Tim A. Ahles

The multidimensional nature of cancer-related pain

Abstract A critical review of the literature examining the assessment of cancer‐related pain revealed a lack of systematic research. In the present study, 40 patients with cancer‐related pain were compared to 37 pain‐free cancer patients matched on diagnosis, stage of disease, age, sex, and inpatient vs. outpatient status. The results supported a multidimensional conceptualization of cancer‐related pain consisting of sensory, affective, cognitive, and behavioral components.

Migraine and tension headache: A meta-analytic review

The relative efficacy of several psychological treatments for headache were compared to each other and to the effects of medication placebo using a procedure known as meta-analysis. Results showed that, for migraine headache, temperature biofeedback alone, relaxation training alone, or temperature biofeedback combined with autogenic training were equally effective and significantly superior to medication placebo. For tension headache, the results showed that frontal EMG biofeedback alone, or combined with relaxation training, or relaxation training alone were equally effective and significantly superior to medication placebo or psychological placebo. The latter two do not differ but are significantly superior to continued headache monitoring only.

Cancer-related pain—II. Assessment with visual analogue scales

As an attempt to develop an assessment methodology which is practical for use with severely ill cancer patients, Visual Analogue Scales (VAS) of pain, depression and anxiety were compared to standard measures of these variables in 29 outpatients and 11 inpatients suffering from cancer-related pain. Support for the validity of the VAS-Pain and VAS-Depression but not the VAS-Anxiety was found. These results demonstrate that the VAS-Pain and VAS-Depression provide a practical, valid method for assessing the sensory and affective components of cancer-related pain.

Cancer-related pain--I. Prevalence in an outpatient setting as a function of stage of disease and type of cancer.

Cancer-related pain is a clinical problem of enormous significance that has received relatively little scientific study. Most reports of its prevalence and treatment have examined inpatient populations with varying degrees of regard for the stage of disease and the presence of non cancer-related sources of pain. In the present study, 208 consecutive ambulatory patients with cancer were evaluated. Nearly half (47.9%) reported no pain during the preceding week, 33.5% had pain directly referable to their cancer and 6.7% were suffering from pain related to therapy for their cancer. A small group (11%) had pain readily attributable to a source other than their cancer. Patients with metastatic disease, particularly those with bone metastases, reported cancer-related pain significantly more often than patients with local and regional disease (p less than 0.001). Patients with lymphoma reported the presence of cancer-related pain significantly less often than patients in all other diagnostic categories (p less than 0.001).

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some time of the time

Abstract Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.

Cancer Pain: A Multidimensional Perspective

Cancer pain has traditionally been studied from a unidimensional/medical model. However, limitations of the medical model have led researchers to the development of multidimensional models of cancer pain. The current manuscript describes a multidimensional model of cancer pain with six components: physiological, sensory, affective, cognitive, behavioral and sociocultural. Research relevant to each component of the model is reviewed with an emphasis on future research directions.

Behavioral Treatment of Psychophysical Disorders

The behavioral treatment of psychophysiological disorders is reviewed with an emphasis on group outcome research and controlled, comparative group outcome studies. These behavioral treatments tend to fall into three categories: (I) biofeed-back training; (2) relaxation training; and (3) other behavioral techniques including assertiveness training and systematic desensitization. Guided by two inclusion criteria-seriousness as defined in terms of prevalence and mortality and the existence of a large body of research-this review discusses the following disorders: essential hypertensions, migraine headaches, muscle contraction headaches, asthma, ulcers, and colitis.

Electromyographic and vasomotor activity in tension, migraine, and combined headache patients: The influence of postural variation

Abstract Electromyographic (EMG) and temporal artery vasomotor activity was evaluated in three groups of headache patients (tension, migraine and combined) and nonheadache control subjects while in reclining, sitting and standing positions. Analysis of the EMG data revealed that at all measurement sites (bilateral frontalis, bilateral trapezius) the three headache groups demonstrated significantly higher levels than the nonheadache group but did not differ from each other. A secondary analysis of the trapezius EMG data revealed that a large percentage of headache patients had “normal” EMG levels in the reclining position but showed abnormalities in the sitting and standing positions. Analysis of the left temporal artery vasomotor activity revealed that all three headache groups vasoconstricted to a significantly greater extent than the nonheadache group in the sitting and standing positions. However, a diagnosis by position interaction was found for the right temporal artery with the migraine group demonstrating a unique pattern of activity.

Cancer-related pain. II. Assessment with visual analogue scales : J. psychosom. Res., 28 (1984) 121–124

As an attempt to develop an assessment methodology which is practical for use with severely ill cancer patients, Visual Analogue Scales (VAS) of pain, depression and anxiety were compared to standard measures of these variables in 29 outpatients and 11 inpatients suffering from cancer-related pain. Support for the validity of the VAS-Pain and VAS-Depression but not the VAS-Anxiety was found. These results demonstrate that the VAS-Pain and VAS-Depression provide a practical, valid method for assessing the sensory and affective components of cancer-related pain.