David V. Nelson

Perspectives of Chronic Pain: An Evaluative Comparison of Restrictive and Comprehensive Models

The authors compare theoretical perspectives of chronic pain using a restrictive comprehensive categorization. Four of the perspectives (mind-body dualism, psychological, radical operant--behavioral, and radical cognitive) are categorized as restrictive. The other 4 perspectives (International Association for the Study of Pain, gate control, nonradical operant--behavioral, and cognitive-behavioral) that incorporate multiple facets are categorized as comprehensive. On the basis of empirical support, practical application, and issues concerning potential research design problems, the restrictive perspectives could be rejected for not providing a model in which chronic pain can be thoroughly investigated. The comprehensive perspectives, however, demonstrate greater potential for serving that role. Nonetheless, the need for additional theory development by the comprehensive perspectives is noted.

Psychometric Comparability of the State-Trait Anxiety Inventory for Different Ethnic Subpopulations

This study, which was based on 285 Ss who were experiencing stressful and potentially anxiety-producing situations associated with pain, revealed comparable psychometric adequacy in descriptive statistics and estimates of internal consistency for the State-Trait Anxiety Inventory (STAI) Form Y across different ethnic groups and gender, namely, White, Black, and Latino men and women. Examination of item-remainder correlations identifies certain particularly salient screening items for Black men and underscores the importance of individualized item analysis in the interpretation of obtained scale scores

Correlates of depression in chronic pain patients: a comprehensive examination

&NA; This study examined the relations between depression and demographic, pain‐related, and work‐related variables in 254 chronic pain patients. Regression analyses were conducted, initially by category (i.e., demographic, pain‐related, and work‐related), and finally a comprehensive regression analysis was performed, containing the significant independent variables from each category. Among the demographic variables, education level and marital status were related to depression, and an interaction between age and gender was associated with depression, with younger women and older men reporting more depression. Among the pain‐related variables, longer duration of pain was associated with increased depression. Among the work‐related variables, unemployment was associated with depression, and there was an interaction between work status and litigation status, with working and litigating being associated with depression and not working and not litigating being associated with depression. In the comprehensive analysis, work status, education level, and marital status accounted for a significant amount of the variance in depression scores. These findings, together with future research directions, are discussed.

What does the beck depression inventory measure in chronic pain?: a reappraisal

&NA; The Beck Depression Inventory (BDI) is widely used to document the prevalence of depression in sufferers of chronic pain and in research designs about this population. Williams and Richardson (1993) initially posed the question, “What does the BDI measure in chronic pain?”. Results from their study found 3 independent constructs, which differed somewhat from those obtained in analyses with other non‐pain subsamples. In our reappraisal of the question, we used confirmatory factor analytic procedures to assess the dimensionality Of the BDI. Specifically, we questioned whether a hierarchical model in which a second‐level depression construct underlies 3 constituent first‐level constructs is reasonable for the data. Our results, based on a sample of 247 chronic pain patients, corroborated the adequacy of this model. The first‐level constituent constructs were labeled Negative Attitudes/ Suicide, Performance Difficulty, and Physiological Manifestations and were conceptually similar to first‐level constructs obtained with other subsamples. Furthermore, external psychological measures and selected questionnaire items were used to assess convergent and discriminant validity of scales operationalizing the factor‐analytically derived constructs. With these analyses, we clarify the constituents of depression as measured by the BDI. The findings from this study have implications for more refined epidemiologic and clinical research with chronic pain patients.

Expert system classification of urban land use/cover for Delhi, India

This study presents the results of classifying land use/land cover for Delhi, India using an expert system approach. For this study Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) data of 22 September 2003 were used. The research goals of this project are two‐fold. In one respect, the research goal is to report on the extent covered by urbanization using the classified image. Thirteen different land‐cover categories were identified with an 85.55% overall classification accuracy based on 256 random points for validation and 50 on the ground observations. Secondly, we report on our efforts to duplicate an expert system model previously developed for Phoenix Arizona as a generalized approach for urban land use classification. Results suggest that while some of the methodology could be duplicated, there are local factors (e.g. data availability and specific land features) that required the approach to be modified.

Psychometric Comparability of the English-and Spanish-Language Versions of the State-Trait Anxiety Inventory:

The psychometric adequacy of the English-and Spanish-language versions of the State-Trait Anxiety Inventory (STAI) was compared across English-speaking Latino American women (n = 17) and men (n = 18) and Spanish-speaking Latino American women (n = 10) and men (n = 14) who were experiencing stressful and potentially anxiety-producing situations associated with physical pain. Subjects were administered the STAI as well as the Minnesota Multiphasic Personality Inventory (MMPI) in their preferred language. Psychometric comparisons of language group and gender revealed nonsignificant differences in (a) mean scores on the STAIscales, (b) internal consistency for the STAI scales, and (c) correlations between the STAI scales and MMPI scales. Item analyses identified several salient screening itemsfor the Spanish-speaking men; several items with low item-remainder correlations were revealedfor the English-and Spanish-speaking women. Overall, results attest to the psychometric strengths of the English-and Spanish-language versions of the STAI.

Subtypes of Psychosocial Adjustment to breast cancer

By means of cluster analytic techniques, four subtypes of psychosocial adjustment were identified in a sample of 122 breast cancer patients who completed the Psychosocial Adjustment to Illness Scale. Internal consistency and internal validity of the derived typology were suggested by the finding that two different hierarchical agglomerative clustering methods (average linkage between groups, Wards) produced similar solutions. Three of the derived subtypes reported normal affect levels but different patterns of relative strengths and dysfunctions, while the fourth subtype appeared to be highly distressed and globally maladjusted. External validation was demonstrated by differentiating the subtypes on variables of negative affect, avoidance coping, and fighting spirit. The clinical and heuristic implications of these findings are discussed. The findings highlight the need for comprehensive assessment of psychosocial functioning of cancer patients. They demonstrate that even non-emotionally distressed patients can have very different profiles of adjustment and may benefit from correspondingly individually tailored psychosocial interventions.

Waddell signs: Distributional properties and correlates

OBJECTIVE To determine what percentage of patients have none of the five nonorganic behavioral processes known as Waddell signs, and the relational pattern between Waddell signs and somatic complaints, disturbed functional performance, negative treatment attitudes, physical pathology, depression, generalized anxiety, and MMPI-2 validity scales. DESIGN Case series survey. SETTING A referral-based multidisciplinary pain center affiliated with a state medical school. PATIENTS Seventy-five consecutive patients with chronic back pain. INTERVENTION Medical evaluation and completion of self-report inventories. MAIN OUTCOME MEASURE Total number of Waddell signs, physical pathology, and pain intensity ratings were assessed by a physician during an initial medical evaluation. Degree of disturbed functional performance and psychological symptoms were assessed by self-report measures at the initial evaluation. RESULTS Sixty-four percent of the patients had no Waddell signs. Total number of Waddell signs yielded positive and statistically significant correlations (p < or = .05) with depression, disturbed functional performance, somatic complaints, and pain intensity ratings. Correlations of slightly smaller and statistically nonsignificant magnitudes were revealed for Waddell signs with generalized anxiety, negative treatment attitudes, and physical pathology. Waddell signs were unrelated to age, duration of pain, gender, number of lumbar surgeries, and MMPI-2 validity scales. CONCLUSIONS Taken together, multiple Waddell signs and some of their correlates present various factors that might interfere with optimal response to treatment.

Neurotherapy of Traumatic Brain Injury/Posttraumatic Stress Symptoms in OEF/OIF Veterans

The Flexyx Neurotherapy System (FNS), a novel variant of EEG biofeedback, was adapted for intervention with seven treatment-refractory Afghanistan/Iraq war veterans, and brought about significant decreases in bothersome neurobehavioral and posttraumatic stress symptoms. FNS may help ameliorate mixed trauma spectrum syndromes.

Neurotherapy of Fibromyalgia

OBJECTIVE To evaluate the efficacy of a novel variant of electroencephalograph biofeedback, the Low Energy Neurofeedback System (LENS), that utilizes minute pulses of electromagnetic stimulation to change brainwave activity for the amelioration of fibromyalgia (FM) symptoms. DESIGN Randomized, double-blind, placebo-controlled clinical trial. SETTING Tertiary referral academic medical center, outpatient. PATIENTS Thirty-four patients diagnosed with FM according to 1990 American College of Rheumatology classification criteria. INTERVENTIONS Active or sham LENS, depending on randomization, for 22 treatment sessions. OUTCOME MEASURES Primary outcome measure was the Fibromyalgia Impact Questionnaire total score. Secondary outcome measures included number of tender points (TPs) and pressure required to elicit TPs on physical examination, quantitative sensory testing heat pain threshold, and self-reported cognitive dysfunction, fatigue, sleep problems, global psychological distress, and depression obtained at baseline, immediate post-treatment, and 3- and 6-month follow-up. RESULTS Participants who received the active or sham interventions improved (Ps < 0.05) on the primary and a variety of secondary outcome measures, without statistically significant between group differences in evidence at post-treatment or 3- or 6-month follow-up. Individual session self-reported ratings of specific symptoms (cognitive dysfunction, fatigue, pain, and sleep, and overall activity level) over the course of the 22 intervention sessions indicated significant linear trends for improvement for the active intervention condition only (Ps < 0.05). CONCLUSION LENS cannot be recommended as a single modality treatment for FM. However, further study is warranted to investigate the potential of LENS to interact synergistically with other pharmacologic and nonpharmacologic therapies for improving symptoms in FM.