The Clinical journal of pain
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Comparative Study Clinical Trial
Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis.
This study examined the ability of two self-report questionnaires, the Beck Depression Inventory (BDI) and the Center for Epidemiological Studies-Depression Scale (CES-D), to discriminate between chronic pain patients with and without major depression. Since previous research has suggested that medical conditions such as chronic pain can influence the endorsement of items that measure neurovegetative symptoms of depression, the accuracy of each of these questionnaires was also assessed eliminating these items. ⋯ The results suggest that both questionnaires have good predictive validity among chronic pain patients, and decisions regarding the use of one questionnaire rather than the other may depend upon the goals of the user and the setting within which the questionnaire is used.
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Clinical Trial
The stability of pain coping strategies in young children adolescents, and adults with sickle cell disease over an 18-month period.
The current study assessed stability of pain coping strategies over an 18-month period in adults, adolescents, and young children with sickle cell disease. ⋯ As compared with the highly stable coping evidenced in adults with SCD, coping in children and adolescents with SCD is more variable. Thus, interventions should target children early before maladaptive coping patterns become entrenched.
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To determine the current status for the association of chronic pain and depression and to review the evidence for whether depression is an antecedent or consequence of chronic pain (CP). ⋯ Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution.
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The Coping Strategies Questionnaire (CSQ), a rationally constructed pain coping assessment instrument, was conceived to measure the extent to which patients used six different cognitive coping strategies and two behavioral coping strategies. A number of studies have factor analyzed the original scales but have not found a reliable factor structure. Recent studies by Turtle et al. and Swartzman et al. have obtained a five-factor solution performing exploratory factor analysis on the individual items. Robinson and associates from the University of Florida performed an item level exploratory factor analysis on a much larger sample (n = 965) and found a six-factor solution that was relatively supportive of the original rationally derived scales. The purpose of the present investigation was to perform a confirmatory factor analysis using the LISREL structural equation modeling program to compare these three different factor structures. ⋯ The results indicated that the Florida six-factor model was a better fit to the sample data than either of the five-factor models. Creation of the Coping Strategy Questionnaire Revised (CSQ-R), which retains 27 of the original items, is suggested.
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Clinical Trial
Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors.
Opiates are commonly used to treat patients with chronic nonmalignant pain. There is much controversy over the definition, incidence, and risk factors of prescription opiate abuse in chronic pain treatment. The present study, done at the Seattle VA Medical Center, was designed to create opiate abuse criteria, test inter-rater reliability of the criteria, apply the criteria to a group of chronic pain patients, and correlate the risk of opiate abuse with the results of alcohol and drug testing. ⋯ Prescription opiate abuse criteria for use in patients with chronic nonmalignant pain were designed. The criteria had good reliability and can be applied during normal clinic interactions. The percentage of chronic opiate users who become opiate abusers in pain treatment is within the range reported by others. Past opiate or alcohol abuse or psychosocial testing on clinic admission failed to predict who would become an opiate abuser. The criteria can be used to identify patients who will subsequently require more intensive treatment or intervention or can be used as an outcome to measure to test the effectiveness of treatment strategies.