Anthony E. Reading

Pain measurement: an overview

&NA; The practice and theoretical basis of pain measurement is reviewed and critically examined in the areas of animal research, human subjects laboratory investigation and clinical study. The advantages and limitations of both physiological and behavioral methods are discussed in each area, and subjective report procedures are evaluated in human laboratory and clinical areas. The need for procedures that bridge these areas is emphasized and specific issues are identified. Progress in the technology of pain measurement over recent decades is reviewed and directions for future work are suggested.

A comparison of the McGill Pain Questionnaire in chronic and acute pain

Abstract The McGill Pain Questionnaire (MPQ) is widely used in pain research and treatment. The internal structure of the questionnaire has been subjected to empirical investigation, with sensory and reactive factors documented. In the present study, questionnaire responses of 95 women experiencing acute (post episiotomy) pain are analyzed. Episiotomy pain patients utilized sensory subgroups more frequently than comparison groups of women experiencing dysmenorrhea (n = 166) or chronic pelvic pain without obvious pathology (n = 31). Chronic pain patients used affective and reaction subgroups with greater frequency. The episiotomy/MPQ scores were subjected to factor analysis and 6 factors were derived, reflecting specific sensory qualities and combined emotional/sensory dimensions. The factor structure to emerge was less distinctive than previously reported on chronic pain patients. It is suggested that acute pain involves less differentiation of sensory, affective and evaluative language dimensions. Rating scales were also administered. Ratings of labor and episiotomy pain were uncorrelated indicating the importance of distinguishing between these in studying pain in the puerperium.

Psychological changes over the course of pregnancy: a study of attitudes toward the fetus/neonate.

Pregnant womens attitudes towards their fetus over the course of the pregnancy were studied in relation to physiological events of pregnancy, namely seeing the fetus via ultrasound and experiencing fetal movement. A consecutive series of primiparae (n = 129) was randomly assigned, at recruitment between 10 and 14 weeks menstrual age, to conditions of high (n = 67) or low (n = 62) feedback real time ultrasound. Thereafter, women were assessed at 16 and 32 weeks gestation, within 24 hours of delivery and by questionnaire at 3 months postpartum. On each occasion women completed attitude rating scales concerning their pregnancy and their fetus or neonate. These scales were subjected to principal components analysis and two main dimensions were derived for ratings of both attitudes towards the pregnancy and the fetus/neonate. No relationship was found between factor scores and ultrasound feedback condition, although scores on the fetal attachment dimension showed a significant linear increase over the pregnancy. Women reporting fetal movement at 16 weeks displayed significantly higher scores on the fetal-attachment dimension at all three assessment points. Multiple regression analyses were utilized to identify predictors of initial reactions to the neonate and attachment ratings at 3 months postpartum. At delivery, ratings of attachment to the neonate were related to drug requirements in labor and attachment ratings at 32 weeks. Reactions to the neonate at delivery and ratings of postpartum mood emerged as significant predictors of maternal attachment at 3 months postpartum. These results are discussed in the context of research attempting to establish the importance of postpartum bonding.

Psychosocial predictors of labor pain

&NA; The relationship between labor pain and concomitant psychological state, in terms of prenatal anxiety levels and post‐partum mood, has been studied. A consecutive series of primiparae (n = 129) was assessed at intervals over the course of their pregnancy and after delivery. State anxiety was measured at recruitment (10–14 weeks of pregnancy), 10 weeks, 32 weeks and at labor. Labor pain was assessed on the McGill Pain Questionnaire (MPQ) and visual analog rating scales. Pain ratings on the MPQ were found to be high when compared to other clinical pain groups. Drug use in labor emerged as the strongest predictor of pain ratings on the MPQ total, sensory and affective scales, accounting for 11, 9 and 7% of the variance respectively. Anxiety scores at 32 weeks accounted for a further 5% of the variance and emerged as the best predictor of MPQ evaluative scores and visual analog ratings. A significant association was found between pain ratings and ratings of post‐partum mood. Neither attendance at preparatory classes nor initial attitudes towards the neonate were related to pain scores.

The effects of ultrasound examination on maternal anxiety levels

A study has been conducted to assess the psychological effects of real-time ultrasound on the pregnant womans attitudes and anxiety levels. A consecutive series of primiparae, fulfilling the selection criteria of obstetrically “low risk,” was assigned at random to two conditions of ultrasound, namely, (a) high feedback (N=67), where the woman saw the moving fetus in utero;and (b) low feedback (N=62), where the monitor screen was not visible and no specific feedback was provided. A third group of women was assessed following a wait period in order to compare state anxiety levels among the three groups. Attitude assessments showed consistent preultra-sound-post-ultrasound change, with more uniformly positive attitudes displayed by the high-feedback group. No between-group differences in state anxiety emerged as a result of ultrasound compared with a wait control period. No differences emerged with respect to anticipatory anxiety measures. The results are considered in the context of evidence on the importance of psychological state on the course and outcome of pregnancy. It is suggested that the low-risk characteristics of this sample may have precluded effects on anxiety and it is concluded that the therapeutic potential of ultrasound warrants further study.

An analysis of self-reported sexual behavior in a sample of normal males

Ninety-eight presumably normal London men, age 20–35 and sexually active in a stable relationship, responded to an invitation at their work place to participate in a detailed sexuality interview. The interview was developed by a group of WHO collaborators to measure possible effects on sexual functioning resulting from various medical regimens (for example, a male contraceptive pill). It assessed frequency of coitus and masturbation during the previous 4 weeks, a variety of subjective ratings of sexual interest, satisfaction, and quality of relationships, as well as reports of the nature and incidence of various sexual problems. The study samples responses displayed internal consistency and in general supported the inference that the sample was not atypical. The data appear to support Westoffs (1974) notion that the frequency of coitus has increased since the early normative reports by Kinsey et al.(1948). Most importantly, the results of principal components analyses point to the fact that overall sexual drive or “libido” (e.g., frequency of sexual behavior) is independent of several other possibly significant dimensions, including latency to orgasm, quality of sexual experience, autoeroticism, and the incidence of erectile difficulties. It is concluded that the sexuality interview provides potentially useful baseline data against which to evaluate effects of sexual therapy or drug regimens.

A comparison of the accuracy and reactivity of methods of monitoring male sexual behavior

Two self-report methods of monitoring male sexuality have been compared—an ongoing method in the form of a diary card and one eliciting retrospective reports in the form of a monthly sexuality interview. Male volunteers were assigned at random to three testing conditions: (a) diary card and monthly interview for 3 months (N=29); (b) three monthly interviews (N=18); and (c) pre- and postinterview only, separated by 2 months (N=21). The correspondence among frequency reports, quality ratings, and number of sexual problems as obtained in diary card and interview measures was examined for respondents in the first condition, revealing that coital frequency and quality ratings were generally quite similar in the two modes of assessment. Interview responses for all subjects were examined for the existence of differential reactive effects according to the frequency of the assessment regimen. No differences emerged among conditions, although a trend for all groups over time was identified. Implications of the results are considered for clinical trials monitoring the effects of new contraceptive methods on sexual functioning.

A survey of patient attitudes towards artificial insemination by donor

The psychological characteristics of a consecutive series (n = 58) of women attending an AID clinic have been examined. Women were assessed prior to treatment on a number of attitudinal and acceptability measures, as well as required to complete personality and martial adjustment inventories. At the time of each insemination, over 6 successive cycles, state anxiety was assessed. Following an interval of 6 months women were reassessed on an acceptability measure. The results showed generally positive attitudes at the outset. No systematic trends in anxiety were identified, with no differences between women becoming pregnant and those continuing in treatment. At follow-up women acknowledged the strain involved in timing the insemination to coincide with ovulation, with both pregnant and nonpregnant women attributing outcome to their psychological and emotional state at the time. The implications of these results are considered in terms of the characteristics of women requesting AID and the ways in which clinics can attend to the psychological states of the patients.

Cognitive functioning in premenstrual syndrome

Objective To evaluate cognitive functioning in women with premenstrual syndrome (PMS) and controls during the follicular and luteal phases of the menstrual cycle. Methods Thirty women with PMS and 31 controls were selected on the basis of psychiatric interview and prospective daily diary recordings. Subjects were tested on two occasions, follicular (days 8–10) and luteal (days 24–26), using complex tasks consisting of measures validated previously for the assessment of “executive” frontal-lobe functions. Tests were counterbalanced for order across subjects. Results The Beck Depression Inventory scores were significantly different between the groups and across time (P < .001). Women with PMS had a mean luteal phase Beck score of 13.3 consistent with mild-to-moderate premenstrual depression. There were no statistically significant score differences in tests for attention, memory, cognitive flexibility, and overall mental agility. The evaluation of our preliminary data with 30 PMS subjects and 31 controls indicated a very small effect size (.02). To detect an effect size this small (if in fact one exists) with a power of .8 would require a sample of more than 1000 subjects per group. Conclusion Our sample of women with PMS failed to demonstrate objective evidence of diminished cognitive performance, despite subjective feelings of inadequacy.

A comparison of response profiles obtained on the McGill Pain Questionnaire and an adjective checklist.

Abstract The response profiles on the McGill Pain Questionnaire (MPQ) were compared with those obtained from a checklist format, consisting of the 78 MPQ words arranged in random order. Both forms were administered to 3 patient groups: (a) primiparae experiencing post‐episiotomy pain (n = 60); (b) outpatients attending a rheumatology clinic wisdom tooth extraction (n = 60); and (c) inpatients having undergone wisdom tooth extraction (n = 60). The order of administration was balanced, so that within each patient group 40 patients received either one of the study forms and 20 both, yielding total sample sizes of 120 and 60 for further statistical analyses. Comparison of numbers of words checked in the two formats showed considerable similarity and so for purposes of further comparison, the MPQ structure was imposed on the checklist. This permitted comparison of summary scores, with no significant differences in mean level, with the sole exception of the evaluative subscale. Comparison of individual subgroup profiles on both forms also showed considerable similarity. A second objective was to compare the format in discriminating between patient groups. It was found that the MPQ offered a higher correct classification rate, although there was little in it, with MPQ subgroup scores rather than subscale scores showing marginally better results.