Treatment of chronic pain is often complex and may be further complicated when patients and health care providers have differing goals and attitudes concerning treatment. Difficulties in engaging in collaborative treatment decision making may result. Efforts to enhance patient-provider communication as well as to systematically examine nonspecific treatment factors are likely to promote effective management of chronic pain.

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Many reports document that bone marrow stromal cells or their cytokine products can influence the formation of B cells in vitro. Most of this data comes from studies using lines or clones of stromal cells after multiple passage in culture, which could alter gene expression. Our aim in the present study was to determine which cytokines are produced by normal stromal cells under conditions that promote B lymphopoiesis. Primary cultured stromal cells were isolated on FACS from active Whitlock cultures. These cells proved to be relatively homogeneous in expression of cell surface antigens (CD44, VCAM-1, MECA10, and a molecule marked by hamster anti-mouse 8.28 monoclonal antibody). RNA from unselected Whitlock cultured adherent cells and sorted stromal cells from the same cultures were subjected to reverse transcriptase polymerase chain reaction to assess constitutive expression of several cytokine genes. Transcripts for interleukin-1 beta (IL-1 beta), IL-7, macrophage (M)-colony-stimulating factor (CSF), stem cell growth factor (SCGF), insulin-like growth factor 1 (IGF-1) and occasionally leukemia inhibitory factor were detected in RNA from intact cultures. Messages for IL-7, M-CSF, and SCGF were selectively contained within the isolated stromal cell fraction; whereas, IL-1 beta was found solely within the non-stromal cell fraction. IGF-1 was transcribed by both stromal cells and macrophages in Whitlock cultures. No evidence was found for constitutive expression of IL-1 alpha, IL-4, IL-6, or granulocyte-macrophage-CSF. This is in contrast to some reported stromal cell lines and clones. To determine if all primary stromal cells from active lymphopoietic cultures produced IL-7, the isolated cells were stained to reveal cytoplasmic IL-7 protein. A majority of the cells produced IL-7, but about 20% had no detectable IL-7 protein. Taken together, our results suggest that the primary stromal cells are a distinguishable cell type but functional subsets may exist. In regard to the differences in IL-7 production, the primary cell phenotype appears to mirror at least one division noted among the stromal cell lines.

A model for defining competencies in clinical health psychology has recently been proposed (France et al., 2008), focusing on the core foundational and functional competency domains outlined by the Cube Model (Rodolfa, Bent, Eisman, Nelson, Rehm, & Richie, 2005). The model characterizes competencies expected of graduates of doctoral training programs with emerging interests and expertise in clinical health psychology. The current paper extends the model by specifically considering the third dimension of the cube model, namely the developmental perspective, with an emphasis beyond the parameters of doctoral training to the predoctoral internship, postdoctoral residency, and postlicensure continuum.

Underlying pain self-management treatments is the expectation that patients must adhere to coping skill practice recommendations to obtain treatment benefits. Recently, a model of motivation for pain treatment has proposed that patients' readiness to adopt a self-management approach serves as a predictor of active participation in treatment, and ultimately, of improved outcomes. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) ratings, to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. Further analyses tested the hypothesis that adherence mediated the relationship between readiness to change and goal accomplishment. Data were collected as part of a larger randomized controlled trial of primary care based CBT. Participants were 78 patients recruited from a VA primary care clinic. At pre-treatment Ss completed the PSOCQ to assess readiness to adopt a self-management approach to chronic pain and an SE measure to quantify certainty of achieving up to five behavioral treatment goals. Criteria were means of aggregated intersession adherence ratings and mean post-treatment goal accomplishment ratings. Pre-treatment PSOCQ variables significantly predicted intersession adherence and goal accomplishment. SE did not significantly predict either criterion. The statistical relationship between pre-treatment PSOCQ and behavioral goal accomplishment was significantly attenuated when intersession adherence was taken into account. These data provide support for a motivational model of pain treatment that asserts adherence to therapist recommendations for coping skill practice mediates readiness to change and self-reported goal attainments.

This study examined effects of applicants' personality and gender on faculty rankings and matching to an Oral and Maxillofacial Surgery (OMS) residency program. Forty-seven applicants completed a standardized personality measure (Adjective Check List, ACL), and faculty interviewers rated each applicant on five personality dimensions during their onsite interview. Applicants were found to be similar to the normative population on all ACL personality dimensions, indicating that there is no distinctive personality profile characteristic of individuals seeking an OMS residency position. Male applicants were rated by interviewers as being more capable of dealing with stress effectively and more affiliative and deferent to authority than female applicants. Applicant ACL scores were unrelated to faculty rankings, but applicants rated as more friendly, motivated, assertive, confident, and tolerant of stress received more favorable rankings. Compared to applicants who did not match at this site, matched applicants were more likely to seek emotional support from others and were rated as being more assertive. Study limitations as well as implications for the use of personality measures and interviews in the selection of OMS residency candidates are discussed.

The integration of mental health services within primary care settings has received major attention recently. This project describes the development and implementation of an integration program at a Veterans Affairs medical center. An additional goal was to conduct a practical program evaluation demonstrating the ability of the program to be implemented within an already existing primary care clinic while still meeting important goals of integration. Despite challenges, the present project demonstrates that this is a feasible goal.

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