Richard Catchlove

Effects of a directive return to work approach in the treatment of workman's compensation patients with chronic pain

Abstract The incidence of work resumption of two groups of differentially treated workmans compensation patients with chronic pain was retrospectively examined. Significantly more patients who were directed to return to work during the treatment program (group II) did so (60%), than did patients in another group (group I) who were similarly treated but for whom work return was not a component of therapy (25%). At follow‐up an average of 9.6 months later, 90% of the group II patients were still working. As well, patients in group II were receiving fewer compensation benefits and had received less additional treatment for their pain than group I patients.

Psychological predictors of pain expression and activity intolerance in chronic pain patients

Abstract Recent research suggests that communicative and protective pain behaviors represent functionally distinct subsystems of behavior associated with pain. The present research examined whether components of pain experience such as pain severity, catastrophizing and fear of pain were differentially associated with communicative and protective pain behaviors. It was predicted that pain severity would be associated with decreased physical tolerance and heightened expression of pain behavior. It was also predicted that pain catastrophizing would be preferentially associated with communicative pain behaviors, and fear of pain would be preferentially associated with protective pain behaviors and decreased physical tolerance. To test these predictions, work‐disabled patients with musculoskeletal pain conditions (N = 72) were filmed as they participated in a simulated occupational lifting task. Multiple regressions revealed that pain severity was uniquely associated with decreased physical tolerance and increased expression of protective pain behaviors. Pain catastrophizing was uniquely associated with the expression of both communicative and protective pain behaviors. Fear of pain was associated with physical tolerance and protective pain behaviors but not when controlling for pain severity. This study provides additional evidence for the functional distinctiveness of different types of pain expression and provides preliminary evidence for the functional distinctiveness of pain expression and activity intolerance. Discussion addresses the processes by which psychological factors might influence the display of different types of pain behaviors. Discussion also addresses how different types of interventions might be required to specifically target the sensory and behavioral dimensions of the pain system.

The influence of communication goals and physical demands on different dimensions of pain behavior

&NA; The purpose of the present research was to examine the influence of communication goals and physical demands on the expression of communicative (e.g., facial grimaces) and protective (e.g., guarding) pain behaviors. Participants with musculoskeletal conditions (N = 50) were asked to lift a series of weights under two communication goal conditions. In one condition, participants were asked to estimate the weight of the object they lifted. In a second condition, participants were asked to rate their pain while lifting the same objects. The display of communicative pain behaviors varied as a function of the communication goal manipulation; participants displayed more communicative pain behavior when asked to rate their pain while lifting objects than when they estimated the weight of the object. Protective pain behaviors varied with the physical demands of the task, but not as a function of the communication goals manipulation. Pain ratings and self‐reported disability were significantly correlated with protective pain behaviors but not with communicative pain behaviors. The results of this study support the functional distinctiveness of different forms of pain behavior. Findings are discussed in terms of evolutionary and learning theory models of pain behavior. Clinical implications of the findings are addressed.

Psychological influences on repetition-induced summation of activity-related pain in patients with chronic low back pain.

Abstract This study examined the role of pain catastrophizing, fear of movement and depression as determinants of repetition‐induced summation of activity‐related pain. The sample consisted of 90 (44 women and 46 men) work‐disabled individuals with chronic low back pain. Participants were asked to lift a series of 18 canisters that varied according to weight (2.9 kg, 3.4 kg, 3.9 kg) and distance from the body. The canisters were arranged in a 3 × 6 matrix and the weights were distributed such that each ‘column’ of three canisters was equated in terms of physical demands. Participants rated their pain after each lift, and in a separate trial, estimated the weight of each canister. Mean activity‐related pain ratings were computed for each Column of the task. An index of repetition‐induced summation of pain was derived as the change in pain ratings across the six ‘columns’ of the task. Pain catastrophizing, fear of movement and depression were significantly correlated with condition‐related pain (e.g., MPQ) and activity‐related pain ratings. Women rated their pain as more intense than men, and estimated weights to be greater than men. A repetition‐induced summation of pain effect was observed where pain ratings increased as participants lifted successive canisters. Fear of movement, but not pain catastrophizing or depression, was associated with greater repetition‐induced summation of pain. The findings point to possible neurophysiological mechanisms that could help explain why fear of pain is a robust predictor of pain‐related disability. Mechanisms of repetition‐induced summation of activity‐related pain are discussed.

The use of cervical epidural nerve blocks in the management of chronic head and neck pain.

Cervical epidural blocks were used as part of a comprehensive multimodal treatment programme for patients with chronic benign pain in the head and neck. Forty-five patients had 141 blocks without major complications. The indications and role of blocks in pain management are discussed.RésuméOn a utilisé des épidurales cervicales à l’intérieur d’un plan de traitement global pour des patients présentant des douleurs chroniques de la tête et du cou. Quarante-cinq patients ont eu 141 blocs sans complication majeure. On discute du rôle et de l’ indication des blocs nerveux dans le contrôle de la douleur.

The Measure of Symbolic Function in Alexithymic Pain Patients

The archetypal test with 9 elements (AT9), a tracer of symbolic function, was completed by 30 pain patients in whom alexithymia had been measured by two means: the Beth Israel psychosomatic questionnaire (BIQ) and the Minnesota multiphasic personality inventory (MMPI) alexithymia scale. Results show a correlation of adequate statistical significance (p less than 0.05) between the AT9 and the BIQ but not with the MMPI alexithymia scale. The scored AT9 (SAT9) allows one to discriminate between forms and degrees of disorganization in symbolic activity within an alexithymic population. The AT9 measures something central to the construct of alexithymia and its advantages and possibilities over other tools to assess alexithymia are discussed.

Alexithymia. The development of a valid and reliable projective measure (the objectively scored Archetypal9 Test).

The aim of this study was to examine whether the Archetypal9 Test (AT9) could meet the need for a valid and reliable test with which to measure the alexithymic trait cluster. Participants in this study included 61 patients drawn from pain clinics in Montreal (Royal Victoria Hospital) and Detroit (Henry Ford Hospital) and 30 patients undergoing minor surgery at the Royal Victoria Hospital in Montreal. All 91 subjects took both the AT9 Test and the Clarke Vocabulary Scale. The results of the attempts at validation reveal that the objectively scored AT9 Test (SAT9) is a highly internally consistent instrument, that it has demonstrated construct validity, and that it can significantly discriminate between patient groups (pain patients and medical patients). The SAT9 is positively related to age, inversely related to occupational level, and uncorrelated with IQ (as measured by the Clarke Vocabulary Scale). The authors concluded that thus far, the SAT9 has proven to be a valid instrument which can be used to measure a central feature of alexithymia.

Contextual determinants of pain judgments

Abstract The objective of this study was to examine the influence of variations in contextual features of a physically demanding lifting task on the judgments of others’ pain. Healthy undergraduates (n = 98) were asked to estimate the pain experience of chronic pain patients who were filmed while lifting canisters at different distances from their body. Of interest was whether contextual information (i.e., lifting posture) contributed to pain estimates beyond the variance accounted for by pain behavior. Results indicated that the judgments of others’ pain varied significantly as a function of the contextual features of the pain‐eliciting task; observers estimated significantly more pain when watching patients lifting canisters positioned further away from the body than canisters closest from the body. Canister position contributed significant unique variance to the prediction of pain estimates even after controlling for observers’ use of pain behavior as a basis of pain estimates. Correlational analyses revealed that greater use of the contextual features when judging others’ pain was related to a lower discrepancy (higher accuracy) between estimated and self‐reported pain ratings. Results also indicated that observers’ level of catastrophizing was associated with more accurate pain estimates. The results of a regression analysis further showed that observers’ level of catastrophizing contributed to the prediction of the accuracy of pain estimates over and above the variance accounted for by the utilisation of contextual features. Discussion addresses the processes that might underlie the utilisation of contextual features of a pain‐eliciting task when estimating others’ pain.

The use of structured group therapy sessions in the treatment of chronic pain patients

Although group therapy is used in a number of multidisciplinary pain treatment centres, few published accounts of procedures are available. The present report describes the use of a moderately directive group therapy method, integrating psychodynamic, cognitive, and behavioural models of therapy. Content of sessions was structured to address problems specific to chronic pain patients. The therapist provided interpretations and confronted patients when appropriate. Problems encountered are described, and two examples are presented. Ideas for improved approaches to group therapy are discussed, with special emphasis on a method integrating physical and psychological therapy.

A Test to Measure the Awareness and Expression of Anger

The purpose of this project was to develop a reliable, objective and practical tool with which the awareness and expression of anger could be investigated. This paper gives a description of the Awareness and Expression of Anger Indicator (AEAI). The AEAI is a short and easy to use test. It provides a new objective assessment instrument of value in cases where deficits in affective processes, particularly anger, are suspected. 30 medical patients were tested with the AEAI. The investigators report a high inter-rater reliability in scoring the test. Four distinct response patterns emerged. Also, when confronted with the same anger-provoking stimulus, subjects responded significantly differently with respect to whether or not they felt angry, depending on the type of question. Traditional inducing questions, e.g.: Would you feel angry?, produced significantly more affirmative responses (reports of feeling angry) than non-inducing questions, e.g.: How would you feel? The contribution of the AEAI to chronic pain work is discussed.