Dennis C. Turk

The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) '

&NA; The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven‐Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients lives, the responses of others to the patients communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.

The McGill Pain Questionnaire reconsidered: confirming the factor structure and examining appropriate uses.

&NA; A major problem in the understanding and psychological treatment of chronic pain patients is the inadequacy of available assessment procedures. Currently, the most frequently used instrument is the Pain Rating Index (PRI) of the McGill Pain Questionnaire, designed to assess 3 components of pain (i.e., sensory, affective and evaluative) postulated by the Gate Control Theory. The PRI has been used in many studies to make differential diagnoses, to describe different groups of pain patients and to identify the factor composition of the instrument itself. To date, however, no study has appropriately tested the a priori structure of the PRI or cross‐validated it. Confirmatory factor analytic procedures employed in the present study supported Melzacks postulated tri‐component structure of the PRI in 2 diverse samples of pain patients from different hospitals. However, the 3 components were found to be highly intercorrelated. Subsequent analyses revealed that the 3 components of the PRI do not display adequate discriminant validity. The current use of 3 subscales to establish differential diagnoses or patterns of different pain syndromes may lead to inappropriate classification and treatment decisions. The major conclusion of these findings is that use of only the total score of the PRI is appropriate for pain assessment.

The effects of cigarette smoking on pain and anxiety

The antinociceptive and anxiolytic consequences of smoking a nicotine-containing cigarette or a zero-nicotine cigarette were investigated in minimally deprived habitual smokers, using a within-subject design. Five subjects were studied in each of two experiments. In one, pain was induced using the cold pressor test; in the other, anxiety, using unsolvable anagrams. All subjects exhibited pain- and anxiety-reduction after smoking a nicotine-containing cigarette. The results support the hypothesis that nicotine from smoking can produce psychological changes that are independent of the state of nicotine withdrawal.

“chronic Pain as a Variant of Depressive Disease”: A Critical Reappraisal

This paper critically examines the hypothesis that chronic pain is the physical manifestation of an underlying depressive disorder, as proposed by Blumer and Heilbronn in 1982 (Blumer, D., and Heilbronn, M. Chronic pain as a variant of depressive disease. The pain-prone disorder. J. Nerv. Ment. Dis., 170: 381–406, 1982). The logic of this argument and the empirical evidence provided by Blumer and Heilbronn to support their hypothesis are discussed and their validity challenged. Alternative interpretations for the results as well as for the relationship between pain and depression are noted. Although it may be plausible to view a small subset of chronic pain patients as manifesting a “muted depressive state,” the burden of proof still lies with those theorists who adhere to this formulation.

Etiological theories and treatments for chronic back pain. II. Psychological models and interventions

&NA; This is the second part of an extended review of the etiology and treatment of chronic back pain (CBP). The first paper dealt with somatic factors and interventions, this paper will examine psychological theories on the etiology of CBP and psychological treatments for CBP. Finally common problems of both the somatic and the psychological approaches will be discussed and suggestions for treatment and research will be made.

Implicit models of illness

This study was designed to be an initial investigation of implicit models of illness, that is, the dimensional structure that organizes an individuals common-sense illness schema. Nurses, college students, and diabetics rated the qualities of two different diseases, one that was personally salient (i.e., flu or diabetes) and one with which they were familiar but did not have direct experience (i.e., cancer), on a 38-item Implicit Models of Illness Questionnaire (IMIQ). An exploratory factor analysis revealed a four-dimensional structure of illnesses composed of (a) Seriousness, (b) Personal Responsibility, (c) Controllability, and (d) Changeability. The stability of this fourdimensional model was established using confirmatory factor analysis to test the fit of this structure to the IMIQ data of another sample of subjects drawn from the same populations. The structure of this implicit model proved stable for judgments of different diseases and across groups of subjects, even though they differed in their physical-health status and occupational roles. The dimensions identified in the present study were compared to those described in other papers. Our dimensions seemed to be both personally and psychologically meaningful. The implications of this preliminary “generic” implicit illness model for future work in the field of health cognition are discussed.

Sources of stress and dissatisfaction in experienced high school teachers

AbstractHigh school teachers (A = 291) were surveyed to identify sources of stress and dissatisfaction that may induce teachers to leave teaching. Data on four sets of independent variables (perceived role, school climate, coping resources, and specific work problems) were entered into a canonical correlational analysis to predict a multidimensional construct of teacher stress encompassing job satisfaction, negative well-being, absences, and intention to leave teaching. Three significant canonical variates were extracted in the canonical correlation procedure, with the independent variables accounting for a total of 86% of the variance in the dependent sets. Certain commonly cited work problems, such as inadequate salary and low status, were found to be important in predicting job stress, but another often-cited problem, pupil misbehavior, was not found to be a factor. The results further suggested that the role teachers perceived for themselves and the school climate, particularly the relationship with a...

Etiological theories and treatments for chronic back pain. I. Somatic models and interventions

&NA; This is the first part of an extended review of the etiology and treatment of chronic back pain (CBP). This paper will address the pathophysiology of CBP, the somatic conceptualizations that have been developed, and the treatment modalities that have been employed to alleviate the symptoms. The adequacy of the different models and treatments will be critically examined. The second paper in this set will examine psychological models and interventions. Common problems to both somatic and psychological approaches will be discussed at the close of the second paper2.

An empirical examination of the "pain-behavior" construct

Observable means of communicating pain and suffering, “pain behaviors,” have been postulated to comprise an important construct relevant in both the development and the maintenance of chronic pain [Fordyce, W. E. (1976). Behavioral Methods for Chronic Pain and Illness, C V. Mosby, St. Louis, Mo.]. Two groups of professionals who have direct contact with chronicpain patients (i.e., physicians and psychologists) participated in a study designed (a) to identify the latent or underlying characteristics of pain behaviors and (b) to assess the degree of agreement of these characteristics between health professionals with very different training. Multidimensional scaling and hierarchical clustering statistical techniques were employed to identify the latent structure of pain behaviors. Two primary pain behavior dimensions were identified, namely, audible-visible and affective-behavioral. Four clusters of pain behaviors were identified and labeled distorted ambulation or posture, negative affect, facial/audible expressions of distress, and avoidance of activity. The two samples of health-care providers identified virtually equivalent latent characteristics of pain behaviors. The data suggest that there is consistency in the pain-behavior construct and that the latent structure is generally congruent with Fordyces original conceptualization. The results provide an empirically derived basis for the assessment of pain behaviors.

Efficacy of EMG biofeedback, pseudotherapy, and conventional medical treatment for chronic rheumatic back pain.

Abstract Twenty‐four patients suffering from chronic rheumatic back pain were treated with EMG biofeedback, a credible pseudotherapy, or conventional medical treatment alone during a 4 week inpatient stay at a Rheumatology Clinic. At the end of the treatment phase and at the 4 month followup the patients in the biofeedback group showed significant improvements in the duration, intensity and quality of their back pain as well as their EMG levels, negative self‐statements and utilization of the health care system. In contrast, the pseudotherapy group showed minimal, but non‐significant improvements and the medically treated group remained unchanged.