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Objective: Chronic back pain is highly prevalent in orthopaedic clinics. The aim of the study was to investigate the relationship of psychological factors affecting disability and distress outcomes in chronic low back pain patients. Clinicians shared the impression that chronic pain patients resulted from Injury on Duty (IOD) were particularly difficult to manage. Profiles of IOD patients and non-IOD patients were compared. Methods: The present study is a prospective follow-up study. Fifty-four patients from a public orthopaedic out-patient clinic were assessed with low back pain as their primary complaint. Self-report inventories together with semi-structured interview were used to assess patients’ pain intensity, pain disability, psychological distress, positive and negative affect, as well as relevant pain-related parameters including pain catastrophizing thought, pain-related fear, pain self-efficacy and chronic pain acceptance. Patients were interviewed during their first visit to the orthopaedic out-patient clinic (i.e. Time 1), after 6 months (i.e. Time 2) and after 1 year (i.e. Time 3) of the first consultation. Both qualitative and quantitative analyses were conducted. Results: Chronic pain acceptance predicted mid-term and long-term pain disability and psychological distress at a period of one year after their initial assessment. However, the pain-related parameters of pain catastrophizing, pain-related fear and pain self-efficacy did not show a significant predictive effect on outcomes. Pain rating is an inadequate estimate to assess patients’ level of disability and psychological status. The meaning of pain is important for patients to make sense of their pain experience and employ appropriate coping strategies. Attaching a positive value to pain helps patients to accept their pain. In addition, half of the chronic pain patients showed a need for psychiatric services at one year follow-up, pointing to a high co-morbidity between chronic pain and psychiatric problems. Among the 54 patients, 17 (31.5%) were injured on duty (IOD). More IOD patients than non-IOD patients took sick leaves or were not working during the year. However, there is no significant difference between IOD group and non-IOD group on psychological distress, pain disability and other pain-related measures across 3 time points. Discussion and Conclusion: Pain problems in the context of chronic pain are different from those in the context of acute pain. Intervention focusing on pain relief is inadequate to treat patients’ chronic pain. A multi-factorial perspective is needed to understand and develop suitable models to account for chronic pain experience instead of just relying on the prevalent fear-avoidance model. A more comprehensive assessment that is tailored to patients’ needs is necessary for more effective rehabilitation. Chronic pain patients’ need for psychiatric intervention is also highlighted, with a focus on work-related issues for IOD patients. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

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Thesis (Ph. D.)--University of Hawaii at Manoa, 1990. / Includes bibliographical references (leaves 145-158) / Microfiche. / viii, 158 leaves, bound 29 cm

Cognitive processes have recently received considerable attention in studies of pain. Belief systems, coping mechanisms, perceptions of control and self-efficacy, and other cognitive systems appear to play a central role in determining individual differences to painful events (Rollman, 1983; Turk, Meichenbaum & Genest, 1983; Weisenberg, 1984). The present investigation sought to examine the cognitive and behavioural relationships that are associated with individual differences in responses to painful stimuli. Sixty female undergraduate psychology students participated in the experimental pain induction procedure which used the cold pressor test as the noxious stimulation. To gain a broad assessment of the different factors that may be characteristic of differences in response to pain, tolerant subjects were contrasted with less tolerant subjects on a variety of self-report, cognitive and behavioural - facial expression - measures. As part of the assessment procedure, subjects completed measures of state anxiety, self-efficacy to withstand pain, and a questionnaire involving a retrospective analysis of cognitive techniques. Half of the subjects were interviewed regarding their cognitions concerning the cold pressor task both pre and post their immersion, and the other half were interviewed post only. Transcriptions were coded independently of pain tolerance status. Subjects' facial expressions were videotaped during the cold pressor task and coded using the Facial Action Coding System (FACS) developed by Ekman and Friesen (1978). It was hypothesized that dysfunctional cognitions, lack of effective coping activity, amplification of sensory intensity and affective discomfort and high levels of facial activity would characterize subjects who were less tolerant of the induced pain. The distribution of the endurance times to the cold pressor task confirmed past observations that subjects cluster into two major groups of high and low tolerance (Turk et al. 1983). The results confirmed the major hypotheses that there are cognitive and self-report differences between pain tolerance groups. In comparison to tolerant subjects, less tolerant subjects had lower scores of perceived self-efficacy to withstand pain, higher scores for both sensation and discomfort ratings, retrospectively reported having experienced more pain, and made more accurate estimates of their duration in the cold water. Less tolerant subjects also reported more dysfunctional cognitions during the cold pressor task and reported using effective coping techniques to a lesser extent than tolerant subjects. Major differences between the tolerance groups also appeared in the length of post-test interviews. Tolerant subjects had much lengthier interviews at the post-test than less tolerant subjects. A discriminant analysis revealed that self-efficacy beliefs during the experimental task and the length of the post-test interviews were the most important discriminators between the groups. These results highlight the role of cognition in individual differences in pain tolerance. These results also suggest that low pain tolerance subjects may be better conceptualized as being ineffective and overwhelmed in their attempts to cope with pain which supports the current notion that cognitive based therapies may be the key in managing and alleviating pain states. No support was found for the hypothesis that subjects of differing pain tolerance thresholds would be characterized by differences in facial activity. Facial actions associated with pain in the present study were similar with facial expressions in previous studies (cf. Craig & Patrick, 1985; Hyde, 1986; Swalm, 1987). Contrary to previous results (Craig & Patrick, 1985), measures of facial expression increased over exposure time similarly to self-report. High levels of facial expression were associated with low levels of self-report of coping cognitions assessed at the post-test and with shorter post-test interviews. / Arts, Faculty of / Psychology, Department of / Graduate

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This study addresses the problem of assessment of chronic pain patients, a population with special needs which have only begun to be recognized by the medical community. While this paper promotes a comprehensive approach to assessment and treatment of chronic pain patients, the research questions in this study specifically address assessment of personality and its relationship to other biopsychosocial variables.The purpose of the study was to replicate cluster analyses done with the Minnesota Multiphasic Personality Inventory (MMPI) in chronic pain patient populations using the revised and re-nonmed Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and. secondly, to identify other variables which are associated with particular personality profile patterns in chronic pain patients.This study examines the archival records of approximately 300 male and female, chronic pain patients who were seen at a hospital-based, multidisciplinary, outpatient pain management clinic from 1989 to 1992. Information analyzed includes The (MMPI), and the Patient Assessment Inventory and Narrative (PAIN), an instrument used at the pain clinic, designed to collect demographic, social, and vocational information, medical history, and cognitive, emotional, and sensory-perceptual characteristics of the patient's pain experience.The data from the MM PI-2 scales was cluster analyzed, yielding three homogeneous profile subgroups for both male and female samples, as well as the full sample. These groups corresponded closely to those found in earlier MMPI research with chronic pain patients. A discriminant analysis was used to examine which combinations of other biopsychosocial variables best explained the differences between each of the groups of patients derived in the cluster analysis. Results indicate that a combination of "negative life-impact" variables most significantly distinguished between the derived groups. Analysis of variance (ANOVA) using Tukey's HSD procedure revealed how each group differed-on the "negative life-impact" spectrum, with more elevated MMPI-2 profiles showing greater negative life-impact and less elevated profiles showing less negative life-impact. Implications and limitations of the study, as well as recommendations for future research are discussed. / Department of Counseling Psychology and Guidance Services

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