Lance M. McCracken

The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain

&NA; Fear of pain has been implicated in the development and maintenance of chronic pain behavior. Consistent with conceptualizations of anxiety as occurring within three response modes, this paper introduces an instrument to measure fear of pain across cognitive, overt behavioral, and physiological domains. The Pain Anxiety Symptoms Scale (PASS) was administered to 104 consecutive referrals to a multidisciplinary pain clinic. The alpha coefficients were 0.94 for the total scale and ranged from 0.81 to 0.89 for the subscales. Validity was supported by significant correlations with measures of anxiety and disability. Regression analyses controlling for measures of emotional distress and pain showed that the PASS made a significant and unique contribution to the prediction of disability and interference due to pain. Evidence presented here supports the potential utility of the PASS in the continued study of fear of pain and its contribution to the development and maintenance of pain behaviors. Factor analysis and behavioral validation studies are in progress.

Prediction of pain in patients with chronic low back pain: effects of inaccurate prediction and pain-related anxiety

This study investigated predictions of pain intensity, reports of pain and anxiety, frequency of pain-related anxiety symptoms, and range of motion, in 43 patients exposed to pain during a physical examination. All patients had primary complaints of low back pain. The pain stimuli used for this study included back and/or leg pain produced by repeatedly raising the extended leg of the patient to the point of pain tolerance. Generally, findings demonstrated that (a) predictions of pain were a function of discrepancies between previous predictions and experiences of pain, (b) patients reporting greater pain-related anxiety showed a tendency to overpredict new pain events, but corrected their predictions readily, (c) patients reporting less pain-related anxiety displayed a persistent tendency to underpredict pain, and (d) higher predictions of pain, independent of pain reports, related to less range of motion during a procedure that involved painful movement. Discussion focuses on differences between these results and those of previous studies and the implications of inaccurate prediction for continued pain and disability.

The detection of malingering in neuropsychological assessment

Although malingering, or the manipulation of data by the patient, is a problem commonly faced by neuropsychologists, there has been little systematic investigation of this problem. This paper reviews the literature on the detection of malingering in assessment instruments commonly used by clinical neuropsychologists. Criticism of previous research is discussed, and suggestions are made both for future research and for clinical practice.

Evaluation of an objective assessment technique for the detection of malingered memory deficits.

Clinicians generally operate under the implicit assumption that their clients are being honest and putting forth their best effort on assessment procedures. However, clients may realize substantial secondary gains by appearing impaired. The present study evaluates an objective assessment procedure for the detection of malingered memory deficits. Results demonstrate that college students instructed to malinger memory impairment show different patterns of responding and can be clearly differentiated from students performing their best and from actual memory-impaired patients. Applying one of two scores derived from this test to a sample of 20 students instructed to malinger, 20 control subjects, and 20 memory impaired subjects performing their best resulted in a 100% hit rate for normal controls and memory-impaired subjects, and a 65% hit rate for experimental malingerers.

Assessing depression in systemic lupus erythematosus: determining reliable change:

Systemic lupus erythematosus (SLE) can follow an unpredictable course. Clinicians and researchers use various self-report inventories to track aspects of the patients functioning during the course of the illness (eg health status, pain, fatigue, quality of life and psychological status). These self-report inventories are used to measure improvement or deterioration as a function of the natural history of the disease process, or as a function of response totreatment. Proper interpretation of scores derived from these inventories requires an understanding of their psychometric properties, in particular, their reliability. It is important to calculate reliable change difference scores fortests commonly used in rheumatology so clinicians can determine if a change score is a reliable indicator of improvement or deterioration in individual patients (ie the change score is not likely to be due to measurement error). The purpose of this article is to illustrate the use of the reliable change difference scores when assessing depression in patients with SLE using the Beck Depression Inventory (BDI).

Treatment of paruresis with in vivo desensitization: A case report

In vivo desensitization was employed with a patient exhibiting chronic paruresis. Measures of urination delay, and subjective units of distress were obtained at pre-training, during training, at a generalization trial, and at a follow-up assessment. Urine volume was also measured at pre- and post-training. There was shorter delay in urination, greater urine output, and less subjective anxiety following treatment. These effects were also demonstrated during a generalization post-test in which the patient was exposed to an unknown observer. A follow-up trial involving exposure to a second unknown observer indicated that treatment effects were maintained at 7.5 months following treatment.

Principal-components analysis of the equivalence of alternate forms of the trail making test

One of the methods of evaluating the reliability of alternative forms of assessment instruments is to evaluate the relation of the 2 forms to other measures in a factor analysis. Using this method, the authors investigated the reliability of alternate forms of trail Making Tests A and B, called Trails C and D. Neuropsychological screening test data were collected from the files of 144 clients referred to a university hospital for neuropsychological evaluations. The tests included Trail Making Tests A, B, C and D ; the Digit Symbol subtest of the Wechsler Adult Intelligence Scale-Revised ; and the Stroop Color-Word test. Analyses provided tentative support for the equivalency of the alternative forms of the Trail Making Test

Research methods for investigating causal relations between SLE disease variables and psychiatric symptomatology

People with systemic lupus erythematosus (SLE) frequently experience psychiatric problems. Some researchers and clinicians presume that these psychiatric problems are a direct manifestation of the disease, while others suggest that psychosocial and environmental factors have greater etiological significance. The majority of the studies addressing these issues in patients with SLE are too methodologically limited to make confident conclusions regarding etiology. More methodologically sound research in this area is needed. This article describes some of the limitations in past research in the areas of sampling, measurement, research design, data analyses and data presentation. Suggestions for improved methodology in future research are offered.