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.     

Pain location and psychological characteristics of patients with chronic pain

The authors assessed psychological characteristics of 140 medical outpatients with chronic non-malignant pain referred for psychiatric consultation. Subjects completed the Toronto Alexithymia Scale, Somatosensory Amplification Scale (SSAS), and Counter-dependency Scale (CDS). The only psychological measure able to differentiate the chronic pain group from the control subjects was the CDS. However, SSAS scores were significantly higher in subjects having pain involving the head, chest, abdomen, or pelvis than in subjects having pain only in their backs or extremities. The latter subgroup had significantly higher CDS scores. The findings suggest that there are discrete subgroups within the chronic pain population defined by pain location and specific psychological characteristics.     

Verbalization of emotion in chronic pain patients and their psychological adjustment

Little attention has been paid to the issue of emotional verbalization in people undergoing chronic situations. We addressed this issue in the present study focusing on chronic pain patients. Our study investigated the verbalization of their health-related emotions, as well as the role of interpersonal variables on patients' disclosure, and their relation to their psychological adjustment. Results indicate that chronic pain patients talk more frequently about their illness with their intimates. Yet, the medical staff represents a favored sharing target as it elicits the highest satisfaction degree. Results also reveal that others' social constraint behavior and lack of credibility of sufferers' health status negatively predict patients' psychological adjustment. Therefore, the social environment appears to play a significant part in patients' well-being.     

Acute and chronic morphine alters formalin pain in neonatal rats

The present study tested the hypothesis that morphine exposure during the human developmental equivalent of the third trimester would alter inflammatory pain. This study examined whether acute or continuous opioid exposure in the neonatal rat alters formalin-induced nociception after 4 days of abstinence. Rats were exposed to a single acute administration of morphine on postnatal day 7 or 72 h of opioid infusion from postnatal days 5-7 via osmotic pump. When challenged with intraplantar formalin on postnatal day 11, rats exposed to acute or chronic morphine had increased phase II pain-associated behaviors. These findings suggest that neonatal morphine exposure may have unintended consequences on inflammatory pain.     

Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links

BACKGROUND: This paper reviews and integrates the growing literature concerning the prevalence of and risk factors for suicidality in chronic pain. METHOD: A series of systematic searches in MEDLINE and PsychINFO identified 12 relevant articles examining suicide, suicide attempts, and suicidal ideation in chronic pain. A selection of theoretical and empirical work identifying psychological processes that have been implicated in both the pain and suicide literature and which may be related to increased suicidality was also reviewed. RESULTS: Relative to controls, risk of death by suicide appeared to be at least doubled in chronic pain patients. The lifetime prevalence of suicide attempts was between 5% and 14% in individuals with chronic pain, with the prevalence of suicidal ideation being approximately 20%. Eight risk factors for suicidality in chronic pain were identified, including the type, intensity and duration of pain and sleep-onset insomnia co-occurring with pain, which appeared to be pain-specific. Helplessness and hopelessness about pain, the desire for escape from pain, pain catastrophizing and avoidance, and problem-solving deficits were highlighted as psychological processes relevant to the understanding of suicidality in chronic pain. CONCLUSIONS: Programmatic research is urgently required to investigate the role of both general and pain-specific risk factors for suicidality, to examine how the psychological processes mentioned above mediate or exacerbate suicidality, and to develop enhanced interventions for pain patients at risk.     

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.     

Acute and chronic ethanol does not affect incisional pain in neonatal rats

We have previously found that in post-natal day 7 rats withdrawal from acute and chronic ethanol (EtOH) exposure lowers mechanical thresholds during withdrawal and exacerbates spontaneous pain responses to an inflammatory injury 4 days post-withdrawal. These findings suggested alterations in somatosensory pathways following EtOH exposure during the third trimester developmental equivalent. In this study we wanted to determine whether EtOH exposure during the third trimester equivalent exacerbates mechanical allodynia and thermal hyperalgesia produced by an incisional model of post-operative pain at post-natal day 21. The extent and duration of mechanical allodynia and thermal hyperalgesia following incision was measured and found to be unaffected by prior EtOH exposure.     

Psychogenic pain and psychological variables: a psychometric study

A sample of 41 women suffering from psychogenic pain according to DSM-III diagnostic criteria were psychometrically studied, in order to ascertain if they showed specific psychological traits or mechanisms. Type A behavior, extraversion, neuroticism, psychoticism and dissimulation and hostility-aggressivity traits were the psychological variables studied both in the pain sample and in a matched control group. Psychogenic pain patients were significantly more neurotic and suspicious and less physically aggressive than healthy subjects and also scored significantly higher in dissimulation, which suggests a tendency to use defense mechanisms of denial.     

Sleep and neighborhood socioeconomic status: a micro longitudinal study of chronic low-back pain and pain-free individuals

Journal of Behavioral Medicine - Individuals with chronic low back pain (cLBP) frequently report sleep disturbances. Living in a neighborhood characterized by low-socioeconomic status (SES) is...     

Decentering,rumination, cognitive defusion,and psychological flexibility in people with chronic pain

The psychological flexibility model appears to be useful for organizing research into chronic pain. One component of the model is called “cognitive defusion.” A process referred to as decentering, measured by the Experiences Questionnaire (EQ), appears similar to cognitive defusion. The purpose of this study is to extend previous investigations of the EQ, to evaluate its factor structure, and examine both indirect and direct roles for decentering in relation to key clinical outcomes. 352 people seeking pain treatment participated in this study. All completed the EQ and standard measures of daily functioning, including emotional functioning. Confirmatory factor analysis (CFA) and structural equation models (SEMs) were utilized to examine the factor structure of the EQ and evaluate the role of decentering in relation to outcomes. In CFA the overall fit of the EQ items to a two-factor model, specifying decentering and rumination factors, was poor. Separate models of decentering (a higher order model consisting of two sub-factors; cognitive defusion and self-a-context) and rumination, including reduced item sets, yielded good statistical fits. Analyses of these factors showed expected relations with emotional and social functioning but not with physical functioning. SEM revealed that both decentering and rumination have direct effects on functioning and indirect effects through measures of acceptance. A shortened 12-item measure of decentering warrants further study. Combined models of acceptance and the type of cognitive-defusion-related process reflected in decentering may improve our understanding social and emotional functioning in relation to chronic pain.     

The differential effects of employment status on chronic pain and healthy comparison groups

We evaluated the differential effects of employment status on chronic pain and healthy comparison groups. Forty unemployed and 43 employed individuals with chronic pain, as well as 43 unemployed and 45 employed healthy comparison participants completed a series of measures assessing background information physical and psychological adjustment, and psychosocial features of employment status. In general, participants experiencing both chronic pain and unemployment reported poorer adjustment than the other groups and more financial strain, less structured and purposeful activity, fewer opportunities for skill use and task variety, and decreased social support than the employed chronic pain and healthy comparison groups. Groups did not differ, however, in work ethic values. Scores on measures of pain severity and features of employment status accurately predicted the group membership of more than 70% of respondents from four groups. The study suggests that there is utility in understanding experiences of chronic pain patients on the basis of features of their current employment status and points to a need for multidimensional measures that evaluate psychosocial facets of employment and unemployment specifically for chronic pain samples.     

Further development of an instrument to assess psychological flexibility in people with chronic pain

Recently, an expansion of traditional coping models for chronic pain has been offered. This model specifically includes acceptance of chronic pain, as well as the more general process of psychological flexibility. Psychological flexibility includes qualities of behavior such as acceptance and mindfulness, and the capacity to take committed and values-directed or goals-directed action, among other qualities. The present study was intended to refine and validate a measure of psychological flexibility, titled the Brief Pain Response Inventory (BPRI), and determine its relation with key indices of patient functioning. In total, 205 adults with chronic pain who were beginning a program of treatment completed a battery of self-report questionnaires. Exploratory factor analysis indicated the presence of two factors within the items of the BPRI: Flexible Action and Willing Engagement. Subscale and total scores were generally unrelated with patient background variables, although they were related to, and accounted for significant variance in, measures of emotional, physical, and psychosocial functioning. These analyses provide additional support for the relevance of psychological flexibility to the problem of chronic pain, as well as initial evidence for the BPRI as a measure of this process.     

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.     

Chronic pain: psychological approaches for the front-line clinician

Many of the techniques and skills the average front-line practitioner possesses (such as intake, psychological testing, cognitive behavior therapy, and relaxation therapy) can be readily and effectively applied to a chronic-pain population. More specialized techniques for pain reduction, such as biofeedback training, can be easily learned by the generalist clinician with a minimum of additional training. In this article, four general steps to assess and reduce chronic pain are reviewed. Through careful use of the available research literature, and by consulting with a colleague who has expertise in chronic pain, most psychologists can straightforwardly begin to help individuals suffering from chronic pain.