The postoperative prescription and administration of analgesics following cardiac surgery for 50 children were compared with those of 50 adults. Six children were the only patients in the sample who were prescribed no postoperative analgesics. Overall, children were prescribed significantly fewer potent narcotics. The administration data revealed even more pronounced group differences. During the observation period, children received 30% of all analgesic administrations while adults received 70%. Some possible reasons for these age differences in analgesic usage are presented, and implications regarding the adequacy of postoperative pain control in children are discussed.

Chronic pain patients frequently report that weather conditions affect their pain; however, no standardized measures of weather sensitivity have been developed. We describe the development and use of the Weather and Pain Questionnaire (WPQ) which assess patient sensitivity to meteorologic variables defined by the National Weather Service (e.g., temperature, precipitation). Seventy chronic pain patients (59% females) with an average age of 43 years completed the WPQ. The instrument was revised using factor analysis to produce a Weather Sensitivity Index (WSI) (48% of variance) with high internal consistency (0.93) and test-retest reliability (r = 0.89). Reporting patterns suggested that patients could reliably identify which meteorologic variables influenced their pain but could not reliably determine which physical symptoms were consistently affected. The most frequently reported meteorologic variables which affect pain complaint were temperature (87%) and humidity (77%). The most frequently reported physical complaints associated with the weather were joint and muscle aches (82% and 79%, respectively). Patients labeled as being 'weather sensitive', defined by greater than median scores on the WPQ, reported significantly greater pain intensity, greater chronicity of pain problems, and more difficulties sleeping than patients with low scores on the WPQ. No differences in gender, education level, disability status, or global psychological distress were found. Results are discussed with respect to physiological and psychological mediating variables.

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The Symptom Checklist-90 (SCL-90) is a potentially useful measure of psychopathology in chronic pain patients. To date, the factor structure of the SCL-90 has not been examined for pain populations. A sample of 600 outpatients treated for chronic pain was randomly split and their SCL-90 responses analyzed via maximum likelihood (with oblique rotation) factoring. A second-order splithalf factor analysis was performed and several restricted factor models were compared within the Linear Structural Relations format (LBREL;Joreskog & Sorbom, 1978, 1979. A 10-fector model was judged most meaningful and statistically appropriate in the first-order analysis. The secondorder analyses produced three factors tentatively named Somatic Distress, Cognitive Distress, and Distrust. All factors replicated across the data halves, thus providing evidence for factorial stability. The complementary use of exploratory and confirmatory factoring methods is illustrated and discussed.It is widely acknowledged that the clinical management of chronic pain requires a multidisciplinary regimen that includes some optimal combination of social, psychological, and medical interventions (Crue, 1985;Schneider & Karoly, 1983;Turk, Meichenbaum, & Genest, 1983). This perspective has given impetus to a burgeoning literature concerned with the development of psychological assessment protocols suitable for medical patients (Leavitt, 1982;Nigl, 1984;Southwick& White, 1983).Consequently, there is a need to examine the responses of medical patients to standardized psychiatric measures in order to adapt such instruments for clinical use within the hospital setting.Several investigators (e.g., Hendler, 1981;D. P. Schwartz & DeGood, 1983) have advocated using the Symptom Checklist-90 (SCL-90;Derogatis, 1977) as a measure of psychological distress in chronic pain patients. The SCL-90 is a multidimensional self-report inventory composed of 90 items, each describing a physical or psychiatric symptom. The instructions require the patient to indicate on a 5-point scale (ranging from not at all [0] to extremely [4]) how much a given symptom has caused discomfort during the past 2 months. The instrument consists of nine subscales: Somatization (SOM), Obsessive-

Above average use of CAM is associated with higher education, greater well-being and higher Absorption. The personality traits associated with alternative therapies are compatible with participation in these therapies and may facilitate the capacity to benefit from them.

The beliefs and expectancies of chronic pain patients have been shown to be critical cognitive facilitators or impediments to the recovery process. In the present study patients presenting to an outpatient pain center were classified according to their response to the questionnaire item "Who do you think is at fault for your pain?". Patients were then grouped according to the responses 'employer', 'other', or 'no one'. The resulting 3 groups of patients did not differ in current pain intensity or activity limitation, but the fault conditions, relative to the no-fault patients, reported greater concurrent mood distress and behavioral disturbance, as well as poorer response to past treatments, and lessor expectations of future benefits. The negative effects were more pronounced in the Employer-Fault group, than for the Other-Fault group (primarily 'doctors' and 'other drivers'). On balance, the present data suggest that attribution of blame may be an under-recognized cognitive correlate of pain behavior, mood disturbance, and poor response to treatment.

Based primarily on anecdotal evidence, patients with reflex sympathetic dystrophy (RSD) have often been suspected of having a high degree of psychosocial disturbance prior to the onset of symptoms as well as in reaction to the disorder. In the present study, patients presenting to a pain center with RSD were compared to patients with low back (LBP) and headache pain (HAP) on a variety of self-reported demographic, behavioral, pain, and mood measures. Typical of most patients experiencing chronic pain, all three groups demonstrated elevations indicative of pain, emotional distress, and behavioral disturbance. However, although the RSD patient group reported the highest level of pain intensity, the most employment disruption, and contained the highest percentage of patients receiving financial compensation, this same group paradoxically reported less emotional distress on the Symptom Checklist-90R than did LBP and HAP patients. This paradox may be due to the lesser chronicity of the RSD patients as well as to their apparently experiencing a more sympathetic response from doctors, employers, and insurance carriers than their LBP and HAP counterparts. On balance, the present data do not support the hypothesis the RSD patients, relative to other pain patients, are uniquely disturbed in psychosocial functioning.

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