This study supports the validity of self-report and behavioral measures of pain in frail elders with and without cognitive impairments. Each of the measures used contributed different information to pain assessment, suggesting that investigations of pain in elders with cognitive impairments should employ varying types of pain assessment tools.

The Chronic Pain Coping Inventory (CPCI; Jensen, M.P., Turner, J.A., Romano, J.M. and Strom, S.E., The Chronic Pain Coping Inventory: development and preliminary validation, Pain, 60 (1995) 203-216) is a recently developed questionnaire comprising eight main subscales that measure coping strategies that are frequently targeted for change in interdisciplinary pain treatment programs. Preliminary research, carried out by the developers of the CPCI, supports the reliability and validity of the scale. The purpose of the present study was to further examine the validity of the CPCI independently. In the present study, 210 patients were administered the CPCI, along with the Coping Strategies Questionnaire (CSQ; Rosenstiel, A.K. and Keefe, F.J., The use of coping strategies in low back pain patients: relationship to patient characteristics and current adjustment, Pain, 17 (1983) 33-44; Riley III, J.L. and Robinson, M.E., CSQ: five factors or fiction? Clin. J. Pain, 13 (1997) 156-162), and the Multidimensional Pain Inventory (MPI; Kerns, R.D., Turk, D.C. and Rudy, T.E.. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI), Pain, 23 (1985) 345-356) as part of a pre-admission screening. Principal components analysis with oblique rotation was performed on the 64 main CPCI scale items. An eight-factor solution was identified as most appropriate. The original subscales were generally supported, however, some modifications to scoring of subscales were suggested. As a second step in the study, the relationship between the modified CPCI subscales and the CSQ subscales were examined and their relative ability to predict concurrent adjustment to pain (MPI subscales) was assessed. Results indicated that CPCI subscales tap coping constructs that are conceptually different than the CSQ subscales. Several CPCI subscales were also found to be significantly and uniquely related to measures of concurrent adjustment, even after taking CSQ subscales and demographic and pain-related variables into account. These results suggest the CPCI is a valuable tool, above and beyond established coping measures, in the clinical assessment and research of pain. Directions for future research are discussed.

BACKGROUND: Objectively coded facial activity provides a useful index of pain among elders who have difficulty in reporting pain because of cognitive impairments. However, limitations of previous research include no direct assessment of participants' level of cognitive impairment; no comparison of the reactions of elders with cognitive impairments with those of nonimpaired elders; observers' expectations about pain levels could have influenced judgements about the severity of pain experienced when global rather than objectively coded measures were used because the painful medical procedure was visible on film.OBJECTIVE: To extend previous findings by incorporating improvements in design and methodology in response to the aforementioned limitations.PARTICIPANTS: Fifty-nine in-patients with a mean age of 73 years.METHODS: Facial reactions were filmed during routine blood tests and coded objectively using the Facial Action Coding System (FACS). Observer ratings of pain were also obtained.RESULTS: FACS indexes revealed substantial changes from baseline to venepuncture indiscriminate of whether elders were cognitively impaired. Furthermore, these changes were apparent to both nurse and student observers although the nurses rated the pain displayed by the patients as being lower.CONCLUSION: After addressing limitations of previous work in this area, the validity of nonverbal indexes of pain in the assessment of elders with cognitive impairments was demonstrated. Such indexes are uniquely suited as outcome measures within the context of clinical trial methodology.

Because insurance adjusters' decisions about whether to grant compensation to disability claimants are often based on subjective criteria, such decisions may be susceptible to the influence of factors irrelevant to the claimant's disabling condition. Objective: To examine whether judgments about compensation claimants are affected by the claimants' way of coping with pain and by claimant sex. Participants: Two hundred undergraduate students. Study Design: Participants made judgments about vignettes describing fictitious compensation claimants with differing strategies of coping with pain. The main analytic approach involved a multivariate analysis of variance with 5 within-subjects factors (i.e., coping style described in each of 5 vignettes) and 2 between-subjects factors (i.e., sex of claimant described in the vignettes). Results: Coping style was significantly related to perceptions of pain severity and disability and to beliefs about whether compensation should be awarded. Claimants who were described as engaging in catastrophizing or in praying and hoping were more likely than other claimants to be perceived as disabled and as deserving compensation for their injuries. Conclusions: Decisions about disability compensation could be influenced by claimant

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