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.     

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.     

Second-order factors of the MMPI item pool in a psychiatric sample

Finn's (1986) two second-order MMPI factors, based on the factor scales of Johnson, Butcher, Null, and Johnson (1984), were examined in a psychiatric sample (N = 2,027) by a confirmatory factor analytic procedure. The two-factor model was rejected in the psychiatric sample, and a three-factor model was derived using exploratory factor analysis. An Anti-social factor was present in the current study, but not in that of Finn (1986). The similarities between the second-order factors identified in this study and other factor analyses, including Finn's (1986), also are discussed.     

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 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.     

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.     

An evaluation of a behavioral program for chronic pain

The current study evaluated a behavioral program for the management of chronic pain. One hundred twenty-one patients were treated. Primary pain complaints were predominantly in the low back or head/neck/face regions. Patients participated in a 4-week inpatient treatment package consisting of controlled medication reduction, physical therapy, behavioral group therapy, self-monitoring, contracting, and biofeedback/relaxation training. Several measures of verbal/nonverbal pain behavior and physical functioning were obtained over the baseline, treatment, and follow-up periods. Results showed significant reductions in analgesic medication use and verbal/nonverbal pain behavior and improvements in physical functioning, employment status, and pro-health behaviors which were maintained at 12-month follow-up.The authors wish to thank the following people for their assistance: D. Bugold, N. Flynn, A. Glavan, L. Graham, J. Henkel-Johnson, E. Martin, P. Panyan, B. Patric, K. Slack, J. Sommerfeld, K. Wahman, S. Wahman, B. Wilk, and M. Wipson. This research was supported in part by a grant from the Paul F. Dwan Foundation.     

Predicting response to cognitive-behavioral therapy in a sample of HIV-positive patients with chronic pain

Introduction  The primary aim of this study was to examine the role of patient characteristics in predicting response to treatment in a sample of HIV-positive patients receiving 12 weekly sessions of a CBT-based pain management protocol. Method  A pre/post test single group design was used. Pain-related functioning was assessed at baseline and 12 weeks post-treatment using the Pain Outcomes Questionnaire-VA. Data analysis and Results   Multivariate regression analysis showed that higher baseline levels of pain-related anxiety were related to greater improvement in pain-related functioning at post-treatment, and non-Caucasian participants reported a greater response to treatment when compared to Caucasian participants. Attendance to CBT treatment sessions focused on progressive muscle relaxation and cognitive reconceptualization of pain were also related to treatment outcome. Conclusion  Non-Caucasian patients reporting higher levels of pain-related anxiety may respond particularly well to treatment. Treatment sessions focused on progressive muscle relaxation and cognitive reconceptualization of pain may be particularly helpful.     

An analysis of the influence of insurance sponsorship on MMPI changes among patients with chronic pain

Pretreatment and posttreatment MMPI scores of 821 patients who completed a chronic pain program were submitted to a multivariate analysis of variance, examining the effects of age, gender, and insurance sponsorship. With the exception of scale 9, all clinical scales were significantly lower at posttreatment. Only the sponsorship variable was found to be a moderator variable for these treatment effects, with decreases on scales 1, 2, 3, and 0 attenuated in subjects with Worker's Compensation sponsorship compared to other sponsorship. Suggestions for further multivariate research with this population are discussed.     

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.     

Changes in MMPI factor scores: Norms for the Welsh A and R dimensions from a contemporary normal sample

Welsh developed scales A (anxiety/maladjustment) and R (repression/control) as measures of two of the underlying dimensions of the MMPI. They are among the most frequently used of the supplemental scales for the MMPI. However, there have been significant changes in MMPI response patterns when profiles from contemporary normal people are compared with the original Minnesota normal sample from which the original MMPI norms were derived more than 40 years ago. Comparable changes are also apparent on scales A and R. New norms based on a large sample (N = 1,408) of contemporary normal people are presented for clinicians and researchers who use scales A and R.