Michael R. Thomas

Chronic pain and depression: A review.

Abstract An interesting association has long been observed between chronic benign pain and depression. Some investigators have even suggested that chronic pain is indeed a particular form of depressive illness. A close examination of literature reveals many fundamental problems with such claims. Research in this area is generally weak and while there may be an interesting relationship between depression and chronic pain both at the psychosocial and biochemical levels, it would be a gross error to equate chronic pain with clinical depression. Chronic pain is not a primary psychiatric disorder.

Patient expectations about success of treatment and reported relief from low back pain

Abstract Expectations of success from medical treatment for back pain was measured in 95 patients seen at a hospital orthopaedic clinic. The degree of subjective relief provided by several different medical treatments were compared. Moderator effects of self-concept, depression and demographic variables were studied. Patient ratings of reduced pain and amount of general relief provided by treatment were differentially correlated with self-concept, depression and demographic variables. Results indicate patient ratings of general relief after treatment are complex and not simply a measure of pain reduction.

Pain and the Use of Health Services among the Elderly

This study examined pain management strategies and the relationship of pain to the use of health services in a sample of community-resident Canadian elderly. Analyses with the Andersen-Newman framework of need, enabling and predisposing variables revealed that pain did not make an incremental contribution to explaining service use. Traditional measures of need for services accounted for the majority of explained variance in health service use. The substantial number of participants who were found to be coping with chronic, frequent pain relied on themselves as much as formal health services for dealing with their pain. The most common coping style for these pain sufferers was a combination of analgesics and accepting mild pain as part of daily life. This combination of medical intervention and attitudinal factors appears to make the coping process very manageable.

Pain, depression, and illness behavior in a community sample of active elderly persons: elderly persons with and without pain. II

Pain, depression, and illness behavior were investigated in a group of 56 elderly persons. Of the subjects, 76.7% reported having pain complaints. The pain group was significantly different from the pain-free group on three of the seven scales of the Illness Behavior Questionnaire. Botrh groups obtained relatively high scores on the Denial Scale, suggesting that denial was used to fend off fear of disease and death. The two groups were nondepressed on the Beck Depression Inventory.

Pain patients and marital relations.

Fifty-one subjects with chronic pain were assessed for couple functioning utilizing the Family Adaptability and Cohesion Evaluation Scale. In addition, they completed the Beck Depression Inventory. Results revealed serious difficulty in virtually all aspects of couple functioning for the subjects. Depressed subjects reported a higher level of couple dysfunction than the nondepressed group. Duration of pain was found to be unrelated to family adaptability, family cohesion, and family stability.

A comparative study of Canadian nonclinical and British pain clinic subjects

Forty-six pain clinic patients (British) were compared with 143 nonclinical subjects (Canadian) on a variety of demographic and illness variables. A subset of 43 nonclinical subjects was further compared with the 46 pain clinic patients for depression and illness behaviour. Both groups were well matched for age, sex, and marital status. The nonclinical group was better educated and had higher incomes. The nonclinical group was significantly more socially active. Low back pain, joint pain, and head and chest pain were commonly reported by both groups. Nearly 75% of subjects in both groups were aware of the diagnosis for their pain condition. On Beck Depression Inventory both groups scored in the nondepressed range. On the Illness Behaviour Questionnaire the pain clinic group scored significantly higher on disease conviction. somatization, and denial than did the nonclinical sample.

Memories of pain: comparison of "worst pain ever" experienced by senior citizens and college students.

Abstract:A total of 124 senior citizens were compared with 99 college students for their memory of worst pain experience and the action they undertook to deal with that experience. Seniors recalled very recent pain experiences, as did the students. There were major differences in their description of the worst pain experience and also how they had their pain problems dealt with. Implications of these findings are discussed.

Nature of marital relations among chronic pain patients

Fifty-two chronic pain patients and their spouses were evaluated for their marital relations utilizing the FACES III. In most areas of family functioning the couples provided evidence of difficulties and demonstrated a significant level of agreement about the nature of the problems. On the circumplex model the couples were functioning at the mid-to extreme-range. This study suggests that marital difficulties among chronic pain sufferers may indeed be pervasive.

Development of a diagnostic checklist for low back pain patients.

The study of psychosomatic disorders implies that environmental variables, as well as attitudes and personality, can influence an individuals physical health. The present study developed a checklist composed of demographic and psychological variables to help to make diagnostic decisions related to chronic low-back pain. The need for the checklist stems from the situation that medical clinical evidence is often inconclusive to identify the etiology of patient complaints of low back pain. Cut-off scores on the checklist were able to discriminate with greater than 80% accuracy patients who received a specific medical diagnosis from patients who received a non-specific medical diagnosis. The findings provide additional support for procedures used to make difficult diagnoses of low back pain.

The changing nature of pain complaints over the lifespan

Part I: Introduction. 1. Life Transition Perspective and Chronic Pain: An Overview. Part II: Pain Issues in Adolescents and Young Adults. 2. Coping with Chronic Pain during Adolescence: Juvenile Rheumatoid Arthritis (JRA) in Perspective. 3. Common Chronic Pain Conditions in a Nonclinical Population of Young Adults. 4: Chronic Pain and Family Function in College Students. Part III: Pain Issues and Middle Age. 5. Epidemiology of Chronic Pain and Related Issues in the Middle Years. 6. Transitional Issues during the Middle Years: Stress and Strain and Chronic Pain. 7. Families of Chronic Pain Patients: Help or Hindrance? Part IV: Pain Issues and the Elderly. 8. Epidemiology of Chronic Pain in the Elderly. 9. Role of Psychopathology in Chronic Pain in the Elderly. 10. Social and Family Issues of the Elderly Chronic Pain Patient. 11. Epilogue. References. Index.