the etiologic method, had Beck Depression Inventory scores (M=24.5) that were comparable to those of patients who were consistently classified with MDD across methods (M=25.6). These scores were much higher than those of patients who were consistently classified without MDD (M=13.8, P<0.001). In conclusion, excluding criterion symptoms that patients attribute to pain can reduce the observed prevalence of MDD by about 45%. However, this method introduces a problem of false-negative diagnoses that appears to be more significant than the problem of false positives associated with the inappropriate inclusion of somatic symptoms.
Collapse
Affiliation(s)
- Keith G Wilson
- Institute for Rehabilitation Research and Development, The Rehabilitation Centre, 505 Smyth Road, Ottawa, Ontario, K1H 8M2, Canada Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada School of Psychology, University of Ottawa, Ottawa, Ontario, Canada Southdown Institute, Aurora, Ontario, Canada
| | | | | | | |
Collapse
|
76
|
Zlot SI, Herrmann M, Hofer-Mayer T, Adler M, Adler RH. Childhood experiences and adult behavior in a group of women with pain accounted for by psychological factors and a group recovered from major depression. Int J Psychiatry Med 2001; 30:261-75. [PMID: 11209993 DOI: 10.2190/b5p1-1pua-ku20-d3wb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study twenty-four women with pain accounted for by psychological factors (DSM-IV, 307.80) and twenty-four with major depression diagnosed according to DSM-III-R were compared to study the relationship between pain and depression. METHOD They were examined by a semi-structured, tape-recorded interview to study their childhood experiences and adult behavior. The interviews were rated by two independent and blind raters. Interrater correlation (Cohen-Kappa) varied between good and close agreement. RESULTS Of childhood experiences, "brutality between parents," "brutality toward child," and "sexual abuse" were often found in both groups and were more strongly represented in these than in comparison groups of former studies. As adults, the pain group had experienced more serious illness (p = 0.037) and surgery (p = 0.014). The depression group more often had a history of depression (15/24 vs. 4/24; p = 0.001). The pain group spoke negatively of its physicians (p = 0.001), was more hostile during the interview (p = 0.041), was less convinced of the benefit of the hospital stay (p = 0.029), felt less self-responsible, and was more pessimistic (p = 0.013). The pain patients also provoked negative emotions in the raters, whereas the latter's reaction to the depression group was compassion and interest (p = 0.0005) (Pearson's chi2 and Fisher's exact tests). CONCLUSIONS The results show that negative childhood experiences are prominent and similar in patients with pain accounted for by psychological factors and in patients after major depression. Adult behavior, however, is very different.
Collapse
Affiliation(s)
- S I Zlot
- University of Geneva, Switzerland
| | | | | | | | | |
Collapse
|
77
|
Mohr DC, Boudewyn AC, Goodkin DE, Bostrom A, Epstein L. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol 2001. [DOI: 10.1037/0022-006x.69.6.942] [Citation(s) in RCA: 224] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
78
|
Menefee LA, Frank ED, Doghramji K, Picarello K, Park JJ, Jalali S, Perez-Schwartz L. Self-reported sleep quality and quality of life for individuals with chronic pain conditions. Clin J Pain 2000; 16:290-7. [PMID: 11153783 DOI: 10.1097/00002508-200012000-00003] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the sleep quality and quality of life for individuals with degenerative spinal disease or failed back surgery syndrome. DESIGN Cross-sectional survey design utilizing standardized instruments. Data were analyzed with use of hierarchical stepwise multiple regression analyses. PATIENTS One hundred sixty-seven individuals with degenerative spinal disease or postlaminectomy syndrome who presented to a tertiary care outpatient patient pain center. OUTCOME MEASURES The Center for Epidemiological Studies Depression Index measured depressive symptomatology. A modified Pittsburgh Sleep Quality Index (PSQI) measured sleep quality. The arithmetic average of least and usual VAS ratings of pain measured everyday pain. A visual analog scale rating of highest pain during the past 2 weeks measured highest pain. The Epworth Sleepiness Scale measured daytime sleepiness. The Medical Outcome Study-Short Form-Health Survey (SF-36) measured the mental health and general health components of quality of life. RESULTS Higher overall sleep quality and lower sleep latency primarily were related to higher ratings of physical functioning and shorter duration of pain. Ratings of the highest pain, but not everyday pain, were independent predictors of overall sleep quality and sleep latency. Daytime sleepiness was associated with younger age and depressed mood. Pain was not associated independently with daytime sleepiness. The quality of life related to mental functioning was associated positively with depressed mood and with the interaction of pain and depressed mood. None of the variables in the model (i.e., pain intensity, sleep quality, depression, and demographic variables) predicted quality of life related to overall general health. CONCLUSIONS These data suggest that physical functioning, duration of pain, and age may be more important than pain intensity and depressed mood in contributing to decreased overall sleep quality and sleep latency. The contribution of physical functioning was particularly strong and should be included in subsequent studies of sleep, pain, and mood. The SF-36 should be compared to pain-specific quality-of-life measures to further evaluate the usefulness of this instrument with outpatients with chronic nonmalignant pain conditions.
Collapse
Affiliation(s)
- L A Menefee
- Department of Psychiatry, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|
79
|
Vendrig AA. The Minnesota Multiphasic Personality Inventory and chronic pain: a conceptual analysis of a long-standing but complicated relationship. Clin Psychol Rev 2000; 20:533-59. [PMID: 10860166 DOI: 10.1016/s0272-7358(00)00053-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Minnesota Multiphasic Personality Disorder (MMPI) and its successor, the MMPI-2, have a long-standing tradition in the assessment of patients with chronic pain. With the introduction of more narrowly defined and factor-analyzed pain inventories, however, the utility of the MMPI-2 for pain assessment has been brought into question. In this review, the relevant literature is carefully scrutinized from a conceptual and historical perspective. It is concluded that many of the (recent) criticisms are largely ungrounded. Rather than the test itself being at fault or of little utility in the field of pain assessment, it has simply been applied inappropriately (i.e., for determination of pain etiology or underlying personality structure "explaining" the chronic pain). In conclusion, it is suggested that the application of the MMPI-2 in the assessment of patients with chronic pain should correspond more closely to the original aims and psychometric properties of the tool--that is, for screening and the generation of hypotheses regarding comorbid psychopathology and personality features having the potential to complicate the treatment process. Guidelines for clinical interpretation of MMPI-2 profiles with regard to chronic pain are provided.
Collapse
Affiliation(s)
- A A Vendrig
- Rug AdviesCentra Nederland, Zeist, The Netherlands.
| |
Collapse
|
80
|
Geisser ME, Roth RS, Theisen ME, Robinson ME, Riley JL. Negative affect, self-report of depressive symptoms, and clinical depression: relation to the experience of chronic pain. Clin J Pain 2000; 16:110-20. [PMID: 10870723 DOI: 10.1097/00002508-200006000-00004] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this study was to examine the relative importance of global affective distress, self-report of depressive symptoms, and presence or absence of major depression to the experience of chronic pain. SETTING A multidisciplinary pain program at a university medical center was the setting for this study. PATIENTS Subjects in this study were 211 consecutive patients with chronic pain. OUTCOME MEASURES Pain duration, compensation, and litigation status were controlled for in the statistical analyses, as each correlated significantly with at least one of the measures of affect. Global affective distress was assessed using the Global Severity Index (GSI) from the Brief Symptom Inventory. The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale were used as measures of self-report of depressive symptoms. Presence or absence of major depression was based on DSM-IV criteria. RESULTS AND CONCLUSIONS The GSI, Beck Depression Inventory, and Center for Epidemiological Studies Depression Scale were significantly correlated with each measure of the experience of pain, although clinical depression was only significantly related to self-reported disability and negative thoughts about pain. The self-report measures of depression maintained their relation to the dependent measures when the somatic items from the scales were removed, suggesting that the relations were not spuriously due to the influence of pain symptoms on the scales. When examining the unique contribution of each variable to the experience of pain (by simultaneously controlling for the other measures of affect), the GSI was uniquely related to the sensory and affective components of pain. Self-report of depressive symptoms was more highly related to a measure of the evaluative component of pain and uniquely related to self-reported disability and negative thoughts about pain. The results are discussed within the context of theoretical models of the relation between pain and affect, and suggestions for future research are presented.
Collapse
Affiliation(s)
- M E Geisser
- University of Michigan Health System, Ann Arbor 48108, USA.
| | | | | | | | | |
Collapse
|
81
|
Abstract
OBJECTIVE To investigate the effectiveness of ultrasound treatment and trigger point injections in combination with neck-stretching exercises on myofascial trigger points of the upper trapezius muscle. DESIGN Depression and anxiety associated with chronic pain were assessed using the Beck Depression Inventory (BDI) and the Taylor Manifest Anxiety Scale (TMAS). The study population comprised 102 patients who had myofascial trigger points in one side of the upper trapezius. The patients were randomly assigned to one of three groups: group 1 received ultrasound therapy to trigger points in conjunction with neck-stretching exercises; group 2 received trigger point injections and performed neck-stretching exercises; and group 3, the control group, performed neck-stretching exercises only. Treatment effectiveness was assessed using subjective pain intensity (PI) with a visual analog scale, pressure pain threshold (PT) with algometry, and range of motion (with a goniometer) of the upper trapezius muscle. RESULTS Compared with the control group, patients in groups 1 and 2 had a statistically significant reduction in PI, an increase in PT, and an increase in range of motion. There were no statistically significant differences between treatment groups 1 and 2. Although not statistically significant, patients in the control group had better results at the 3-mo follow-up. The BDI scores indicated depression in 22.9% of the patient, with 4.8% of the patients having severe depression. High anxiety scores on the TMAS were present in 89.3% of the patients. When BDI and TMAS scores were compared with PI or PT levels, no significant correlations were found, but when compared with pain duration before treatment, correlations were significant. CONCLUSIONS Patients with myofascial pain syndrome had higher scores for anxiety than for depression. When combined with neck stretching exercises, ultrasound treatment and trigger point injections were found to be equally effective.
Collapse
Affiliation(s)
- M Esenyel
- Department of Physical Medicine and Rehabilitation, Vakif Gureba Teaching Hospital, Istanbul, Turkey
| | | | | |
Collapse
|
82
|
de C Williams AC, Nicholas MK, Richardson PH, Pither CE, Fernandes J. Generalizing from a controlled trial: the effects of patient preference versus randomization on the outcome of inpatient versus outpatient chronic pain management. Pain 1999; 83:57-65. [PMID: 10506672 DOI: 10.1016/s0304-3959(99)00074-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients accepting randomization in a randomized controlled trial (RCT) may not be representative of the clinical population from which they are drawn, calling into question the generalizability of study findings. Comparison of randomized and non-randomized inpatient and outpatient samples at baseline and in treatment outcomes up to one year was made to determine whether the findings of the RCT generalized to non-randomized patients in the same treatment program. One hundred and twenty one patients with intractable pain, randomized between inpatient, outpatient and waiting list control, were compared with 128 who elected for either inpatient or outpatient treatment. Treatment was a group-based multidisciplinary cognitive-behavioral treatment program aimed at enabling patients to return to more normal function despite persistent pain, delivered to mixed groups of randomized and elective patients, and outcome was measured by physical performance, pain impact on function, mood, and drug use. Agreement to randomization was a function of travelling distance from home to hospital. Non-randomized patients largely resembled their randomized counterparts before and after treatment. In order to indicate the clinical significance of results, analyses were conducted using numbers needed to treat (NNTs). NNTs estimate the number of patients required in the treatment condition for one of them to achieve the specified outcome who would not have achieved it in the comparison condition. Across a range of measures at one month follow-up, comparison of inpatients with outpatients gave NNTs between 2.3 and 7.5, and comparison of inpatients with waiting list controls gave NNTs between 2.3 and 3.6. At one year inpatients showed greater likelihood than outpatients of maintaining these treatment gains.
Collapse
Affiliation(s)
- A C de C Williams
- Division of Psychiatry and Psychology, King's, Guy's and St. Thomas' Medical and Dental Schools, University of London, London, UK.
| | | | | | | | | |
Collapse
|
83
|
Abstract
The main aspects of the most common models describing depression in chronic pain patients are reviewed. It is suggested that dualistic thinking provides neither a satisfactory model of chronic pain, nor of depression, and relies on questionable assumptions of homogeneous, diagnostically defined entities. Models of depression based in cognitive psychology, although apparently more suitable, cannot be applied to populations of pain patients without clarifying the relationship between pain and depression. Furthermore, commonly used depression measurement instruments are criticized for criterion contamination, lack of external reference, and lack of sensitivity when applied to these groups, all of which further obscure the relationship. Finally, we suggest more promising directions for research in this area.
Collapse
Affiliation(s)
- T Pincus
- Department of Psychology, Royal Holloway & Bedford New College, Egham, Surrey, UK.
| | | |
Collapse
|
84
|
Aikens JE, Reinecke MA, Pliskin NH, Fischer JS, Wiebe JS, McCracken LM, Taylor JL. Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory? J Behav Med 1999; 22:127-42. [PMID: 10374139 DOI: 10.1023/a:1018731415172] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- J E Aikens
- Department of Psychiatry, University of Chicago Medical Center, Illinois 60637, USA.
| | | | | | | | | | | | | |
Collapse
|
85
|
Da Costa D, Dobkin PL, Pinard L, Fortin PR, Danoff DS, Esdaile JM, Clarke AE. The role of stress in functional disability among women with systemic lupus erythematosus: a prospective study. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1999; 12:112-9. [PMID: 10513499 DOI: 10.1002/1529-0131(199904)12:2<112::aid-art6>3.0.co;2-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In the last decade, the biopsychosocial approach has been applied to systemic lupus erythematosus (SLE) to understand the multiple factors involved in the disease course. This study examined the link between stress and changes in functional disability as assessed by the Stanford Health Assessment Questionnaire (HAQ) in women with SLE. METHODS Forty-two women with SLE were assessed at baseline and 8 months later. Major stress (Life Events), minor stressors (Hassles), depression (Beck Depression Inventory), disease activity (Systemic Lupus Activity Measure), and functional disability were collected at both time points, while demographic and disease damage variables (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were collected once at baseline. RESULTS Mean HAQ scores at baseline (0.52) and followup (0.46) indicated mild disability and remained fairly stable, although individual variation was observed (mean change -0.07; range -1.25-0.5). Demographic (age, education) and disease (duration, activity, damage) variables were not related to 8-month changes on the HAQ. Of the baseline stress measures, greater negative life events in the preceding 6 months was correlated with reduced functional ability (r = 0.42) 8 months later. Individual changes in depressed mood over the 8-month period were correlated (r = 0.33) with changes in functional ability. Hierarchical multiple regression revealed that after controlling for baseline HAQ scores and changes in depressed mood, baseline negative life events remained a significant predictor of changes in functional ability. CONCLUSION We found that the major short-term determinants of functional disability were not demographic- or disease-related factors, but rather stress caused by negative life events. Comprehensive treatment of SLE requires management of life stress.
Collapse
Affiliation(s)
- D Da Costa
- Division of Clinical Epidemiology, Montreal General Hospital, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
86
|
Riley JL, Robinson ME. Validity of MMPI-2 profiles in chronic back pain patients: differences in path models of coping and somatization. Clin J Pain 1998; 14:324-35. [PMID: 9874012 DOI: 10.1097/00002508-199812000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To show clinical utility and empirical validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) chronic pain patient subgroups by identification of differential multivariate relationships across groups. METHOD This study used structural equation modeling to test cognitive coping strategies and somatization as mediator variables in path models with pain severity and depression used as exogenous (independent) variables and patient's activity level as the final endogenous (dependent) variable, across MMPI-2 profiles. RESULTS Hierarchical cluster analysis, performed on a sample of 569 chronic low back patients, resulted in four cluster profiles identifiable as those found in previous work with the MMPI-2 (within normal limits, V-type, neurotic triad, and depressed-pathological). Somatization mediated the relationship between depression and activity level for the neurotic triad group but not the other three groups. A positive linear relationship was found between somatization and depression for the within normal limits, neurotic triad, and depressed-pathological groups, whereas their linear association was negative for the V-type group. Cognitive coping strategies mediated the relationship between depression and activity level for the within normal limits group. In addition, cognitive coping was predictive of activity level for the within normal limits, V-type, and neurotic triad groups but not for the depressed-pathological group. CONCLUSION Consistent with previous cluster analytic studies, this study replicated four MMPI-2 cluster profile groups in chronic pain patients. These results have also shown that several multivariate relationships between variables are different across MMPI-2 groups, providing evidence for the validity for these MMPI-2 subgroups.
Collapse
Affiliation(s)
- J L Riley
- The Claude Pepper Center for Research of Oral Health in Aging, College of Dentistry, University of Florida, Gainesville 32610, USA
| | | |
Collapse
|
87
|
Brown-DeGagne AM, McGlone J, Santor DA. Somatic complaints disproportionately contribute to Beck Depression Inventory estimates of depression severity in individuals with multiple chemical sensitivity. J Occup Environ Med 1998; 40:862-9. [PMID: 9800170 DOI: 10.1097/00043764-199810000-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A number of individuals with multiple chemical sensitivity (MCS) are also diagnosed with depression. However, there is content overlap in MCS and symptoms of depression with respect to somatic complaints. The Beck Depression Inventory (BDI) was used to document severity of depressive symptomatology in 42 individuals with MCS. The purpose was to determine the extent to which somatic complaints contributed to the total BDI score. Analysis of cognitive-affective and somatic-performance complaints subscale indicated a significantly higher mean item score on somatic-performance items, relative to cognitive-affective items (t = 6.43, P < 0.05). Consequently, the total BDI score classified a greater percentage (43%) of the sample as moderately depressed than did the cognitive-affective subscale score (29%). An item analysis of the BDI revealed that individuals with MCS tended to endorse more somatic-performance items than did a sample of depressed outpatients. Two alternative interpretations are possible: (a) the BDI total score overestimated severity of depressive symptomatology in this sample, and/or (b) individuals with MCS tended to express depressive symptomatology in terms of somatic complaints. It was recommended that until the etiology of MCS is better understood, caution be used when estimating severity of depressive symptomatology in individuals with MCS when measures include somatic items.
Collapse
Affiliation(s)
- A M Brown-DeGagne
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | |
Collapse
|
88
|
Sist TC, Florio GA, Miner MF, Lema MJ, Zevon MA. The relationship between depression and pain language in cancer and chronic non-cancer pain patients. J Pain Symptom Manage 1998; 15:350-8. [PMID: 9670635 DOI: 10.1016/s0885-3924(98)00006-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study investigated the relationship between depression and pain description among cancer and chronic non-cancer pain patients in a large outpatient sample. Participants consisted of 312 patients (158 men and 154 women) attending a pain management clinic at a comprehensive cancer institute. Sixty-one percent of the patients (190/312) were experiencing pain related to cancer and 39% (122/312) were experiencing chronic nonmalignant pain. Multivariate analyses of covariance were used to assess differences in the sensory and affective indices of the McGill Pain Questionnaire (MPQ) associated with depression and type of pain. Current pain intensity was the covariate. The results indicated that the MPQ affective and sensory intensity scales did not significantly differ among patients with cancer and chronic non-cancer pain. There were also no significant differences in the percentage of affective and sensory pain descriptors chosen by these patients. However, depression significantly influenced MPQ pain description. Depressed patients with pain scored higher on the affective pain intensity dimension of the MPQ than non-depressed patients with pain (P < 0.001). Depressed patients also chose more affective pain descriptors than non-depressed patients (P < 0.001). Chi-square analyses revealed that depressed and non-depressed pain patients made significantly different choices on four of the five MPQ affective adjective lists. There were no differences in the sensory pain index or the percentage of sensory pain descriptors based on depression. These findings are discussed in terms of their clinical implications and their relationship to the existing literature.
Collapse
Affiliation(s)
- T C Sist
- Department of Anesthesiology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | | | | | | | | |
Collapse
|
89
|
de C. Williams AC. Depression in Chronic Pain: Mistaken Models, Missed Opportunities. ACTA ACUST UNITED AC 1998. [DOI: 10.1080/02845719808408497] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
90
|
|
91
|
Andersson G. CBT and Behavioural Medicine: On Definitions, Applications and Practical Considerations. ACTA ACUST UNITED AC 1998. [DOI: 10.1080/02845719808408490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
92
|
Rainville J, Sobel JB, Hartigan C, Wright A. The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain. Spine (Phila Pa 1976) 1997; 22:2016-24. [PMID: 9306533 DOI: 10.1097/00007632-199709010-00016] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared. OBJECTIVES To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts. BACKGROUND Previous studies have produced conflicting results concerning this issue. METHODS Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables. RESULTS The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group. CONCLUSIONS In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.
Collapse
Affiliation(s)
- J Rainville
- New England Spine Care Center, Chestnut Hill, Massachusetts, USA
| | | | | | | |
Collapse
|
93
|
Mohr DC, Goodkin DE, Likosky W, Beutler L, Gatto N, Langan MK. Identification of Beck Depression Inventory items related to multiple sclerosis. J Behav Med 1997; 20:407-14. [PMID: 9298438 DOI: 10.1023/a:1025573315492] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The percentage contribution of each item on the Beck Depression Inventory (BDI) to the total BDI score was compared across patients with multiple sclerosis (MS), patients diagnosed with major depressive disorder, and normal college students. We considered an item to be confounded by MS-related symptoms if its percentage contribution to the total BDI score was significantly greater in the MS group than the major depression and control groups. Items measuring work difficulty, fatigue, and concerns about health met this criterion. These items accounted for 34, 17, and 19% of the total BDI score in the MS, major depression, and control groups, respectively. Using the 18-item BDI (BDI-18) which resulted from excluding the 3 confounded items, MS patients found to be were more depressed than controls but less depressed than the major depression group. The identification of signs of depression not confounded with MS which could be substituted for confounded signs was also discussed.
Collapse
Affiliation(s)
- D C Mohr
- UCSF/Mt. Zion MS Center 94115-1642, USA
| | | | | | | | | | | |
Collapse
|
94
|
Södeman E, Lisspers J. Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI). ACTA ACUST UNITED AC 1997. [DOI: 10.1080/16506079708412476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
95
|
Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain 1997; 13:163-70. [PMID: 9186024 DOI: 10.1097/00002508-199706000-00011] [Citation(s) in RCA: 368] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study examined the ability of two self-report questionnaires, the Beck Depression Inventory (BDI) and the Center for Epidemiological Studies-Depression Scale (CES-D), to discriminate between chronic pain patients with and without major depression. Since previous research has suggested that medical conditions such as chronic pain can influence the endorsement of items that measure neurovegetative symptoms of depression, the accuracy of each of these questionnaires was also assessed eliminating these items. SUBJECTS These included 132 consecutive patients with chronic pain, 44 of whom were diagnosed as suffering from major depression according to DSM-IV criteria. METHODS Patients were administered a battery of questionnaires that included the CES-D and BDI. They were also interviewed by a clinical psychologist to determine the presence or absence of major depression. RESULTS Both questionnaires were able to discriminate significantly between persons with and without major depression. Removal of the somatic items on each questionnaire did not improve their accuracy. Discriminant function analysis revealed an optimal cut-off score of 21 for the BDI, and 27 for the CES-D. Overall hit rates at these cut-offs for the two questionnaires were comparable, while the CES-D had somewhat better sensitivity (81.8% vs. 68.2%). Conversely, the BDI had slightly better specificity (78.4% vs. 72.7%). CONCLUSION The results suggest that both questionnaires have good predictive validity among chronic pain patients, and decisions regarding the use of one questionnaire rather than the other may depend upon the goals of the user and the setting within which the questionnaire is used.
Collapse
Affiliation(s)
- M E Geisser
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor 48108, USA
| | | | | |
Collapse
|
96
|
|
97
|
Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997; 13:116-37. [PMID: 9186019 DOI: 10.1097/00002508-199706000-00006] [Citation(s) in RCA: 676] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the current status for the association of chronic pain and depression and to review the evidence for whether depression is an antecedent or consequence of chronic pain (CP). DESIGN A computer and manual literature review yielded 191 studies that related to the pain-depression association. These reports were reviewed and sorted into seven categories relating to the topic of this paper. Eighty-three studies were then selected according to inclusion criteria and subjected to a structured review. SETTING Any medical treatment setting including pain treatment as inclusion criteria for selection of studies. PATIENTS Any patients with any type of chronic pain. RESULTS The reviewed studies were consistent in indicating that there is a statistical relationship between chronic pain and depression. For the relationship between pain and depression, there was greater support for the consequence and scar hypotheses than the antecedent hypothesis. CONCLUSIONS Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution.
Collapse
Affiliation(s)
- D A Fishbain
- Department of Psychiatry, University of Miami, School of Medicine, Florida 33131, USA
| | | | | | | |
Collapse
|
98
|
Landrø NI, Stiles TC, Sletvold H. Memory functioning in patients with primary fibromyalgia and major depression and healthy controls. J Psychosom Res 1997; 42:297-306. [PMID: 9130186 DOI: 10.1016/s0022-3999(96)00301-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Memory functioning was assessed in 25 primary fibromyalgia (FM) patients by comparing them with 22 major depressed patients and 18 healthy controls. A broad range of short- and long-term memory tasks were included. Both major depressed and FM patients were significantly impaired on long-term memory tasks requiring effortful processing, compared to healthy controls. When the depressive status of the fibromyalgia patients was accounted for, only the subsample with a lifetime major depressive disorder showed memory impairment as compared with the healthy controls.
Collapse
Affiliation(s)
- N I Landrø
- Department of Psychiatry and Behavioral Medicine, University of Trondheim, Norway.
| | | | | |
Collapse
|
99
|
Abstract
Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physical disease [corrected]. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale (Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.
Collapse
Affiliation(s)
- D S Ciccone
- Department of Psychiatry, University of Medicine and Dentistry, New Jersey Medical School, Newark 07103, USA
| | | | | |
Collapse
|
100
|
Schmitz U, Saile H, Nilges P. Coping with chronic pain: flexible goal adjustment as an interactive buffer against pain-related distress. Pain 1996; 67:41-51. [PMID: 8895230 DOI: 10.1016/0304-3959(96)03108-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the present study, Brandtstädter's (1992) distinction between assimilation and accommodation as two fundamental means of coping is applied to the field of chronic pain. Assimilative coping involves active attempts (e.g. instrumental activities, self-corrective actions, compensatory measures) to alter unsatisfactory life circumstances and situational constraints in accordance with personal preferences. Conversely, accommodative coping (e.g. downgrading of aspirations, positive reappraisal, self-enhancing comparisons) is directed towards a revision of self-evaluative and personal goal standards in accordance with perceived deficits and losses. Our research is based on the assumption that chronic pain can be described as a major source of threat or impediment to personal goals. When goals are no longer perceived to be attainable through active-assimilative coping efforts, accommodative coping should become increasingly important in dealing with chronic pain. In a study of 120 chronic pain patients, dispositional differences in assimilative (tenacious goal pursuit) and accommodative coping tendencies (flexible goal adjustment), as well as measures of pain-related coping and adjustment (depression, pain-related disability, pain intensity) were assessed. The results suggest that accommodative coping functions as a protective resource by preventing global losses in the psychological functioning of chronic pain patients and maintaining a positive life perspective. Most important, the ability to flexibly adjust personal goals attenuated the negative impact of the pain experience (pain intensity, pain-related disability) on psychological well-being (depression). Furthermore, pain-related coping strategies led to a reduction of disability only when accompanied by a high degree of flexible goal adjustment. The theoretical and clinical implications of these findings for coping research and the treatment of chronic pain patients are discussed.
Collapse
Affiliation(s)
- Ulrich Schmitz
- Universität Trier, Fachbereich I - Psychologie, 54286 Trier, Germany DRK-Schmerz-Zentrüm Mainz, Auf der Steig 14-16, 55131 Mainz, Germany
| | | | | |
Collapse
|