Contextual determinants of pain judgments.

The objective of this study was to examine the influence of variations in contextual features of a physically demanding lifting task on the judgments of others' pain. Healthy undergraduates (n=98) were asked to estimate the pain experience of chronic pain patients who were filmed while lifting canisters at different distances from their body. Of interest was whether contextual information (i.e., lifting posture) contributed to pain estimates beyond the variance accounted for by pain behavior. Results indicated that the judgments of others' pain varied significantly as a function of the contextual features of the pain-eliciting task; observers estimated significantly more pain when watching patients lifting canisters positioned further away from the body than canisters closest from the body. Canister position contributed significant unique variance to the prediction of pain estimates even after controlling for observers' use of pain behavior as a basis of pain estimates. Correlational analyses revealed that greater use of the contextual features when judging others' pain was related to a lower discrepancy (higher accuracy) between estimated and self-reported pain ratings. Results also indicated that observers' level of catastrophizing was associated with more accurate pain estimates. The results of a regression analysis further showed that observers' level of catastrophizing contributed to the prediction of the accuracy of pain estimates over and above the variance accounted for by the utilisation of contextual features. Discussion addresses the processes that might underlie the utilisation of contextual features of a pain-eliciting task when estimating others' pain.

Alexithymia. The development of a valid and reliable projective measure (the objectively scored Archetypal9 Test).

The aim of this study was to examine whether the Archetypal9 Test (AT9) could meet the need for a valid and reliable test with which to measure the alexithymic trait cluster. Participants in this study included 61 patients drawn from pain clinics in Montreal (Royal Victoria Hospital) and Detroit (Henry Ford Hospital) and 30 patients undergoing minor surgery at the Royal Victoria Hospital in Montreal. All 91 subjects took both the AT9 Test and the Clarke Vocabulary Scale. The results of the attempts at validation reveal that the objectively scored AT9 Test (SAT9) is a highly internally consistent instrument, that it has demonstrated construct validity, and that it can significantly discriminate between patient groups (pain patients and medical patients). The SAT9 is positively related to age, inversely related to occupational level, and uncorrelated with IQ (as measured by the Clarke Vocabulary Scale). The authors concluded that thus far, the SAT9 has proven to be a valid instrument which can be used to measure a central feature of alexithymia.

Incidence and implications of alexithymia in chronic pain patients.

Alexithymia is a clinical phenomenon that has been found to occur with some frequency in psychosomatic disorders. Its prevalence in psychosomatic patients suggests that it could be observed in chronic pain patients as well. The present study examines the incidence of alexithymia in chronic pain patients as assessed by the Archetypal Test with Nine Elements (AT9). Patients' scores on the AT9 (SAT9) were examined in conjunction with McGill Pain Questionnaire (MPQ) data, MMPI subscale scores, and patient data. There were no significant relationships found between SAT9, MMPI, and MPQ scores. These observations are examined with reference to the nature of the assessment instruments used. Implications of these observations for theory and therapy are discussed.

A test to measure the awareness and expression of anger.

The purpose of this project was to develop a reliable, objective and practical tool with which the awareness and expression of anger could be investigated. This paper gives a description of the Awareness and Expression of Anger Indicator (AEAI). The AEAI is a short and easy to use test. It provides a new objective assessment instrument of value in cases where deficits in affective processes, particularly anger, are suspected. 30 medical patients were tested with the AEAI. The investigators report a high inter-rater reliability in scoring the test. Four distinct response patterns emerged. Also, when confronted with the same anger-provoking stimulus, subjects responded significantly differently with respect to whether or not they felt angry, depending on the type of question. Traditional inducing questions, e.g.: Would you feel angry?, produced significantly more affirmative responses (reports of feeling angry) than non-inducing questions, e.g.: How would you feel? The contribution of the AEAI to chronic pain work is discussed.

The use of cervical epidural nerve blocks in the management of chronic head and neck pain.

Cervical epidural blocks were used as part of a comprehensive multimodal treatment programme for patients with chronic benign pain in the head and neck. Forty-five patients had 141 blocks without major complications. The indications and role of blocks in pain management are discussed.

A protocol for the medico-psychosocial evaluation of patients with chronic pain.

A protocol is presented for the full medico-psychosocial evaluation of patients with chronic benign pain. Complete history taking is often difficult with these patients. However, this can be accomplished with a combined approach by an anaesthetist and a psychiatrist following a structured interview pattern which respects the patient's attitude towards psychological factors. The specific format of this interview is described.

Phantom pain following limb amputation in a paraplegic. A case report.

The pain of the phantom limb remains a diagnostic and therapeutic challenge. A case is reported in which a paraplegic patient with full sensory ablation below T11 experienced phantom limb pain only after actual amputation of one of his legs. This suggests that the cause in this case could only be central in origin. Visual appreciation seems to be an important step in this process.

The measure of symbolic function in alexithymic pain patients.

The archetypal test with 9 elements (AT9), a tracer of symbolic function, was completed by 30 pain patients in whom alexithymia had been measured by two means: the Beth Israel psychosomatic questionnaire (BIQ) and the Minnesota multiphasic personality inventory (MMPI) alexithymia scale. Results show a correlation of adequate statistical significance (p less than 0.05) between the AT9 and the BIQ but not with the MMPI alexithymia scale. The scored AT9 (SAT9) allows one to discriminate between forms and degrees of disorganization in symbolic activity within an alexithymic population. The AT9 measures something central to the construct of alexithymia and its advantages and possibilities over other tools to assess alexithymia are discussed.

The SAT9: a quantitative scoring system for the AT9 test as a measure of symbolic function central to alexithymic presentation.

This paper reports the result of preliminary efforts to devise a more objective and quantifiable system with which to score the AT9 test. The AT9 traces symbolic function, a trait central to an alexithymic presentation, and until now has been available only to those clinicians who have the prior knowledge necessary to projectively interpret it. Based on a sample of 42 patients, the inter-rater reliability on the new scale (SAT9) reaches highly acceptable levels of significance as does the correlation between the SAT9 and the ranked projectively interpreted protocols (RPAT9). These results support the further refinement of the SAT9 scale as a means of facilitating the use of this test as a measure of a central alexithymic process.

Peridurography with metrizamide: animal and human studies.

Metrizamide (300 mg l/ml) was tested for spinal peridurography in conscious dogs and humans. Epidural metrizamide was non-irritating in volumes up to 12 ml. Larger volumes caused mild discomfort in two patients. Radiographic contrast was satisfactory, and there were no sequelae. Peridurography with metrizamide (300 mg l/ml) appears to be a safe, useful diagnostic procedure in ambulant patients.