Linda M. Dougherty

Assessing the stages of pain processing: a multivariate analytical approach.

&NA; A four‐stage model of pain processing was proposed, consisting of pain sensation intensity, pain unpleasantness (stage 1 affect), suffering (stage 2 affect), and pain behavior. We studied 506 chronic pain patients (230 male and 276 female) using a multivariate statistical technique (LISREL) in order to demonstrate the structural relationship among multiple indicators of pain processing; and to characterize these stages in terms of their interactions. A strong relationship was revealed between the majority of the underlying indicators of each pain processing stage. A linear stage sequence best fitted the relationship between the four stages. Successive stages did not have recursive effects on earlier pain components. A confirmatory LISREL analysis was conducted with an additional sample of 502 chronic pain patient. In this replication analysis the structural equation model consisted of pain intensity, unpleasantness (stage 1 affect), emotional suffering (stage 2 affect), and pain behavior. This study extends the validation of these pain dimensions, as well as the validity of the measure(s) of each separate stage.

A canonical correlation analysis of the influence of neuroticism and extraversion on chronic pain, suffering, and pain behavior☆

&NA; The relationship between neuroticism and extraversion on the 4 major stages of pain processing, that of pain sensation intensity, pain unpleasantness, suffering, and pain behavior, were studied in 205 chronic pain patients (88 male and 117 female). Patients underwent psychological evaluation which included the Pain Experience visual analogue scales (VAS) (Price et al. 1983), NEO Personality Inventory (NEO‐PI) (Costa and McCrae 1985), and the Psychosocial Pain Inventory (PPI) (Getto and Heaton 1980). Canonical correlation was used to control for pain sensation intensity in evaluating affective dimensions of pain and to control for neuroticism in assessing effects of extraversion on different stages and dimensions of pain. Neither neuroticism nor extraversion were related to pain sensation intensity. Only neuroticism was associated with pain unpleasantness. Personality factors had their greatest impact on stages 3 (suffering) and 4 (illness behavior) of pain processing. The results of multiple regression analyses indicated that life‐long vulnerability to anxiety and depression is paramount in understanding the relationship between personality and suffering in chronic pain. These findings provide support for the idea that personality traits influence the ways in which people cognitively process the meanings that chronic pain holds for their life, and hence the extent to which they suffer.

Patterns of normal personality structure among chronic pain patients

&NA; Fifty‐nine chronic pain patients satisfying one of four previously identified pain group classifications were evaluated using the NEO Personality Inventory (NEO‐PI), a standardized measure of normal adult personality structure. Minnesota Multiphasic Personality Inventory (MMPI) pain subgroups differed with respect to level of NEO‐PI Neuroticism. In particular, emotionally overwhelmed pain patients as defined by multiple MMPI scale elevations had higher NEO‐PI Neuroticism scores. Post hoc analyses revealed higher levels of depression, anxiety, vulnerability, and hostility in emotionally overwhelmed subjects. None of the remaining groups differed from each other on NEO‐PI Neuroticism. Additionally, none of the other NEO‐PI domains discriminated pain subgroups. NEO‐PI profiles for pain patients (except for Neuroticism in emotionally overwhelmed patients) yielded t scores in the average range, suggesting that chronic pain patients present with a relatively normal underlying personality structure.

Recall of clustered and unclustered word lists in elderly adults

We present descriptive data for alternate forms of clustered and unclustered word list recall in 102 healthy elderly adults and test results for 11 patients with Parkinsons disease. The word list test provided a relatively stable measure of verbal memory. Alternate forms were equivalent except for a tendency of the unclustered list of Form 1 to be easier than those of the other three forms. Verbal intelligence, total word recall, and the ability to cluster related words at recall were related significantly. There were modest effects of education on word recall; female subjects tended to recall more words than males.

Positive Ego and Coping Functions in Chronic Pain and Depressed Patients

Three groups of elderly subjects (chronic pain patients, patients with major depression, and healthy individuals) were administered measures of self-esteem, ego defense mechanisms, and coping style to examine how these personality components are affected by illness. Ego defense mechanisms and self-esteem for all three groups were not found to be different and were positive except for depressed patients, who used greater levels of projection and demonstrated lower levels of self-esteem. Each subject group utilized equally problem-focused and emotion-focused coping styles. These findings from a preliminary study are consistent with previous research demonstrating stability of personality throughout the life span, and suggest that the psychological functioning of older individuals with chronic pain syndromes or depression remains positive and resilient. (J Geriatr Psychiatry Neurol 1990; 3:48-52).

Mental stress and the cardiovascular system part I: Cardiovascular response to acute mental stress in normal subjects

Abstract In normal subjects, acute mental stress may alter baseline cardiovascular parameters. During this stimulation, blood pressure and heart rate commonly increase. Changes in peripheral vascular resistance are variable. Parameter responses during acute mental stress may be incorporated in the model of isotonic (dynamic or volume) exercise with increased blood pressure and decreased peripheral vascular resistance or in the model of isometric (static or pressure) exercise with increased blood pressure and increased peripheral vascular resistance. Sustained isotonic exercise such as jogging or swimming is generally considered healthful. In contrast, sustained isometric exercise such as weight lifting or snow shoveling is generally not considered healthful. Measuring peripheral vascular resistance may be important in distinguishing between healthful and unhealthful activities. In normal subjects, acute mental stress may also alter heart rate, double product (blood pressure × heart rate), cardiac output, stroke volume, forearm blood flow, left ventricular ejection fraction, and cardiac microcirculation. Studies in normal subjects have identified relationships between hostility and increased arousal, and blood pressure and heart rate increases. Failure to measure peripheral vascular resistance in these studies confounds full interpretation of the findings.

Mental stress and the cardiovascular system part II: Acute mental stress and cardiovascular disease

Abstract As in normal subjects, acute mental stress increases blood pressure measurements (sometimes to hypertensive levels) in subjects with cardiovascular disease. We found examples in the literature of acute mental stress increasing peripheral vascular resistance (as in isometric exercise) in patients with cardiovascular disease. We did not, however, find examples of acute mental stress decreasing peripheral vascular resistance (as in isotonic exercise) in subjects with cardiovascular disease. Acute mental stress commonly increases heart rate in subjects with cardiovascular disease. Angina pectoris or other evidence of ischemia may accompany this increase in heart rate. Acute mental stress may alter cardiac electrical stability and lead to arrhythmias—some life-threatening. Acute mental stress may provoke coronary artery vasoconstriction, reduce left ventricular ejection fraction, or induce or exacerbate left ventricular wall motion abnormalities in subjects with cardiovascular disease. In particular, anger among subjects with cardiovascular disease may leave them vulnerable to cardiac complications.

Lifespan of male attorneys: Preliminary findings

Background Our objective was to test the hypotheses that trial attorneys have shorter lifespans than other attorneys, and that attorneys in general have a shortened lifespan compared with the general population. Methods Using obituaries from the Annual Report of the Virginia State Bar, we compared the lifespans of male trial attorneys with those of male non-trial attorneys. We also compared these findings with the lifespans of males in the general population. Results For white male attorneys in Virginia, the mean ± SD age at death was 66.2 ± 12.6 years for 250 trial attorneys and 65.0 ± 12.5 years for 598 non-trial attorneys. This was not statistically significant. The lifespans of both trial and non-trial attorneys exceeded those of the general population. Conclusion This small preliminary study showed that the occupation of male trial attorneys does not shorten their lives, and that male attorneys, in general, do not have shortened lifespans compared with the general population.