Ali Asghari - Academia.edu (original) (raw)

Papers by Ali Asghari

Transplantation Proceedings, 2006

Introduction. Azathioprine (AZA) and mycophenolate mofetil (MMF) are major immunosupressants used... more Introduction. Azathioprine (AZA) and mycophenolate mofetil (MMF) are major immunosupressants used to prevent rejection following renal transplantation. Bone marrow suppression is a potential adverse effect of these agents manifesting itself as leukopenia, thrombocytopenia, and anemia. The aim of this study was to compare the effects of AZA versus MMF immunosuppressive regimens on the erythropoietic system of renal transplant recipients within 6 months after transplantation. Methods. Eighty kidney allograft recipients who were on AZA (n ϭ 40) or MMF (n ϭ 40) plus cyclosporine and prednisolone were enrolled in this study. Hematologic parameters included red blood cell counts, hemoglobin (Hb), hematocrit, mean corpuscular volume, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) and were measured before and at 1 week, as well as 1 and 6 months posttransplantation. Plasma erythropoietin level was measured at the end of 6 months. Statistical analysis was performed with Student t test; a P value less than .05 was considered significant.

Pain, 2006

Research on the role of acceptance in adjustment to persisting pain has been facilitated by the d... more Research on the role of acceptance in adjustment to persisting pain has been facilitated by the development of the Chronic Pain Acceptance Questionnaire (CPAQ). However, to date the CPAQ has been used to explore acceptance of pain without taking into account the likely contribution of other cognitive variables that have been shown to influence adjustment to persisting pain. This study examined the role of pain acceptance, as measured by the CPAQ, in accounting for adjustment to pain when controlling for the effects of other cognitive variables. The results indicated that while the Activity engagement subscale of the CPAQ was predictive of depression severity, neither of the CPAQ's two subscales was predictive of pain severity or physical disability. These findings differ from some reported previously and they suggest that the CPAQ, by itself, may not be sufficient to explain the processes of acceptance of pain and, hence, adjustment to pain. The findings also indicate that the Pain willingness subscale of the CPAQ is not robust and should be discarded. A broader approach to investigating acceptance of pain is proposed. Ó

Pain Medicine, 2009

Objectives. 1) To determine the psychometric properties of a Persian-language version of the Pai... more Objectives. 1) To determine the psychometric properties of a Persian-language version of the Pain Self-Efficacy Questionnaire (P-PSEQ) in Iranian chronic pain patients; and 2) to evaluate the validity of the P-PSEQ in another Iranian chronic pain sample.Design. Cross-sectional designs.Setting. Two medical centers and a large industrial company.Method. In Study 1, the P-PSEQ was administered to 348 chronic pain patients. In Study 2, 169 males with chronic pain who were working completed the P-PSEQ, Beck Depression Inventory, Roland–Morris Disability Questionnaire, Short Form Health Survey, and a pain scale.Results. The psychometric properties (internal consistency, test–retest reliability, construct validity, and concurrent validity) of the P-PSEQ were found to be strong. Multiple hierarchical regression analyses indicated that pain self-efficacy scores accounted for a significant proportion of the variance in scores on measures of disability, depression, and general health even after controlling for the possible confounding effects of pain severity and education.Conclusion. The psychometric properties of the P-PSEQ were confirmed. Consistent with findings in other countries with other language versions of the same scale, pain self-efficacy beliefs are associated with levels of physical disability, depression and general health status of chronic pain patients, over and above the influence of pain severity in this sample of Iranians with chronic pain.

Pain, 2004

This study examined the pain/discomfort ratings during mammography and their relationship to pain... more This study examined the pain/discomfort ratings during mammography and their relationship to pain-coping strategies. Prior to their mammogram in order to assess how they cope with day-to-day pain experience 220 women completed an Iranian translation of the Coping Strategies Questionnaire (IR-CSQ). Immediately after mammography, all subjects completed a modified version of the IR-CSQ to assess their coping style with pain during mammography. Ratings of pain/discomfort during the mammogram were also collected, using a 100-mm Visual Analog Scale and a 6-point Pain/Discomfort Rating Scale (PRDS). Up to 92% of the women reported that the mammogram examination was painful. However, considerable variability in pain ratings was found, with some women reporting severe pain and others reporting little or no pain. While the ratings of coping effectiveness in facing day-to-day pain experience were not significantly related to mammography pain ratings, there was a significant association between the ratings of coping efficacy in facing mammography pain specifically and measures of mammography pain. Multiple hierarchical regression analyses revealed that while higher use of catastrophising and coping self-statements in facing mammography pain were predictors of more severe pain during mammography, higher use of ignoring pain sensations was predictive of less severe pain during mammography. The potential significance of these findings for identifying patients at risk of poor adjustment to chronic pain is discussed.

Journal of Psychosomatic Research, 2008

Background: Depression is a common contributor to suffering and disability in people with chronic... more Background: Depression is a common contributor to suffering and disability in people with chronic pain. However, the assessment of depression in this population has been hampered by the presence of a number of somatic symptoms that are shared between chronic pain, treatment side-effects and traditional concepts of depression. As a result, the use of depression measures that do not contain somatic items has been encouraged. Objective: This study examined the psychometric properties of the Depression sub-scale of the Depression Anxiety and Stress Scales (DASS) in a Brazilian chronic pain patient population. Method: Data on a number of measures were collected from 348 participants attending pain facilities. Results: Principal components and exploratory factor analyses indicated the presence of only one factor. Item analyses indicated adequate itemscale correlations. The Cronbach a was .96, which suggests an excellent internal consistency. Conclusion: The DASS-Depression scale has adequate psychometric properties and its further use with Brazilian chronic pain populations can now be supported. D

Journal of Pain, 2010

This study examined the assessment of pain intensity and pain distress with the Numerical Rating ... more This study examined the assessment of pain intensity and pain distress with the Numerical Rating Scale (NRS) in elderly patients (age > 60 years) with persistent pain. A consecutive sample of 800 elderly patients were categorized by age into 3 groups: 61 to 70 years (n = 366), 71 to 80 years (n = 308), and 81 years and over (n = 126). Participants completed 3 Numerical Rating Scales assessing current pain intensity, and both the usual level of pain and average pain distress in the preceding week. The failure rate for scale completion was low for all scales for all age groups, but was significantly higher in the oldest group compared to the youngest group for the scales assessing current pain intensity and average pain distress in the preceding week. The NRS was shown to be a reliable and valid measure of pain intensity and pain distress in all these age groups. Distress related to pain appeared to be specific to the pain experience and was only weakly related to more generalized affective distress. These findings confirm that measures of pain intensity and pain distress, like the NRS, capture only part of the pain experience in older patients and should be supplemented by other measures in the assessment process. This article confirms the utility of the Numerical Rating Scale (NRS) as a measure of pain intensity and pain distress in elderly patients with persistent pain. The use of a large sample increases confidence in the psychometric soundness of the NRS with this population.

Pain, 2001

This study examined the relationship between pain self-efficacy beliefs and a range of pain behav... more This study examined the relationship between pain self-efficacy beliefs and a range of pain behaviours, as measured by the pain behaviour questionnaire (PBQ), using a prospective design. A heterogeneous sample of 145 chronic pain patients completed sets of questionnaires on four occasions over a nine-month period. Multiple hierarchical regression analyses revealed that the subjects' confidence in their ability to perform a range of tasks despite pain (assessed at baseline), was predictive of total pain behaviour and avoidance behaviour over the ninemonth study period. This finding was particularly significant because the analyses controlled for the possible effects of pain severity (at each measurement occasion), pain chronicity, age, gender, physical disability, depression, neuroticism and catastrophising. These findings suggest that pain self-efficacy beliefs are an important determinant of pain behaviours and disability associated with pain, over and above the effects of pain, distress and personality variables. In particular, higher pain self-efficacy beliefs are predictive of reduced avoidance behaviours over an extended period.

European Journal of Pain, 2009

There is evidence that cognitions (beliefs) and mood contribute to physical disability and work s... more There is evidence that cognitions (beliefs) and mood contribute to physical disability and work status in people with chronic pain. However, most of the current evidence comes from North America and Europe. This study examined the contribution of demographic, pain and psychosocial factors to disability and work status in chronic pain patients in two matched samples from quite different countries (Australia and Brazil). Data were collected from 311 chronic pain patients in each country.

Pain, 2008

Although self-reported measures play a central role in the assessment of pain and its treatment, ... more Although self-reported measures play a central role in the assessment of pain and its treatment, it has long been recognized that interpretation of these measures is severely limited by the absence of normative data. Despite that, relatively few of the measures used in pain clinics or research studies have normative data for reference. Using a pain centre sample (n=6124), this paper describes the development of a normative dataset on a number of commonly used pain-related measures. The measures cover many of the key dimensions in pain assessment, including pain severity/quality, disability (physical functioning), and mood (emotional functioning). Measures of different cognitive and coping constructs are also included. Mean scores are reported for each measure according to age group, gender, pain site, as well as percentiles for different scores for patients with chronic low back pain. The potential uses for datasets of this type include the assessment and evaluation of individual cases, as well as the interpretation of published clinical trials. It is also argued that future systematic reviews of pain treatments should include consideration of such patient characteristics as pain levels, disability and mood in the studies reviewed rather than pain site and chronicity alone.

Stress and Health, 2007

While some people become severely or moderately disabled by chronic pain (pain that persists >3 m... more While some people become severely or moderately disabled by chronic pain (pain that persists >3 months), others seem to adjust reasonably well to it. Higher levels of disability are often associated with higher levels of distress, and this relationship can be bidirectional resulting in a vicious cycle. There is evidence suggesting that self-efficacy is one of the most important contributors to disability and emotional adjustment to chronic pain. Defining pain self-efficacy beliefs as confidence in ability to function despite pain, the Pain Self-Efficacy Questionnaire (PSEQ) has been widely used to examine the role of self-efficacy in chronic pain patient populations. However, to date it has not been validated in Brazil. This study examined the reliability and validity of the PSEQ in a Brazilian chronic pain population. Data were collected from a convenience sample of 348 chronic pain patients. Reliability of the PSEQ has been found to be adequate (split-half correlation was 0.76 and internal consistency was 0.90). Factor analysis indicated the existence of only one factor. Discriminant and concurrent validity were also adequate. Altogether these results indicate that the PSEQ has good psychometric properties when used in this sample. These findings are also consistent with those previously published in the literature. Copyright © 2007 John Wiley & Sons, Ltd.

Clinical Journal of Pain, 2006

The ways in which people adjust to chronic pain has been partly attributed to pre-existing person... more The ways in which people adjust to chronic pain has been partly attributed to pre-existing personality traits, but most evidence to date is from cross-sectional studies and mainly with arthritis groups. The present study examined the effects of 5 personality dimensions on measures of pain-related beliefs and catastrophizing assessed 9 months apart with a heterogeneous chronic pain sample. One hundred forty-five patients with chronic pain presenting to a hospital pain center completed the NEO-Personality Inventory-Revised, 3 measures of pain related beliefs, the catastrophizing scale of the Coping Strategy Questionnaire, and a 0 to 10 pain scale. Nine months from the initial assessment, patients completed the same measures, apart from the NEO-Personality Inventory-Revised. Of the 5 personality dimensions studied, only neuroticism was related to the pain-related variables. Multiple hierarchical regression analyses revealed that neuroticism was a significant predictor of residualized change in pain self-efficacy beliefs and pain control appraisals over the time of the study, after controlling for initial values of both constructs. However, the effects were small, suggesting that other factors play a role in the determination of such beliefs, in addition to neuroticism. In contrast, neuroticism was not a significant predictor of residualized change in catastrophizing responses over the same period. The findings provide partial support for the hypothesis that pre-existing personality traits place some patients at risk for poor adjustment to chronic pain.

European Journal of Pain

There is generally good evidence that pain management interventions that include self-management ... more There is generally good evidence that pain management interventions that include self-management strategies can substantially reduce disability and improve psychological well-being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear-avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self-management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self-management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3-week cognitivebehavioural pain management program. The post-treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear-avoidance beliefs, and increased pain self-efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self-management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self-management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear-avoidance and pain self-efficacy beliefs.

Social Psychiatry and Psychiatric Epidemiology, 1997

The aim of this study was to determine risk factors that may differentiate early onset from late ... more The aim of this study was to determine risk factors that may differentiate early onset from late onset depression. A non-clinical cohort that had been assessed from 1978 to 1993 at 5 yearly intervals and that had a high prevalence rate of lifetime depression took part in the study. We established an appropriate age cut-off to distinguish early onset (i.e. before 26 years) of major and of minor depression, and examined the relevance of a number of possible determinants of early onset depression assessed over the life of the study. Despite several dimensional measures of depression, self-esteem and personality being considered, they generally failed (when assessed early in the study) to discriminate subsequent early onset depression, with the exception of low masculinity scores being a weak predictor of major and/or minor depression. Early onset depression was strongly predicted, however, by a lifetime episode of a somewhat stronger and more consistent predictor than panic disorder, agoraphobia and minor anxiety disorders (ie social phobia, simple phobia). The possibility that anxiety may act as a key predispositional factor to early onset depression and to a greater number of depressive episodes is important in that clinical assessment and treatment of any existing anxiety disorder may be a more efficient and useful strategy than focussing primarily on the depressive disorder.

Journal of Affective Disorders, 1999

Aim: To examine for differential psychological risk factors in a nonclinical sample having single... more Aim: To examine for differential psychological risk factors in a nonclinical sample having single or recurrent episodes of major depression. Methods: A cohort of 164 subjects was assessed initially in 1978 in their last year of teacher training, and at five-yearly intervals in 1983, 1988 and 1993. Experience of episodes of DSM major depression and anxiety disorders from each wave were summed and three groups (nil, one, and two or more episodes of major depression) were derived. The cohort also completed a series of self-report measures including neuroticism, state and trait depression, self-esteem, dependency, childhood parental environment and social support. Results: The group with two or more episodes were distinctly more likely to have met lifetime criteria for an anxiety disorder and to have had multiple anxiety disorder diagnoses over their lifetime. Groups with one or more episodes reported higher mean scores for trait depression, neuroticism and maternal overprotection and lower mean scores for paternal care and self esteem at baseline in 1978, but these variables did not predict differences between groups with single and recurrent episodes. At 1993, those with two or more episodes differed from those with none and single episodes in reporting lower trait depression scores and decreased perception of satisfactory social support over time, suggesting a psychological scarring effect for those with repeated episodes.

Social Psychiatry and Psychiatric Epidemiology, 1997

A study was conducted to examine sex differences in frequency, duration and severity of experienc... more A study was conducted to examine sex differences in frequency, duration and severity of experience of depressed mood state in a non-clinical group and to consider how such findings contribute to the understanding of sex differences in depressive experience. A cohort of 156 subjects, assessed initially in 1978 in their last year of teacher training, was reassessed at 5-yearly intervals over 15 years. On each occasion, the subjects completed self-report ratings of experience of “normal depression” and measures of neuroticism, trait depression, self-esteem and sex role. The study found no sex differences in the number or duration of episodes. Women reported more symptoms per episode and some specific symptoms (including tearfulness, appetite and weight gain) more often. The number of symptoms was correlated with neuroticism, self-esteem and trait depression scores, and with gender but not sex role. The number of episodes was related to trait depression and self-esteem but not neuroticism. The results showed that there are links between female gender, neuroticism and number of symptoms experienced during depressed mood state episodes. These links are related more to female gender than to feminine sex role or premenstrual problems, and are reflected in the severity of affective change (and some specific symptoms) but not in the number of episodes.

Social Psychiatry and Psychiatric Epidemiology, 1997

A study was conducted to contrast depressed mood states in those positive and negative for lifeti... more A study was conducted to contrast depressed mood states in those positive and negative for lifetime depressive syndromes. A non-clinical cohort of 156 subjects was assessed on four occasions over 15 years, with 35% having had a major depression and 22% a minor depression at the most recent assessment. At 5-yearly reviews, estimates were obtained of episode frequency, duration and symptom patterns during depressed mood states. Such characteristics were then contrasted across the three groups of those who had experienced major depression, those who had suffered minor depression and lifetime non-cases. Depressive states were affirmed by at least 96% of subjects at each assessment, with the mean number of episodes per assessment year ranging from 8.6 to 21.2. Those who had experienced a lifetime episode of major depression differed from the two contrast groups (i.e. those with minor depression: non-cases) in having more episodes and more features during episodes. By contrast, there was a gradient across the three groups for two other examined features, with those having major depression being more likely than those with minor depression, who in turn were more likely than the non-cases to have longer episodes and a greater number of symptoms. The greater frequency, severity and duration of depressed mood states in those who met lifetime criteria for a major depressive episode suggest that their threshold to onset and persistence of a variety of depressive experiences is lowered, so supporting a general vulnerability hypothesis.

The research was conducted at the Agricultural University of Timiriazev, Moscow, and University o... more The research was conducted at the Agricultural University of Timiriazev, Moscow, and University of Mohaghegh, Ardabili, Iran, to determine the effect of fertilizer application on density, dry biomass and seed characteristic of garden cornflower (Centaurea cyanus L.) and corn spurrey (Spergula vulgaris L.) during [2004][2005][2006]. The analysis show that N and P application increased density and dry biomass of garden cornflower compared with no fertilizer (control), while density and dry biomass of corn spurrey was decreased. The results show that density of corn spurrey reduced as density of garden cornflower increased. After one year, only 11.5 and 30% seeds of garden cornflower and corn spurrey germinated, respectively. Conditions during maternal plant growth affected the seed characteristics of the two species. Seed germination of garden cornflower and corn spurrey in laboratory increased with P application compared with control and N application. These findings suggest that fertilizer application influences weeds, not only for weed density and biomass, but also by affecting seed characteristics.

Transplantation Proceedings, 2006

Introduction. Azathioprine (AZA) and mycophenolate mofetil (MMF) are major immunosupressants used... more Introduction. Azathioprine (AZA) and mycophenolate mofetil (MMF) are major immunosupressants used to prevent rejection following renal transplantation. Bone marrow suppression is a potential adverse effect of these agents manifesting itself as leukopenia, thrombocytopenia, and anemia. The aim of this study was to compare the effects of AZA versus MMF immunosuppressive regimens on the erythropoietic system of renal transplant recipients within 6 months after transplantation. Methods. Eighty kidney allograft recipients who were on AZA (n ϭ 40) or MMF (n ϭ 40) plus cyclosporine and prednisolone were enrolled in this study. Hematologic parameters included red blood cell counts, hemoglobin (Hb), hematocrit, mean corpuscular volume, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) and were measured before and at 1 week, as well as 1 and 6 months posttransplantation. Plasma erythropoietin level was measured at the end of 6 months. Statistical analysis was performed with Student t test; a P value less than .05 was considered significant.

Pain, 2006

Research on the role of acceptance in adjustment to persisting pain has been facilitated by the d... more Research on the role of acceptance in adjustment to persisting pain has been facilitated by the development of the Chronic Pain Acceptance Questionnaire (CPAQ). However, to date the CPAQ has been used to explore acceptance of pain without taking into account the likely contribution of other cognitive variables that have been shown to influence adjustment to persisting pain. This study examined the role of pain acceptance, as measured by the CPAQ, in accounting for adjustment to pain when controlling for the effects of other cognitive variables. The results indicated that while the Activity engagement subscale of the CPAQ was predictive of depression severity, neither of the CPAQ's two subscales was predictive of pain severity or physical disability. These findings differ from some reported previously and they suggest that the CPAQ, by itself, may not be sufficient to explain the processes of acceptance of pain and, hence, adjustment to pain. The findings also indicate that the Pain willingness subscale of the CPAQ is not robust and should be discarded. A broader approach to investigating acceptance of pain is proposed. Ó

Pain Medicine, 2009

Objectives. 1) To determine the psychometric properties of a Persian-language version of the Pai... more Objectives. 1) To determine the psychometric properties of a Persian-language version of the Pain Self-Efficacy Questionnaire (P-PSEQ) in Iranian chronic pain patients; and 2) to evaluate the validity of the P-PSEQ in another Iranian chronic pain sample.Design. Cross-sectional designs.Setting. Two medical centers and a large industrial company.Method. In Study 1, the P-PSEQ was administered to 348 chronic pain patients. In Study 2, 169 males with chronic pain who were working completed the P-PSEQ, Beck Depression Inventory, Roland–Morris Disability Questionnaire, Short Form Health Survey, and a pain scale.Results. The psychometric properties (internal consistency, test–retest reliability, construct validity, and concurrent validity) of the P-PSEQ were found to be strong. Multiple hierarchical regression analyses indicated that pain self-efficacy scores accounted for a significant proportion of the variance in scores on measures of disability, depression, and general health even after controlling for the possible confounding effects of pain severity and education.Conclusion. The psychometric properties of the P-PSEQ were confirmed. Consistent with findings in other countries with other language versions of the same scale, pain self-efficacy beliefs are associated with levels of physical disability, depression and general health status of chronic pain patients, over and above the influence of pain severity in this sample of Iranians with chronic pain.

Pain, 2004

This study examined the pain/discomfort ratings during mammography and their relationship to pain... more This study examined the pain/discomfort ratings during mammography and their relationship to pain-coping strategies. Prior to their mammogram in order to assess how they cope with day-to-day pain experience 220 women completed an Iranian translation of the Coping Strategies Questionnaire (IR-CSQ). Immediately after mammography, all subjects completed a modified version of the IR-CSQ to assess their coping style with pain during mammography. Ratings of pain/discomfort during the mammogram were also collected, using a 100-mm Visual Analog Scale and a 6-point Pain/Discomfort Rating Scale (PRDS). Up to 92% of the women reported that the mammogram examination was painful. However, considerable variability in pain ratings was found, with some women reporting severe pain and others reporting little or no pain. While the ratings of coping effectiveness in facing day-to-day pain experience were not significantly related to mammography pain ratings, there was a significant association between the ratings of coping efficacy in facing mammography pain specifically and measures of mammography pain. Multiple hierarchical regression analyses revealed that while higher use of catastrophising and coping self-statements in facing mammography pain were predictors of more severe pain during mammography, higher use of ignoring pain sensations was predictive of less severe pain during mammography. The potential significance of these findings for identifying patients at risk of poor adjustment to chronic pain is discussed.

Journal of Psychosomatic Research, 2008

Background: Depression is a common contributor to suffering and disability in people with chronic... more Background: Depression is a common contributor to suffering and disability in people with chronic pain. However, the assessment of depression in this population has been hampered by the presence of a number of somatic symptoms that are shared between chronic pain, treatment side-effects and traditional concepts of depression. As a result, the use of depression measures that do not contain somatic items has been encouraged. Objective: This study examined the psychometric properties of the Depression sub-scale of the Depression Anxiety and Stress Scales (DASS) in a Brazilian chronic pain patient population. Method: Data on a number of measures were collected from 348 participants attending pain facilities. Results: Principal components and exploratory factor analyses indicated the presence of only one factor. Item analyses indicated adequate itemscale correlations. The Cronbach a was .96, which suggests an excellent internal consistency. Conclusion: The DASS-Depression scale has adequate psychometric properties and its further use with Brazilian chronic pain populations can now be supported. D

Journal of Pain, 2010

This study examined the assessment of pain intensity and pain distress with the Numerical Rating ... more This study examined the assessment of pain intensity and pain distress with the Numerical Rating Scale (NRS) in elderly patients (age > 60 years) with persistent pain. A consecutive sample of 800 elderly patients were categorized by age into 3 groups: 61 to 70 years (n = 366), 71 to 80 years (n = 308), and 81 years and over (n = 126). Participants completed 3 Numerical Rating Scales assessing current pain intensity, and both the usual level of pain and average pain distress in the preceding week. The failure rate for scale completion was low for all scales for all age groups, but was significantly higher in the oldest group compared to the youngest group for the scales assessing current pain intensity and average pain distress in the preceding week. The NRS was shown to be a reliable and valid measure of pain intensity and pain distress in all these age groups. Distress related to pain appeared to be specific to the pain experience and was only weakly related to more generalized affective distress. These findings confirm that measures of pain intensity and pain distress, like the NRS, capture only part of the pain experience in older patients and should be supplemented by other measures in the assessment process. This article confirms the utility of the Numerical Rating Scale (NRS) as a measure of pain intensity and pain distress in elderly patients with persistent pain. The use of a large sample increases confidence in the psychometric soundness of the NRS with this population.

Pain, 2001

This study examined the relationship between pain self-efficacy beliefs and a range of pain behav... more This study examined the relationship between pain self-efficacy beliefs and a range of pain behaviours, as measured by the pain behaviour questionnaire (PBQ), using a prospective design. A heterogeneous sample of 145 chronic pain patients completed sets of questionnaires on four occasions over a nine-month period. Multiple hierarchical regression analyses revealed that the subjects' confidence in their ability to perform a range of tasks despite pain (assessed at baseline), was predictive of total pain behaviour and avoidance behaviour over the ninemonth study period. This finding was particularly significant because the analyses controlled for the possible effects of pain severity (at each measurement occasion), pain chronicity, age, gender, physical disability, depression, neuroticism and catastrophising. These findings suggest that pain self-efficacy beliefs are an important determinant of pain behaviours and disability associated with pain, over and above the effects of pain, distress and personality variables. In particular, higher pain self-efficacy beliefs are predictive of reduced avoidance behaviours over an extended period.

European Journal of Pain, 2009

There is evidence that cognitions (beliefs) and mood contribute to physical disability and work s... more There is evidence that cognitions (beliefs) and mood contribute to physical disability and work status in people with chronic pain. However, most of the current evidence comes from North America and Europe. This study examined the contribution of demographic, pain and psychosocial factors to disability and work status in chronic pain patients in two matched samples from quite different countries (Australia and Brazil). Data were collected from 311 chronic pain patients in each country.

Pain, 2008

Although self-reported measures play a central role in the assessment of pain and its treatment, ... more Although self-reported measures play a central role in the assessment of pain and its treatment, it has long been recognized that interpretation of these measures is severely limited by the absence of normative data. Despite that, relatively few of the measures used in pain clinics or research studies have normative data for reference. Using a pain centre sample (n=6124), this paper describes the development of a normative dataset on a number of commonly used pain-related measures. The measures cover many of the key dimensions in pain assessment, including pain severity/quality, disability (physical functioning), and mood (emotional functioning). Measures of different cognitive and coping constructs are also included. Mean scores are reported for each measure according to age group, gender, pain site, as well as percentiles for different scores for patients with chronic low back pain. The potential uses for datasets of this type include the assessment and evaluation of individual cases, as well as the interpretation of published clinical trials. It is also argued that future systematic reviews of pain treatments should include consideration of such patient characteristics as pain levels, disability and mood in the studies reviewed rather than pain site and chronicity alone.

Stress and Health, 2007

While some people become severely or moderately disabled by chronic pain (pain that persists >3 m... more While some people become severely or moderately disabled by chronic pain (pain that persists >3 months), others seem to adjust reasonably well to it. Higher levels of disability are often associated with higher levels of distress, and this relationship can be bidirectional resulting in a vicious cycle. There is evidence suggesting that self-efficacy is one of the most important contributors to disability and emotional adjustment to chronic pain. Defining pain self-efficacy beliefs as confidence in ability to function despite pain, the Pain Self-Efficacy Questionnaire (PSEQ) has been widely used to examine the role of self-efficacy in chronic pain patient populations. However, to date it has not been validated in Brazil. This study examined the reliability and validity of the PSEQ in a Brazilian chronic pain population. Data were collected from a convenience sample of 348 chronic pain patients. Reliability of the PSEQ has been found to be adequate (split-half correlation was 0.76 and internal consistency was 0.90). Factor analysis indicated the existence of only one factor. Discriminant and concurrent validity were also adequate. Altogether these results indicate that the PSEQ has good psychometric properties when used in this sample. These findings are also consistent with those previously published in the literature. Copyright © 2007 John Wiley & Sons, Ltd.

Clinical Journal of Pain, 2006

The ways in which people adjust to chronic pain has been partly attributed to pre-existing person... more The ways in which people adjust to chronic pain has been partly attributed to pre-existing personality traits, but most evidence to date is from cross-sectional studies and mainly with arthritis groups. The present study examined the effects of 5 personality dimensions on measures of pain-related beliefs and catastrophizing assessed 9 months apart with a heterogeneous chronic pain sample. One hundred forty-five patients with chronic pain presenting to a hospital pain center completed the NEO-Personality Inventory-Revised, 3 measures of pain related beliefs, the catastrophizing scale of the Coping Strategy Questionnaire, and a 0 to 10 pain scale. Nine months from the initial assessment, patients completed the same measures, apart from the NEO-Personality Inventory-Revised. Of the 5 personality dimensions studied, only neuroticism was related to the pain-related variables. Multiple hierarchical regression analyses revealed that neuroticism was a significant predictor of residualized change in pain self-efficacy beliefs and pain control appraisals over the time of the study, after controlling for initial values of both constructs. However, the effects were small, suggesting that other factors play a role in the determination of such beliefs, in addition to neuroticism. In contrast, neuroticism was not a significant predictor of residualized change in catastrophizing responses over the same period. The findings provide partial support for the hypothesis that pre-existing personality traits place some patients at risk for poor adjustment to chronic pain.

European Journal of Pain

There is generally good evidence that pain management interventions that include self-management ... more There is generally good evidence that pain management interventions that include self-management strategies can substantially reduce disability and improve psychological well-being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear-avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self-management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self-management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3-week cognitivebehavioural pain management program. The post-treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear-avoidance beliefs, and increased pain self-efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self-management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self-management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear-avoidance and pain self-efficacy beliefs.

Social Psychiatry and Psychiatric Epidemiology, 1997

The aim of this study was to determine risk factors that may differentiate early onset from late ... more The aim of this study was to determine risk factors that may differentiate early onset from late onset depression. A non-clinical cohort that had been assessed from 1978 to 1993 at 5 yearly intervals and that had a high prevalence rate of lifetime depression took part in the study. We established an appropriate age cut-off to distinguish early onset (i.e. before 26 years) of major and of minor depression, and examined the relevance of a number of possible determinants of early onset depression assessed over the life of the study. Despite several dimensional measures of depression, self-esteem and personality being considered, they generally failed (when assessed early in the study) to discriminate subsequent early onset depression, with the exception of low masculinity scores being a weak predictor of major and/or minor depression. Early onset depression was strongly predicted, however, by a lifetime episode of a somewhat stronger and more consistent predictor than panic disorder, agoraphobia and minor anxiety disorders (ie social phobia, simple phobia). The possibility that anxiety may act as a key predispositional factor to early onset depression and to a greater number of depressive episodes is important in that clinical assessment and treatment of any existing anxiety disorder may be a more efficient and useful strategy than focussing primarily on the depressive disorder.

Journal of Affective Disorders, 1999

Aim: To examine for differential psychological risk factors in a nonclinical sample having single... more Aim: To examine for differential psychological risk factors in a nonclinical sample having single or recurrent episodes of major depression. Methods: A cohort of 164 subjects was assessed initially in 1978 in their last year of teacher training, and at five-yearly intervals in 1983, 1988 and 1993. Experience of episodes of DSM major depression and anxiety disorders from each wave were summed and three groups (nil, one, and two or more episodes of major depression) were derived. The cohort also completed a series of self-report measures including neuroticism, state and trait depression, self-esteem, dependency, childhood parental environment and social support. Results: The group with two or more episodes were distinctly more likely to have met lifetime criteria for an anxiety disorder and to have had multiple anxiety disorder diagnoses over their lifetime. Groups with one or more episodes reported higher mean scores for trait depression, neuroticism and maternal overprotection and lower mean scores for paternal care and self esteem at baseline in 1978, but these variables did not predict differences between groups with single and recurrent episodes. At 1993, those with two or more episodes differed from those with none and single episodes in reporting lower trait depression scores and decreased perception of satisfactory social support over time, suggesting a psychological scarring effect for those with repeated episodes.

Social Psychiatry and Psychiatric Epidemiology, 1997

A study was conducted to examine sex differences in frequency, duration and severity of experienc... more A study was conducted to examine sex differences in frequency, duration and severity of experience of depressed mood state in a non-clinical group and to consider how such findings contribute to the understanding of sex differences in depressive experience. A cohort of 156 subjects, assessed initially in 1978 in their last year of teacher training, was reassessed at 5-yearly intervals over 15 years. On each occasion, the subjects completed self-report ratings of experience of “normal depression” and measures of neuroticism, trait depression, self-esteem and sex role. The study found no sex differences in the number or duration of episodes. Women reported more symptoms per episode and some specific symptoms (including tearfulness, appetite and weight gain) more often. The number of symptoms was correlated with neuroticism, self-esteem and trait depression scores, and with gender but not sex role. The number of episodes was related to trait depression and self-esteem but not neuroticism. The results showed that there are links between female gender, neuroticism and number of symptoms experienced during depressed mood state episodes. These links are related more to female gender than to feminine sex role or premenstrual problems, and are reflected in the severity of affective change (and some specific symptoms) but not in the number of episodes.

Social Psychiatry and Psychiatric Epidemiology, 1997

A study was conducted to contrast depressed mood states in those positive and negative for lifeti... more A study was conducted to contrast depressed mood states in those positive and negative for lifetime depressive syndromes. A non-clinical cohort of 156 subjects was assessed on four occasions over 15 years, with 35% having had a major depression and 22% a minor depression at the most recent assessment. At 5-yearly reviews, estimates were obtained of episode frequency, duration and symptom patterns during depressed mood states. Such characteristics were then contrasted across the three groups of those who had experienced major depression, those who had suffered minor depression and lifetime non-cases. Depressive states were affirmed by at least 96% of subjects at each assessment, with the mean number of episodes per assessment year ranging from 8.6 to 21.2. Those who had experienced a lifetime episode of major depression differed from the two contrast groups (i.e. those with minor depression: non-cases) in having more episodes and more features during episodes. By contrast, there was a gradient across the three groups for two other examined features, with those having major depression being more likely than those with minor depression, who in turn were more likely than the non-cases to have longer episodes and a greater number of symptoms. The greater frequency, severity and duration of depressed mood states in those who met lifetime criteria for a major depressive episode suggest that their threshold to onset and persistence of a variety of depressive experiences is lowered, so supporting a general vulnerability hypothesis.

The research was conducted at the Agricultural University of Timiriazev, Moscow, and University o... more The research was conducted at the Agricultural University of Timiriazev, Moscow, and University of Mohaghegh, Ardabili, Iran, to determine the effect of fertilizer application on density, dry biomass and seed characteristic of garden cornflower (Centaurea cyanus L.) and corn spurrey (Spergula vulgaris L.) during [2004][2005][2006]. The analysis show that N and P application increased density and dry biomass of garden cornflower compared with no fertilizer (control), while density and dry biomass of corn spurrey was decreased. The results show that density of corn spurrey reduced as density of garden cornflower increased. After one year, only 11.5 and 30% seeds of garden cornflower and corn spurrey germinated, respectively. Conditions during maternal plant growth affected the seed characteristics of the two species. Seed germination of garden cornflower and corn spurrey in laboratory increased with P application compared with control and N application. These findings suggest that fertilizer application influences weeds, not only for weed density and biomass, but also by affecting seed characteristics.