Alexis M. Nehemkis

Is Tinnitus a Psychological Disorder

There have been consistent reports in the psychosomatic literature indicating that a patients perception of tinnitus as well as differential response to various treatment modalities may be affected by personality variables. The present study examined several personality correlates of subjective tinnitus in forty-five male patients referred to the Audiology Clinic of a large VA Medical Center with constant tinnitus of at least six months duration. Information was also collected on etiology, onset and chronicity, medications, prior treatment and related medical problems. Four standard psychological tests (MMPI, Cattels 16 PF, Rotters Locus of Control and Holmes and Rahe Life Stress Scale) were administered to all patients in the study, in addition to a comprehensive audiologic and otologic evaluation. Correlational analyses were used to examine the relationship between personality profiles and the demographic, medical and audiologic data. The expected psychosomatic characteristics of this patient population did not emerge as had been predicted from previous reports in the literature. Findings suggest that tinnitus may have an unwarranted reputation as a psychopathological disorder. Therefore, conventional psychotherapy may be of limited efficacy whereas standard audiologic treatment approaches may be more promising.

Fear of death, death attitudes, and religious conviction in the terminally ill

The way in which an individuals belief system about death affects fear of death (FOD) has been largely neglected in the thanatology literature. The present study addresses the dimension of certainty or uncertainty with which beliefs about death are held and examines the way in which such attitudes might affect the FOD in dying patients. Twenty terminally ill patients were administered three FOD measures and a death perspective scale which assessed eight death attitudes. FOD among the terminally ill at both the conscious and fantasy level was low. Increased age was associated with declining conscious FOD, independent of life expectancy. Of the eight death perspectives, the attitudes toward death as afterlife-of-reward most directly tap the dimension of certainty or uncertainty. A significant curvilinear relationship emerged between this death perspective and FOD, suggesting that beliefs are a less critical determinant of death fear than is the certainty with which these beliefs are held. The study raises research and clinical issues pertinent to understanding FOD in dying patients.

THE LANGUAGE OF PAIN INTENSITY AND COMPLEXITY: NEW METHODS OF SCORING THE MCGILL PAIN QUESTIONNAIRE

In Part I the McGill Pain Questionnaire was administered to 25 cancer patients, scored and analyzed in the traditional manner. Results indicated that patients with cancer pain appear to be similar in terms of intensity of the pain and the kind of pain which they experience with respect to sensory, affective, and evaluative qualities. Part II presents a new method of administering, scoring, and analyzing responses to the questionnaire, which allows for a more comprehensive interpretation of pain. In Part III the data from Part I are reanalyzed using the new scoring system. As hypothesized, the intensity of cancer pain is higher along the affective dimension than along the sensory. With regard to complexity of the experience of cancer pain, neither the sensory nor the affective dimension is more salient. The new system of scoring and analysis may enable future investigators to specify a unique pain intensity-complexity relationship for each clinical pain syndrome.

The Cancer Ward: Patient Perceptions – Staff Misperceptions

The disparity the between patient and staff perceptions of life experiences associated with the diagnosis of cancer has relevance to our understanding of the dynamics of patient-staff interaction on an oncology unit. In order to better delineate the psychological issues within the staff-patient relationship, 26 advanced cancer patients, 5 oncologists and 10 nursing staff ranked in order of personal importance to the patients, 14 areas of life changes or loss commonly alluded to in the psychosocial oncology literature. Findings indicated considerable interpatient variability in what constitutes a major loss. Staff ratings of patient loss showed greater consistency and overemphasized certain losses. MDs significantly overrated the importance of pain in these patients. Such biased staff preconceptions about patient values may deleteriously affect the treatment milieu.

Staff support group on a cancer ward: a pilot project.

Despite strong evidence of high stress among oncology nursing staffs, few empirical intervention studies have been attempted. This study involved a pilot project to combine two anxiety-reducing aids--group support and the provision of pertinent information--into a single format for maximum stress reduction. Weekly groups producing both support and information lasted 8 months and covered a wide range of topics. Both unstructured and didactic sessions were used. Pre- and postquestionnaires were distributed to each participant to assess ward atmosphere, attitudes about cancer, and level of stress. Participants expressed great satisfaction with the project, but their enthusiasm was not supported by statistical evaluation. Various methodological and programmatic aspects that may account for the discrepancy between anecdotal and statistical results are discussed.

Reattribution of Cancer Pain

The psychological aspects of cancer pain have been largely neglected except in the treatment related research literature. The present study examines the role of attribution theory in illuminating the experience of cancer pain. Twenty-five cancer patients were administered pain and discomfort vertical visual analogue scales and a measure of locus of control. Data pertaining to intensity and perceived source (cancer, cancer therapy or unrelated benign conditions) of pain and discomfort, per cent attribution to each and physician ratings as to source were also obtained. While results indicate that a variety of reattributional phenomena do occur in cancer patients, such cognitive reappraisal does not diminish pain intensity. The findings further suggest that locus of control expectancies are important mediating variables in the reattribution of cancer pain and discomfort. The study raises research and clinical issues pertinent to understanding the experience of pain associated with cancer.

The Limits of Verbal Pain Descriptors

The evidence that verbal descriptors can reliably portray the sensory and affective qualities of pain states and various clinical groupings of pain patients is examined. Support for the proposition that different pain syndromes can be distinguished on the basis of such word patterns is lacking.

Comparison of Arthritis and Cancer Pain Patients: Are Distinct Clinical Pain Syndromes Definable Using the McGill Pain Questionnaire?

Melzack ( 2 ) set the agenda for one aspect of subsequent pain-measurement research when, in 1975, he presented the McGill Pain Questionnaire ( M P Q ) as a method for the multidimensional measurement of clinical pain, capable of defining individual pain syndromes and identifying interesting differences between major syndromes. This study compared 4 0 patients with rheumatoid arthritis and 20 with degenerative arthritis to 20 patienn with cancer pain using a new method which yields two indices of pain intensity [APT-over-all intensity for all questionnaire word groups within the sensory or affective dimension and APC-average intensiry reflected by only those word groups selected within a dimension] and an index of complexity (APT-APC) for both the sensory and affective dimensions of the questionnaire ( 1 ) . Recent work2 has shown these arthritides to be indistinguishable as pain syndromes in terms of intensity and complexity of associated pain. Cancer pain patients ( M = 2.14, S D = .98) and subgroups of arthritis pain patients (rheumatoid: M = 2.26, SD = .98; degenerative: M = 1.98, S D = 9 7 ) are virtually identical with respect to the intensity and complexity of their clinical pain descriptions (F3.18 = 1.78, p > .05). All three groups emphasize the affective ( M = 2.24, S D = 1.13) rather than the sensory ( M = 2.08, S D = .70) intensity of their pain (F1,;a = 4.02, p < .05) . However, the sensory aspects of pain are described with greater complexity (Fl,;o = 11.85, p < .05) , reflecting varied sources and combinations of somatic pathology. O n APT means for both sensory and affective dimensions were 1.63. O n APC the mean for the affective dimension ( M = 2.85) was higher than for the sensory ( M = 2.53). Higher affective scores may indicate that fear o r anxiety plays a significant role in the perception of pain. Not only is any form of arthritis chronic, but it is also progressive, while cancer is fraught with its own profound, often life-threatening, implications. In sum, results d o not permit specification of a particular pattern of pain intensitycomplexity relationships which uniquely defines cancer pain as a clinical pain syndrome distinct from arthritis pain. Whether further research with this questionnaire will yield interesting and potentially unique differences among the major pain syndromes is problematic, based on these data.

Functional use of secondary cancer symptomatology.

This article presents several case studies which illustrate the way in which a terminal patients attention may be diverted from the primary disease process, cancer, to secondary somatic symptomatology such as pain and nausea. This phenomenon has important consequences for the patient, family, physician, and the patients medical treatment. These consequences are discussed in terms of primary gain, tertiary gain, and the “medicalization of existential problems.”

In Search of Pain Syndromes: Some Unresolved Issues

Issues relevant to more precise definition of pain syndromes are identified. Previous research approaches to the definition of clinical pain groupings or syndromes are examined. Emphasis is placed on the importance of matching definition of the clinical pain sample under study with the specific research question(s) being addressed. Problems inherent in the study of cancer and low back pain groups are discussed in detail. Conceptual and methodological issues related to definition of pain populations and methods for their comparison, utilizing McGill Pain Questionnaire data, are examined and suggestions for future research are offered.