Chronic pain and the questionable use of the Minnesota Multiphasic Personality Inventory.

Several studies have observed that patients who complain of chronic pain have significantly elevated scores on the first 3 clinical scales of the Minnesota Multiphasic Personality Inventory (MMPI). Some studies imply that this profile allows one to conclude that such patients exaggerate their symptoms, have strong feelings of inadequacy, have emotional problems which are neurotic, with implications that this is functional pain. The present study and its results challenges the use of the MMPI in attempting to distinguish psychogenic from organic pain. The MMPI was administered to 62 patients on their admission to the hospital. All 62 patients had a diagnosis of some organic findings consistent with their pain symptomatology. The average MMPI scores resulted in an elevated "Conversion-V" profile. It was also noted that as characteristics such as age of the subject, number of surgeries, and number of physicians seen increased, there was a corresponding increase in the neurotic scales. It was concluded that utmost caution should be used in interpreting individual pain patients' MMPI scores. It is especially important to avoid dismissing the pain symptomatology as functional by simply giving the patient a psychiatric diagnosis consistent with the profile. The potential of the MMPI as an aid in developing the treatment plan and as a possible predictive tool for certain treatment procedures is discussed. It is suggested that MMPI data be collected on a comparison group of patients, who have had successful relief of pain through surgical intervention.

Chemonucleolysis: evaluation of effectiveness by electromyography.

Findings in 97 consecutive patients who had undergone chemonucleolysis were analyzed. The purpose of this prospective clinical study was two-fold: (1) to provide a comparison of preoperative findings of electromyography, myelography and discography and (2) to evaluate postoperative electromyography as an objective test of recovery. All the patients had complete history and physical examination, five-view roentgenographic study of the lumbosacral spine, electromyography preoperatively and again at three months postoperatively, myelography and discography. Computer analysis of the results was done for the multiple cross-correlations in the study. All patients had had at least three months preoperative conservative care without relief of symptoms. The study shows that electromyographic study three months postchemonucleolysis is of value for corroboration of clinical improvement only if the EMG becomes completely normal. A greater percentage of patients recovered clinically after chemonucleolysis when the preoperative EMG was normal as compared to those for whom the preoperative EMG was abnormal. We were surprised to find no significant correlation between end result and the existence of pending litigation.