Interactive effects of the affect quality and directional focus of mental imagery on pain analgesia.

College students (25 men and 25 women) were randomly assigned (within sex) to each of the 4 factorial groups, based on manipulation of affect quality (positive vs. negative) and directional focus (internal vs. external) of mental imagery, and to a control group receiving no manipulation. Both imagery variables had a significant impact on pain tolerance and ratings during a cold-pressor test with positive affect and external imagery producing greater analgesia than their counterpart conditions. Positive affect imagery combined with external imagery resulted in the lowest reported pain amongst the groups. However, self-reported mood descriptors did not consistently parallel the pain tolerance and rating data. Likewise, although heart rate and skin potential responses increased during the cold pressor for the group as a whole, the only significant difference amongst the experimental groups was the relatively higher skin potential reactivity of the positive affect-external imagery group--possibly reflecting greater task engagement for this group. Seemingly, imagery in this situation operates primarily via cognitive, rather than via physiological mediators of the pain experience.

Complementary and alternative medicine and psychologic factors: toward an individual differences model of complementary and alternative medicine use and outcomes.

CONTEXT: Complementary and alternative medicine (CAM) is in widespread use. Study of the psychologic factors associated with CAM use may provide descriptions of subgroups of health care consumers and give further insight into the reasons for using alternative therapies. OBJECTIVES: To see if the use of CAM is associated with psychologic factors in two outpatient samples and one community sample. SETTING: The University of Virginia Hospital and Charlottesville community. PATIENTS: Patients at the Cancer Center (60) and Pain Management Center (63) and adults from the Charlottesville community (63) for a total of 186 participants. DESIGN: A survey of CAM with psychologic assessment. MAIN MEASURES: Level of CAM use, effectiveness ratings of CAM, positive affect, negative affect, and the Absorption Scale, which measures a personality factor associated with the capacity for focused attention and mind-body awareness. RESULTS: Participants using six or fewer CAM scored an average of 13.9 on the Absorption Scale compared to participants using seven or more CAM, who scored an average of 21.4 on Absorption (F = 48.73, p < .0001). Higher effectiveness ratings of CAM were associated with greater positive affect. Pain Center patients rated alternative therapies as least effective, and reported lower positive affect and greater negative affect compared with the Cancer Center patients and community adults. CONCLUSIONS: Above average use of CAM is associated with higher education, greater well-being and higher Absorption. The personality traits associated with alternative therapies are compatible with participation in these therapies and may facilitate the capacity to benefit from them.

Touch relieves stress and pain.

There are few systematic investigations of the potential benefits of incidental touch as it occurs in medical health care settings. In the present laboratory study 60 college students participated in two testing sessions 1 month apart. These sessions involved counterbalanced conditions of baseline, pulse palpation (touch), cold pressor test (stressor), and combined cold pressor/pulse palpation. Heart rate and systolic and diastolic blood pressure were measured during each condition. Subjective pain ratings were recorded during stress conditions. Significant decreases in cardiovascular measures and pain ratings were associated with physical contact. However, these changes were small and individual responses to physical contact were not stable over time. Physical contact produces a small but significant decrease in cardiovascular variables and the experience of pain. However, the tendency to show a cardiovascular response to touch does not represent a stable trait for individuals in the laboratory setting.

Paraspinal EMG and autonomic reactivity of patients with back pain and controls to personally relevant stress.

The reactivity of surface paraspinal EMG was contrasted among groups of (1) patients seeking treatment for chronic back pain, (2) nonpatients reporting chronic back pain, and (3) healthy controls. The EMG response to the personally relevant stressor (all stimuli were 1 min.) tasks was greater for the patient group relative to the other two groups. However, the patients' magnitude of response elicited by the control task was nearly equal to that of the personally relevant task, suggesting that the task demand to "describe a recent event" may be the "personally relevant" stressor component rather than the emotional valence attached to the content of that description.

Effects of humorous stimuli and sense of humor on discomfort.

The effects of humor on increasing discomfort thresholds were tested with Transcutaneous End Nerve Stimulation (TENS). Undergraduate students (n = 31) with high or low scores on Martin and Lecourt's Situational Humor Questionnaire were randomly assigned to a humor or nonhumor condition. Discomfort thresholds for TENS were assessed before and during treatment. There was a significant increase in discomfort thresholds in the humorous treatment compared to the nonhumorous condition. Evidence was found for subjects to smile "wryly" (an increase in zygomatic and corrugator tensions) more during humorous stimuli than nonhumorous stimuli when they were waiting to be stimulated with the TENS.

Chronic pain patients' beliefs about their pain and treatment outcomes.

A novel assessment procedure measuring chronic pain patients' agreement with information presented on a clinic orientation videotape was evaluated as a predictor of short-term treatment outcome. One hundred randomly selected outpatients viewed a 15-minute videotape detailing conservative approaches to pain management and completed a questionnaire measuring factual recall of the videotape presentation and their acceptance or rejection (ie, agreement) of this information. Patient ratings of satisfaction with treatment were assessed one month after treatment. Multivariate analyses revealed that extent of agreement with the videotape content was significantly associated with lower pain ratings, increased ratings of physical ability, and higher treatment satisfaction. Prognostic use of this procedure for identifying patients at risk for nonadherence to treatment is discussed.

The development of a Somatic Amplification Rating Scale for low-back pain.

The development of a new scale, the Somatic Amplification Rating Scale (SARS), for the quantification of exaggerated (nonorganic) motor, sensory, and pain responses occurring during a standardized physical examination is described. This 13-item scale, partially based on a measure of nonorganic physical signs developed by Waddell et al, was administered to 127 low-back pain patients at an outpatient pain center. It was determined that the 13-item scale could be shortened to seven items with improved ease of administration and little loss of reliability and validity. Interrater reliability of the finalized seven-item scale was excellent (R = 0.93). Finally, it was determined that patients with high SARS scores were significantly more likely to be receiving workers' compensation benefits and to endorse physical symptoms with greater intensity on psychologic testing (Symptom Checklist 90).

The Balans chair and its semi-kneeling position: an ergonomic comparison with the conventional sitting position.

Recently, the Balans chair has been introduced with claims that, because of its semi-kneeling position, individuals will experience decreased low-back pain (LBP) as well as improvement in circulation. This study investigated the validity of these claims. Twenty healthy subjects were randomly assigned to one of two groups. Group 1 subjects sat in the Balans chair for a 30-minute study period and then sat in a conventional office chair for an additional 30-minute period. Group 2 subjects were studied in the reverse seating order. Parameters studied were cervical and lumbar paraspinous surface EMG, and pedal cutaneous blood flow measured by laser-Doppler flowimetry. In addition, a questionnaire comparing the comfort of the two chairs was completed at the end of the study session. Comfort ratings showed an overall preference for the conventional chair. Increased cervical (P = .004) and lumbar muscle EMG measurements were noted after sitting in the Balans chair. Pedal cutaneous blood flow was increased by 15% in the Balans chair (P = .001). The data do not support the manufacturer's claim that the Balans chair is likely to decrease complaints of LBP.

Cognitive and somatic item response pattern of pain patients, psychiatric patients, and hospital employees.

Standard psychological tests generally provide a single global score that reflects multidimensional constructs, such as depression and anxiety. This single score, however, integrates a range of item contents, including cognitive/affective, somatic, and behavioral characteristics of these multidimensional constructs. The present study was designed to compare the pattern of item endorsement among chronic pain patients (N = 50), psychiatric inpatients (N = 50), and hospital employees (N = 50) on the SCL-90-R (Derogatis, Rickels, & Rock, 1976). Pain patients reported the highest SCL-90 scale level of Somatization, while the psychiatric inpatients reported the highest level of Anxiety and Depression. Additionally, the within-scale pattern of item responses on the Anxiety and Depression scales differed among groups. Although psychiatric inpatients endorsed equivalent levels of somatic and cognitive items, the pain patients' reports of psychological distress were limited primarily to somatic signs of anxiety and depression. Thus, the interpretation of pain patients' psychological profiles and subsequent treatment recommendations may be inappropriate if based on normative data obtained from psychiatric and/or normal populations.

Direct assessment of beliefs and attitudes of chronic pain patients.

Traditional approaches to psychological assessment of chronic pain patients have centered either on underlying psychopathology or environmental reinforcers for pain behavior. The current research focuses on patient beliefs and attitudes about their pain and its treatment, an additional dimension which appears to be important in treatment outcome but has seldom been systematically examined. Patients' ratings of agreement/disagreement with information presented in a brief educational videotape about chronic pain were examined via factor analysis. The four factors which emerged from the rating were: admission of emotionality, perceived relevance of the videotaped information, acknowledgment of personal responsibility in the treatment, and discrimination of noninvasive treatments. These four factors appear to have convergent validity with those suggested by other researchers. The validity and utility of this approach to patient assessment in rehabilitation settings are discussed.

Concordance among self-regulated responses: is self-regulatory ability a psychophysiological "trait"?

The purposes of this study were to examine whether or not self-regulation of physiological responses demonstrates day-to-day reliability, to determine the degree of individual subject consistency (or concordance) in the ability to self-regulate across several different physiological responses, and, finally, to explore the impact of biofeedback training on interresponse concordance. Twenty normal subjects participated in six bidirectional self-regulation sessions-the first and last sessions involving instructions only, and the remainder, biofeedback. Self-regulation scores consisted of the absolute difference between increase and decrease trial means. The average test-retest reliability coefficients (rs) for the self-regulation scores, across the four biofeedback sessions, were a highly significant .50, .68, .30, and .47 for EEG, EMG, HR, and SCL, respectively. By contrast, the average concordance among the self-regulation scores for the four feedback sessions, estimated by Kendall's coefficient of concordance, was a marginally significant 39% of the possible variance of the rank sums. This corresponds to an average between-response rs value only of .19. The concordance level from the initial no-feedback (i.e., instructions only) session was not significant. Multivariate concordance levels did increase during the first three feedback sessions, but declined at the fourth, and again was nonsignificant during the final no-feedback session. Among the individual self-regulation response pairings, only the EEG/EMG combination was consistently associated during the no-feedback sessions. The present results suggest that self-regulatory ability is neither a highly unitary "trait"-like phenomenon nor an entirely response-specific event, but may vary considerably as a function of subject factors, or the situational circumstances, under which it is measured.

Parasympathetic rebound following EMG biofeedback training: a case study.

The self-regulation literature contains very few reports of negative side-effects stemming from biofeedback training. Nevertheless, the case reported here is unique in that immediately following each of several early EMG feedback sessions, an otherwise headache-free patient reported an acute attack of headache and nausea. These attacks, the conditions under which they appeared, and the conditions leading to their remission will be described. Discussion will focus on the possible physiological mechanisms involved.