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.     

Medical visits and psychological disturbance in chronic low back pain. A study of a back education class.

Associations between the frequency of medical visits and psychological disturbance were explored using chronic low back pain patients from a back education class. Psychometric measures included the illness Behaviour Questionnaire (IBQ), somatic problems, and current mood. Males and females responded similarly on all psychological measures. Pain duration and IBQ disease affirmation significantly predicted visits to both general practitioners and specialists. Additional predictors for specialist visits included a self-rated pain/mood association, sex, age, and IBQ denial. Patients' expectations and attitudes about illness and treatment appeared most central to medical visits and several different forms of psychological disturbance accompanied increased visits.     

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.     

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.     

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.     

Pain-patient MMPI subgroups: The psychological dimensions of pain

Two-hundred-forty male pain patients were given the MMPI and an extensive pain history questionnaire. A hierarchical clustering procedure was used, and three distinct profiles emerged. One profile was essentially normal, while a second profile revealed the hypochondriasis configuration, and a third was highly elevated on scales which reflect a psychopathological type of profile. A discriminant analysis yielded functions correctly classifying over 90% of the subjects in each group. Although the three groups did not significantly differ on age, education, income, IQ, assertiveness, type of pain, or years of pain duration, they did differ on the pain history questions relating to pain severity and pain impact on their lives. The psychopathological group reported significantly more distress than the hypochondriasis group, and the hypochondriasis group reported significantly more distress than the normal group. The implications for pain treatment are discussed.     

MMPI measures of psychological disturbance in adolescent and adult victims of father-daughter incest

The MMPI was used to study psychological disturbance in two different age groups of victims of father-daughter incest. The profiles of a group of 27 adolescent victims and 31 adult victims were compared and analyzed. All subjects had a history of being molested when they were children by their fathers or stepfathers, and all were in psychotherapy at the time of testing. In order to establish clear age differentiation between the two groups, no adolescent was over the age of 19 and no subject in the adult group was under age 30 when they were tested. The results indicated that the overall profiles were more elevated for the adult victims than for the adolescent victims. Both groups were elevated (T greater than 70) on Scale 8 (Sc), and the adults also were elevated on Scale 4 (PD), while the adolescents were high (T = 69) on Scale 9 (MA). The results are discussed in terms of core personality disturbance shared by the two groups and the probable influence of time or age on how the psychopathology is expressed.     

Validity of a computerized on-line MMPI interpretive system

Three independent, experienced clinicians trained at the University of Minnesota were asked to rate the quality and accuracy of codetype interpretations and associated rules used in the Psych Systems' automated MMPI program. Results showed that this system is rated highly by clinicians. The authors discuss how this approach can be used in validating other automated test interpretation systems and suggest that feedback by expert judges can be used to improve such systems.     

Distress associated with cancer as measured by the illness distress scale

Over 400 cancer patients were given the Illness Distress Scale (IDS), a brief measure of the physical and emotional distress related to serious illness. Physical manifestations of the disease proved to be the source of greatest discomfort among these patients. Greater distress was reported by younger patients and by those who were unmarried. Also, patients with more advanced disease scored higher on the scale. The IDS appeared to measure four dimensions of distress related to the experience of illness, including loss of meaning, physical disease, medical treatment and social isolation. Scores on the instrument correlated highly with a measure of depression, the Beck Depression Inventory. The IDS appears to be a reliable and valid measure of distress associated with serious illness.