The use of contemporary MMPI norms in the study of chronic pain patients

Personality and fibromyalgia syndrome

Objectives:

We aimed to review how personality characteristics contribute to the onset, maintenance or modulation of fibromyalgia.

Method:

The databases Medline and PsychINFO were examined from 1967 to 2012 to identify studies that investigated associations between fibromyalgia and personality. Search terms included fibromyalgia and personality, trait psychology, characteristics and individual differences.

Results:

Numerous studies indicate that patients with fibromyalgia experience psychological distress. Various instruments have been used to evaluate distress and related psychological domains, such as anxiety or depression, in fibromyalgia. In many cases, these same instruments have been used to study personality characteristics in fibromyalgia with a subsequent blurring of cause and effect between personality and psychological distress. In addition, the symptoms of fibromyalgia may change pre-illness personality characteristics themselves. These issues make it difficult to identify specific personality characteristics that might influence the fibromyalgia process. Despite this inherent problem with the methodologies used in the studies that make up this literature review, or perhaps because of it, we found no defined personality profile specific to fibromyalgia. However, many patients with fibromyalgia do show personality characteristics that facilitate psychological responses to stressful situations, such as catastrophising or poor coping techniques, and these in turn associate with mechanisms contributing to fibromyalgia.

Conclusion:

No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person’s response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism.

MMPI-2 profiles: fibromyalgia patients compared to epileptic and non-epileptic seizure patients

We compared MMPI-2 profiles of Gulf War veterans with fibromyalgia (FM) to epileptic seizure (ES) patients, psychogenic non-epileptic seizure (PNES) patients, and Gulf War veteran healthy controls. Both PNES and FM are medically unexplained conditions. In previous MMPI-2 research PNES patients were shown to have significantly higher Hs and Hy clinical scales than ES patients. In the present research the FM group had significantly higher Hs and Hy scale scores than both the ES group and the healthy control group. There was no significant difference between the FM and PNES Hs scale scores; however, the FM Hy scale score was significantly lower than the PNES Hy scale score. Present findings indicate a high level of psychological distress in the FM group.

What can rehabilitation interventions achieve in patients with primary fibromyalgia?

Symptoms of primary fibromyalgia (FM) persist for years, independent of applied therapy. That is the sad reality we have to deal with. But is that really true? The following review is a scan of literature from September 1, 2001 to August 31, 2002, concerning rehabilitation interventions for patients with FM, to find progress in this field and to ascertain state-of-the-art treatment strategies for the disease. The main problem when treating patients with FM successfully is the heterogeneity of the patients' group. Several investigators determined subgroups within FM patients diagnosed by the 1990 American College of Rheumatology classification criteria of FM. Therefore, uniform recommendations for treatment cannot be given. Current treatment recommendations for FM include reassurance and explanation of the nature of the illness, evaluation and eradication of mechanical stressors as far as possible, symptomatic analgesic drug treatment, moderate individually adapted physical exercises, and adjuvant psychotherapeutic support in an interdisciplinary setting. Individually adapted measures are highly emphasized to differentially treat FM subgroups, as far as identified. This review will focus on these points on the one hand, and provide an overview about the current symptomatically-oriented therapy on the other hand. This all occurs against the background of an unknown etiology of the disease so far. Experimental approaches will be noted as well. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed.

Pain in fibromyalgia

Just as our caveman forebears were frail in the face of predatory animals, we are frail in today's society of childhood neglect or abuse, bumper-to-bumper traffic, frustration at work, and multiple daily hassles. The same neuroendocrine systems and pain regulatory mechanisms that protected early man during acute stress are still encoded in our genome, but may be maladaptive in psychologically and physiologically vulnerable people faced with chronic stress. Many patients with fibromyalgia become vulnerable because of the long-lasting psychological and neurophysiological effects of negative experiences in childhood. Ill-equipped with positive cognitive, emotional, and behavioral skills as adults, they display maladaptive coping strategies, low self-efficacy, and negative mood when confronted with the inevitable stressors of life. Psychological distress ensues, which reduces thresholds for pain perception and tolerance (already relatively low in women) even further. Converging lines of psychological and neurobiological evidence strongly suggest that chronic stress-related blunting of the HPA, sympathetic, and other axes of the stress response together with associated alterations in pain regulatory mechanisms may finally explain the pain and fatigue of fibromyalgia. Vulnerable people who can be classified by the ACR criteria as having fibromyalgia do not have a discrete disease. They are simply the most ill in a continuum of distress, chronic pain, and painful tender points in the general population.

Personality in patients with long-term patellofemoral pain syndrome

Personality characteristics in patients with long-term patellofemoral pain were compared to those of matched controls and other groups both of non-patients and of psychiatric outpatients with character disorders. Personality was described using the self-administered dependency and alexithymia scales, the Karolinska Scales of Personality and the Rorschach inkblot method. The hypothesis was that the patellofemoral pain patients would have higher levels of anxiety, depression, helplessness, aggression and alexithymic characteristics than the matched controls. There were only a few significant differences between the knee patients and the matched controls. The Rorschach measures suggested significantly greater depression, hostility and passive attitude in the knee patients as compared to the reference data. There were no indications of the hypothesised alexithymic characteristics in the knee patients. If patellofemoral pain patients do not improve as expected, referral to a pain clinic with psychological expertise could be considered.

Psychological symptoms in primary fibromyalgia syndrome: relationship to pain, life stress, and sleep disturbance

Twenty-five subjects with primary fibromyalgia syndrome and 22 subjects with rheumatoid arthritis were compared on measures of psychological distress, pain, health status, life stress, sleep disturbance, and coping strategies. Higher levels of psychological distress were found in the primary fibromyalgia syndrome group, but the degree of life stress was shown to be a significant covariate.

Millon Behavioral Health Inventory norms for chronic pain patients

The Millon Behavioral Health Inventory (MBHI) is being used more widely in pain treatment settings; however, normative data on a large sample of chronic pain patients have not been published. In the present study, norms were established for 247 chronic pain patients. The chronic pain patient norms then were compared statistically to norms for non-medical population. Overall, the results showed that the score distributions for chronic pain patients and normals were similar on most MBHI scales. The differences that were found are consistent with other research on pain patients and indicate that chronic pain patients are more likely to be depressed and anxious. Differences in scales between chronic pain patients and controls may be explained by state vs. trait factors. In evaluating chronic pain patients by personality tests, one needs to keep in mind state-trait problems and their potential influence on test results.

Fibromyalgia syndrome among the elderly. Comparison with younger patients

Thirty-one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self-assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P less than .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation.

Predictors of outcome in back surgery candidates

This study employed a prospective design to examine the value of three demographic, three orthopaedic, and four psychometric variables as predictors of orthopaedic and rehabilitation outcome in 116 Workers' Compensation patients seriously considered for first lumbar surgery, separately for the 74 who eventually did undergo surgery, and the 42 who did not. The two groups differed only with respect to the number of Nonorganic Physical Signs, but a complex pattern of predictive relationships emerged, in which orthopaedic outcome was generally easier to predict than rehabilitation outcome. Among the demographic factors, level of English proficiency was the best predictor and correlated positively with orthopaedic outcome in both surgery and non-surgery cases and with rehabilitation outcome in non-surgery patients. The Nonorganic Physical Signs test emerged as the predictor of choice and correlated with orthopaedic outcome in both groups and with rehabilitation outcome in the non-surgery group. Scale 1 of the MMPI correlated with orthopaedic outcome in both groups and Scale 3 with both orthopaedic and rehabilitation outcome, but only in the non-surgery patients.

Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients

This study describes the development of a self-report questionnaire, the Vanderbilt Pain Management Inventory, which assesses the frequency with which chronic pain patients use active or passive coping strategies when their pain reaches a moderate or greater level of intensity. Two internally reliable scales, Active Coping and Passive Coping, were derived using factor analytic techniques from a sample of 361 rheumatoid arthritis patients. The 2 scales showed an opposite pattern of relationships with criterion measures. While Active Coping was associated with reports of less pain, less depression, less functional impairment, and higher general self-efficacy, Passive Coping was correlated with reports of greater depression, greater pain and flare-up activity, greater functional impairment, and lower general self-efficacy. The relationship of these scales to previous theory and research on coping is presented. These scales appear useful for the assessment of coping strategies in clinical settings and in treatment outcome research on chronic pain.

Private body consciousness, anxiety and the perception of pain

Two studies are described which present data consistent with Barsky and Klerman's hypothesis that people who report pain in the absence of an identifiable organic etiology may be attending to and amplifying normal bodily sensations. The results of these studies demonstrated that young college students with a predisposition toward focusing attention on somatic symptoms (high private body consciousness) and scoring high on State Anxiety reported more areas of aches and pains and rated these sensations as more noxious. Additionally, the most frequent areas of pain identified corresponded to the areas commonly seen in a chronic pain population. An attempt to manipulate self-focused attention with a mirror manipulation in Study 2 failed to produce reliable results.

Is chronic pain a variant of depressive disease? The case of primary fibromyalgia syndrome

The responses of 45 primary fibromyalgia syndrome (PFS) patients, 29 rheumatoid arthritis (RA) patients and 31 healthy non-pain controls (NC) on the Zung Self-Rating Depression scale were compared. No difference between the PFS and RA groups was found, although the former has no known organic pathology, unlike the latter. Therefore, the hypothesis that the presentation of chronic pain in the absence of a known organic pathology is a variant of 'depressive disease' was not supported in the case of PFS. However, a subgroup of PFS (28.6%) and RA (31.0%) patients appeared to be experiencing significant depressive symptomatology.

Concepts of illness in populations as applied to fibromyalgia syndromes

Fibromyalgia syndromes are common noninflammatory, painful musculoskeletal disorders that vary in the extent and intensity of involvement. The biologic gradient of musculoskeletal pain varies from no or few symptoms and tender points in the majority of persons to generalized fibromyalgia with multiple tender points. Standardized criteria are needed in order to categorize different strata of the biologic gradient of fibromyalgia syndromes and differentiate them from other conditions. Both the sensitivity and specificity of criteria should be high. The course and prognosis of fibromyalgia syndromes are not yet known. Limited clinical data suggest three basic patterns: remitting-intermittent; fluctuating-continuing; and progressive. However, course patterns need to be derived scientifically. Multiple host and environmental factors seem to contribute to the onset and course of fibromyalgia syndromes, and these require definition. Generalized fibromyalgia syndromes share many constitutional manifestations with other common functional disorders, e.g., irritable bowel syndrome and tension headache syndrome, which suggest common underlying psychoneurophysiologic mechanisms in a subset of patients. Progress made in fibromyalgia research will find application in many dysfunctional syndromes without obvious organ pathology.