The MMPI as a predictor of response to conservative treatment for low back pain.

Studies that used the MMPI to predict the response of chronic low back pain patients to standard medical treatment have not produced definitive results. Patients seen in a university hospital orthopedic back pain clinic were given the MMPI before treatment, and 6 to 12 months later 76 patients completed follow-up forms that indicated their level of intensity during the previous week and their ratings of the success of treatment in relieving their pain as well as in enabling them to return to normal activities. Predictions of poor response were made in terms of either single MMPI scales or code types. Patients with poor outcome on two of the three criteria (level of pain intensity and ability to return to normal activities) had significantly higher scores on the Hs scale. The predicted high risk code types very accurately identified patients with poor response on the same two criteria; however, the code-type procedure overpredicted poor response in the good outcome group.     

慢性疼痛患者与神经症患者MMPI模式特征的对照研究

目的：研究慢性疼痛患者的个性特征及其与神经症患者的异同。方法采用ＭＭＰＩ对５９例慢性疼痛患者进行测试，并将结果与社会症患者的ＭＭＰＩ模型式特征相比较。结果：慢性疼痛患者的ＭＭＰＩ表现为Ｈｓ、Ｄ、Ｈｙ、Ｐｔ等临床量表分升高，其模式特点与神经症患者的模式特征相一致，尤其与神经症中的疑病症和癔症有更多的相似之处。结论：慢性疼痛患者具有神经症患者类似的个性特征。     

The relationship of Minnesota Multiphasic Personality Inventory (MMPI) profile clusters to pain behaviors

Previous research involving cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI) profiles among persons with chronic low back pain has suggested the existence of four distinct profile clusters. The present study had two goals: (1) to replicate the previous finding independently and (2) to investigate the relationship of the profiles to the subjects' self-reported pain history and response to treatment. Subjects were 92 patients in a multimodal inpatient low back-pain treatment program. A cluster analysis of the MMPI profiles was performed and the resultant clusters were compared in terms of histories and treatment outcome. The four clusters were successfully replicated for the total sample and for males and females separately. The profiles were significantly related to subjects' pain histories, but only one outcome difference was found. It was inferred that the MMPI is of value in understanding patients' pain coping behaviors but that further research is needed to explore the utility of the MMPI in understanding their response to treatment.     

The Minnesota Multiphasic Personality Inventory (MMPI) Hysteria (Hy) scale: Scoring Bodily Concern and Psychological Denial subscales in chronic back pain patients

Chronic back pain patients were compared to two nonpain comparison groups on Minnesota Multiphasic Personality Inventory (MMPI) Hysteria (Hy) scores and scores on two Hy subscales: Bodily Concern and Psychological Denial. Pain subjects had significantly higher scores on the Bodily Concern Subscale and lower scores on the Psychological Denial Subscale than nonpain subjects with similar elevated Hy scores. However, pain subjects had Psychological Denial scores similar to those of subjects with normal MMPI profiles, despite significantly higher Hy scores. These findings are interpreted to support the hypothesis that, among pain patients, Hy elevations are partially accounted for by the endorsement of a disproportionate number of Bodily Concern items. Finally, within pain patients, scores on the Bodily Concern subscale were significantly related to more indices of pain duration and severity than were scores on the Psychological Denial subscale. The potential clinical utility of scoring these subscales is discussed.     

The relationship between surgical outcome and MMPI profiles in chronic pain patients

Administered the MMPI as part of a comprehensive pain evaluation to 44 patients who were receiving surgery for low back pain. Surgical outcomes then were determined after 6 to 18 months, and the patients were grouped as surgery success (22) or surgery failures (22). MMPI profiles were examined for each group, and while there was a significant difference on the Hs scale, no other mean scores were discriminative. In contrast, when patients were divided into subgroups based upon MMPI profile configurations, a strong relationship existed between subgroup MMPI profile and surgery outcome. Thus, while these data argue against attempting to use group MMPI profiles to predict surgical outcome in patients who are suffering from pain, subgroup profiles do bear a strong relationship with surgery outcome and appear worthy of further investigation.     

MMPI short forms as predictors of response to conservative treatment for low back pain.

This study (N = 115) compared the abilities of the Faschingbauer Abbreviated Minnesota Multiphasic Personality Inventory (FAM), the Midi-Mult, and the standard MMPI to predict response to conservative medical treatment for low back pain, as assessed by patient ratings of pain intensity 6 to 12 months later. The results indicated that all three inventory formats yielded significant correlations between the Hypochondriasis, Depression, and Hysteria scales and follow-up pain ratings. Less consistent findings were obtained with other scales and indices. The results provide tentative support for the clinical and research utility of these abbreviated MMPIs in substituting for the standard MMPI in outcome studies with back pain patients.     

Multidimensional pain inventory profile classifications and psychopathology

The Multidimensional Pain Inventory (MPI) and the MMPI have been used widely to assess chronic pain patients. This study examined the relationship between patient profile classifications generated by the MPI and psychopathology as measured by the MMPI. MPI Dysfunctional and Interpersonally Distressed means were significantly different than the MPI Adaptive Coper means on scales 4, 6, 7, and 8 of the MMPI. The Dysfunctional and Adpative Coper means were also significantly different on MMPI scale 2. MMPI profiles for 79% classified as Dysfunctional and 62% classified as Interpersonally Distressed displayed psychopathology as defined by significant two-point scale elevations. Only 23% of those classified as Adaptive Copers had significant two-point MMPI scale elevations.     

Validity of a back pain classification scale for detecting psychological disturbance as measured by the MMPI

Constructed a Back Pain Classification Scale (BPCS) to detect serious psychological disturbance in low back pain patients, validated against the MMPI. One hundred and twenty patients with low back pain were classified as functional or organic on the basis of BPCS scores. The group identified as psychologically disturbed (functional) had significantly higher MMPI elevations on Scales F, HS, D, HY, PD, MF, PA, PT and SC. None of their scale scores was significantly lower than the group identified as organic. T-scores above 70 were present only on Scales 1 and 3, which suggests a high incidence of essentially neurotic disorders in patients classified as functional. The use of the BPCS as a viable alternative to the MMPI in the medical setting was discussed.     

Utility of the Faschingbauer abbreviated MMPI as a function of patient group and sex.

Assessed the utility of the 166-item FAM with medical and psychiatric patients. FAM items were extracted from MMPI data of 60 female and 45 male patients classified into pain and psychiatric patients based on suspected disorder and referral questions. Although all correlations between FAM and MMPI mean T-scores on all scales were highly significant, 54% of the means were significantly different. The number and the nature of the difference between FAM and MMPI group means and individual profile classifications varied as a function of patient subgroup and sex. Such subgroup delineation of FAM accuracy is discussed as necessary for decisions about appropriate clinical and research utilization.     

Chronic low back pain and depression

It is not clear whether the psychological disturbances associated with chronic low back pain are the cause or the result of the chronicity. It is also not clear whether increasing duration of low back pain is associated with depression. Three groups of patients (N = 148), with recent (0-6 months), relatively longstanding (6-24 months) and chronic (more than 24 months) low back pain were given the MMPI, Multiple Affect Adjective Check List (MAACL), State Trait Anxiety Inventory (STAI) and Low Back Pain Questionnaire (LBPQ). Increasing chronicity is associated with significant increases on MMPI Hs, D, HY, PT and MA scales, and on STAI Trait Anxiety scale. These results suggest that chronicity leads to the development of psychopathological characteristics and that these characteristics include a heightened awareness of somatic functioning and the vegetative aspects of the depressive syndrome, but that there is no increase in depressive mood or in the perception of the pain itself.     

Development of a three-scale MMPI: The MMPI-TRI

A 60-item short form of the MMPI with very high content validity and items that appear on both the MMPI and MMPI-2 was developed and named the MMPI-TRI. It contains three 20-item scales—the Subjective Distress, Acting-Out, and Psychosis scales. These three scales have excellent internal consistency and sufficient independence from each other. An anxiety and depression group of patients, prison inmate group, and a schizophrenic and other psychotic group had the highest mean scores on Subjective Distress, Acting-Out, and Psychosis, respectively. Correlations with the 13 regular scales of the MMPI and MMPI-2, their content and supplementary scales, and four other psychometric instruments provided very strong evidence for validity. Norms are provided.     

The use of the Minnesota Multiphasic Personality Inventory with low back pain patients.

The MMPI was administered to 36 male low back pain patients at the Seattle Veterans Administration Hospital. The patients were divided into three groups of 12 each. The organic group contained patients who had an organic basis for their pain. The functional group contained patients who had no organic basis for their pain. The mixed group contained patients who had some organic basis for their pain, but one that was thought to be insufficient to account for the pain they were reporting. The mixed and functional groups differed significantly from the organic group on the Hs, Hy, Pt, Sc, Hy-O, D-O, and DOR scales. The mixed and functional groups differ significantly from each other only on the Hy-O scale. The special low back pain scales of Lb and DOR were found to have little utility when used separately. When used in conjunction, however, the scales discriminated correctly 75% of the time.     

Characteristics of treatment drop-outs among two samples of chronic headache patients

To examine the psychological characteristics of those who terminate treatment for headaches prematurely, this investigation employed 179 posttraumatic headache patients and 67 nontrauma headache patients who underwent electromyographic (EMG) biofeedback therapy. Dependent variables included the patient's age, socioeconomic status, duration of headache, forehead EMG levels, and MMPI. Multivariate analyses of variance revealed no significant differences between the drop-outs and non-drop-outs among the trauma headache patients, but three MMPI scales (Psychopathic-Deviate, Paranoia, and Mania) were significantly higher among the nontrauma headache patients who dropped out of treatment. These data imply that different characteristics underlie the drop-out behavior for different pain conditions and that efforts to uncover a single drop-out pattern may not be realistic.     

Pain-patient Minnesota Multiphasic Personality Inventory (MMPI) subgroups: Evaluation of long-term treatment outcome

Six hundred thirty-five chronic pain patients completed the Minnesota Multiphasic Personality Inventory (MMPI) prior to participation in a multidisciplinary inpatient pain treatment program. Three male and four female MMPI subgroups were identified by means of cluster analyses for each of two samples. Pretreatment and long-term follow-up differences were then examined among the MMPI subgroups. Results indicated that the subgroups identified in the present study closely resembled each other and those previously reported in the literature. However, at long-term follow-up only a few outcome differences were identified among male subgroups, while no differences were found among female subgroups. Possible explanations for no differential treatment outcomes among the MMPI subgroups are discussed.     

MMPI correlates of menstrual distress.

The MMPI and Moos' Menstrual Distress Questionnaire (MDQ) were administered to 60 undergraduate women. Partial correlations between MMPI clinical scales and menstrual and premenstrual MDQ symptom scales were computed with intermenstrual (baseline) symptom reports and response set (Gough's F-K index) statistically controlled MMPI variables tended to correlate with some symptom scales (premenstrual pain, negative affect; menstrual behavior change) but not with others (water retention, arousal). Where correlations did occur, common MMPI scales (Sc, Hs, Hy, Pt) were involved. Results suggest that psychological factors are more closely associated with some areas of menstrual symptomatoloty than with others.     

Locus of control, repression-sensitization, and psychological disorder in chronic pain patients

Examined the relationship between locus of control and psychological disorder in chronic pain patients controlling for the effects of response sets. Fifty-nine patients with chronic low back pain were given Rotter's Internal-External Locus of Control (I-E) scale and the MMPI. Multiple regression analysis showed that the MMPI K, F, and Pt scales produced the most efficient prediction of I-E scores. Response set tendencies to dramatize problems and traits that involve excessive rumination and self-doubt were related to external locus of control.     

Influence of Elevated K-Scale Scores on the Validity of Adolescent Minnesota Multiphasic Personality Inventories

Having received three Minnesota Multiphasic Personality Inventory (MMPI) interpretations, therapists judged the accuracy of the three narratives for their adolescent patients. Profiles were then sorted into a group with scaled scores, as determined by adolescent norms, on the K scale greater than versus less than or equal to 60. Narratives derived from profiles plotted with K-corrected adult norms were rated by therapists as more accurate for MMPI profiles with scaled scores on K in excess of 60, whereas narratives developed from adolescent norms were rated as more accurate for profiles with scaled scores on K less than or equal to 60. Means for clinical scales, which were developed with K-corrected adult versus adolescent norms, and profile configurations were markedly affected by this selection of Elevated K-scale scores were not associated with effective coping, length of hospitalization, and involuntary patient status.     

The MMPI and chronic pain: The diagnosis of psychogenic pain

This study investigates the capacity of the MMPI to discriminate among groups of patients with different types of pain. When multivariate analysis of variance is used, the standard set of MMPI scales discriminates between acute pain and chronic pain but not between chronic pain of two different etiologies (surgicaliatrogenic vs. unknown). The three scales that discriminate acute from chronic pain patients are those in the neurotic triad, Hs, D, and Hy. The possibility that the unknown pain etiology group could be broken down into psychogenic pain and undetected somatogenic pathology subgroups was explored using cluster analysis. This procedure did not yield any group of patients who could be identified as having chronic pain of psychogenic origin. These results suggest that the MMPI is not a reliable tool for the differential diagnosis of chronic pain. It appears, however, that patterns of findings are partly contingent on population characteristics. Researchers should be cautious about generalizing to populations other than those from which samples are drawn.This research was supported in part by a grant from Roche Laboratories, Nutley, New Jersey, and the Anesthesiology Research Center, Grant No. GM1599-1-06, University of Washington, Seattle, Washington.     

Frequency of MMPI profile types in three chronic illness populations

Clinical interpretation of the MMPI most often utilizes configural or profile analysis. However, most MMPI research has focused only on single scale comparisons. In this study sorting rules to identify four common MMPI configurations were developed and applied to four S populations (N = 157): Chronic low back pain patients, migraine headache patients, hypertensives, and diabetics. No differences in frequencies of these profile types were found among the groups, although the chronic low back pain patients did have more elevated profiles. Variables of age, chronicity of illness and gender did not seem to influence profile type, while some differences were found between patients who rated themselves high and low in activity limitation due to the illness.