Ronald B. Margolis

a rating system for use with patient pain drawings

&NA; Patients entering treatment for chronic benign pain often are asked to complete drawings indicating the intensity and location of their pain as part of the diagnostic process. While inferences have been made from pain drawings about the relative contributions of physiological and psychological factors to the patients experience of pain, previous research has provided only equivocal support for this practice. A reliable method for assessing pain drawings is needed both for clinical use and to assess the validity of such interpretations. While a number of systems for using such drawings have been proposed, it is not always clear exactly what aspect of the drawing is being quantified. In this study, 101 patients who presented with chronic pain were asked to complete pain drawings which were than scored for the presence or absence of pain in each of 45 body areas. Scorers achieved a high rate of inter‐rater agreement with relatively little training. The body surface scores obtained were shown to correlate highly with the penalty point system developed by Ransford et al., suggesting that extent of pain may account for much of the variance in this system. The results are discussed in relation to the clinical and experimental uses for such a system.

Test-retest reliability of the pain drawing instrument

&NA; Test‐retest reliability of a pain drawing instrument was investigated. Pain drawings of chronic pain patients (n = 51) were scored for percentage of total body surface in pain and location of pain. A test‐retest reliability coefficient of r = 0.85 was calculated for a time interval that averaged 71 days. In addition, a percentage of agreement based on distribution of pain over time was calculated at 88.2%. The effect on reliability of age, gender and time‐interval differences was investigated. The utility of the pain drawing instrument as a measure of extent of pain and location of pain over time is discussed.

Application of the Trail Making Test in differentiating neuropsychological impairment of elderly persons.

This study investigated differences in Trail Making Test performance as a function of over-all level of neuropsychological impairment in a sample of elderly patients diagnosed as having various dementing diseases. Patients were classified as mildly, moderately, or severely impaired (ns = 19, 25, 26) based on the seven measures used to compute the Impairment Index of the Halstead-Reitan Neuropsychological Battery. The mean ages for the mildly, moderately, and severely impaired groups were 67.72, 71.56, and 71.16 yr., respectively. Using level of impairment as the grouping variable, subjects were compared on the mean number of seconds required to complete Trail Making Test A, B, and A + B. Three one-way analyses of variance indicated significant differences for Parts A, B, and A + B. As over-all level of impairment increased, time required to complete the Trail Making Test increased. Results are discussed and directions for further research are recommended.

Pain extent: relations with psychological state, pain severity, pain history, and disability

&NA; The present study examined relationships between pain extent and measures of psychological state, pain‐related disability, pain severity, and pain history in 416 patients with chronic pain. Previous research has examined the pain extent‐psychological state relationship and has generally concluded that it is weak. Results of multiple regression analyses in this study indicated a moderate association between pain extent and psychosomatic symptoms. Weaker relationships were obtained for depression, pain severity, and length of time in pain. Results are discussed in light of prior studies of psychological state and pain extent.

The Relationship of Anger, Depression, and Perceived Disability Among Headache Patients

SYNOPSIS

Teaching Humanistic and Psychosocial Aspects of Care: Current Practices and Attitudes

ObjectiveTo assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs.Design and participants: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985–1986. Response rate for two mailings was 71%.Measurements and main results: 78% of residency directors and 70% of department chairpersons bad high or moderately high levels of commitment to teaching bumanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the bumanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%).Conclusions: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

Prevalence of Temporomandibular Symptoms in a Large United States Metropolitan Area

The prevalence of five symptoms of temporomandibular disorder and associated symptoms of pain, headache, and stress was estimated in a random telephone survey of a large United States metropolitan area. The prevalences for nocturnal bruxing, joint noise with use, soreness on waking, soreness with use, and diurnal clenching were roughly equivalent (ranging from 8% to 12%) and were within the range of prevalences reported in previous studies. Overall, 149 of the 500 respondents reported one or more of the five symptoms. Symptoms were not more prevalent among women than men, but were more prevalent among younger respondents. Soreness on waking and daytime clenching were the only symptoms significantly associated with report of pain. Pain was more commonly reported by respondents with multiple (four or five) symptoms. The results are compared with those of previous random surveys, and limitations to generalization of the present findings are discussed.

Psychological assessment in chronic pain.

Assessment of psychological status in chronic pain patients is an important aspect of evaluation and treatment in pain management programs. Unfortunately, most of the psychological tests used in common practice have not been used extensively with chronic pain patients. Normative and comparative data must be generated to allow for valid and efficient psychometric assessment. The present paper is a preliminary comparison of several instruments of potential usefulness in the assessment of anxiety and depression among pain patients (N = 34). The SCL-90-R appeared to offer the best combination of relevant data and efficient assessment. However, it was noted that there were significant intercorrelations among the SCL-90-R subscales, which suggests a unitary factor structure.

Help-seeking patterns of anxiety-disordered individuals in the general population

Abstract From a sample of the general population, 142 individuals who had been diagnosed by structured interview as having agoraphobia, social phobia, or obsessive compulsive disorder according to DSM-III criteria were asked if and where they sought help and how they found or would find treatment. Only 40% of the agoraphobics, 28% of those with obsessive compulsive disorder, and 8% of the social phobics reported having sought professional assistance. No demographic differences were found between help-seekers and non-help-seekers, except an equivocal finding suggesting that help-seekers were more likely to live in the city. Almost half of the help-seekers had not seen a mental health professional. Nonpsychiatric physicians and members of the clergy were most frequently cited as the first point of contact for locating treatment. Results suggest that most anxiety disordered individuals do not receive help from professionals with appropriate expertise. Greater involvement of physicians and the clergy may facilitate future attempts to increase public awareness of and access to effective treatments currently available for anxiety disorders.

A cross-validation of two short forms of the WAIS-R in a geriatric sample suspected of dementia

This study investigated two short forms of the Wechsler Adult Intelligence Scale-Revised reported by Silverstein (1982). The short form IQs were calculated from test data of 42 geriatric patients with suspected dementia. The short form IQs were compared to the actual Full Scale IQs. Correlations between the two and four subtest short forms and the actual IQs were .93 and .96, respectively. In addition, the two subtest short forms correctly classified 67% of the sample on the basis of Wechslers intelligence categories, and the four subtest short forms correctly classified 83% of the sample. It was concluded that these short forms should not be used when a precise IQ assessment is required; however, they may be useful for various screening purposes.