A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain.

Individuals reporting chronic, nonmalignant pain for at least 6 months (N=114) were randomly assigned to 8 weekly group sessions of acceptance and commitment therapy (ACT) or cognitive-behavioral therapy (CBT) after a 4-6 week pretreatment period and were assessed after treatment and at 6-month follow-up. The protocols were designed for use in a primary care rather than specialty pain clinic setting. All participants remained stable on other pain and mood treatments over the course of the intervention.

A placebo-controlled randomized clinical trial of nortriptyline for chronic low back pain.

To assess the efficacy of nortriptyline, a tricyclic antidepressant, as an analgesic in chronic back pain without depression, we conducted a randomized, double-blind, placebo-controlled, 8-week trial in 78 men recruited from primary care and general orthopedic settings, who had chronic low back pain (pain at T-6 or below on a daily basis for 6 months or longer). Of these 57 completed the trial; of the 21 who did not complete, four were withdrawn because of adverse effects. The intervention consisted of inert placebo or nortriptyline titrated to within the therapeutic range for treating major depression (50-150 ng/ml).

One-year follow-up of first onset low back pain.

Efforts to examine the process and risk of developing chronic back pain have relied generally upon retrospective study of individuals with already established pain. In an alternative approach to understanding the clinical course and evolution of low back disorders, a cohort of 76 men experiencing their first episode of back pain was assessed prospectively at 2, 6 and 12 months following pain onset. Standard measures of pain (Descriptor Differential Scale: DDS), disability (Sickness Impact Profile: SIP), and distress (Beck Depression Inventory: BDI) were employed to classify the sample into five groups: Resolved, Pain Only, Disability/Distress Only, Pain and Mild Disability/Distress, and Clinical Range.

Psychosocial factors discriminate multidimensional clinical groups of chronic low back pain patients.

Previous studies have empirically defined clinical subgroups of chronic low back pain (CLBP) patients, based on differing patterns of pain, disability and emotional distress. Because these identified groups generally are comparable in terms of physical and demographic variables, variation in functional status cannot be adequately explained by medical or social factors. In the present study we evaluated whether other psychosocial factors (stress, coping attempts, and satisfaction with social supports) might differentiate the observed groups.

The Descriptor Differential Scale of Pain Intensity: an evaluation of item and scale properties.

Improved methods for pain measurement have both theoretical and clinical importance. This study evaluated the Descriptor Differential Scale (DDS) of Pain Intensity, a recent methodology designed for assessing pain reports in clinical samples. Experiment 1 evaluated the sensitivity of the measure to small changes in electrocutaneous stimulation relative to a traditional visual analogue scale (VAS) of pain intensity.

An empirical evaluation of multidimensional clinical outcome in chronic low back pain patients.

Individuals with persisting pain often present a constellation of symptoms that includes pain, health-related impairment and dysphoric mood. It is now widely accepted that comprehensive assessment must address each of these dimensions. Despite recognition of the value of multidimensional assessment, no empirical efforts have validated the construct of a multidimensional clinical outcome presentation based on the dimensions of pain, impairment and dysphoric mood.

Coping activities in chronic low back pain: relationship with depression.

To help clarify the nature of coping activities in chronic pain, this study compared how depressed (n = 37) and non-depressed (n = 40) chronic low back pain (CLBP) patients attempted to cope with pain-specific and general non-pain life stressors, relative to matched healthy control subjects (n = 40). We hypothesized that depressed mood, rather than pain alone, would account for differences in coping activities between groups. Specifically, we expected that depressed CLBP patients would report a greater proportion of passive and avoidant coping responses and less active problem solving coping attempts than non-depressed patients and controls.

Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study.

This study used structured diagnostic interviews and DSM-III criteria to assess lifetime prevalence and pre-morbid risk of psychiatric disorder in a sample of men with long-standing chronic back pain (CLPB) attending a primary care clinic. A control group of age and demographically matched men without history of back pain was also studied. Compared to controls, men with CLBP had significantly higher lifetime rates of major depression (32% vs.

Depression in spouses of chronic pain patients: the role of patient pain and anger, and marital satisfaction.

Although several studies have shown that spouses of chronic pain patients may experience clinically significant depressive symptoms few studies have comprehensively examined the role of both patient and spouse-related factors in the development and maintenance of this emotional distress. Twenty-nine married male chronic benign low back pain patients and their spouses were recruited in order to examine the role of patient, spouse, and marital factors in spouse depressive symptomatology. The results indicated that 28% percent of the spouses in the sample reported significantly depressed mood.

Pain and impairment beliefs in chronic low back pain: validation of the Pain and Impairment Relationship Scale (PAIRS).

Few validated instruments are available to assess beliefs and attitudes that patients have regarding pain, or ability to function despite discomfort. The Pain and Impairment Relationship Scale (PAIRS) was developed to tap these important beliefs and attitudes in chronic pain patients. Preliminary data indicate that the PAIRS is internally consistent and significantly related to impairment in a highly selected pain clinic sample of patients, including some chronic low back pain patients.

The language of pain: affective descriptors of pain are a better predictor of psychological disturbance than pattern of sensory and affective descriptors.

The language used by chronic benign pain patients to characterize their pain complaint was analyzed to determine the best predictor of psychiatric disturbance. Using the 78 adjectives provided by the McGill Pain Questionnaire, the number of affective descriptors used was the best predictor of psychiatric disturbance. Addition of sensory descriptors either to augment the total number of descriptors used (magnitude) or as a pattern of sensory greater than affective or sensory less than affective failed to increase predictive strength.

Pain measurement: the affective dimensional measure of the McGill pain questionnaire with a cancer pain population.

Two experiments used the McGill Pain Questionnaire (MPQ) to examine the affective dimension of pain in patients whose pain was secondary to malignancy. In experiment I, segregating groups of cancer patients on the basis of extreme scores (high versus low) on the MPQ failed to produce segregation on independent measures of affect and infirmity. This outcome contrasts with earlier work with chronic benign pain patients.

Pain measurement: construct validity of the affective dimension of the McGill Pain Questionnaire with chronic benign pain patients.

The research reported here used a population of chronic benign pain patients and examined the relationship between scores in the affective dimension of the McGill Pain Questionnaire and independent measures of affect and infirmity The data indicated that patients who reported high affective dimensional scores were significantly more depressed and anxious and somatized more than patients who reported low effective scores. Similarly, these high affective patients reported significantly greater perceived infirmity secondary to their pain. These results suggest that the affective dimension score of the McGill Pain Questionnaire can serve as a useful index of the overall affective status of pain patients and given this interpretation the dimension has good construct validity.

Measurement of pain: patient preference does not confound pain measurement.

Chronic pain patients reported pain intensity on each of 3 pain intensity scales, the visual analog, numerical and adjectival scales, and then ranked the scales in order of perceived best communication of pain intensity. All patients were able to complete an adjectival scale but 11% were unable to complete a visual analog scale and 2% failed at a numeric scale. The intensity of the pain ratings on the 3 scales were significantly correlated and there were no reliable differences in reported intensity as a function of preference.