Relationship of patient semantic pain descriptions to physician diagnostic judgements, activity level measures and NMPI

Abstract

A consecutive sample of chronic pain patients presenting themselves for evaluation was studied. A set of 25 bi-polar adjectives was developed from medical records of previous pain patients' descriptions of their pain. Using the Semantic Differential (S-D) method, each patient rated the extent to which his/her pain was best described by either of the adjective pairs. The S-D findings were then compared with three other data sets and those data sets were compared with each other. First, six physicians classified each patient along an "organic"--"non-organic" continuum based on ratings derived from the full set of medical diagnostic labels each patient had accrued. Secondly, each patient, prior to examination, had completed up to two weeks of diary forms at home on which were recorded amount and distribution of time among sitting, standing/walking, and reclining. Finally, each patient completed a Minnesota Multiphasic Personality Inventory (MMPI). Few and only marginally significant relationships between patient semantic descriptions of their pain and the other measures were found. Secondly, physician agreement ot the "organic"--"non-organic" criterion, using diagnostic labels as their data, was statistically significant but clinically modest. The most substantial findings were between walking hours per week recorded on diary forms and five MMPI scales. Patients who walked more were less depressed, had fewer diffuse somatic complaints, and described themselves as less frustrated or angry and as less hypersensitive in interpersonal situations. The major conclusion of the study is that chronic pain patients present sets of interrelated problems too complex to be discriminated reliably by a single set of measures; particularly, by simple word sets.

Pain assessment: Model construction and analysis of words used to describe pain-like experiences

“…In contrast to the above findings, Fordyce et al (1978) found only weak correspondence between patients' semantic descriptions of pain and medical diagnostic labels. They stated that it appears unlikely that choices of words by which pain is described will hold up as reliable discriminators among subgroups across a spectrum of patients, cultures, and patient selection factors.…”

“…If it is the case that pain and ache can be correlated with neurophysiological and anatomical structures, then in contrast to the suggestion by Fordyce (1978) it seems likely that there is a universal basis for the different distinctions employed in the pain vocabularies of different languages.…”

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

“…Both psychological and psychosocial interventions in addition to conventional exercise therapy may have a more positive effect on treatment outcome [80][81][82][83][84][85][86][87][88][89][90]. The targeted effect of such an approach would be the development of a sense of control over pain and the elimination of pain-avoidance mechanisms, whilst simultaneously improving overall physical fitness/function.…”

Psychosocial Adjustment of People with Chronic Pain: A Conceptual Framework of Risk and Resistance Factors

“…Therefore, psychological support contributes to not only the physical assistance that family or friends can offer, but also contributes to the self-worth of individuals experiencing an injury (e.g., Andrews & Brown, 1988;Elliott, Herrick, & Witty, 1992;Elliott & Shewchuk, 1995;Hwang, Chang, & Kasimis, 2000). Similar evidence is documented in the association of pain with decreased social, recreational, vocational, and domestic activities (e.g., Fordyce, Brena, Holcomb, Delateur, & Loeser, 1976: Kerns & Haythornthwaite, 1988Kerns & Jacob, 1993;Rudy et al, 1988).…”