Christine M. Gagnon

Stigmatizing attributions about mental illness

Work and housing opportunities of persons with psychosis, substance abuse disorder, and other mental illnesses are significantly hampered by societal stigma. Earlier research by Weiner and colleagues (1988) examined stigmatizing attitudes associated with general health disabilities in terms of attributions about the controllability and stability of these disabilities. The relevance of this model for describing attributions about four psychiatric disorders is examined in this study. One hundred and fifty two adults rated four psychiatric groups (cocaine addiction, depression, psychosis, and mental retardation) and two physical health groups (cancer and AIDS) on six items corresponding with controllability and stability attributions. Findings from a factor analysis supported the distinction between controllability and stability factors. Results also suggested that mental health disabilities were rated more negatively on these factors than physical disabilities. Participants clearly discriminated among mental health disabilities, with cocaine addiction rated most negative in terms of controllability and mental retardation rated most negative in terms of stability. Attribution analyses provide useful information for changing the communitys reactions to persons with mental illness.

Botulinum Toxin A in the Treatment of Chronic Tension-Type Headache With Cervical Myofascial Trigger Points: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

Objective.— To evaluate the efficacy of botulinum toxin A (BT‐A) as a prophylactic treatment for chronic tension‐type headache (CTTH) with myofascial trigger points (MTPs) producing referred head pain.

Predictors of participation in campaigns against mental illness stigma.

Author Information 1 University of Chicago Center for Psychiatric Rehabilitation, 7230 Arbor Drive, Tinley Park, Illinois 60477. Send reprints requests to Dr. Corrigan. 2 Prairie State College, Chicago Heights, Illinois. The social opportunities of persons with severe psychiatric disorders are greatly diminished by societal stigma (Farina, 1998; Link et al., 1989; Penn et al., 1994). Citizens are less likely to hire persons who are labeled mentally ill (Bordieri and Drehmer, 1986; Farina and Felner, 1973; Link, 1987) or to lease them apartments (Alisky and Iczkowski, 1990; Page, 1977, 1983), and more likely to falsely press charges against them for violent crimes (Sosowsky, 1980; Steadman, 1981). Hence, advocacy groups like the National Alliance for the Mentally Ill and the National Mental Health Association have identified anti-stigma campaigns as a necessary adjunct to clinical services for enhancing the quality of life of people with psychosis and other mental illnesses.

The use of botulinum toxin for spasticity after spinal cord injury.

Marciniak C, Rader L, Gagnon C: The use of botulinum toxin for spasticity after spinal cord injury. Am J Phys Med Rehabil 2008;87:312–320. Objective:To describe the use and effects of botulinum toxin (BTX) injections in persons with spinal cord injury (SCI) and focal spasticity. Design:Chart review of patients with SCI receiving their first injection of BTX for spasticity control at a freestanding urban rehabilitation hospital. Charts were reviewed for history and level of SCI, one of five self-identified goals (ambulation, positioning, upper-extremity function, hygiene, and pain control) before and after injection; site and doses of BTX used; and self-reported outcome on clinical follow-up. Results:Charts of 28 adults receiving BTX were reviewed. All patients received BTX type A. Dosages of BTX ranged from 10 to 119 units per muscle. Improvement was noted for 56% in ambulation and 71% in positioning. Overall, upper-extremity function improved in 78%, hygiene improved in 66.6%, and pain decreased in 83.3%. Early use of BTX injections (less than a year after onset of symptoms) vs. late use of BTX injections did not influence effectiveness. Conclusions:BTX seems to be an effective treatment for focal spasticity and for reducing disability in persons with SCI. Randomized trials are needed to confirm the value of this treatment in the setting of SCI.

Medication Quantification Scale Version III: internal validation of detriment weights using a chronic pain population.

Introduction:  We report an internal validation of the Medication Quantification Scale (MQS III) using a chronic pain population. The MQS was designed as a methodology of quantifying different drug regimens in 1992, updated in 1998 (MQS II), and again updated in 2003 (MQS III) using “detriment” weights determined by surveying physician members of the American Pain Society. The MQS has been used as a unitary clinical and research outcome.

Sex differences in pain anchors revisited: further investigation of “most intense” and common pain events⋆

Recent research suggests that the interpretation of maximal endpoints of pain scales vary between sexes. The purposes of this study were to investigate sex differences in (a) maximal endpoints of pain scales and (b) bias, discrimination, and the “better than average effect” for ratings of common pain events. Study participants described and rated the intensity of events that were the “most intense pain imaginable” for the typical woman, typical man, and ones self. Study participants also described and rated the intensity of the “most painful” events they had experienced. Study participants completed the situational pain questionnaire (SPQ), which measured the amount of pain that the typical woman, typical man, or ones self would be expected to experience during thirty common painful events. One hundred and fifteen undergraduate psychology students completed this study. Men and women differed in the categories of events selected for most intense pain imaginable for ones self. There were no significant sex differences for the intensity of most intense self‐imagined pain or most painful event experienced. However, women were more likely to report the intensity of their worst self‐imagined pain event as 100/100. In addition, only women demonstrated a significant correlation between the intensity of most painful self‐experienced event and intensity of most intense self‐imagined event. Analyses of the SPQ discrimination scores revealed no sex or version differences. Analyses of the SPQ bias scores showed that both sexes indicated that the typical woman would rate the intensity of common pain events higher than would the typical man. Women rated the intensity of common pain events for themselves lower than for the typical woman, but higher than the typical man, and men rated also rated themselves as lower than the typical women, but the same as the typical man. Thus, there was inconsistent support for the “better than average effect”. Future research is needed to determine the clinical relevance of sex differences in pain anchors and gender‐related stereotypes for evaluating other peoples pain.

The Osteoarthritis Knee Model: Psychophysical Characteristics and Putative Outcomes

UNLABELLED The knee osteoarthritis (KOA) model is a convenient and coherent archetype that is frequently used in pharmaceutical trials of drugs with analgesic and/or anti-inflammatory properties; yet, little is known about its specific pathophysiology. The presumed chronic inflammatory etiology of osteoarthritis suggests that nociceptive processes and neurogenic inflammation predominate in this condition. However, most chronic pain conditions are associated with changes in peripheral and central processing. Recent data corroborate this as an important mechanism in KOA. We compared psychophysical characteristics (including thermal Quantitative Sensory Testing); thermal, mechanical, and functional wind-up; thermal and mechanical aftersensations; and pressure algometry of 37 subjects with KOA with 35 age- and sex-matched controls. A third of the KOA subjects demonstrated hypoesthesia to vibration and the 4.56 von Frey fiber, yet few showed allodynia in their worse knee. The majority of subjects had abnormalities to pinprick (41% were hyperalgesic and 27% were hypoesthetic). Compared to controls, the more painful knee was hypoesthetic to cold detection and had greater thermal wind-up, lower pressure-pain thresholds, thermal and mechanical aftersensations, and twice the pain ratings of controls after stair climb. Substantial intraindividual differences were found in KOA subjects and controls for mechanical wind-up and algometric thresholds. PERSPECTIVE These results develop the KOA model and suggest mechanistic hypotheses. Certain of these tests may ultimately prove to be responsive, quasi-objective, and quantitative outcomes for research and lend empirical support to the notion of measurable sensitization in osteoarthritis.

Does Botulinum Toxin Type A Decrease Pain and Lessen Disability in Hemiplegic Survivors of Stroke with Shoulder Pain and Spasticity?: A Randomized, Double-blind, Placebo-controlled Trial

Objective The aim of this study was to assess the efficacy of botulinum toxin type A injections in reducing pain, impairment, and disability in patients who have had a stroke with shoulder pain and spasticity. Design In this prospective randomized, double-blind, placebo-controlled trial, adults (n = 37) with post-stroke shoulder spasticity were screened for preinjection spasticity, rated 3 or 4 on the Modified Ashworth Scale for the shoulder adductors/internal rotators and shoulder pain. After the baseline screening, 21 subjects were randomized to receive either onabotulinumtoxinA (Botox; 140–200 units), into the pectoralis major with or without injections to the teres major, or placebo (saline) injections. Daily pain ratings using visual analog scales of best and worst pain and Disability Assessment Scale for dressing, hygiene, pain, and cosmesis; McGill Pain Questionnaire–Short Form; Fugl-Meyer Scale; upper limb range of motion; and Modified Ashworth Scale scores were assessed at baseline and 2, 4, and 12 wks after injection. Primary outcomes were assessed at week 4. Results The subject groups were well matched at baseline. Both the botulinum toxin type A and placebo groups showed decreased pain scores at 4 wks (P’s < 0.05), with no significant differences between the groups found for any of the daily pain ratings (P’s > 0.05). Significant improvement (P < 0.05) in change scores for hygiene on the Disability Assessment Scale was found in the botulinum toxin type A group compared with the placebo group at week 4, and there was a similar trend toward significance for improvement on the Disability Assessment Scale dressing scale (P = 0.061). Conclusions Although botulinum toxin type A shoulder muscle injections in patients who have had a stroke with spasticity and shoulder pain resulted in improvement in selected disability measures, the observed pain reduction was not greater than that found for placebo.

Residual Limbs of Amputees Are Significantly Cooler than Contralateral Intact Limbs

Objective:  To test the hypothesis that distal residual limbs (DRLs) have significant vasomotor abnormalities.

Treatment Outcomes for Workers Compensation Patients in a US-Based Interdisciplinary Pain Management Program

Objectives:  Assess the efficacy of an outpatient‐based interdisciplinary pain rehabilitation program for patients with active workers compensation claims.