Chronic pain: a multiple-setting comparison of patient characteristics.

Chronic pain patients attending four different pain management programs (N = 160) were compared on multiple variables encompassing demographics, the nature of the pain problem, and treatment history. Programs were selected because they differed on several dimensions (e.g., geographic location, general hospitals vs those serving veterans of Armed Services, university affiliated vs nonaffiliated) believed potentially to interact with treatment outcome. Results indicated differences between hospital programs serving veterans and general hospital programs (serving nonveterans) in terms of patients' age, percentage married, disability compensation, duration of pain symptoms, and treatment history. In addition, findings indicated that covariance among pain variables was dissimilar across the four types of pain programs, making it difficult to generalize from one type of setting to another regarding issues such as choice of optimal treatment.

Is tinnitus a psychological disorder?

There have been consistent reports in the psychosomatic literature indicating that a patient's perception of tinnitus as well as differential response to various treatment modalities may be affected by personality variables. The present study examined several personality correlates of subjective tinnitus in forty-five male patients referred to the Audiology Clinic of a large VA Medical Center with constant tinnitus of at least six months duration. Information was also collected on etiology, onset and chronicity, medications, prior treatment and related medical problems. Four standard psychological tests (MMPI, Cattel's 16 PF, Rotter's Locus of Control and Holmes and Rahe Life Stress Scale) were administered to all patients in the study, in addition to a comprehensive audiologic and otologic evaluation. Correlational analyses were used to examine the relationship between personality profiles and the demographic, medical and audiologic data. The expected psychosomatic characteristics of this patient population did not emerge as had been predicted from previous reports in the literature. Findings suggest that tinnitus may have an unwarranted reputation as a psychopathological disorder. Therefore, conventional psychotherapy may be of limited efficacy whereas standard audiologic treatment approaches may be more promising.

The cancer ward: patient perceptions--staff misperceptions.

The disparity the between patient and staff perceptions of life experiences associated with the diagnosis of cancer has relevance to our understanding of the dynamics of patient-staff interaction on an oncology unit. In order to better delineate the psychological issues within the staff-patient relationship, 26 advanced cancer patients, 5 oncologists and 10 nursing staff ranked in order of personal importance to the patients, 14 areas of life changes or loss commonly alluded to in the psychosocial oncology literature. Findings indicated considerable interpatient variability in what constitutes a major loss. Staff ratings of patient loss showed greater consistency and overemphasized certain losses. MD's significantly overrated the importance of pain in these patients. Such biased staff preconceptions about patient values may deleteriously affect the treatment milieu.

Reattribution of cancer pain.

The psychological aspects of cancer pain have been largely neglected except in the treatment related research literature. The present study examines the role of attribution theory in illuminating the experience of cancer pain. Twenty-five cancer patients were administered pain and discomfort vertical visual analogue scales and a measure of locus of control. Data pertaining to intensity and perceived source (cancer, cancer therapy or unrelated benign conditions) of pain and discomfort, per cent attribution to each and physician ratings as to source were also obtained. While results indicate that a variety of reattributional phenomena do occur in cancer patients, such cognitive reappraisal does not diminish pain intensity. The findings further suggest that locus of control expectancies are important mediating variables in the reattribution of cancer pain and discomfort. The study raises research and clinical issues pertinent to understanding the experience of pain associated with cancer.

Indirect self-destructive behavior in chronic hemodialysis patients.

As one of a series of investigations of indirect self-destructive behavior, a pilot study was conducted with a group of 32 chronic hemodialysis patients for those characteristics of such behavior which had emerged as most salient in earlier studies: self-esteem, locus of control, rigidity, impulsivity, futurity, risk-taking and denial. Using an average of ratings of cooperativeness obtained from the head nurse, physician, dietician, technician, and staff nurse, the group was divided into two subgroups of more and less cooperative patients, and the demographic, medical, and psychological data from the two groups were compared. The findings suggest that the less cooperative hemodialysis patients have experienced the illness as a more severe blow to their self-concept and have failed to integrate their illness into an effective adaptive life pattern. The uncooperative patients feel less valued and less appreciated not only by their family but also by fellow patients and by hospital staff. They show significantly more anger and withdrawal than the more cooperative group and appear to have compensated for a significantly greater sense of powerlessness by the development of manipulative behaviors in relating to their medical caretakers.