- Email: [email protected]
(963)
S90
Abstracts
(961) Refer to Oral Paper Session 324
(964) A prospective evaluation of the impact of TMD on sleep using actigraph and diary measures of sleep
G09 - Prediction of Outcome
L Buenaver, T Kronfli, M Smith, E Grace, J Haythornthwaite; Johns Hopkins University School of Medicine, Baltimore, MD Sleep disturbance increases risk for both medical and psychiatric comorbidity and is a common complaint among individuals suffering from chronic pain conditions such as tempormandibular joint disorders (TMD). The quality of previous studies examining sleep in TMD have largely been poor, and have generally found poor sleep to be associated with pain severity and psychological distress. In this study, we evaluated baseline data from our ongoing clinical trial to: (1) describe the degree of sleep disturbance in a sample of TMD patients using both subjective (diaries) & objective (actigraphy) sleep continuity measures, and (2) to prospectively investigate sleep disturbance predictors, focusing on selfreported pain severity, psychological distress, and clinical TMD diagnostic exam indices of pain sensitivity and jaw dysfunction. Subjects completed baseline measures of pain and distress and received a TMD diagnosis based on the RDC-TMD dental exam. Analyses of the prediagnosed study population (N⫽170) reporting chronic jaw pain revealed that 58.2% (N⫽170) reported difficulty falling asleep or staying asleep of which 88.3% (N⫽99) reported daytime dysfunction. Diary and actigrpahy data on individuals diagnosed with TMD (N⫽87), respectively, indicated that: 13.8%-28.6% of the sample had difficulty with sleep onset (⬎30 mins), 28.6%-79.8% had difficulty with sleep maintenance, and 39.1%-50% were found to have significantly curtailed total sleep time (⬍ 6.5 hours per night). Multivariate analyses showed that RDC examine indices of pain sensitivity on palpation of head, neck, and masticatory muscles and jaw-opening limitations were the primary predictors of both diary and actigraphic sleep measures. Further, older age and female gender were related to some indices of sleep disturbance. Although other studies have found relationships between self-reported pain, psychological distress and sleep, our findings suggest that enhanced pain sensitivity and jaw-opening limitations may play a more prominent role deserving further investigation with an aim towards treating insomnia associated with TMD.
(962) Workers with new back injury claims: Early predictors of one-year outcomes J Turner, G Franklin, D Fulton-Kehoe, R Wu, J Gluck, L Sheppard, K Egan, T Wickizer; University of Washington, Seattle, WA This prospective, population-based cohort study tested the hypothesis that specific worker psychosocial characteristics, assessed soon after submission of a workers’ compensation back injury claim, would predict pain and physical disability one year later. Workers completed telephone interviews assessing demographic, pain-related, and psychosocial characteristics 21 days (median) after submitting a Washington State workers’ compensation claim for a disabling back injury. Among 1,893 study participants who received wage loss compensation, 1,333 (70%) completed a 1-year follow-up telephone interview. Among these 1,333 workers (67% male, mean age ⫽ 40 years), after controlling for demographics (age, gender, race, education) and baseline pain intensity, baseline measures of recovery expectations, catastrophizing, and mental health (SF-36v2) were each associated with 1-year pain intensity (all P-values ⬍ .0001). After controlling for demographics and baseline Roland physical disability scores, baseline recovery expectations, catastrophizing, and mental health were each associated with 1-year Roland scores (all P-values ⬍ .0001). Baseline fear-avoidance was not significantly associated with 1-year pain or disability after controlling for the covariates. The psychosocial measures explained modest amounts of additional variance in the 1-year outcome measures (R-square ⫽ .23 for the covariates, .26 for the covariates plus the psychosocial variables for pain intensity; .42 and .46 for Roland scores). Baseline pain (B ⫽ .49, SE ⫽ .03) and Roland scores (B ⫽ .64, SE ⫽ .02) were strong predictors of pain and disability one year later, suggesting that screening workers with these measures early after a low back injury might assist in allocating appropriate clinical resources to at-risk workers. Funded by the Centers for Disease Control and Prevention National Institute for Occupational Safety and Health grant R01 OHO4069.
(963) Prediction of chronic pain treatment outcomes: Incremental validity of selected MMPI-2 restructured clinical scales P Sloan, M Clark, R Gironda; James A. Haley Veterans Affairs Hospital, Tampa, FL The Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) has been widely used in the evaluation of people suffering with chronic pain. Several Clinical Scales have demonstrated modest utility in predicting pain treatment outcomes. Nevertheless, MMPI-2 Clinical Scales have been criticized for their lack of discriminant validity due to overlapping constructs and shared scale variance. The Restructured Clinical (RC) Scales were developed to address this psychometric limitation. However, their utility vis-a`-vis enhanced prediction of pain treatment outcomes has not been determined. The current study was conducted to assess the incremental validity of selected RC scales in the prediction of chronic pain treatment outcomes. More than 200 participants in a CARF-accredited, inpatient, multidisciplinary, chronic pain treatment program located in a Southeastern VA Medical Center completed the MMPI-2 at program admission, and the Pain Outcomes Questionnaire, Veteran’s Affairs Version (POQ-VA), at admission and following discharge. Hierarchical multiple regression techniques were used to compare the relative contributions of selected MMPI-2 Clinical (1, 2, and 3) and RC (RC1, RC2, RC3, and Demoralization) scales in the prediction of treatment-related change across multiple outcomes domains. Results indicated that some of the selected RC Scales accounted for statistically significant but modest gains in predictive power for some outcomes measures when compared to their Clinical Scale counterparts. Additionally, there was evidence of several interaction effects which complicate the interpretation of these scales when used in clinical settings. Implications of these findings with respect to the use of the MMPI-2 with chronic pain populations were discussed.
(965) Refer to Oral Paper Session 336 (966) Self-rated health pattern variations in power, pain, depression, and disability S Siedlecki; Cleveland Clinic Foundation, Cleveland, OH Self-rated health (SRH) is an important outcome measure that may provide insight into the multidimensionality of the chronic pain experience. Previous studies have demonstrated SRH predicts mortality, morbidity, function, and psychological wellbeing. While several studies have compared SRH in those with and without chronic pain, no studies have examined SRH differences within a chronic pain population. Understanding factors that affect SRH within a chronic pain population may provide the basis for interventions that improve overall health for millions of people with disabling chronic pain conditions. Individuals with chronic non-malignant pain (CNMP) typically present with a cluster of symptoms that includes low levels of power, and high levels of pain, depression, and disability. Differences in SRH may be related to variations within this symptom cluster. The purpose of this analysis was to describe SRH pattern variations in power, pain, depression, and disability in a CNMP sample. Self-rated health was measured by response to a single question: “Compared to other people you know your age, how would you rate your health?” 1) less healthy; 2) as healthy; or 3) more healthy. Power as Knowing Participation in Change Tool (PKPCT); McGill Pain Questionnaire Short Form (MPQ-SF), Center for Epidemiological Studies Depression Scale (CES-D), and the Pain Disability Index (PDI) were used to measure dependent variables. MANOVA revealed significant differences (p ⫽ .001) between SRH categories on combined dependent variable. Analysis of variance (ANOVA) was conducted as a follow-up to MANOVA and differences were significant for power (p ⫽ ⬍.001), and depression (p ⫽ .003), but not for pain or pain-related disability. Findings suggest individualized multimodal pain management programs that improve mood and provide opportunities for knowing participation may have a greater impact on overall health than those that target only pain and disability.
Abstracts
(961) Refer to Oral Paper Session 324
(964) A prospective evaluation of the impact of TMD on sleep using actigraph and diary measures of sleep
G09 - Prediction of Outcome
L Buenaver, T Kronfli, M Smith, E Grace, J Haythornthwaite; Johns Hopkins University School of Medicine, Baltimore, MD Sleep disturbance increases risk for both medical and psychiatric comorbidity and is a common complaint among individuals suffering from chronic pain conditions such as tempormandibular joint disorders (TMD). The quality of previous studies examining sleep in TMD have largely been poor, and have generally found poor sleep to be associated with pain severity and psychological distress. In this study, we evaluated baseline data from our ongoing clinical trial to: (1) describe the degree of sleep disturbance in a sample of TMD patients using both subjective (diaries) & objective (actigraphy) sleep continuity measures, and (2) to prospectively investigate sleep disturbance predictors, focusing on selfreported pain severity, psychological distress, and clinical TMD diagnostic exam indices of pain sensitivity and jaw dysfunction. Subjects completed baseline measures of pain and distress and received a TMD diagnosis based on the RDC-TMD dental exam. Analyses of the prediagnosed study population (N⫽170) reporting chronic jaw pain revealed that 58.2% (N⫽170) reported difficulty falling asleep or staying asleep of which 88.3% (N⫽99) reported daytime dysfunction. Diary and actigrpahy data on individuals diagnosed with TMD (N⫽87), respectively, indicated that: 13.8%-28.6% of the sample had difficulty with sleep onset (⬎30 mins), 28.6%-79.8% had difficulty with sleep maintenance, and 39.1%-50% were found to have significantly curtailed total sleep time (⬍ 6.5 hours per night). Multivariate analyses showed that RDC examine indices of pain sensitivity on palpation of head, neck, and masticatory muscles and jaw-opening limitations were the primary predictors of both diary and actigraphic sleep measures. Further, older age and female gender were related to some indices of sleep disturbance. Although other studies have found relationships between self-reported pain, psychological distress and sleep, our findings suggest that enhanced pain sensitivity and jaw-opening limitations may play a more prominent role deserving further investigation with an aim towards treating insomnia associated with TMD.
(962) Workers with new back injury claims: Early predictors of one-year outcomes J Turner, G Franklin, D Fulton-Kehoe, R Wu, J Gluck, L Sheppard, K Egan, T Wickizer; University of Washington, Seattle, WA This prospective, population-based cohort study tested the hypothesis that specific worker psychosocial characteristics, assessed soon after submission of a workers’ compensation back injury claim, would predict pain and physical disability one year later. Workers completed telephone interviews assessing demographic, pain-related, and psychosocial characteristics 21 days (median) after submitting a Washington State workers’ compensation claim for a disabling back injury. Among 1,893 study participants who received wage loss compensation, 1,333 (70%) completed a 1-year follow-up telephone interview. Among these 1,333 workers (67% male, mean age ⫽ 40 years), after controlling for demographics (age, gender, race, education) and baseline pain intensity, baseline measures of recovery expectations, catastrophizing, and mental health (SF-36v2) were each associated with 1-year pain intensity (all P-values ⬍ .0001). After controlling for demographics and baseline Roland physical disability scores, baseline recovery expectations, catastrophizing, and mental health were each associated with 1-year Roland scores (all P-values ⬍ .0001). Baseline fear-avoidance was not significantly associated with 1-year pain or disability after controlling for the covariates. The psychosocial measures explained modest amounts of additional variance in the 1-year outcome measures (R-square ⫽ .23 for the covariates, .26 for the covariates plus the psychosocial variables for pain intensity; .42 and .46 for Roland scores). Baseline pain (B ⫽ .49, SE ⫽ .03) and Roland scores (B ⫽ .64, SE ⫽ .02) were strong predictors of pain and disability one year later, suggesting that screening workers with these measures early after a low back injury might assist in allocating appropriate clinical resources to at-risk workers. Funded by the Centers for Disease Control and Prevention National Institute for Occupational Safety and Health grant R01 OHO4069.
(963) Prediction of chronic pain treatment outcomes: Incremental validity of selected MMPI-2 restructured clinical scales P Sloan, M Clark, R Gironda; James A. Haley Veterans Affairs Hospital, Tampa, FL The Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) has been widely used in the evaluation of people suffering with chronic pain. Several Clinical Scales have demonstrated modest utility in predicting pain treatment outcomes. Nevertheless, MMPI-2 Clinical Scales have been criticized for their lack of discriminant validity due to overlapping constructs and shared scale variance. The Restructured Clinical (RC) Scales were developed to address this psychometric limitation. However, their utility vis-a`-vis enhanced prediction of pain treatment outcomes has not been determined. The current study was conducted to assess the incremental validity of selected RC scales in the prediction of chronic pain treatment outcomes. More than 200 participants in a CARF-accredited, inpatient, multidisciplinary, chronic pain treatment program located in a Southeastern VA Medical Center completed the MMPI-2 at program admission, and the Pain Outcomes Questionnaire, Veteran’s Affairs Version (POQ-VA), at admission and following discharge. Hierarchical multiple regression techniques were used to compare the relative contributions of selected MMPI-2 Clinical (1, 2, and 3) and RC (RC1, RC2, RC3, and Demoralization) scales in the prediction of treatment-related change across multiple outcomes domains. Results indicated that some of the selected RC Scales accounted for statistically significant but modest gains in predictive power for some outcomes measures when compared to their Clinical Scale counterparts. Additionally, there was evidence of several interaction effects which complicate the interpretation of these scales when used in clinical settings. Implications of these findings with respect to the use of the MMPI-2 with chronic pain populations were discussed.
(965) Refer to Oral Paper Session 336 (966) Self-rated health pattern variations in power, pain, depression, and disability S Siedlecki; Cleveland Clinic Foundation, Cleveland, OH Self-rated health (SRH) is an important outcome measure that may provide insight into the multidimensionality of the chronic pain experience. Previous studies have demonstrated SRH predicts mortality, morbidity, function, and psychological wellbeing. While several studies have compared SRH in those with and without chronic pain, no studies have examined SRH differences within a chronic pain population. Understanding factors that affect SRH within a chronic pain population may provide the basis for interventions that improve overall health for millions of people with disabling chronic pain conditions. Individuals with chronic non-malignant pain (CNMP) typically present with a cluster of symptoms that includes low levels of power, and high levels of pain, depression, and disability. Differences in SRH may be related to variations within this symptom cluster. The purpose of this analysis was to describe SRH pattern variations in power, pain, depression, and disability in a CNMP sample. Self-rated health was measured by response to a single question: “Compared to other people you know your age, how would you rate your health?” 1) less healthy; 2) as healthy; or 3) more healthy. Power as Knowing Participation in Change Tool (PKPCT); McGill Pain Questionnaire Short Form (MPQ-SF), Center for Epidemiological Studies Depression Scale (CES-D), and the Pain Disability Index (PDI) were used to measure dependent variables. MANOVA revealed significant differences (p ⫽ .001) between SRH categories on combined dependent variable. Analysis of variance (ANOVA) was conducted as a follow-up to MANOVA and differences were significant for power (p ⫽ ⬍.001), and depression (p ⫽ .003), but not for pain or pain-related disability. Findings suggest individualized multimodal pain management programs that improve mood and provide opportunities for knowing participation may have a greater impact on overall health than those that target only pain and disability.