Validation of the Multidimensional Affect and Pain Survey (MAPS).

UNLABELLED: The concurrent construct validity of the Multidimensional Affect and Pain Survey (MAPS) was determined in a sample of 100 oncology outpatients. As recommended by Jensen, we examined the frequency pattern of correlations between MAPS and standard questionnaires that reached a criterion level of significance. As predicted, the 17 subclusters in the MAPS Somatosensory Pain supercluster showed a higher mean frequency of criterion correlations with the 4 sensory-related groups of items from the MPQ and, equally important, a lower frequency of criterion correlations with unrelated constructs, POMS, and the MPQ Affective Class. The 8 subclusters in the MAPS Emotional Pain supercluster revealed a high frequency of correlations with related POMS and FACT-G scales and (negatively) with the KPS score; equally important, there were far fewer criterion correlations of these scales with unrelated MPQ sensory classes. The 5 subclusters of the MAPS Well-Being supercluster showed a high frequency of criterion correlations with the POMS Vigor/Activity Scale, related FACT-G scales, and the KPS score and lower frequencies of correlation with the unrelated MPQ sensory groups. In conclusion, the 101-item MAPS yields more information about a patient's pain, emotional, physical, and cognitive status than does a much longer test battery consisting of 191 items contained in the MPQ, POMS, and FACT-G questionnaires. PERSPECTIVE: This study demonstrates the validity of a new pain questionnaire developed objectively by multivariate cluster analysis rather than subjectively by expert opinion. MAPS assesses patients' somatosensory and emotional experiences, and feelings of well-being with greater scope and accuracy than a battery of questionnaires, and it does so in much less time.

What do ratings on unidimensional pain and emotion scales really mean? A Multidimensional Affect and Pain Survey (MAPS) analysis of cancer patient responses.

The purpose of the study was to determine what dimensions of pain predicted scores on numerical rating scales (NRSs) of Pain, Anxiety, Depression, and Health Expectation in cancer patients. Seventy-one patients with intra-abdominal cancer responded to the Multidimensional Affect and Pain Survey (MAPS) and rated their pain and emotion on the NRSs. Scores on the Pain NRS were predicted by 41% of clusters in the MAPS Somatosensory Pain Supercluster, but by 100% of clusters in the Emotional Pain Supercluster, and negatively by 51% of clusters in the Well-Being Supercluster. The Anxiety and Depression NRSs were each predicted by only the Intense Pain cluster in the Somatosensory Pain Supercluster, but by all of clusters in the Emotional Pain Supercluster. The findings indicate that cancer patients' emotional state is a strong co-determinant of their sensory pain ratings. Negative emotional aspects of pain contribute also to scores on the Anxiety, Depression and Health Expectation NRSs.

Factor analysis validates the cluster structure of the dendrogram underlying the Multidimensional Affect and Pain Survey (MAPS) and challenges the a priori classification of the descriptors in the McGill Pain Questionnaire (MPQ).

The purpose of this study was to validate the content and structure of the Multidimensional Affect and Pain Survey (MAPS) by means of factor analysis. The 101-MAPS is based on a dendrogram obtained by cluster analysis and contains 30 clusters subsumed within three superclusters. If the MAPS is a valid questionnaire for the quantification of emotion and pain in patients, then factor analysis of patients' intensity ratings should produce factors which correspond to the cluster structure of the dendrogram. To confirm the structure of the dendrogram and hence, MAPS, factor analysis was applied to the responses by 100 outpatients diagnosed with early stage cancer. Principal components analysis of responses to the MAPS yielded six factors. In accordance with the hypothesis, 13 of the 17 clusters within the MAPS somatosensory pain supercluster loaded on three sensory factors: factor 1, severe sensory pain; factor 3, moderate sensory pain; and factor 6, numb/cold. Five of the eight clusters within the emotional pain supercluster loaded on factor 2, negative emotions. Four of the five clusters in the well-being supercluster loaded on factor 4, good health. Factor 5, manageable illness was loaded on by clusters from the well-being supercluster and the somatosensory pain supercluster. The homogeneity of the six factors found demonstrate the validity of the MAPS and the cluster structure of the dendrogram. MAPS proved sensitive to sex differences; women endorsed the negative emotions factor more strongly than did men. The MAPS factors were much more homogeneous than those reported in the literature for the McGill Pain Questionnaire.

A case of human orf contracted from a deer.

Orf, or contagious ecthyma, is a rare viral dermatosis caused by a member of the genus Parapoxvirus. The typical lesion consists of solitary or multiple papules that progress through a series of stages, terminating in complete resolution. This zoonotic disease is most commonly transmitted to humans from infected sheep or goats. We report a case of human orf, likely contracted from exposure to deer carcasses.

Pain sensitivity in silent myocardial ischemia.

Although the cause of silent myocardial ischemia (SMI) is unknown, several theories have been advanced to explain the disorder. Most prominent among these are the suggestions that attribute the condition to generalized impaired pain sensitivity and/or enhanced endorphin activity. The present study examined both hypotheses. It was carried out in 33 patients with myocardial ischemia: 13 with silent myocardial ischemia (silents) and 20 with symptomatic ischemia (symptomatics). Pain sensitivity was determined with thermal, electrical, and ischemic pain tests using signal detection theory (SDT) and conventional threshold procedures. To evaluate the significance of endorphin mechanisms naloxone (6 mg i.v.) and placebo were administered on alternate days in a double-blind, cross-over procedure before the pain tests and again before a treadmill exercise test (TET). Somatic pain sensitivity was found not to be impaired in patients with SMI, and no evidence was found to support a causal role for endorphins in the disorder.

Are runners stoical? An examination of pain sensitivity in habitual runners and normally active controls.

Anecdotal and clinical reports suggest that athletes are stoical. However, there are few studies comparing persons who exercise regularly with those who do not. This study compared two independent samples of regular runners and normally active controls, both without recent exercise, on cold pressor, cutaneous heat, and tourniquet ischemic pain tests. Results demonstrated that the runners' threshold for noxious cold was significantly higher than that of controls. The heart rate and blood pressure responses to cold were similar in the 2 groups, suggesting that differences in cold pain report did not result from differences in autonomic reactivity to cold. Signal detection theory measures demonstrated that runners discriminated among noxious thermal stimuli significantly better than controls, but neither noxious nor innocuous thermal report criteria differed between groups. The cohorts also did not differ in their report of ischemic pain sensations. Thus, these data do not generally support the hypothesis of pain insensitivity or stoicism in habitual runners. Rather, insensitivity occurs only in their response to noxious cold, which is suggested to be an adaptation to regular training.