The Chronic Illness Problem Inventory as a measure of dysfunction in chronic pain patients

Patient-reported physical activity questionnaires: a systematic review of content and format

Background

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.

Methods

Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers.

Results

104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories.

Conclusions

A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.

Evaluating chronic pain impact among patients in primary care: further validation of a brief assessment instrument

OBJECTIVE

To evaluate the psychometric properties of the Profile of Chronic Pain: Screen (PCP:S) in primary care. The PCP:S is a brief assessment device designed to gauge pain severity, interference, and emotional burden.

DESIGN

Questionnaire survey with short-term reliability and validity follow-up.

METHODS

Two hundred and forty-four outpatients (52% female) with chronic pain recruited from five primary care settings completed the 15-item PCP:S at an initial testing session. Approximately 1 week later, two subgroups participated in a retest reliability and validity follow-up. The battery of follow-up questionnaires included a measure of social desirability response bias and several instruments designed to provide convergent validity for the PCP:S.

RESULTS

Retest reliability, internal consistency, factor structure, and social desirability bias were all found to be acceptable. Likewise, preliminary evidence suggests that, by virtue of its correlation with established measures of pain adjustment, the PCP:S is a valid pain assessment device.

CONCLUSIONS

Although the PCP:S was initially developed and validated using a national community sample of adults with chronic pain who provided data via telephone interviews, the present findings support its use as a brief and psychometrically sound paper-and-pencil measure for the assessment of three key components of chronic pain in primary care.

I get by with a little help from my friends: The interaction of chronic pain and organizational support on performance

The authors conducted three studies to examine the interactive effects of perceived organizational support (POS) and chronic pain on performance outcomes (i.e., effectiveness, work intensity, citizenship behavior, and task performance). After controlling for demographic factors, tenure variables, the number of subordinates, and main effects, the POS chronic pain interaction explained criterion variance for perceived effectiveness and citizenship behavior in Study 1; effectiveness, work intensity, and citizenship behavior in Study 2; and supervisor-rated task performance in Study 3. Higher levels of chronic pain were associated with lower levels of performance when coupled with low support, as hypothesized. Conversely, high levels of POS reduced the adverse effects of chronic pain on performance. Contributions, strengths and limitations, and future research directions are provided.

Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) Scale

INTRODUCTION

The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies- Depression Scale (CES-D).

METHODS

40 depressed patients 29.65 +/- 9.38 years old, and 120 normal controls 27.23 +/- 10.62 years old entered the study. In 20 of them (12 patients and 8 controls) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (alpha)

RESULTS

Both Sensitivity and specificity exceed 90.00 at 23/24, Chronbach's alpha for the total scale was equal to 0.95. Factor analysis revealed three factors (positive affect, irritability and interpersonal relationships, depressed affect and somatic complains). The test-retest reliability was satisfactory (Pearson's R between 0.45 and 0.95 for individual items and 0.71 for total score).

CONCLUSION

The Greek translation of the CES-D scale is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain

OBJECTIVE

To examine in a prospective manner the long-term safety and efficacy of chronic intrathecal morphine in patients with severe, nonmalignant pain refractory to less invasive modalities.

METHODS

Forty patients with severe, chronic nonmalignant pain poorly managed by systemic medications were identified as candidates for intraspinal trial of morphine. Thirty participants reported successful pain relief during trial and were implanted with an intraspinal delivery system. Standardized measures of pain and functional status were assessed before treatment was begun and at defined intervals during the subsequent 24 months. Intrathecal opioid use and pharmacological and device-related complications were also monitored.

RESULTS

The participants had a mean age of 58 +/- 13 years and a mean pain duration of 8 +/- 9 years. Fifty-three percent of the study participants were women. Pain type was characterized as mixed neuropathic-nociceptive (15 of 30 patients, 50%), peripheral neuropathic (10 of 30 patients, 33%), deafferentation (4 of 30 patients, 13%), or nociceptive (1 of 30 patients, 3%). Forty-seven percent of the patients were diagnosed with failed back surgery syndrome. Significant improvement over baseline levels of visual analog scale pain was measured at each follow-up examination after implant. Overall, 50% (11 of 22 patients) of the population reported at least a 25% reduction in visual analog scale pain after 24 months of treatment. In addition, the McGill Pain Questionnaire, visual analog scale measures of functional improvement and pain coping, and several subscales of the Chronic Illness Problem Inventory showed improvement throughout the follow-up period. Pharmacological side effects were managed medically by morphine dose reduction, addition of bupivacaine, or replacement of morphine with hydromorphone. Device-related complications requiring repeat operations were experienced by 20% of the patients.

CONCLUSION

Continuous intrathecal morphine can be a safe, effective therapy for the management of severe, nonmalignant pain among a carefully selected patient population and can result in long-term improvement in several areas of daily function.

Pain-related disability and effects of chronic morphine in the adjuvant-induced arthritis model of chronic pain

Functional disability has been identified as one of the most important aspects of chronic pain, yet modeling pain-related disability has received little attention. Adjuvant-induced arthritis was induced, and one group of arthritic rats was implanted with SC 75-mg morphine pellets 1 week postadjuvant, and reimplanted every 2 weeks thereafter. The results confirm that the rodent adjuvant-induced arthritis model of severe chronic pain can be used to model pain-related disability: spontaneous activity levels and ambulatory function were reduced in arthritic rats and they exhibited substantial weight loss. The results of the present study suggest that the operant delayed nonmatching-to-position task can be used as a measure of pain-related disability, which may be especially relevant to the effects of chronic pain on performance in a work setting. The delayed nonmatching-to-position operant bar-pressing task is an "apical" test that is sensitive to deficits across a wide range of behavioral functions: motor ability, attention, motivation, learning, and memory, and arthritic rats were severely impaired in this task. In addition, analgesic treatments that impair functional abilities in normal healthy rats may actually improve the performance of rats exhibiting pain-related disability. Previous work demonstrated that acute morphine injections of only 4 mg/kg impaired performance in the delayed matching-to-position task. The results of the present study demonstrate that chronic morphine attenuates the degree of pain-related disability exhibited by arthritic rats in the test of ambulatory function and the delayed nonmatching-to-position bar-pressing test. These results demonstrate that novel analgesic treatments can be screened preclinically, both with respect to their direct analgesic effects, and with respect to their ability to reduce pain-related disability.

An empirical investigation of the 'Biopsychosocial Disease Consequence model': psychological impairment, disability and handicap in chronic pain patients

The purpose of this study is to emphasize the meaningfulness of a global, functional rather than a narrow medical view in the efficacy evaluation of chronic pain treatment. Therefore, the 'Biopsychosocial Disease Consequence (BPSDC) model' to assess function more globally than before, is presented in this article. The model is based on two theories: (1) the biopsychosocial approach and (2) WHO's classification of impairments, disabilities and handicaps. In addition to the presentation of the conceptual model, the development of the hypothetical criteria and assessment models for psychological impairments, disabilities and handicaps, and the validity testing of the psychological assessment axis are described. Within each of the three classes, i.e. psychological impairments, disabilities and handicaps, the results supported the independence of the hypothetical criteria from each other. On the other hand, results suggested that some changes to the hypothetical assessment models for some of the criteria might be valuable. It was concluded that although the most adequate psychological assessment models for function, found in this study, can be considered as robust and recommendable as one set of tools for functional assessment, the main aim of this article is to encourage multidisciplinary team efforts to develop and systematize the assessment procedures of function in patients suffering from chronic diseases.

The Pain Disability Index: factor structure and normative data

The factor structure and normative data for the Pain Disability Index (PDI) were examined in a large (N = 1,059) sample of chronic pain patients. The results support a one-factor solution for the PDI. Analyses of normative data indicated very small effects associated with gender, age, and pain duration. Relatively larger effects were associated with compensation status, litigation status, and circumstances of pain onset. Working patients reported less disability than their nonworking counterparts, litigating patients reported more disability than nonlitigants, and patients injured at work reported higher levels of disability than those with pain origins unrelated to work. The results reflect the disability level of patients referred to a hospital-based pain management program and may be useful as a reference point when comparing disability levels of other patient groups or research samples.