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(522) A behavioral telehealth program for chronic pain: participant characteristics, goals, and psychosocial outcomes
Abstracts
attenuation of increases in pain unpleasantness. Due to the lack of an adequate control condition, these results should be interpreted cautiously. However, these findings support the efficacy of guided imagery in general and warrants further examination of the specific effects of resilience-focused imagery.
(521) Randomized assignment of Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory – 2- Restructured Format – 2 (MMPI-2-RF) in 2 unique pain populations: mixed musculoskeletal pain and chronic daily headache T Clark, J Wakim, R Marek, and Y Ben Porath; Baylor Center for Pain Management, Dallas, TX
Patients in two populations (mixed musculoskeletal pain and chronic daily headache) were randomly administrated either the MMPI-2-RF or the PAI in a prospective study. Although data exists for PAI and MMPI-2-RF in persons with chronic pain, no study has compared these two instruments in the same setting to reduce sample bias. In addition, no studies were found for MMPI-2-RF in persons with chronic daily headache. Ninety three (93) patients with mixed pain (MP) including lumbar, cervical and fibromyalgia pain in a chronic pain clinic and 109 patients with chronic daily headache (CDH) at a tertiary headache clinic were randomly assigned either the PAI or MMPI-2-RF. Profiles on each instrument did not differ based on setting (diagnostic group). Only 6% of scales on the PAI differed by more than 5 points. MP demonstrated elevated health complaints (SOM, SOM-C, SOM-H) while CDH was higher for Stimulus Seeking (ANT-S). Similarly, only 8% of scales on the MMPI-2RF differed by more than 5 points. CDH had lower positive emotion (RC2), but higher head pain (HPC) and cognitive complaints (COG) while MP had higher neurological complaints (NUC). In this light, both groups were combined for further analysis. These analyses revealed significant elevations on health concerns but not on affective distress, interpersonal problems, or other issues. On the MMPI-2-RF, only scales measuring health concerns were elevated (T score =>70 for scales FBS-r, RC-1, MLS, T score = 65-69 for scales Fs, RBS, NUC. Similarly, on the PAI only scales measuring health complaints fell above T score of 70 (SOM=72, SOMS-S=72) or between T scores of 65 and 69 (SOM-C, SOM-H). In summary, profiles were similar for patients with chronic mixed pain and chronic daily headache. Clinical elevations were found only on health complaints without marked elevations for emotional distress or other pathology.
(522) A behavioral telehealth program for chronic pain: participant characteristics, goals, and psychosocial outcomes H Greenberger, A Peters, L Dent, L Vue, and R Pande; AbilTo, Inc., New York, NY
Telehealth-delivered behavioral therapy for chronic pain has been evaluated in the research setting; few data have described real world implementation and outcomes. The purpose of this study was to evaluate characteristics, behavioral health goals, and psychosocial outcomes among participants enrolled in a nationally available standardized 8-week behavioral therapy program for chronic pain provided by both a licensed therapist and a behavior coach via telephone/secure video. This was mixed-methods retrospective cohort analysis among consecutive program graduates (enrollment February-July 2015; N=100; mean age 52y; 23% male). Participant chief complaint, behavioral goals, and mood triggers were abstracted by de-identified clinical record review using structured qualitative research methods. Depression, anxiety, and stress symptoms data were collected at baseline and program graduation by validated survey (DASS-21). Back pain (42%) and hip/leg/knee pain (28%) comprised the most common chief complaints. Pain management (44%) and weight loss (43%) were the most frequently cited goals. At baseline, approximately half of participants had elevated depression (54%), anxiety (50%), and/or stress (45%) scores. Triggers for depressed, anxious or stressed mood included severe pain (47%), health concerns (46%), and interpersonal relationship challenges (45%). At graduation, significant improvement in depression (-48%), anxiety (-44%), and stress (-23%) scores were observed among those with non-normal baseline values (p<.001); degree of improvement did not vary by participant age or sex. In summary, participants in a national behavioral telehealth program for chronic pain shared several common complaints, goals, and mood triggers, and experi-
The Journal of Pain
S105
enced significant improvement in depression, anxiety, and stress symptoms. This work was supported by AbilTo, Inc., New York, NY.
(523) Psychological and personality differences between male and female veterans in an inpatient interdisciplinary chronic pain program M Echevarria Baez, S Miller, and E Banou; James A. Haley Veterans Hospital, Tampa, FL
Given the complexity, variability, and potential negative outcomes associated with chronic pain, the Department of Veterans Affairs has made its treatment a priority. It is projected that by 2016, the VA will have at least a 10% increase in service utilization amongst female veterans, with that number rising each year. Research in the general population has revealed important gender differences in the experience and manifestations of chronic pain; it will be important to continue exploration of these gender differences in veteran samples. A recent study conducted with male and female veterans engaged in an inpatient pain rehabilitation program demonstrated that women differed from their male counterparts on some notable demographic and pain variables, as well as in their maintenance of treatment gains. The current study explored personality and psychological differences between male and female veterans in an inpatient pain rehabilitation program, using the restructured form of the MMPI-2 (MMPI-2-RF). The MMPI-2-RF is a measure of psychopathology used widely in clinical settings, with a broad array of scales useful in a pain setting. Examination of these differences may inform pain management and treatment programming for both male and female veterans. Results indicated that women reported greater levels of somatic dysfunction, while men were higher on measures of externalizing. Detailed results, limitations, clinical implications, and future research directions will be presented.
(524) Changes in pain severity, physical disability and perceptions of injustice following total knee replacement surgery E Yakobov, W Stanish, G Richardson, M Tanzer, M and M Sullivan; McGill University, Montreal, Quebec, Canada
Dunbar,
Evidence accumulated to suggest that perceived injustice is a risk factor for poor pain related outcomes in individuals with various chronic pain conditions. Perceived injustice has been conceptualized as an appraisal process that is characterized by themes of unfairness, tendency to blame others for one’s suffering and perceived severity and irreparability of losses. The robust cross-sectional and prospective associations between perceived injustice, pain intensity, and physical disability in individuals with chronic pain conditions draw attention to perceived injustice as a target for intervention. However the development of psychosocial interventions neccesiates better understanding of the factors that influence perceptions of injustice. To date, no empirical studies explored whether decrease in pain intensity and improved physical function following a surgical procedure can reduce perceptions of injustice. The aim of the present study was to investigate whether perceived injustice changes as a function of reduction in pain and disability in individuals with severe osteoarthritis of the knee after total knee arthroplasty (TKA). TKA is a highly effective procedure in reducing osteoarthritis related pain and results in marked improvement in physical function. After surgery, many individuals report reduction in symptoms and improved ability to participate in life activities. We hypothesized that reduction in suffering associated with pain severity, and reparation of losses associated with resumption of valued life activities will translate into reduced scores of perceived injustice. Participants of the present study completed measures of pain, disability, and perceived injustice one week before TKA, and one year after TKA. Changes in scores of perceived injustice were associated with improvement in physical function but not with reductions in pain. Clinical and theoretical implications of the present findings are discussed.
(525) Feelings of doctor-patient similarity, trust, and liking predict pain report: Evidence from simulated clinical interactions S Anderson, E Losin, L Chang, M Powell, and T Wager; University of Miami, Miami, FL
Racial and ethnic disparities in pain treatment are widespread and costly. Although racial and ethnic discordance between the doctor and patient has been hypothesized to contribute to pain disparities, the mechanisms of this effect remain unclear. Evidence suggests that
attenuation of increases in pain unpleasantness. Due to the lack of an adequate control condition, these results should be interpreted cautiously. However, these findings support the efficacy of guided imagery in general and warrants further examination of the specific effects of resilience-focused imagery.
(521) Randomized assignment of Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory – 2- Restructured Format – 2 (MMPI-2-RF) in 2 unique pain populations: mixed musculoskeletal pain and chronic daily headache T Clark, J Wakim, R Marek, and Y Ben Porath; Baylor Center for Pain Management, Dallas, TX
Patients in two populations (mixed musculoskeletal pain and chronic daily headache) were randomly administrated either the MMPI-2-RF or the PAI in a prospective study. Although data exists for PAI and MMPI-2-RF in persons with chronic pain, no study has compared these two instruments in the same setting to reduce sample bias. In addition, no studies were found for MMPI-2-RF in persons with chronic daily headache. Ninety three (93) patients with mixed pain (MP) including lumbar, cervical and fibromyalgia pain in a chronic pain clinic and 109 patients with chronic daily headache (CDH) at a tertiary headache clinic were randomly assigned either the PAI or MMPI-2-RF. Profiles on each instrument did not differ based on setting (diagnostic group). Only 6% of scales on the PAI differed by more than 5 points. MP demonstrated elevated health complaints (SOM, SOM-C, SOM-H) while CDH was higher for Stimulus Seeking (ANT-S). Similarly, only 8% of scales on the MMPI-2RF differed by more than 5 points. CDH had lower positive emotion (RC2), but higher head pain (HPC) and cognitive complaints (COG) while MP had higher neurological complaints (NUC). In this light, both groups were combined for further analysis. These analyses revealed significant elevations on health concerns but not on affective distress, interpersonal problems, or other issues. On the MMPI-2-RF, only scales measuring health concerns were elevated (T score =>70 for scales FBS-r, RC-1, MLS, T score = 65-69 for scales Fs, RBS, NUC. Similarly, on the PAI only scales measuring health complaints fell above T score of 70 (SOM=72, SOMS-S=72) or between T scores of 65 and 69 (SOM-C, SOM-H). In summary, profiles were similar for patients with chronic mixed pain and chronic daily headache. Clinical elevations were found only on health complaints without marked elevations for emotional distress or other pathology.
(522) A behavioral telehealth program for chronic pain: participant characteristics, goals, and psychosocial outcomes H Greenberger, A Peters, L Dent, L Vue, and R Pande; AbilTo, Inc., New York, NY
Telehealth-delivered behavioral therapy for chronic pain has been evaluated in the research setting; few data have described real world implementation and outcomes. The purpose of this study was to evaluate characteristics, behavioral health goals, and psychosocial outcomes among participants enrolled in a nationally available standardized 8-week behavioral therapy program for chronic pain provided by both a licensed therapist and a behavior coach via telephone/secure video. This was mixed-methods retrospective cohort analysis among consecutive program graduates (enrollment February-July 2015; N=100; mean age 52y; 23% male). Participant chief complaint, behavioral goals, and mood triggers were abstracted by de-identified clinical record review using structured qualitative research methods. Depression, anxiety, and stress symptoms data were collected at baseline and program graduation by validated survey (DASS-21). Back pain (42%) and hip/leg/knee pain (28%) comprised the most common chief complaints. Pain management (44%) and weight loss (43%) were the most frequently cited goals. At baseline, approximately half of participants had elevated depression (54%), anxiety (50%), and/or stress (45%) scores. Triggers for depressed, anxious or stressed mood included severe pain (47%), health concerns (46%), and interpersonal relationship challenges (45%). At graduation, significant improvement in depression (-48%), anxiety (-44%), and stress (-23%) scores were observed among those with non-normal baseline values (p<.001); degree of improvement did not vary by participant age or sex. In summary, participants in a national behavioral telehealth program for chronic pain shared several common complaints, goals, and mood triggers, and experi-
The Journal of Pain
S105
enced significant improvement in depression, anxiety, and stress symptoms. This work was supported by AbilTo, Inc., New York, NY.
(523) Psychological and personality differences between male and female veterans in an inpatient interdisciplinary chronic pain program M Echevarria Baez, S Miller, and E Banou; James A. Haley Veterans Hospital, Tampa, FL
Given the complexity, variability, and potential negative outcomes associated with chronic pain, the Department of Veterans Affairs has made its treatment a priority. It is projected that by 2016, the VA will have at least a 10% increase in service utilization amongst female veterans, with that number rising each year. Research in the general population has revealed important gender differences in the experience and manifestations of chronic pain; it will be important to continue exploration of these gender differences in veteran samples. A recent study conducted with male and female veterans engaged in an inpatient pain rehabilitation program demonstrated that women differed from their male counterparts on some notable demographic and pain variables, as well as in their maintenance of treatment gains. The current study explored personality and psychological differences between male and female veterans in an inpatient pain rehabilitation program, using the restructured form of the MMPI-2 (MMPI-2-RF). The MMPI-2-RF is a measure of psychopathology used widely in clinical settings, with a broad array of scales useful in a pain setting. Examination of these differences may inform pain management and treatment programming for both male and female veterans. Results indicated that women reported greater levels of somatic dysfunction, while men were higher on measures of externalizing. Detailed results, limitations, clinical implications, and future research directions will be presented.
(524) Changes in pain severity, physical disability and perceptions of injustice following total knee replacement surgery E Yakobov, W Stanish, G Richardson, M Tanzer, M and M Sullivan; McGill University, Montreal, Quebec, Canada
Dunbar,
Evidence accumulated to suggest that perceived injustice is a risk factor for poor pain related outcomes in individuals with various chronic pain conditions. Perceived injustice has been conceptualized as an appraisal process that is characterized by themes of unfairness, tendency to blame others for one’s suffering and perceived severity and irreparability of losses. The robust cross-sectional and prospective associations between perceived injustice, pain intensity, and physical disability in individuals with chronic pain conditions draw attention to perceived injustice as a target for intervention. However the development of psychosocial interventions neccesiates better understanding of the factors that influence perceptions of injustice. To date, no empirical studies explored whether decrease in pain intensity and improved physical function following a surgical procedure can reduce perceptions of injustice. The aim of the present study was to investigate whether perceived injustice changes as a function of reduction in pain and disability in individuals with severe osteoarthritis of the knee after total knee arthroplasty (TKA). TKA is a highly effective procedure in reducing osteoarthritis related pain and results in marked improvement in physical function. After surgery, many individuals report reduction in symptoms and improved ability to participate in life activities. We hypothesized that reduction in suffering associated with pain severity, and reparation of losses associated with resumption of valued life activities will translate into reduced scores of perceived injustice. Participants of the present study completed measures of pain, disability, and perceived injustice one week before TKA, and one year after TKA. Changes in scores of perceived injustice were associated with improvement in physical function but not with reductions in pain. Clinical and theoretical implications of the present findings are discussed.
(525) Feelings of doctor-patient similarity, trust, and liking predict pain report: Evidence from simulated clinical interactions S Anderson, E Losin, L Chang, M Powell, and T Wager; University of Miami, Miami, FL
Racial and ethnic disparities in pain treatment are widespread and costly. Although racial and ethnic discordance between the doctor and patient has been hypothesized to contribute to pain disparities, the mechanisms of this effect remain unclear. Evidence suggests that