Thomas P. Guck

Multidisciplinary pain center follow-up study: Evaluation with a no-treatment control group

&NA; The long‐term efficacy of a multidisciplinary pain management center was evaluated by comparing 20 treated patients with 20 no‐treatment control patients who met the programs entrance criteria, wanted to participate, but could not because they did not have insurance coverage. At 1–5 years follow‐up, 60% of the treated patients met all of the criteria for success established by Roberts and Reinhardt, while none of the untreated patients did so. Treated patients reported less interference with activities, more uptime, lower pain levels, less depression, and fewer hospitalizations than untreated patients. Also, more treated patients reported being employed, while fewer used either narcotic or psychotropic medications at follow‐up compared to untreated patients. Pretreatment‐to‐follow‐up changes are reported for both the treated and untreated groups.

Pain-patient Minnesota Multiphasic Personality Inventory (MMPI) subgroups: Evaluation of long-term treatment outcome

Six hundred thirty-five chronic pain patients completed the Minnesota Multiphasic Personality Inventory (MMPI) prior to participation in a multidisciplinary inpatient pain treatment program. Three male and four female MMPI subgroups were identified by means of cluster analyses for each of two samples. Pretreatment and long-term follow-up differences were then examined among the MMPI subgroups. Results indicated that the subgroups identified in the present study closely resembled each other and those previously reported in the literature. However, at long-term follow-up only a few outcome differences were identified among male subgroups, while no differences were found among female subgroups. Possible explanations for no differential treatment outcomes among the MMPI subgroups are discussed.

Predictive validity of the pain and impairment relationship scale in a chronic nonmalignant pain population

OBJECTIVE To examine the predictive and incremental validity of the Pain and Impairment Relationship Scale (PAIRS) and to determine its ability to measure changes in pain beliefs following interdisciplinary treatment. DESIGN A before-after treatment design. SETTING A comprehensive interdisciplinary pain center at a large midwest university medical center. INTERVENTIONS A cognitive-behavioral approach to pain management. The day-long program lasted 5 days a week for 4 weeks. Interventions were designed to improve physical functioning, reduce use of health care, and improve pain coping. MAIN OUTCOME MEASURES Six-month follow-up outcome measures included interference with daily activity, pain severity, and life control as measured by the Multidimensional Pain Inventory, medication use measured by the Medication Quantification Scale, depression measured by the Beck Depression Inventory, and the number of health care visits and pain-related hospitalizations. RESULTS Pretreatment PAIRS scores correlated significantly with interference with daily activities, pain severity, life control, health care visits, and depression. Stronger correlations were obtained between posttreatment PAIRS scores and all follow-up outcome measures. Posttreatment PAIRS scores accounted for a significant portion of the variance beyond that in demographic variables and pretreatment PAIRS scores in all but one of the follow-up measures. PAIRS scores changed significantly (p < .0001 ) in a positive direction after treatment. CONCLUSIONS The PAIRS has excellent predictive validity, and can be used effectively to monitor individual and programmatic changes.

Medical student beliefs: spirituality's relationship to health and place in the medical school curriculum

The relationship between spirituality and health is receiving increased attention; consequently medical schools have begun asking how and in what manner these issues should be addressed in medical education. Unfortunately, student beliefs concerning spirituality and health have not been adequately assessed. This study examined medical student beliefs regarding the relationship between spirituality and health and the level of instruction spirituality should receive in the curriculum. Questionnaire results from 254 medical students indicated that religiousness and spirituality are important, with spirituality more important than religiousness. Spiritual practices were seen as more helpful for acute and mental health conditions than for chronic or terminal conditions and believed to be more helpful for coping with a health condition than healing tissue. Students believed that patients could benefit from spiritual practices more than they could for their own health conditions. Most students endorsed a lecture or one- to two-week seminar with instruction in the first or second year of medical school. Student spirituality was the only predictor of required level of instruction in the medical school curriculum. Practice points•Students from a Catholic medical school believe spirituality is a more important factor for health than religion.•Students from a Catholic medical school believe spirituality is most helpful for acute and mental illnesses.•Students from a Catholic medical school believe spirituality is helpful for coping with illness but not for healing tissue.•Students from a Catholic medical school endorse a lecture or one- to two-week week seminar on spirituality and health rather than a full course.•Students from a Catholic medical school prefer that spirituality and health issues be addressed in the first or second years of medical school.

Relationship between acceptance of HIV/AIDS and functional outcomes assessed in a primary care setting

Abstract Acceptance, a third wave cognitive-behavioral concept originally developed for chronic pain patients, was applied to acceptance of chronic illness in an HIV/AIDS population. This study examined the internal reliability of two scales of the chronic illness acceptance questionnaire (CIAQ) called activities engagement (AE), and illness willingness (IW), their relationships with functional outcomes, and their ability to predict functional outcomes after controlling for demographic and medical variables. Sixty-nine HIV-positive persons served as subjects while attending a routine visit at an urban Midwestern US Family Medicine clinic. Mean scores for the AE, IW, and total scales of the CIAQ were slightly higher than pretreatment, but slightly lower than post-treatment scores originally reported for chronic pain patients. Internal reliability values for AE, IW, and total scales of the CIAQ were excellent and consistent with those found in chronic pain acceptance studies. In addition, the AE and IW scales were significantly related to the criterion dimensions of depression, mental functioning, and physical functioning. In multiple regression analyses, it was found that only AE was a significant predictor of the three functional outcome measures beyond demographic and medical variables. In contrast, IW was not predictive of any of the three functional outcome variables.

Timed Up and Go (TUG) Test Normative Reference Values for Ages 20 to 59 Years and Relationships With Physical and Mental Health Risk Factors

Purpose: The Timed Up and Go (TUG) test is a reliable, cost-effective, safe, and time-efficient way to evaluate overall functional mobility. However, the TUG does not have normative reference values (NRV) for individuals younger than 60 years. The purpose of this study was to establish NRV for the TUG for individuals aged between 20 and 59 years and to examine the relationship between the TUG and demographic, physical, and mental health risk factors. Methods: Two hundred participants, 50 per decade (ages 20-29, 30-39, 40-49, 50-59 years) were selected at their primary care visit, and timed as they performed the TUG by standing up out of a chair, walking 3 m, turning around, walking back to the chair, and sitting down. Information regarding the risk factors socioeconomic status, body mass index, an index of multimorbidities, perceptions of overall physical and mental health was obtained and used as predictors of TUG time independent of age. Results: TUG times were significantly different among the decades (F = 6.579, P = .001) with slower times occurring with the 50-year-old decade compared with the 20s (P = .001), 30s (P = .001), and 40s (P = .020). Slower TUG times were associated with lower SES, higher body mass index, more medical comorbidities, and worse perceived physical and mental health. Regression results indicated that perceived physical and mental health accounted for unique variance in the prediction of TUG time beyond age, gender, and socioeconomic status. Conclusions: This study provided TUG NRV for adults in their 20s, 30s, 40s, and 50s. The TUG may have utility for primary care providers as they assess and monitor physical activity in younger adults, especially those with physical and mental health risk factors.

A psychosocial taxonomy of patients with diabetes: validation in a primary care setting

Aims  The aims of this study were (i) to extend a psychosocial taxonomy of patients with diabetes to a primary care setting, and (ii) to validate the taxonomy using more sophisticated clustering methods across an array of psychological dimensions independent of demographic and medical variables.

The Medication Quantification Scale: measurement of medication usage at a multidisciplinary pain center

Program evaluation standards require pain centers to assess medication use as one of an array of outcome criteria. The Medication Quantification Scale (MQS) has been introduced as a continuous method for quantifying medication use in chronic nonmalignant pain patients that overcomes methodological concerns inherent in previous pain medication measures. The reliability and sensitivity to program effects of the MQS was demonstrated by the original authors. The present study reexamined the reliability and sensitivity, and provided evidence for the validity of the MQS in an effort to determine whether use of the MQS can be generalized to other pain centers. Interrater reliability between two nurses on 40 pretreatment and 40 6-month follow-up MQS scores were .958 (p < .0001) and .968 (p < .0001) respectively. Six month follow-up MQS scores were significantly lower than pretreatment MQS scores (t = 5.40, p < .0001) for 106 chronic nonmalignant pain patients treated at a multidisciplinary pain center. Convergent and divergent validity of the MQS were demonstrated by higher correlations between the MQS and conceptually similar rather than dissimilar outcome measures. The reliability, sensitivity, and validity of the MQS was demonstrated suggesting it can be generalized for program evaluation purposes to other pain centers.

A brief primary care intervention to reduce fear of movement in chronic low back pain patients

Fear avoidance model of chronic pain-based interventions are effective, but have not been successfully implemented into primary care. It was hypothesized that speed walking times and key measures of the fear avoidance model would improve following the brief intervention delivered in primary care. A brief primary care-based intervention (PCB) that included a single educational session, speed walking (an in vivo desensitization exposure task), and visual performance feedback was designed to reduce fear avoidance beliefs and improve function in 4 patients with chronic low back pain. A multiple baseline across subjects with a changing criterion design indicated that speed walking times improved from baseline only after the PCB intervention was delivered. Six fear avoidance model outcome measures improved from baseline to end of study and five of six outcome measures improved from end of study to follow-up. This study provides evidence for the efficacy of a brief PCB fear avoidance intervention that was successfully implemented into a busy clinic for the treatment of chronic pain.

Pain assessment index: Evaluationfollowing multidisciplinary pain treatment

Abstract The Pain Assessment Index is a weighted composite of MMPI scales which has been shown tobe useful in predicting surgical outcome for chronic pain patients. In this study, 48 patients treated at a nonsurgical multidisciplinary pain clinic were categorized into predicted success (N=23) or predicted failure (N=25) groups based on their PAI scores. The groups did not differ on any of the pretreatment variables, and they differed on only one follow-up outcome measure. More patients in the predicted failure group reported using narcotics than did their predicted success group counterparts. Implications of these results and recommendations for future research are discussed. J Pain Sympt Manag 1987;2:23–27.