Paul Karoly

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.

Assessing global pain severity by self-report in clinical and health services research

In this article, the assessment of global pain severity in clinical and health services research is considered. Specifically, the focus is on assessing pain during a defined period by retrospective self-report. Evidence is reviewed that indicates that it can be useful to regard pain severity as a global construct measured by pain intensity and interference with activities. In contrast, pain experience per se is more usefully regarded as multidimensional. Research on methods of assessing key dimensions of pain experience is reviewed, including pain intensity, affect, and chronicity. The authors suggest that global pain severity (made up of pain intensity and interference with activities) and pain persistence (chronicity) should be focal points for brief pain assessment. Two brief measures of pain severity are reviewed that provide practical, reliable, and valid approaches to pain assessment in clinical and health services research.

Self-control: A behavioristic excursion into the lion's den

The concept of ‘self-control,” until recently embedded in intrapsychic personality theories and banished from strict behavioral accounts of human activity, is considered from the perspective of a closed-loop learning paradigm. In considering self-regulatory and self-control behavior, an attempt is made (1) to extricate these concepts from the realm of philosophical debate on the image of man, (2) to point to their growing relevance in the context of rapidly changing environments, (3) to provide behavioral definitions and a tentative and testable process model, and (4) to outline their clinical (therapeutic) implications. The current conceptualization emphasizes (a) the contractual elements in self-control, (b) the critical importance of insuring the link between intentions (often of a verbal variety) and behavioral execution, and (c) the interdependence of external and internal controlling variables. In a larger context, the paper seeks to show how mans “selfreflectiveness” can be incorporated within an empirically based behavior theory. Suggestions for research are presented.

Fear-avoidance model of chronic pain: the next generation.

Objective:The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. Methods:A narrative review. Results:There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. Discussion:To address these 3 key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.

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.

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.

Fibromyalgia and women's pursuit of personal goals: A daily process analysis

For 30 days, 50 women with primary fibromyalgia syndrome reported daily progress and effort toward a health-fitness and a social-interpersonal goal and the extent to which their pain and fatigue hindered their accomplishment. They also carried palmtop computers to assess their sleep and their pain, fatigue, and positive and negative mood throughout the day. Analyses of the person-day data set showed that on days during which pain or fatigue increased from morning to evening, participants perceived their goal progress to be more attenuated by pain and fatigue. Unrestorative sleep the night before predicted the following days effort and progress toward accomplishing health-fitness goals, but not social-interpersonal goals. Finally, participants who reported more progress toward social-interpersonal goals on a given day were more likely to evidence improvements in positive mood across the day, regardless of any changes in pain or fatigue that day.

Psychological “resilience” and its correlates in chronic pain: Findings from a national community sample

Abstract The display of effective functioning despite exposure to stressful circumstances and/or internal distress is often termed ‘resilience’. The study of resilience is believed to provide information about the nature of illness adaptation that is distinct from that obtained via the analysis of clinically impaired groups. In recent years, the concept of resilience has seen only limited exploration in the chronic pain literature. This article describes a multi‐step procedure that first identifies resilience among chronic pain sufferers selected from a national sample of adults and then examines a set of its psychological correlates. Using the Profile of Chronic Pain:Screen (PCP:S), administered to a national sample of adults with chronic pain, a resilient subsample was identified on the basis of high scores on a Severity scale (at least 1 SD above the mean) combined with low scores (at least 1 SD below the mean) on scales assessing Interference and Emotional Burden. An age‐ and gender‐matched non‐resilient subsample was then selected who scored high (at least one standard deviation above the mean) on Severity, Interference, and Emotional Burden. The results of a series of comparisons between the resilient and non‐resilient groups revealed significant differences favoring resilient individuals in coping style, pain attitudes and beliefs, catastrophizing tendencies, positive and negative social responses to pain, and health care and medication utilization patterns. The findings provide a preliminary foundation for further research aimed at understanding the nature and causal underpinnings of resilience in persons with chronic pain.

Social support and social norms: do both contribute to predicting leisure-time exercise?

OBJECTIVE To clarify the contribution of social support and social norms to exercise behavior. METHODS A sample of 363 college students completed a questionnaire that assessed social support and social negativity from friends, descriptive and injunctive social norms related to friends, perceived behavioral control, attitude, intention, and leisure-time exercise. RESULTS Esteem social support was the strongest predictor of total and strenuous leisure-time exercise (P < .001), and descriptive norm was a significant (P < .01 predictor of strenuous leisure-time exercise. CONCLUSION Social support and social norms contribute independently to our understanding of variation in the frequency of strenuous leisure-time exercise.