Behavioral assessment of low back pain: identification of pain behavior subgroups.

A hierarchical cluster analysis procedure was used to identify homogeneous subgroups of low back pain patients who show similar pain behavior patterns during a videotaped behavior sample. Subjects, 106 chronic low back pain patients, were divided into 2 samples. The cluster analysis procedure identified 4 very similar subgroups in sample 1 and sample 2. The first subgroup showed a low or moderate level of guarding and a low level of other pain behaviors. The second subgroup showed a high level of guarding and a moderate level of rubbing of the painful area. The third subgroup showed high levels of guarding and moderate levels of bracing and rubbing. The fourth subgroup exhibited a very high level of rubbing and moderate levels of bracing. The subgroups identified may require somewhat different approaches to pain assessment and treatment. The results of this study suggest that the variability in pain behavior evident in low back pain populations may be due to the fact that within these populations there are homogeneous subgroups of patients who differ in the motor pain behaviors they display.

The relationship of locus of control to pain coping strategies and psychological distress in chronic pain patients.

Although behavioral scientists have long been interested in how an individual's locus of control relates to coping and adjustment, basic information remains to be gathered on the relevance of locus of control to adaptation to persistent pain. This study examined the relationship of locus of control orientation to pain coping strategies and psychological distress in chronic pain patients. Subjects were 62 chronic pain patients. All patients were administered: (1) the Multidimensional Health Locus of Control Scales to assess locus of control, (2) the Coping Strategies Questionnaire to evaluate pain coping strategies, and (3) the Symptom Checklist-90 Revised to assess psychological distress. Correlational analyses revealed that patients who viewed outcomes as controlled by chance factors such as fate or luck tended to rely on maladaptive pain coping strategies and rated their abilities to control and decrease pain as poor. They also exhibited greater psychological distress. Regression analyses indicated that patients having a chance orientation toward locus of control were more likely to report depression, anxiety, and obsessive-compulsive symptoms and to have higher overall levels of psychological distress. Chance locus of control also predicted greater reliance on diverting attention and praying/hoping in dealing with their pain. In addition, patients high on chance locus of control reported feeling helpless to deal effectively with their pain problem. Clinicians evaluating chronic pain patients need to be aware that patients who view outcomes as controlled by external factors such as chance may have deficits in pain coping strategies and may report greater psychological distress than patients who do not have this locus of control orientation.

Social support and pain behavior.

Research has shown that social support is generally associated with better adaptation to chronic disease. However, the role that social support plays in adjustment to chronic pain syndromes has received less research attention. The present study was designed to examine the relation of high versus low levels of social support to pain behavior in chronic pain patients. Fifty-one patients with chronic pain completed the Social Support Questionnaire (SSQ) and the McGill Pain Questionnaire. Patients were also observed using a standard observation system to assess pain behaviors. In order to compare pain behaviors displayed by subjects with high versus low levels of social support, a median split was performed on the 2 dimensions of the SSQ: satisfaction with support, and availability of people for support. The results indicated that pain behavior varied as a function of level of satisfaction with social support. Individuals reporting high satisfaction with social support exhibited significantly higher levels of total pain behavior and higher levels of individual pain behaviors such as guarding, rubbing, and bracing. There was no significant difference in total pain behaviors between those high versus low in terms of level of availability of support. There also were no differences between high versus low social support groups in total pain ratings as measured by the McGill Pain Questionnaire. The results are discussed in terms of an operant conditioning perspective on social support. Individuals who are satisfied with the quality of their social support may be satisfied because they receive positive reinforcement from the social environment when they engage in pain behavior.

Osteoarthritic knee pain: a behavioral analysis.

This study used behavioral assessment techniques to analyze pain in osteoarthritis (OA) patients. Eighty-seven OA patients having chronic knee pain served as subjects. Pain behavior was evaluated using a standard observation method and functional impairment was assessed using the Arthritis Impact Measurement Scales. Data analysis revealed that pain and limitations in physical activities were the most common functional impairments and that the most frequently observed pain behavior was guarded movement. Predictive analyses indicated that disability support status and scores on a Pain Control and Rational Thinking factor of the Coping Strategies Questionnaire (CSQ) were predictive of functional impairment. Patients receiving disability support payments were much more functionally limited than those not receiving this financial support. Patients scoring high on the Pain Control and Rational Thinking factor of the CSQ were much less functionally impaired, walked a 5 m course more rapidly and moved from a standing to a sitting or reclining position more quickly than patients scoring low on this factor. The implications of these results for behavioral treatment of OA knee pain are discussed.

Behavioral assessment of head and neck cancer pain.

Behavioral evaluations of pain were carried out on a sample of 30 head and neck cancer patients before, at the midpoint, and at the end of their treatment. Observations of patients' behavior as they carried out functional activities revealed that patients tended to display their pain primarily through facial expression and to a lesser extent through guarded movement. During the period of treatment there were significant increases in the number of simple daily activities that increased pain, in the time spent sitting each day, and in the number of patients using narcotics. There was also a strong tendency for patients to lose weight and to use a greater number of pain relieving methods. A behavioral dysfunction index based on scores on each of the behavioral measures was clearly related to pain ratings. Measures of pain taken before treatment were highly predictive of behavioral dysfunction index scores recorded at the completion of cancer treatments.