The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
Chronic pain management in a health maintenance organization.
The purpose of this study is to investigate the management of chronic pain in a large health maintenance organization using cognitive-behavioral techniques and a blinded control group. ⋯ Gains were achieved in pain severity, negative mood, pain affect, self-control, and pain interference with the patient's life. Other behavioral variables and activity did not improve. Except in self-control, pain affect, and distracting responses from their significant others, the blinded minimal treatment group demonstrated similar findings. Patient satisfaction with treatment strongly favored the treatment group with over 78% of the treatment participants satisfied with the care provided.
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Randomized Controlled Trial Clinical Trial
Does gender affect appraisal of pain and pain coping strategies?
To investigate the impact of gender and a set of pain characteristics on the threat or challenge appraisal of pain and the impact of these appraisals on the coping strategies used to manage the pain. ⋯ Interference of pain has a greater impact on threat appraisal of pain for women. Increasing threat appraisal is associated with health care utilization for women, but women's more frequent use of several coping strategies is unrelated to their appraisal of pain. Appraisal of pain may have important implications on coping and overall well-being of women and men.
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Randomized Controlled Trial Clinical Trial
Cognitive-behavioral treatment in unselected rheumatoid arthritis outpatients.
This trial was performed to evaluate the efficacy of an adjunctive cognitive-behavioral treatment compared with rheumatological treatment alone in unselected rheumatoid arthritis outpatients. ⋯ Cognitive-behavioral therapy has proven an effective adjunct to standard treatment of rheumatoid arthritis outpatients. These effects were shown in an unselected sample with increasing disease activity and with comparable changes in medication during treatment. We recommend cognitive-behavioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.
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Clinical Trial
Block of pinprick and cold sensation poorly correlate with relief of postoperative pain during epidural analgesia.
To test the following hypotheses: there is a correlation between spread of epidural analgesia as assessed postoperatively by pinprick/cold test and postoperative pain intensity; block of pinprick/cold sensation is associated with absence of postoperative pain. ⋯ Spread and efficacy of epidural analgesia as assessed by pinprick and cold stimulation correlate poorly with postoperative pain. These methods are of limited value both as clinical indicators of the efficacy of postoperative pain control and for investigating the effect of epidural drugs and techniques.
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Clinical Trial
Empirical test of the factor structure of the West Haven-Yale Multidimensional Pain Inventory.
Although the West Haven-Yale Multidimensional Pain Inventory (MPI) is frequently used in clinical evaluation and research with chronic pain patients, few studies have reported item-level factor analyses. After performing such an analysis, Bernstein et al. (Spine 1995;20:956-63) reported lack of independence between the solicitous and distracting response scales in section II as well as the activities away from home and social activities scales in section III. They suggested that the combination of these scales would improve the internal structure of the MPI. The purpose of this study was to perform a confirmatory factor analysis testing whether the MPI would be improved by the consolidation of these scales. In addition, a third, empirical model was generated for comparison with the West Haven-Yale and Bernstein models. ⋯ Principal axis factor analysis resulted in an empirical model that suggested that the primary psychometric problem of the MPI was lack of item-factor discrimination for several items. When the three models were tested using confirmatory factor analysis, improvement in model fit occurred when cross loading items were excluded. Nevertheless, the goodness of fit of original factor structure was adequate, suggesting it would be premature to suggest changes in this instrument.