Comparison of the Psychological Status of Chronic Pain Patients and the General Population (original) (raw)
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The British journal of medical psychology, 2001
A sample of chronic pain patients (N = 40) was described with reference to defence mechanisms, interpersonal problems, psychological symptoms and bodily conditions. The relationships between pain intensity and different psychological and bodily indexes were examined. The defence mechanisms of somatization and denial measured by the Minnesota Multiphasic Personality Inventory (MMPI) characterized the sample. Interpersonal relations were typically overly nurturant, exploitable, non-assertive and socially avoidant according to the circumplex version of Inventory of Interpersonal Problems (IIP-C). Somatization, obsession, depression and anxiety were the highest symptom scales on the Symptom Check-List 90, revised (SCL-90-R). The Comprehensive Body Examination (CBE) produced moderate findings mainly reflecting stiffness, and the intensity of pain was medium high. The MMPI psychosomatic pattern, the combined IIP-C index consisting of the elevated subscales, and the elevated subscales on S...
Psychological Assessment of Persons with Chronic Pain
A Practical Guide, 2010
Chronic pain is one of the most prevalent and costly health care problems and variability is the rule more than the exception in terms of pain related outcomes. Clearly, psychological factors such as depression, anxiety, post traumatic stress, excessive somatic thoughts and a variety of psychiatric syndromes are recognized as actively contributing to a patient's perceptions and responses to pain and can represent significant potential impediments to functioning and optimal health care outcome. As a result, it is becoming increasingly common, and even required by many programs, for individuals who seek treatment for pain to undergo a comprehensive assessment that evaluates not only their medical findings, but also beliefs about their condition, coping strategies, psychological adjustment, activity level and quality of life. Psychological assessment instruments that provide information about a person's physiological, behavioral, and cognitive-affective functioning in terms of vulnerabilities and strengths can be a valuable tool for treatment providers. In the present paper, a biopsychosocial conceptual model is employed to provide an overview of a method and approach in evaluating patients with chronic pain, toward the goal of facilitating optimal outcome and management of pain syndromes.
Do Number of Pain Conditions Influence Emotional Status?
Pain Physician, 2002
This study was designed to evaluate psychological status of 150 individuals; 50 without chronic pain and without psychotherapeutic drug therapy, Group I or control group; 50 patients with chronic pain, Group II, chronic pain group with involvement of one region; and 50 chronic pain patients with involvement of two or more regions, Group III. All the participants were tested utilizing Millon Clinical Multiaxial Inventory-III (MCMI-III). Results were analyzed and compared for various clinical personality patterns including personality traits and personality disorders; severe personality pathology for schizotypal, borderline and paranoid personality pathology; and multiple clinical syndromes including generalized anxiety disorder, somatization disorder, major depression, bipolar manic disorder and dysthymic disorder, etc. There were no significant differences noted in clinical personality patterns or severe personality pathology. In the analysis of clinical syndromes, generalized anxiety disorder, somatization disorder, and depressive disorders were seen in a progressively greater proportion of patients in Groups I to III. In conclusion, this evaluation showed that abnormal clinical personality patterns are present in both groups of patients. Psychological abnormalities with generalized anxiety disorder, somatization disorder, and depression are commonly seen in chronic pain patients.
Understanding psychological aspects of chronic pain in interventional pain management
Pain physician, 2002
There is no doubt that chronic pain is recognized as a biopsychosocial phenomenon in which biological, psychological, and social factors dynamically interact with each other. Thus, the role of psychological factors and understanding chronic, persistent disabling pain has been well recognized, but poorly understood. Approximately 1/2 to 2/3 of all patients diagnosed with chronic pain manifest to various levels of psychological distress. Chronic pain and psychological disorders are the two most common elements in the United States. Statistics show that, approximately 22% of Americans suffer from a diagnosable mental disorder in a given year. In addition, 28% of the American population suffers with chronic pain. Depression in chronic pain is the most common condition, followed by generalized anxiety disorder, somatization disorder, and drug dependence. However, psychogenic pain appears to be the least prevalent of all psychopathological issues. Chronic pain disability is a complex psyc...
Journal of Psychosomatic Research, 2018
The objective of the present study was to test the moderating impact of an unknown pain etiology on the relationship between psychological factors and chronic pain intensity and disability. Methods: N = 471 chronic pain sufferers presented to an online Cognitive Behavioral Therapy randomized control trial, known as the Pain Course. Participants' etiology was classified as medically unexplained or medically explained via interview and self-reported data. Standardized psychological measures at baseline were used in a non-hierarchical cluster analysis, which allocated chronic pain participants into mutually exclusive groups. Results: Four distinct clusters were identified: Psychologically healthy, mild psychological distress, high psychological distress, and average. The profile with high psychological distress experienced the greatest pain intensity (mean: 6.44 (SD = 1.66)) and disability (mean: 17.53 (SD: 3.65)). This relationship was not moderated by preceding pain etiology being medically explained or unexplained (χ 2 (3) = 0.45, p = 0.93 and χ 2 (3) = 7.07, p = 0.07 respectively). Conclusion: These findings indicate that an unknown pain etiology has little role in altering the relationship between psychological factors and pain disability in individuals experiencing chronic pain. This suggests that the psychological association with pain disability and intensity experienced by people with medically unexplained symptoms is similar to people with medically explained symptoms.
The psychological assessment of patients with chronic pain
Current review of pain, 2000
This article reviews the objectives of psychological evaluations, as well as the standard pain center evaluation protocol that uses a pain questionnaire, a structured clinical interview, and pain assessment measures that include pain intensity rating scales and the McGill Pain Questionnaire. The most frequently used measures of psychological status, such as the Beck Depression Inventory and the Minnesota Multiphasic Personality Inventory (MMPI), are reviewed. Psychological predictors of invasive procedures and of disability are also outlined. The importance of listening to the patient in a multidisciplinary setting is emphasized.
Psychosomatic concepts in chronic pain
Archives of Physical Medicine and Rehabilitation, 2003
Rashbaum IG, Sarno JE. Psychosomatic concepts in chronic pain. Arch Phys Med Rehabil 2003;84 Suppl 1:S76-80.
Comorbidity of Chronic Pain and Mental Health Disorders: The Biopsychosocial Perspective
American Psychologist, 2004
We are entering an exciting period in mental and physical health research, resulting from a paradigm shift away from an outdated biomedical reductionism approach, to a more comprehensive biopsychosocial model, which emphasizes the unique interactions among biological, psychological and social factors required to better understand health and illness. This biopsychosocial perspective is important in evaluating the comorbidity of mental and physical health problems. Psychiatric and medical pathologies interface prominently in pain disorders. Important topics in the biopsychosocial approach to comorbid chronic mental and physical health disorders, focusing primarily on pain, are presented. Though this biopsychosocial model has produced dramatic advances in health psychology over the past two decades, important challenges to moving the field forward still remain.
Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria
Pain, 1986
Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%) passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general 0304-3959/86/$03.50 0 1986 Elsevier Science Publishers B.V. (Biomedical Division) 182 population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.
Chronic Pain and the Measurement of Personality: Do States Influence Traits?
Pain Medicine, 2006
Study Design. This is a structured evidence-based review of all available studies on the effect of pain, (a state phenomenon) on the measurement of personality characteristics (a trait phenomenon). Objectives. To determine whether pain treatment changes trait scores. Summary of Background Data. Recent evidence from the psychiatric literature indicates that the measurement of personality characteristics (traits) can be affected or changed by the presences of state psychiatric disorders, for example, depression. At issue then is whether the measurement of chronic pain patients' (CPPs') trait characteristics is affected by the presence of pain, a state problem. Methods. Computer and manual literature searches for pain studies that reported a prepain treatment and postpain treatment (test-retest) personality test or inventory score produced 35 such reports. These references were reviewed in detail and information relating to the above problem was abstracted and placed into tabular form. Each report was also categorized as to the type of study it represented according to the guidelines developed by the Agency of Health Care Policy and Research (AHCPR). In addition, a list of 15 quality criteria was utilized to measure the quality of each study. Each study was independently categorized for each criterion as positive (criterion filled), negative (criterion not filled), or not applicable, by two of the authors. Only studies having a quality score of 65% or greater were utilized to formulate the conclusions of this review. The strength and consistency of the evidence represented by the remaining studies were then categorized according to the AHCPR guidelines. Conclusions of this review were based on these results. Results. Of the 35 reports, 32 had quality scores of 65% or greater. According to the AHCPR guidelines, there was a consistent finding that the Minnesota Multiphasic Personality Inventory (MMPI) scores changed (improved) with treatment. In reference to the Millon Behavioral Health Inventory, Locus of Control, the Symptom Checklist-90-Revised (SCL-90-R), trait anxiety, and personality disorders, there were not enough studies to draw conclusions about consistency. In reference to coping/self-efficacy inventories, somatization/illness behavior inventories, and personality questionnaire studies, there was a generally consistent finding that these tests changed (improved) with pain treatment. Overall, of the 32 reports, 92.3% demonstrated a change in trait scores (improvement) with pain treatment. This evidence was categorized as consistent. Finally, 100% of a subgroup of reports (N = 12) that had controlled for pain indicated that there was a relationship between a change in pain scores and a change in trait scores. Conclusions. Based on the above results, it was concluded that some trait tests and inventories may not be pain state independent. Therefore, caution is warranted in interpreting postpain development personality profiles as being indicative of the true prepain personality structure, if measured