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In this study 42 chronic back pain patients participated twice in a treadmill test. During 1 of these 2 sessions, the partner was present. Walking time, pain intensity ratings, and heart rate were measured before and after the tests. From the results of previous studies it was expected that, in the presence of a relatively solicitous spouse, patients would report more pain, would have a shorter walking time, and would exert themselves less physically. Spouse solicitousness was measured in 2 ways: from the patient's perspective as well as from that of the spouse. Results based on the patient's interpretation of his/her partner's responses are not in accordance with previous findings. Results based on the spouse's view demonstrate, however, that patients with solicitous spouses do, in fact, report more pain and walk for a shorter duration in the presence of the spouse than patients with relatively non-solicitous spouses. Theoretical and practical implications are discussed.

The three-systems model of chronic pain emphasizes the partially independent relationship among physiological, gross motor and verbal-cognitive responses of chronic pain patients. This study describes the development of an assessment instrument representing a measure for the verbal-cognitive response system of chronic pain. Fifty items, each of which is assigned to one of five factors (pain impact, catastrophizing, outcome efficacy, acquiescence and reliance on health care) constitute the new Pain Cognition List (PCL). The PCL was developed using a Dutch back pain population and proves to be stable across sex and back pain diagnosis. By means of three experiments the PCL is shown to be reliable and sufficiently valid. The PCL might be a promising tool for identifying pain patients whose pain problem is mainly controlled by cognitive factors.

OBJECTIVE: To investigate the long-term effects of surgically induced weight loss on the psychological functioning of morbidly obese patients. DESIGN: Comparison between preoperative and postoperative psychometric test results in a cross-sectional study. PATIENTS AND METHODS: Three psychometric tests were administered to 62 morbidly obese patients before and after surgery. RESULTS: The mean follow-up was 85.9 AE 48.1 months. Surgical treatment resulted in a mean weight loss of 45.0 AE 21.3 kg (P`0.0001). The psychometric test results before surgery demonstrated somatisation, depression, denial of emotional stress, social incompetence and an indifferent attitude towards certain aspects of interpersonal behaviour. All psychopathology, except for somatisation, disappeared after surgical treatment. Improvement of psychological functioning was determined by weight loss and not in¯uenced by the surgical procedure. The level of self-esteem before surgery predicted 15.4% of the outcome variance (P`0.05). CONCLUSION: The psychopathology before surgery is almost totally reversed after sustained, surgically induced weight loss. This suggests that the preoperative psychological disturbances are the result, rather than the cause, of morbid obesity.

This study is a replication of a study done by Turk et al. but under different conditions. It is an attempt to empirically examine the dimensions and components of overt and observable chronic pain behavior. A broader definition of pain behavior is chosen, namely the interaction between the pain patient and his or her direct environment. The results suggest that pain behavior can be characterized by 3 dimensions: withdrawal-approach, high arousal-low arousal and visible-audible. Furthermore, chronic pain behavior seems to be composed of at least 9 components: anxiety, attention seeking, verbal pain complaints, medication use, general verbal complaints, distorted posture and mobility, fatigue, insomnia, and depressive mood. More dimensions and components were discovered than in the study by Turk and his colleagues. However, they correspond with the variety of psychosocial problems associated with the chronic pain syndrome. This information seems to provide a useful basis for the development of an observational measurement technique for chronic pain.

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Two experiments were carried out to study operant conditioning of pain report. Further, it was investigated whether pain-related psychophysiological and psychological measures (skin conductance response and magnitude matching) could also be conditioned operantly. In both experiments subjects received 12 painful electric shocks of equal intensity. In Exp. 1 healthy subjects were assigned to either a control group or an up-conditioning group. Up-conditioning occurred by verbally rewarding increases in pain report and punishing decreases. Analyses indicated that up-conditioning of both pain report and the pain-related psychophysiological measures succeeded. To rule out alternative explanations of the results (attention shift towards pain and conditioning of anxiety) the verbal punishments were adjusted in Exp. 2. A down-conditioning group was also added. The attempt to replicate the results of Exp. 1 failed and down-conditioning of the pain report could not be established. These inconsistent results are most probably due to modified punishment of responses. The consequences for the results of Exp. 1 are discussed. Based on the results of post hoc analyses, some suggestions are made for operant conditioning studies of pain.

It is argued that the personality of the cosmetic surgical patient is undisturbed. Furthermore it is argued that a vast majority of these patients are very pleased with the results of the cosmetic correction. A very small percentage however is dissatisfied (although no surgical-technical mistake was made) and is urging again and again for a repetition of the procedure. The terms in which the personality of the unsatiable patient is described resemble strikingly the description of borderline personality organization. The hypothesis is put forward that the personality of the cosmetic surgical insatiable patient has a borderline organization. A clinical procedure of how to identify preoperatively the insatiable patient is proposed.