Mary Casey Jacob

Anger expression and chronic pain

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.

The pain behavior check list (PBCL): factor structure and psychometric properties

The construct of “pain behaviors” as observable and measurable manifestations of pain occupies a central role in Fordyces operant model of pain. The present study was designed to evaluate the multidimensional nature of the construct and to explore the psychometric properties of a newly developed self-report instrument called the Pain Behavior Check List (PBCL). Subjects were 126 chronic pain patients who completed an initial version of the PBCL and other standardized questionnaires as part of their evaluation by the West Haven VAMC. Factor analysis identified four factors labeled Distorted Ambulation, Affective Distress, Facial/Audible Expressions, and Seeking Help. Substantial reliability and stability estimates for the total PBCL and the subscales support the potential clinical and theoretical utility of the instrument.

Teaching the medical interview: an intervention study.

To study the effects of teaching specific interviewing techniques on verbal behaviors and on health outcomes, internal medicine residents working in a screening clinic were assigned to either an experimental or a control group. The entire clinic visit was audiotaped, transcribed, and coded according to the Verbal Response Mode (VRM) system. Residents in the experimental group were taught interviewing behaviors (patient exposition and physician explanation) that had been found in previous studies to be associated with patient outcomes. Through telephone interviews, patient satisfaction, compliance, and symptom status were determined for all patients. Two hundred and sixty-eight interviews (156 in the experimental group and 112 in the control group) were included in the study. Training did increase patient exposition and physician explanation, but did not affect health outcomes. Residents’ attitudes and behaviors during the training are described.

A prospective study of donor insemination recipients: secrecy, privacy, and disclosure.

OBJECTIVES To study prospectively the attitudes and behaviors of heterosexual couples undergoing donor insemination. DESIGN Couples undergoing donor insemination completed psychological questionnaires before treatment regarding psychiatric symptoms, self-esteem, marital adjustment, and their attitudes about privacy or disclosure. PARTICIPANTS Forty-one of 82 heterosexual couples participated. MEASURES A donor insemination questionnaire, a self-esteem scale, the Brief Symptom Inventory, and the Dyadic Adjustment scale were used. RESULTS Psychiatric symptoms, self-esteem, and marital adjustment were all in the normal range. The amount of time taken by the couple to decide to do donor insemination was not related to reported psychiatric symptoms, self-esteem, marital adjustment, or marital satisfaction. Ninety-five percent of the couples believed a psychological consultation should be a mandatory part of the donor insemination treatment. The greatest concern the couples had about the donor child was its genetic and medical background. Thirty-eight percent of the couples did tell or planned to tell others about using donor insemination to conceive, and only 27% of the couples planned to tell the child of his or her donor origin. CONCLUSIONS The results of this study support those of others, which have indicated that the majority of donor recipients are psychologically well adjusted and have average marital adjustment. In addition, this prospective study replicated the findings of other retrospective studies, indicating that most donor insemination recipients do not plan to tell the child of his or her donor origin. Additional prospective studies are needed to determine if attitudes and behavior regarding disclosure change over time.

Lesbian couples as therapeutic donor insemination recipients: do they differ from other patients?

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except that lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.

Toward an Integrative Diathesis-Stress Model of Chronic Pain

The devastating problem of chronic pain exemplifies the need for innovation in conceptualizing health problems and the importance of developing alternative health-care delivery systems. First, there is probably no greater source of stress and human suffering than the experience of pain. Researchers have estimated that one third of Americans suffer from persistent and recurrent pain (Bonica, 1981) with 35 million people suffering from low back pain alone (Bonica, 1980). In a survey of subscribers to a large community health maintenance organization, Von Korff, Dworkin, LeResche, and Kruger (1988) reported that 41% had suffered low back pain in the last 6 months. In the same sample, 26% had recurrent headaches, 18% reported abdominal pain, 12% had chest pain, and 12% had facial pain. The economic costs of chronic pain are equally staggering due to both direct health-care costs, including the purchase of prescribed and over-the-counter medications, and the indirect financial burden of underemployment, lost productivity, and disability compensation. As one example, Stone (1984) estimated the lifetime economic costs of rheumatoid arthritis to exceed

Career and leadership development: strategies in lean times.

20,000 per patient in 1977 dollars!

The Role of the Mental Health Professional in the Management of Chronic Pelvic Pain

To the Editor: These days, faculty and leadership development programs are often the first to fall under the budget ax. One idea for continuing to sponsor programs without the expense of outside speakers or tuition feeds is to utilize the expertise that the academic health center (AHC) has already paid for—that is, encouraging the faculty and administrators who have attended a high-quality program (e.g., a Harvard clinical chief program, an AAMC women faculty conference, ELAM) to share the skills they’ve acquired.

Psychological Aspects of Chronic Pelvic Pain in Women With Endometriosis

Chronic pelvic pain (CPP), defined as pelvic pain that is noncyclic and has persisted for more than 6 months, can be frustrating and demoralizing for the patient and is often a particularly enigmatic problem for the medical team. There are a number of gynecological conditions that can contribute to pelvic pain (e.g., endometriosis, pelvic adhesions, vulvovaginitis, vulvar vestibulitis, adenomyosis, and pelvic relaxation) as well as nongynecological conditions (e.g., irritable bowel syndrome, interstitial cystitis, urethral syndrome, and myofascial syndrome). Some patients will alternatively present with chronic pelvic pain but the medical workup may fail to determine a clear-cut etiology.

Frustrated Fertility: Infertility and Psychological Distress Among Women

For many women with endometriosis, chronic pain is the most challenging aspect of the disease. Because the illness is invisible to the casual observer, and generally isn’t life threatening, the woman with endometriosis and those around her may struggle to know how much attention and worry to accord it. It can be very difficult to accept that having so much pain does not imply an emergency. Chronic pain is a significant challenge to the physician as well as the patient. Physicians want to relieve suffering, and yet with chronic pain their task is sometimes to say, “I can’t fix it.”