Mark P. Jensen

The measurement of clinical pain intensity: a comparison of six methods

&NA; The measurement of subjective pain intensity continues to be important to both researchers and clinicians. Although several scales are currently used to assess the intensity construct, it remains unclear which of these provides the most precise, replicable, and predictively valid measure. Five criteria for judging intensity scales have been considered in previous research: (a) ease of administration of scoring; (b) relative rates of incorrect responding; (c) sensitivity as defined by the number of available response categories; (d) sensitivity as defined by statistical power; and (e) the magnitude of the relationship between each scale and a linear combination of pain intensity indices. In order to judge commonly used pain intensity measures, 75 chronic pain patients were asked to rate 4 kinds of pain (present, least, most, and average) using 6 scales. The utility and validity of the scales was judged using the criteria listed above. The results indicate that, for the present sample, the scales yield similar results in terms of the number of subjects who respond correctly to them and their predictive validity. However, when considering the remaining 3 criteria, the 101‐point numerical rating scale appears to be the most practical index.

Coping with chronic pain: a critical review of the literature

&NA; A growing number of investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. This article reviews the empirical research which has examined the relationships among beliefs, coping, and adjustment to chronic pain. Although preliminary, some consistent findings are beginning to emerge. For example, patients who believe they can control their pain, who avoid catastrophizing about their condition, and who believe they are not severely disabled appear to function better than those who do not. Such beliefs may mediate some of the relationships between pain severity and adjustment. Although coping strategies appear to be associated with adjustment in chronic pain patients, methodological problems limit conclusions regarding the strenght and nature of this association. Our recommendations for future research include the development of coping and belief measures which: (1) do not confound different dimensions (e.g., coping, beliefs, and adjustment) in the same measure; (2) assess specific (rather than composite) constructs; (3) are psychometrically sound; and (4) assess behavioral coping strategies more objectively. We also recommend a greater use of experimental research designs to examine causal relationships among appraisals, coping, andadjustment.

Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?

Abstract Physical and psychosocial disability in patients with chronic pain have been shown to be associated with patients pain‐related beliefs, tendency to catastrophize, and pain coping strategy use. However, little is known about whether beliefs, catastrophizing, and coping strategies are independently associated with patient adjustment. Identification of specific beliefs, cognitive responses, and coping strategies strongly and independently associated with physical and psychosocial functioning would suggest the importance of targeting those variables for modification in treatment. One hundred sixty‐nine patients entering a multidisciplinary pain treatment program completed measures of pain, beliefs, coping, catastrophizing, physical disability, and depression. Principal components analyses were used to create belief and coping components, which were then entered in multiple regression analyses predicting physical disability and depression. Belief scores significantly and independently predicted both physical disability and depression, after controlling for age, sex, pain intensity, catastrophizing, and coping. Coping scores significantly and independently predicted physical disability, but not depression, whereas catastrophizing independently predicted depression, but not physical disability. These findings suggest the importance of targeting specific pain‐related beliefs and coping strategies, as well as catastrophizing, for modification in the treatment of patients with chronic pain.

Relationship of pain-specific beliefs to chronic pain adjustment

Cognitive-behavioral models suggest that pain patients beliefs about their pain play a critical role in their adjustment. This study sought to replicate and extend previous research that has examined the relationship between pain-specific beliefs and adjustment to chronic pain. Two hundred forty-one chronic pain patients evaluated for possible admission to an inpatient pain treatment program completed the Sickness Impact Profile (SIP) and the Survey of Pain Attitudes (SOPA), as well as measures of pain, medical services utilization and demographic characteristics. The results indicated that the beliefs that emotions affect pain, that others should be solicitous when the patient experiences pain, and (for subjects reporting low and medium levels of pain severity) that one is disabled by pain were associated positively with psychosocial dysfunction. The beliefs that one is disabled and that activity should be avoided because pain signifies damage were associated positively with physical disability. None of the beliefs assessed was significantly associated with number of physician visits in the previous 3 months, although belief in the appropriateness of medications for managing chronic pain was associated positively with pain-related emergency room visits. The results support a cognitive-behavioral model of chronic pain adjustment and suggest specific pain beliefs to target in treatment studies examining causal relationships between beliefs and adjustment.

The subjective experience of acute pain. An assessment of the utility of 10 indices.

Sixty-nine postoperative patients indicated the severity of their pain using eight measures designed to assess pain intensity and two designed to measure pain affect. The utility and validity of the 10 measures were evaluated according to two criteria: (a) the magnitude of the relationship between each scale and a linear combination of the pain measure, and (b) relatives rates of incorrect responding. The results indicate that each of the measures of the pain intensity is adequately valid. In addition, this sample of patients failed to differentiate pain intensity and pain affect using the present measures, suggesting the need for additional research to explore the validity of the affective measures employed in the study. The 11-point Box Scale (BS-11) of pain intensity demonstrated the strongest relationship to a linear combination of all of sample. All else being equal, these results suggest that the BS-11 scale may be the most useful clinical index of pain measurement—Postoperative pain—Pain intensity—Pain affect.

Coping with chronic pain: a comparison of two measures.

&NA; Cognitive‐behavioral models of chronic pain hypothesize that how a person copes with pain influences how well he or she adjusts to the pain. Several measures have been developed to assess pain coping, but no studies have yet examined whether these measures are complementary or redundant. In the current study, two pain coping measures (the Chronic Pain Coping Inventory, CPCI, and the Coping Strategies Questionnaire, CSQ) were completed by a large number (N=564) of primarily male veterans referred to a chronic pain program. Regression analyses indicated that the CPCI scales did not contribute unique variance to the prediction of depression over and above the CSQ scales. The CSQ Catastrophizing scale was the single most powerful predictor of depression, although several other CSQ scales (Coping Self‐Statements, Diverting Attention, and Increasing Behavioral Activities) also contributed. Both the CPCI and the CSQ contributed unique variance to the prediction of disability, although the CPCI scales appear to be more strongly related to disability than the CSQ scales. The CPCI Guarding scale was the single most powerful predictor of disability of all the coping responses assessed in this study. Other scales predicting disability were the CPCI Seeking Social Support, the CSQ Catastrophizing, and the CSQ Increasing Behavioral Activities. While both CSQ and CPCI contribute unique but modest variance to the prediction of pain severity, the CSQ Catastrophizing scale was the single most powerful predictor of pain severity. The findings of this study are consistent with cognitive‐behavioral models of pain. Future research will need to determine whether changes in coping responses (catastrophizing and guarding, in particular) merely reflect, or actually influence, adjustment to chronic pain. In the meantime, clinicians would be wise to give these coping responses particular attention in chronic pain programs.

The development and preliminary validation of an instrument to assess patients' attitudes toward pain

This paper describes the development and preliminary validation of a questionnaire designed to assess five attitudes considered important in the long-term adjustment of chronic pain patients. The specific subscales of the questionnaire were chosen to represent attitudes believed to influence the ways by which chronic pain patients manage their pain. Following the development of five reliable subscales, correlations of the subscales with self-reported pain behaviors and coping strategies were calculated, providing preliminary support for the concurrent validity of the instrument.

Patient beliefs predict patient functioning: further support for a cognitive-behavioural model of chronic pain.

According to the cognitive-behavioral model of chronic pain, patient beliefs about their chronic pain influence their behavioral and psychological functioning. Previous correlational and longitudinal studies have supported this hypothesis. However, since previous research has relied almost exclusively on patient self-report to assess both beliefs and functioning, shared method variance may explain some of the relationships found. The aim of the current study was to replicate and extend previous research on the relationship between pain beliefs and patient functioning and behavior by assessing the latter based on three sources of information: patient report, spouse report and direct observation. A total of 121 patients with chronic pain completed self-report measures of beliefs and function. Their spouses completed a measure of patient pain behavior, and both participated in a protocol, from which patient pain behaviors were coded by trained observers. Previously reported relationships between patient beliefs about pain and patient-reported functioning were replicated. Measures of patient beliefs were more strongly associated with self-report measures of pain behaviors and functioning than with spouse and observer ratings of patient pain behaviors. However, significant associations between patient beliefs and both spouse- and observer-reported frequency of patient pain behaviors were found. These findings argue for the generalizability of the relationship found between patient beliefs and patient behaviors across assessment domains, and for the continued application of the cognitive-behavioral model to the understanding of patient adjustment to chronic pain.

Pain-specific Beliefs, Perceived Symptom Severity, and Adjustment to Chronic Pain

AbstractCognitive theories of appraisal argue for the importance of beliefs as determinants of adjustment to stress. The current investigation sought to examine the relation between beliefs about chronic pain and adjustment in a group of chronic pain patients. Patients belief in themselves as disabled was found to be inversely related to activity level for patients reporting low and medium levels of pain severity. This same belief correlated with professional services utilization and was negatively related to psychological functioning. Believing in a medical cure for pain was also positively related to professional services utilization. Finally, an expressed belief in the appropriateness of solicitous responses from family members was negatively related to psychological functioning for patients reporting relatively low levels of pain. Although these findings support the broad-based hypothesis that the illness-relevant beliefs of chronic pain patients are associated with their multidimensional pain adjustment, they emphasize the importance of beliefs concerning whether or not one is disabled by pain. The findings also highlight the fact that the belief/functioning relation is not always direct and can be moderated by perceived pain severity.

Gender, sex roles, and attitudes toward war and nuclear weapons

The observation that men are usually more supportive of war than women had led several authors to suggest that masculinity plays a causal role in the decision to make war and stockpile nuclear arms. In order to examine the relationship between sex role orientation and attitudes towards war and nuclear weapons, gender and measures of sex role orientation were used to predict three attitudes about nuclear weapons and the use of military force. Two specific and two classes of hypotheses regarding the possible relationships among these variables were tested: masculinity, femininity, Masculinity × Femininity interaction, and Gender × Sex Role Orientation hypotheses. The results provided limited support only for the femininity hypothesis—that attitudes toward war are associated with feminine traits. However, neither masculinity nor femininity was found to be the only mediators of the gender/war attitude relationship, indicating that sex role orientation (and especially masculinity) should be given less emphasis when trying to explain the relationship between gender and attitudes toward war.