S. Abashian

Botulinum toxin in the treatment of myofascial pain syndrome

&NA; Six patients with chronic myofascial pain syndrome involving cervical paraspinal and shoulder girdle muscles received trigger point injections of botulinum toxin type A (Botox) or saline in a randomized, double‐blind, placebo‐controlled study. Four patients experienced reduction in pain of at least 30% following Botox, but not saline, injections, as measured by visual analog scales, verbal descriptors for pain intensity and unpleasantness, palpable muscle firmness, and pressure pain thresholds. Results were statistically significant. Botox, which inhibits muscle contraction by blocking the release of acetylcholine from peripheral nerves, appears to be an effective treatment for focal myofascial pain disorders.

Relationship of sexual and physical abuse to pain description, coping, psychological distress, and health-care utilization in a chronic pain sample

OBJECTIVE We investigated the association of physical/sexual abuse to pain description, coping, psychological distress, and health-care utilization in a heterogeneous sample of chronic pain patients. DESIGN A cross-sectional, retrospective design was used. Patients were categorized as abused (n = 22) or nonabused (n = 58) based on responses to a valid and reliable sexual/physical abuse questionnaire. MAIN OUTCOME MEASURES Pain description (Visual Analog Scale measures of pain intensity and frequency, and the McGill Pain Questionnaire); coping ability and attributional style (Functional Interference Estimate, Self-Control Schedule, Pain Locus of Control Scale); psychological distress (SCL-90-R Global Severity Index); and a Health-care utilization measure. RESULTS AND CONCLUSIONS No differences between abused and nonabused groups were found for the pain description or functional interference variables. Compared to the nonabused group, the abused group had significantly lower Self-Control Schedule scores, higher Pain Locus of Control Scale Chance Factor scores, and higher SCL-90-R Global Severity Index scores and was more likely to use the emergency room for pain symptoms. These results replicate the findings of previous studies of the effects of abuse in more specific pain samples and underscore the importance of assessment of abuse in patients with chronic pain. The data suggest that interventions which involve coping-skills training or self-control management of pain may be affected by an abuse history via reduced perceptions of efficacy, resourcefulness, and beliefs that external variables are responsible for pain.

Relationship between perceived self-control of pain, pain description and functioning.

&NA; Recent research has shown an association between preferred coping style and pain report. The present study explores in a sample of 51 patients with chronic pain of myofascial origin the relationship between a dispositional measure of coping, the internality dimension of the Pain Locus of Control Scale (PLOC), and ratings of pain intensity, frequency, and pain‐related behavioral functioning. Patients above the median on the internality dimension of the PLOC reported their pain as less intense and frequent than those below the median. No differences were noted on the behavioral functioning measures. Results are consistent with previous studies and indicate an association between ability to control pain and variations in magnitude and periodicity of pain. The clinical implication of the data is that strategies which provide reduction in pain intensity and frequency might be expected to result in increased perception of personal control of pain.

Relationship of pain drawing scores to ratings of pain description and function

We examined the relationship between pain distribution and measures of self-reported behavioral functioning, pain intensity, frequency, and quality in 51 patients with chronic pain. Results indicate that patients with more distributed pain report their pain as more disruptive to important areas of functioning and also report their pain as more intense and frequent. These results corroborate previous findings and suggest that pain distribution may be used as a useful clinical marker of disability status in chronic pain patients.

Pain locus of control scores in chronic pain patients and medical clinic patients with and without pain

Abstract: Objective:We investigated the association between treatment setting and pain control attributions as assessed by the Pain Locus of Control Scale (PLOC). Design: Nonrandomized consecutive samples. Patients and Setting: The patient groups included an outpatient pain clinic sample of chronic pain patients (n = 48), a group of medical clinic outpatients with chronic pain (n = 28), and a group of medical clinic outpatients without current pain (n = 22). Medical clinic patients without current pain were asked to reply to the PLOC items in terms of their usual response when experiencing pain. Results and Conclusions:Results indicated that pain clinic patients were the least likely of the three groups to report predictable control of their pain as reflected by their significantly lower “powerful other” and higher “chance” dimension scores. Medical clinic patients without pain reported greater personal control of pain than the other two groups as evidenced by their higher “internality” dimension score and lower “chance” dimension score. Results indicate that pain control appraisals differ among patients with chronic pain and illness as a function of the treatment setting and suggest that differences in cognitive appraisal can affect treatment efficacy.

Psychometric characteristics of a brief measure of pain-related functional impairment

This study presents reliability and validity data from two samples (pain clinic vs medical clinic) on a five-item self-report scale, termed the Functional Interference Estimate (FIE), designed to measure functional impairment associated with chronic pain. Results from the pain clinic sample demonstrated that the FIE is internally consistent and has satisfactory levels of test-retest reliability, item-total score correlations, and convergent validity. Results from the medical clinic sample demonstrated that the FIE discriminated between medical clinic patients without pain and both medical clinic patients with pain and pain clinic patients. The data support the use of the FIE as one of several available assessment methods for evaluation of pain-related functional impairment.

Relationship of learned resourcefulness to measures of pain description, psychopathology and health behavior in a sample of chronic pain patients.

OBJECTIVE We investigated the association between the coping style of learned resourcefulness and the variables of pain description, pain locus of control, psychological distress, and health-care utilization. DESIGN A cross-sectional, retrospective, correlational design was used. PATIENTS AND SETTING The sample was comprised of 87 outpatients from a university-based, multidisciplinary pain clinic. MAIN OUTCOME MEASURES Self-Control Schedule, pain intensity, McGill Pain Questionnaire, Pain Locus of Control Scale, SCL-90-R, Health-Care Utilization Questionnaire. RESULTS AND CONCLUSIONS Results indicated that chronic pain patients obtained comparable resourcefulness ratings to normal subjects but there were wide individual differences. Consistent with theoretical predictions, resourcefulness was found to be associated with better psychological adjustment and less impulsive health-care measures. Results suggest that assessment of learned resourcefulness may be useful in predicting behavioral outcome in clinical settings with chronic pain patients.