The assessment of anxiety and fear in persons with chronic pain: a comparison of instruments.

Instruments used to study anxiety and fear responses related to chronic pain vary along two dimensions. They differ in terms of the stimuli or situations that evoke anxiety responses and the types of anxiety responses included (i.e. cognitive, motoric, and physiological). This study examined relations of variables from the Pain Anxiety Symptoms Scale (PASS), the Fear-Avoidance Beliefs Questionnaire (FABQ), the Fear of Pain Questionnaire (FPQ), and the trait version of the Spielberger State-Trait Anxiety Inventory (STAI) with variables related to pain severity, perceived disability, and pain behavior. Subjects were 45 consecutive referrals to a university pain clinic who completed these measures during their evaluation. Results suggested that anxiety responses directly related to the patient's particular pain sensations are more relevant to the understanding of chronic pain than are more general tendencies to respond anxiously or fear more varied pain stimuli. Regression analyses showed that empirically selected subsets of the anxiety variables predict from 16 to 54% of the variance in pain severity, disability and pain behavior. Also, assessment of multiple anxiety response types appears useful for understanding pain behavior and disability. Further study of fear and anxiety responses of persons with pain is likely to benefit from careful selection of measures dependent on the stimulus and response dimensions assessed.

Long-term outcome of kidney-pancreas transplant recipients with good graft function at one year.

To assess the long-term outcome of kidney/pancreas transplantation, patients were identified who had good graft function at one year posttransplant and a minimum of 3 years' follow-up. Fifty recipients from 1987-92 met these criteria. Records were reviewed for graft survival, graft function, readmissions, and medical complications. Psychosocial adjustment and quality of life were assessed using the SCL-90-R and SIP surveys, respectively. Patient, kidney, and pancreas survivals were 94%, 86%, and 85% at five years (Kaplan-Meier), with a mean follow-up of 4.3 years. The 3 deaths were due to 2 sudden arrests at home (presumed to be cardiac events) and 1 episode of sepsis. Other graft losses were due to rejection, except for one case of sepsis. The remaining patients are normoglycemic (glucose 92 +/- 23 mg/dl) and have a creatinine of 1.8 +/- 0.6 mg/dl. Mortality after the first year was 0.9%/year. Estimated kidney and pancreas half-lives were 15 +/- 2 and 23 +/- 7 years, respectively. Hospitalization, acute rejection, graft pancreatitis, dehydration, and severe infections all decreased dramatically after the first year. While CMV was the most common infection in the first year, foot infections predominated thereafter. Retinal hemorrhage was infrequent. Sudden death (presumably cardiac) was the chief cause of mortality, while peripheral vascular disease resulted in several amputations. Fractures were common, suggesting the need for increased attention to bone demineralization. Psychosocial and quality of life evaluations were within normal limits. In conclusion, most complications specifically related to transplantation occur in the first year, but underlying disease renders these patients susceptible to a variety of cardiovascular, bone, and other disorders.

Social desirability, perceived stress, and PACT ratings in lung transplant candidates: A preliminary investigation.

Some aspect of psychosocial criteria is commonly utilized by most transplant programs in assessing candidates' acceptability for transplantation. However, regardless of the assessment methodology, information obtained in pretransplant assessments may be limited given the evaluative nature of the assessment as well as the sensitive nature of the contents. Indeed, transplant candidates may present themselves in a favorable fashion, minimizing any negative traits or psychological dysfunction which they perceive might prevent transplantation. Unfortunately, there are limited data addressing the extent to which transplant candidates may present themselves in an overly positive light. This investigation surveys the prevalence of social desirability in lung transplant candidates as well as its association with self-reports of perceived stress. Further, the relationship between social desirability and interviewer ratings of transplant candidacy is examined. Subjects included 24 patients in end-stage organ failure being evaluated for lung transplant candidacy. Subjects completed the Perceived Stress Scale and a brief version of the Marlowe-Crowne Social Desirability Scale. Additionally, subjects were interviewer-rated on the Psychosocial Assessment of Candidates for Transplantation. Results indicate social desirability is a prevalent phenomenon in lung transplant candidates, with more than half of the sample scoring at or above the 84th percentile on the social desirability measure. Further, self-reports of perceived stress are moderately and inversely associated with social desirability (r=-.55,p ≤ .01). Social desirability was unrelated to interviewer-ratings of transplant candidates acceptability (r=.13,p ≤ .56). Future research might include larger samples of subjects, other organ transplant candidates, and more detailed assessments of symptom distress.

Chronic pain and depression: is social support relevant?

This study examined the relationship between social support and depression for 70 patients with chronic back pain. We also explored whether the family environments of these patients related to depression and whether the patients' depression predicted outcome subsequent to involvement in a functional restoration program. The patients completed a battery of psychological questionnaires to assess depression, social support, and family environment. Outcome of a rehabilitation program was measured in terms of physical gains, vocational gains, and progress made toward program goals. Analysis indicated that the 25 depressed and 23 nondepressed patients differed as to perceived social support and quality of family environment; however, no association was found between depression and rehabilitation outcome. Implications for family interventions are discussed.

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

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.

Reliability and validity of the appraisal of diabetes scale.

The present research evaluated the psychometric properties of a brief self-report instrument designed to assess appraisal of diabetes. Two hundred male subjects completed the Appraisal of Diabetes Scale (ADS) and provided blood samples that were subsequently assayed to provide an index of glycemic control (i.e., glycosylated hemoglobin). Subjects also completed either (a) additional measures of diabetes-related health beliefs, diabetic daily hassles, perceived stress, diabetic adherence, and psychiatric symptoms or (b) the ADS on two additional occasions. Results indicated that the ADS is an internally consistent and stable measure of diabetes-related appraisal. The validity of the measure was supported by correlational analyses which documented the relationship between the ADS and several related self-report measures.

Learned resourcefulness, drinking, and smoking in young adults.

The purpose of this study was to examine the relationship between learned resourcefulness and two common addictive behaviors, namely, drinking and smoking. Male and female college students (N = 175) completed the Self-Control Schedule (SCS), the Quantity-Frequency-Variability questionnaire, and a smoking history form. Learned resourcefulness was related to self-reported patterns of alcohol consumption; specifically, heavy drinking subjects were lower in learned resourcefulness than were light and moderate drinkers who, in turn, were lower in learned resourcefulness than were infrequent drinkers and abstainers. Learned resourcefulness was only modestly related to smoking, with students who had never smoked evidencing somewhat higher learned resourcefulness than ex-smokers and current smokers. Overall, these data provide correlational support for the notion that learned resourcefulness may protect young adults against substance abuse.

Blepharospasm: a case study comparison of trihexyphenidyl (Artane) versus EMG biofeedback.

Blepharospasm is a chronic condition characterized by involuntary spasmodic closure of the eyelid(s). The present investigation empirically evaluated the relative efficacies of a current pharmacological and a psychological approach in the treatment of blepharospasm. An A-B-A-C-A single-case design was used to compare trihexyphenidyl [Artane] with EMG biofeedback. EMG activity in the frontalis muscle and number of eyeblinks were the dependent variables. The results indicated that Artane had no effect on either dependent measure and that biofeedback had a dramatic treatment effect on both dependent variables. Treatment gains were maintained at a 42-week follow-up. These results are discussed in light of the methodological considerations, the efficacy of psychological intervention, and the need for future research.

Blepharospasm and Meige syndrome: a review of diagnostic, aetiological and treatment approaches.

No known pathophysiological mechanism can explain the majority of cases of blepharospasm, i.e. spasm of the orbicularis oculi muscle; it may also affect the lower face, neck and jaw--Meige syndrome. Only symptomatic treatment is possible, and surgery should be a last resort for severe cases. Much more clinical research will be required before promising behavioural interventions, including biofeedback, can be considered treatments of choice.

Informed consent for investigational chemotherapy: patients' and physicians' perceptions.

One hundred forty-four patients and 68 physicians at three cancer centers were studied for their perceptions of the consent procedure, in which they participated one to three weeks earlier, for chemotherapy by one of 65 investigational protocols. Patients recalled the procedure positively and relied heavily on physician's advice. They felt most physicians wanted them to accept; 29% felt their participation in the decision was not encouraged. Primary reasons for accepting were trust in the physician, belief the treatment would help, and fear the disease (viewed as highly serious) would get worse without it. Nearly a fourth did not recall the information given that treatment was investigational. The consent form played no role in decision-making for 69%. Physicians believed therapeutic benefits would exceed potential problems for most patients; they viewed 41% of the patients as less than eager for details of treatment, a third as avoiding the seriousness of the discussion, and a third as passive in decision-making. The perceptual set of both parties places inadvertent constraint on patients' autonomy in decision making.

Oncologists' views of cancer patient noncompliance.

Cancer patient compliance with medical advice and procedures is crucial to successful treatment. This study assessed the views of 246 randomly selected oncologists about the extent of, and reasons for, cancer patient noncompliance. A questionnaire was designed to assess aspects of a) appointment-keeping, b) adherence to outpatient and inpatient treatments, and c) adherence to self-medication instructions. Difficulties with cancer patients' adherence to either inpatient or outpatient treatments were reported as the most difficult problems. Oncologists who reported greater problems with noncompliance had significantly more patients on randomized clinical trials. Oncologists cited psychological problems as a prime determinant for noncompliance. Treatment-related side effects were also seen as contributing to patient noncompliance. The results suggest that mental health and educational disciplines could play a significant role in the reduction of cancer patient noncompliance.

Tonic immobility: effects of dopamine receptor blockade and stimulation.

Blockade of dopaminergic receptors by haloperidol enhanced the duration of tonic immobility in chickens. Apomorphine, a dopamine receptor agonist, produced short durations. Apomorphine also produced an increase in stabilimeter activity. These data suggest dopaminergic involvement in tonic immobility, and support a competing response interpretation of the apomorphine effect.