The Clinical journal of pain
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Multicenter Study Comparative Study Clinical Trial
The utility of somatic items in the assessment of depression in patients with chronic pain: a comparison of the Zung Self-Rating Depression Scale and the Depression Anxiety Stress Scales in chronic pain and clinical and community samples.
To investigate the role of somatic items in the assessment of depression in chronic pain. ⋯ It was concluded that depression measures that give emphasis to somatic symptoms provide poor measures of depression severity in any individuals and in patients with chronic pain may lead to an overestimation of the severity of depression. More recently developed instruments avoid these limitations and are also better able to discriminate depression from related states such as anxiety and tension/stress.
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Randomized Controlled Trial Clinical Trial
Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction?
Clinical research of graded exposure in vivo with behavioral experiments in patients with chronic low back pain who reported fear of movement/(re)injury shows abrupt changes in self-reported pain-related fears and cognitions. The abrupt changes are more characteristics of insight learning rather than the usual gradual progression of trial and error learning. The educational session at the start of the exposure might have contributed to this insight. ⋯ Performance of relevant daily activities, however, were not affected by the educational session and improved significantly only in the exposure in vivo condition. All improvements remained at half-year follow-up only in patients receiving the exposure in vivo. These patients also reported a significant decrease in pain intensity at follow-up.
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No previous study has adequately demonstrated the test-retest reliability of the Short-Form McGill Pain Questionnaire, yet it is increasingly being used as a measure of pain. This study evaluates the test-retest reliability in patients with osteoarthritis. ⋯ Problems of adequate completion of the Short-Form McGill Pain Questionnaire were highlighted in this sample, and supervision via telephone contact was required. Patients recruited in clinic who had practiced completing the Short-Form McGill Pain Questionnaire demonstrated fewer errors than those recruited by mail. The Short-Form McGill Pain Questionnaire was demonstrated to be a highly reliable measure of pain. These results should not be generalized to a more elderly population, as increasing age was correlated with greater variability of the sensory component scores.
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In attempts to decrease chronic pain and the negative impact of chronic pain on broader functioning, patients can be stimulated to adopt self-management skills. However, not all patients are motivated to do so. Insight into the causes of motivation and the process of behavior change could increase the practitioners' effectiveness in stimulating patients to use self-management skills. ⋯ The present article reviews the 8 available publications in which the stages of change construct is studied in patients with chronic pain. The results show that the theory of the stages of change needs more articulation, that the operationalization should be more directly derived from the theory, and that the results from more appropriate tests of the theory should be used to change the theory when necessary to develop it. Recommendations are made with regard to the theory, the operationalizations, and the tests to be conducted to develop the theory and assess its validity.
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Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. ⋯ In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.