Empirical descriptors of unelevated MMPI profiles among chronic pain patients: A typological approach

The task of the clinician in evaluating the possible role of psychological factors in patients' pain disability is a most difficult one. This task becomes even more arduous when confronted with unelevated MMPI profiles from patients in whom physical findings are minimal or absent. The current study employs a multivariate, quantitative taxonomic procedure to delineate homogeneous subroupings of chronic pain patients who meet this criterion. Subsequent analyses of base rate data for subgroups across a broad range of pain-related variables provide an actuarial basis for assessment of psychological factors within this population. Results indicate that of five subtypes identified, only one group of patients, who comprise 9% of the total sample are likely to be free of significant psychological components in their pain behavior. Implications for clinical interpretation and future research are discussed.     

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.     

Multivariate analyses of the MMPI profiles of low back pain patients

A multivariate clustering procedure was used to identify replicable, homogeneous MMPI profile subgroups among three independent cohorts of male (N=233) and female (N=315) low back pain (LBP) patients. Three subgroups were replicated across all male cohorts and four subgroups were replicated across all female cohorts. Multiple discriminant analysis showed that for both male and female patients between-subgroup variability was significantly greater than within-subgroup variability. The results suggest that LBP patients may not be solely characterized by MMPI profiles featuring the conversion V configuration. Examination of the profile subgroups also suggests there may be distinct, pain-related, behavioral attributes associated with each subgroup which might have important implications for practitioners' choice of treatment modalities. Suggestions are made for research regarding the development of specific, optimal treatments for various LBP patient subgroups.The current study was originally presented at the meeting of the Southeastern Psychological Association, Hollywood, Florida, May 1977.     

An analysis of the relationship of gender and age to MMPI scores of patients with chronic pain

This study investigated the relationship of age and gender to the MMPI scores of patients with chronic pain; 1,766 patients with musculoskeletal lumbar and/or cervical pain were evaluated, using the MMPI. Multivariate analysis of variance (p < .001) revealed main effects for gender and age group variables; no interaction effects were found. For the age group variable, significant differences were found on two validity and seven clinical scales. Subjects in the 70- to 90-year age group produced the lowest scores on all scales except L, F, and MF. Linear declines across age groups, and quadratic effects were found on some scales. The authors hypothesize that developmental transitions may account in part for these findings.     

MMPI profiles among neuropsychology patients

Examined MMPI profiles in a sample of 345 patients who were referred for neuropsychological evaluation because of known or suspected brain damage in an effort to determine how these profiles compare to MMPI profiles among general mental health outpatients. The relationship between the severity of brain damage as determined by the neuropsychological evaluation and the severity of emotional problems as reflected by the MMPI also was examined. A third part of the study focused on two MMPI “organic” codes (“29” and “139”) to determine whether these code types reflect brain disorders at greater than chance level. Results indicate that a large majority of neuropsychology patients exhibit significant emotional problems as evidenced by one or more scale elevations on the MMPI. These patients differ considerably from general outpatients in terms of the scales most frequently elevated. In contrast to earlier findings, present results suggest only a low relationship between the severity of emotional problems and the severity of brain damage with much of this relationship reflected in SC scale elevations.     

The relationship between WAIS PA and MMPI SI is mediated by MMPI PD

Investigated the effects of MMPI PD on the relationship between WAIS PA and MMPI SI. WAIS PA performance and MMPI SI have been reported to be related negatively in university undergraduates (Schill, 1966) and related positively in psychiatric patients (Johnson, 1969). This study was derived from the assumption that Schill's undergraduates had higher MMPI PD than Johnson's patients. Data from 65 psychiatric hospital patients showed that the PA - SI relationship was negative in high PD Ss and positive in low PD Ss, in support of this assumption. Thus, WAIS PA performance does have clinical implications for assessing social involvement, but the interpretation of PA depends on MMPI PD.     

The relationship of process to outcome in brief experiential psychotherapy for chronic pain

Six adult females with active rheumatoid arthritis were treated with a 10-session course of focused Gestalt Psychotherapy with the intent of assessing the relationship between key psychotherapy processes and both session and final outcome. Results suggested that high levels of patient participation were related to reduced patient distress, while high ratings of both session depth and session smoothness were related to increased positive feelings at the end of sessions. However, these session results did not generalize to final treatment outcome.     

The relationship between strategies of coping and perception of pain in three chronic pain groups

Examined the relationship between perception of pain, personality, coping and the reactions of family members in three chronic pain groups (sickle cell anemia, arthritis, and low back pain). Sixty black Ss equally distributed in the three medically diagnosed pain groups completed the McGill Pain Questionnaire, Maudsley Personality Inventory, a self-control measure, and the modified spouse response questionnaire. Nonsignificant association was detected between measures of pain and neuroticism; a significant inverse relationship was found between self-controlling behaviors and the affective dimension of pain; the relationship between perceived solicitous behavior and intensity and quality of pain differentiated the sickle cell and arthritic groups from the low back pain group; for the low back pain group, intensity of pain was related significantly to solicitous behaviors of family members, but the reverse was true for the arthritic and sickle cell groups.     

The use of the MMPI in a chronic back pain rehabilitation program

Assessed the usefulness of the MMPI in predicting treatment outcome for chronic low back pain patients. One hundred and thirty-two chronic low back pain patients who participated in a 6-week rehabilitation program were differentiated according to “successful” outcome. Outcome was defined in three major ways: Vocational restoration, significantly improved physical mobility, and patients' subjective evaluations of improved functional level. Pretreatment MMPIs of all outcome groups were compared. Data were analyzed by examining individual scale scores and code-types and by applying multiple regression analyses to the data. Results demonstrate that the MMPI can predict successful outcome. However, the strength of the relationship varies according to the outcome measure employed and the type of analysis completed on the data. It is concluded that, though an interesting research tool, at this time the MMPI is not a consistently valid clinical tool with the chronic back pain population in terms of predicting response to rehabilitation.     

Ethnic comparability of the MMPI in pain patients

The MMPI basic validity and clinical scales' patterns of 295 White-, African- and Latino-American pain patients were compared. Mean group differences across ethnic groups on scales L, F, K, Mf, and Si were revealed in multivariate analysis of covariance for females, while differences across ethnic groups on scales F, K, Mf, Sc, Ma, and Si were revealed for males. In the univariate follow-up analyses of covariance, significant main effects were obtained for ethnicity along with education and (occasionally for males) duration of pain. Various high-point, two-point, and other profile patterns were examined and notable gender/ethnic group differences were found. The pattern of intercorrelations of the MMPI scales mean T scores with various demographic and clinical characteristics suggested some notable divergence across subgroups on certain correlates of the pain experience. © 1996 John Wiley & Sons, Inc.     

The relationship between pain and depression in a trial using paroxetine in sufferers of chronic low back pain

Previous studies have shown a positive association between pain and depression, though evidence supporting a direct link between these two variables is less robust. Using a placebo-controlled trial, the authors examined the analgesic and antidepressant efficacy of paroxetine (20 mg) in chronic low back pain sufferers. The authors examined the associations among pain, depression, disability, and illness attitudes. Paroxetine showed no effects on pain or depression compared with placebo; however, subjects randomized to paroxetine were more likely to reduce concomitant analgesic medication. The cross-sectional association of depression and pain at baseline (r = 0.2, P = 0.02) was weaker than the association between depression and disability (r = 0.3, P = 0.004). Similarly, the association of change in depression scores with change in pain (r = 0.25, P = 0.016) was weaker than change between depression and disability (r = 0.49, P<0.0005). Whereas the relationship between pain and depression became nonsignificant when disability and illness attitudes were controlled, the relationship between depression and disability remained highly significant when pain and illness attitudes were controlled. These data are consistent with the association between pain and depression being wholly modulated by disability and illness attitudes, with no direct relationship between pain and depression.     

The Test-Retest Index and high F MMPI profiles

Using the Test-Retest (TR) Index, male psychiatric inpatients (N = 87) with very high MMPI F scale scores (T greater than 90) were designated either consistent or inconsistent responders. Inconsistent MMPI responding was associated with psychotic thought disorder and abstract reasoning deficits, which suggests that these Ss were too confused to conscientiously complete the MMPI. Consistent responders endorsed more obvious pathological items of the MMPI. The two groups did not differ in vocabulary intelligence, and their mean MMPI profiles were very similar. Uses of the TR Index for clarifying the meaning of high F MMPI profiles are discussed.     

The relationship between plasma leptin and nutritional status in chronic hemodialysis patients

Leptin serves an important role in suppressing appetite in mice and is known to be elevated in chronic renal failure (CRF) patients. But clinical significance of leptin as an appetite-reducing uremic toxin, remains to be determined. So we studied the relationship between plasma leptin and nutritional status in 46 chronic hemodialysis (HD) patients. Pre HD leptin was measured and divided by body mass index (BMI) to give adjusted leptin levels. KT/Vurea (K, dialyzer urea clearance; T, duration of HD; V, volume of distribution of urea), C-reactive protein (CRP), plasma insulin and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assessment (SGA), BMI and mid-arm muscle circumference (MAMC) were also measured. Mean plasma leptin levels were 8.13+/-2.91 ng/mL (male 3.15+/-0.70; female 14.07+/-6.14, p<0.05). Adjusted leptin levels were positively correlated with nPCR (male r=0.47, p<0.05; female r=0.46, p<0.05), SGA (male r=0.43, p<0.05; female r=0.51, p<0.05) and MAMC (male r=0.60, p<0.005; female r=0.61, p<0.05). They did not correlate with KT/Vurea, serum albumin, hematocrit, bicarbonate, insulin and CRP. Presence of DM and erythropoietin therapy had no effect on leptin levels. These results suggest that leptin is a marker of good nutritional status rather than a cause of protein energy malnutrition in chronic HD patients.     

Potential relationship between genotype and clinical outcome in propionic acidaemia patients

Propionic acidaemia (PA) is an autosomal recessive disorder caused by mutations in either of the PCCA or PCCB genes which encode the alpha and beta subunits, respectively, of the mitochondrial enzyme propionyl-CoA carboxylase (PCC). In this work we have examined the biochemical findings and clinical outcome of 37 Spanish PA patients in relation to the mutations found in both PCCA and PCCB genes. We have detected 27 early-onset and 101 late-onset cases, showing remarkably similar biochemical features without relation to either the age of onset of the disease or the defective gene they have. Twenty-one of the patients have so far survived and three of them, now adolescents, present normal development. Different biochemical procedures allowed us to identify the defective gene in 9 PCCA deficient and 28 PCCB deficient patients. Nine putative disease-causing mutations accounting for 77.7% of mutant alleles were identified among PCCA deficient patients, each one carrying a unique genotypic combination. Of PCCB mutant alleles 98% were characterised. Four common mutations (ins/del, E168K, 1170insT and A497V) were found in 38/52 mutant chromosomes investigated, whereas the remainder of the alleles harbour 12 other different mutations. By examining the mutations identified both in PCCA and PCCB genes and the clinical evolution of patients, we have found a good correlation between certain mutations which can be considered as null with a severe phenotype, while certain missense mutations tend to be related to the late and mild forms of the disease. Expression studies, particularly of the missense mutations identified are necessary but other genetic and environmental factors probably contribute to the phenotypic variability observed in PA.     

The relationship between inflammatory markers, leptin and adiponectin in chronic hemodialysis patients

Chronic inflammation is prevalent in dialysis patients. We investigated the relationship between inflammation and newly identified adipokines: leptin and adiponectin in this population. A total of 129 chronic hemodialysis patients were collected. Serum high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), leptin and adiponectin levels were determined as well as other metabolic variables. Correlation studies and multiple regression analysis were performed among variables. Our results showed that hemodialysis patients had elevated levels of inflammatory markers, leptin and adiponectin. Diabetic subjects had higher serum CRP and lower albumin levels than non-diabetics. Serum CRP levels were positively correlated with IL-6 levels and negatively correlated with albumin levels. Serum leptin levels were directly related to CRP levels while adiponectin levels were inversely related to CRP levels. A significant negative correlation was observed between serum leptin and adiponectin levels. Serum IL-6 levels were the single independent factor affecting CRP levels. Body mass index can predict both serum leptin and adiponectin levels. We conclude that hemodialysis patients are at an increased risk of chronic inflammation and diabetes patients are even more susceptible to this status. Both serum leptin and adiponectin levels are associated with inflammatory markers. As adipose tissue is the major secreting site of these adipokines, our results suggest that adipose tissue plays an important role in the pathogenesis of chronic inflammation in dialysis patients.     

A multimethod evaluation of the MMPI in a chronic pain patient sample

Previous reports on the use of the MMPI with chronic pain patients have produced a variety of results. No single configural feature or scale identifies the chronic pain patient, regardless of the origin or verifiability of the etiology of the pain. Elevations on the neurotic triad occur frequently, but do not have the specificity of more recently reported chronic-pain subtypes on the MMPI. The present nonexperimental study (N = 72) provides an example of a multi-method analysis of a carefully selected sample of chronic pain patients without physical findings. Blind clinical analysis, simple two-point code aggregation, and multivariate profile methods were used and produced similar subtypes of the sample and understanding of the data. The obtained sample subtypes were similar to those found in other studies and were hypothesized to be related to each other along an underlying continuum of what might be depression. Further research is needed to facilitate understanding of the causation of chronic pain of obscure origin.     

The relationship between resting blood pressure and acute pain sensitivity: effects of chronic pain and alpha-2 adrenergic blockade

This study tested for alpha-2 adrenergic mediation of the inverse relationship between resting blood pressure and acute pain sensitivity in healthy individuals. It also replicated limited prior work suggesting this inverse blood pressure/pain association is altered in chronic pain, and provided the first test of whether chronic pain-related changes in alpha-2 adrenergic function contribute to these alterations. Resting blood pressure was assessed in 32 healthy controls and 24 chronic low back pain participants prior to receiving placebo or an intravenous alpha-2 adrenergic receptor antagonist (yohimbine hydrochloride, 0.4 mg/kg) in a randomized crossover design. Participants experienced three acute pain tasks during both sessions. A significant Systolic Blood Pressure × Participant Type × Drug interaction on finger pressure McGill Pain Questionnaire-Sensory ratings (P < .05) reflected significant hyperalgesic effects of yohimbine in chronic pain participants with lower systolic blood pressures (P < .05) but not those with higher systolic pressures, and no significant effects of yohimbine in controls regardless of blood pressure level. A Drug × Systolic Blood Pressure interaction on finger pressure visual analog scale unpleasantness indicated the inverse blood pressure/pain association was significantly stronger under yohimbine relative to placebo (P < .05). Significant Participant Type × Systolic Blood Pressure interactions (P’s < .05) were noted for finger pressure visual analog scale pain intensity and unpleasantness, ischemic pain threshold, and heat pain threshold, reflecting absence or reversal of inverse blood pressure/pain associations in chronic pain participants. Results suggest that blood pressure-related hypoalgesia can occur even when alpha-2 adrenergic systems are blocked. The possibility of upregulated alpha-2 adrenergic inhibitory function in chronic pain patients with lower blood pressure warrants further evaluation.