R. Steele-Rosomoff

Relationships between Functional Capacity Measures and Baseline Psychological Measures in Chronic Pain Patients

The extent to which baseline psychological measures, pain, and compensation status are related to admission and posttreatment functional capacity and employment outcome was investigated. Four pass/fail functional capacity tests based on the DOT (Dictionary of Occupational Titles) classification system and previously shown to be predictive of treatment outcome in chronic pain patients were analyzed in relation to baseline measures of depression, state and trait anxiety, and perceived stress. Statistical tests of all measures with employment level at admission to treatment, 1 month follow-up and at long-term follow-up were also performed. The results showed that pain level and/or compensation status were the primary predictors of functional capacity and employment status at follow-up. Admission functional capacity measures were also predictors of employment outcome. Depression scores at admission predicted some admission functional capacity results, however, psychological scores were not as significantly related to discharge functional capacity tests. One functional capacity test, the crouching test, was an independent predictor of short- and long-term employment outcome. Trait anxiety was the only psychological factor that was independently predictive of long-term employment outcome. In conclusion, these results suggest that psychological variables are related to measures of functional capacity measured at admission. However, psychological measures at admission are not good predictors of later functional capacity measures. Functional capacity measures are important predictors of follow-up employment outcome, but return to work cannot be predicted without taking pain into account.

Pain facilities: A review of their effectiveness and referral selection criteria

This article first provides a definition of a pain facility, then describes types of pain facilities and treatments available at these facilities. In addition, a review of the meta-analytic evidence for the effectiveness of pain facility treatment is provided. Finally, the authors suggest a number of criteria by which a physician can make a decision for or against potential referral to a pain facility.

'Movement' in work status after pain facility treatment

Study Design This was a randomized prospective follow‐up study of pain facility treatment of chronic pain patients with low back pain, with return to work and work capacity as the outcome measures. Objectives To determine if after pain facility treatment chronic pain patients “move” in and out of work and in their work capacity; to determine the patterns of “movement;” and to determine the post‐pain facility treatment follow‐up sampling time points that would maximize the number of chronic pain patients correctly classified according to their final work and work capacity status. Summary of Background Data Past research and empiric observation have indicated that chronic pain patients may “move” after pain facility treatment in and out of work and in their job work capacity. Such “movement” can affect the results of outcome studies. Methods Two hundred thirty‐six consecutive chronic pain patients who fit study selection criteria were followed up at 1, 3, 6, 12, 18, 24, and 30 months after pain facility treatment for determination of work and work capacity status and separated according to the pattern of movement. Stepwise discriminant analysis was used to answer the study objectives. “Movement” in and out of work for these chronic pain patients also was compared with the US general population. Results Chronic pain patients demonstrated eight work and four work capacity movement patterns. The 24‐ and 1‐month time points predicted final work status correctly for 97.0% and 77.0% of the chronic pain patients, respectively, whereas the most significant predictor for correct work capacity status was the 24‐month point. The annual percentage change in employment status for these chronic pain patients was more than in the US general population. Conclusions Because chronic pain patients “move” in and out of employment and for work capacity status after pain facility treatment, future outcome studies using these measures will have to consider carefully the impact of “movement” on their results.

II. Do chronic pain patients' perceptions about their preinjury jobs differ as a function of worker compensation and non-worker compensation status?

OBJECTIVES (1) To demonstrate a relationship between intent to return to preinjury job and preinjury job perceptions about that job; and (2) to demonstrate that worker compensation chronic pain patients (WC CPPs) would be more likely than non-worker compensation chronic pain patients (NWC CPPs) not to intend to return to a preinjury type of job because of preinjury job perceptions. STUDY DESIGN The relationship between preinjury job perceptions and intent to return to the preinjury job was investigated and compared between worker compensation (WC) and nonworker compensation (NWC) chronic pain patients (CPPs). Within the WC and NWC groups CPPs not intending to return to their preinjury type of work were compared to those CPPs intending to return on preinjury job perception. BACKGROUND DATA Compensation status, being a WC CPPs or being a non-WC CPPs, has been claimed to be predictive or not predictive of return to work post pain treatment. These studies have, however, ignored the preinjury job stress perception variable as an area of research. METHODS WC CPPs were age- and sex-matched to NWC CPPs and statistically compared on their responses to rating scale and yes/no questionnaires for intent to return to work and perceived preinjury job stress. In a second analysis, both the WC and NWC groups were divided according to their intent to return to work and statistically compared on their responses to these questionnaires. RESULTS Both male and female WC CPPs were less likely than their counterparts to intend to return to their preinjury job. Both WC and NWC were found to complain of preinjury job complaints, and these complaints were found to differ between WC and NWC CPPs. An association between intent not to return to work and the perceptions of preinjury job dissatisfaction and job dislike was found for male and female WC CPPs and for male and female NWC CPPs. CONCLUSIONS There may be a relationship between some preinjury job perceptions and intent to return to the preinjury type of work in some groups of CPPs. However, a specific relationship between WC status, intent not to return to the preinjury type of work, and preinjury job perceptions in comparison to NWC CPPs could not be demonstrated.

Millon Behavioral Health Inventory norms for chronic pain patients

The Millon Behavioral Health Inventory (MBHI) is being used more widely in pain treatment settings; however, normative data on a large sample of chronic pain patients have not been published. In the present study, norms were established for 247 chronic pain patients. The chronic pain patient norms then were compared statistically to norms for non-medical population. Overall, the results showed that the score distributions for chronic pain patients and normals were similar on most MBHI scales. The differences that were found are consistent with other research on pain patients and indicate that chronic pain patients are more likely to be depressed and anxious. Differences in scales between chronic pain patients and controls may be explained by state vs. trait factors. In evaluating chronic pain patients by personality tests, one needs to keep in mind state-trait problems and their potential influence on test results.

Modafinil for the treatment of pain-associated fatigue: review and case report.

Fatigue is a symptom that is frequently found in chronic pain patients with low back pain and/or neck pain. At the present time, no specific psychopharmacological treatment for this problem has been identified. Modafinil is a wakefulness-promoting agent that the FDA has approved for the treatment of excessive daytime sleepiness associated with narcolepsy. There have been reports on the use of modafinil for the treatment of fatigue in various neurological syndromes. This literature is reviewed. As such, modafinil treatment was initiated for a patient with severe fatigue associated with chronic low back pain and neck pain. There was dramatic improvement in fatigue and associated function. This case is described. It is the first such case report in the literature. The significance of this finding to the treatment of pain-associated fatigue is discussed.

Chronic pain patients who lie in their psychiatric examination about current drug/alcohol use

Convergent lines of evidence indicate that one can expect a high rate of suicide death for chronic pain patients. However, this problem has never previously been systematically examined. From our patient follow-up data we became aware of three chronic pain patients (2 males and 1 female) who completed suicide. These three cases are presented. The sequential nature of our data enabled us to calculate suicide rates (number of suicides per 100,000 patients per year) for a sub-sample of our chronic pain population. These suicide rates are as follows: 16.5 females per year; 29.3 males per year; 57.1 white males in the age range 35-64 per year and; 78.6 white worker compensation males in the age range 35-64 per year. These results indicate that chronic pain white males and chronic pain white worker compensation males in the age range 35-64 years are twice and three times as likely, respectively, as their counterparts in the U.S.A. general population, to die by suicide. Initial evidence indicates that chronic pain and worker’s compensation status in 35-64 year old white males may be suicide death risk factors. These results indicate a great need for future research in this area and a careful psychiatric evaluation for suicide potential with all chronic pain patients.

Postural correction for protective scoliosis using physical therapy and biofeedback

Two cases which demonstrate the utility of physical therapy in conjunction with electromyographic (EMG) biofeedback for correcting maladaptive back posture resulting from low back pain, are presented. Both cases involved males, aged 29 and 33 years, who, at the time of admission, had suffered low beck pain for periods of 3 to 5 years. In each case, the pain was on the left side with radiation down the left side. Both patients evidenced protective scoliosis by a lateral shift of the thoraco-lumber region away from the painful side as well as decreased left side weightbearing. Physical therapy involved physical modalities, traction, postural exercises, and menue 1 stretching. EMG biofeedback was used to identify abnormal peraspinal muscular activity and to train each patient to eppropriately use these muscles to correct posture. In both cases, the treatment combination of physical therapy and biofeedback wes successful in correcting posture and reducing pain. We conclude that physical therapy coupled with biofeedback can be en effective treatment regimen for some pain patients with maladeptive postures even in the presence of radicular type symptoms. The success of this approach in these two patients indicates a need for some further studies of this approach.

Are myofascial pain syndrome (MFS) physical findings associated with Residual Radiculopathy (RR)

METHODS: This study was approved by the Institution Committee on Human Use. Patients admitted for assessment to the Chronic Pain Management Program were asked to complete a detailed patient assessment inventory, which provided information concerning demographic data, depression, as well as characterization and treatment of their pain complaint. in addltlon, they were asked to complete the Eysenck Personality inventory (EPI). The patient on admission underwent structured interviews and clinical examination. Patients were diagnosed as having myofasciai pain disorder according to the criteria of Travel1 and Simons. The psycho/social proftles of these patients were then defined and oompared statistically to the other diagnostic categories of pain patients.

Magnesium levels in chronic pain patients

METHODS: A vocabulary selection was made from previous Spanish MPQ adaptations and :;ranslaticns. already published, medical literature and pain patients. After gathering 261 descriptors, a selection was made of these and the final number was substantially reduced. The selection of descriptors as well as their ordering into classes and subclasses were carried out by different groups of 30 university graduates (15 psychologists and 15 filologists), 30 medical doctors and 30 pain patients. The final vocabulary was formed with those words which had been selected with the highest frequency. Next, an intensity value was assigned to each descriptor using a visual analogue scale. Those words which proved to have a significant level of at least 5 % of intensity variation were finally selected.