Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data

245

also found a positive relationship of pain behavior to compensation surgeries and patient preferences for ice or heat as treatment modalities.

status,

obesity,

number

of prior

Overt

pain behaviors: relationship to patient functioning and treatment outcome. - J.M. Romano, K.L. Syrjala, R.L. Levy, J.A. Turner, P. Evans and F.J. Keefe, Behav. Ther., 19 (1988) 191-201. This article presents 2 studies that examined the relationship of pain behavior to patient functioning and treatment outcome. Study 1 found that pretreatment levels of pain behavior in chronic low back pain patients were significantly correlated with patients’ ratings of pain, pain behavior and physical disability, but not psychosocial functioning. Study 2 found that pain behavior decreased significantly following an inpatient pain management program. Decreases in pain behavior were found to correlate with decreases in depression, but not with changes in self-reported pain or pain behavior. The authors conclude that their results support the need to use both observational and self-report measures to provide a comprehensive evaluation of chronic pain patients. Depression

among

chronic

pain patients:

cognitive-behavioral

analysis

and effect

on rehabilitation

outcome.

~ R.D.

Kerns and J.A. Haythornthwaite, J. Consult. Clin. Psychol., 56 (1988) 870-876. This study addressed 2 important issues. The first issue was whether reliable differences among depressed, mildly depressed and non-depressed chronic pain patients can be identified. Multivariate analyses revealed significant differences between these 3 patient groups on instrumental activities and coping skills, with more depressed individuals reporting lower levels of functioning. The second issue investigated was whether depression influenced participation in or outcome following a rehabilitation program. Data analysis revealed that depressed pain patients showed a greater tendency to drop out of treatment. Outcome did not differ as a function of depression among patients who completed treatment. The authors conclude that their results support a cognitive-behavioral model of depression secondary to chronic pain. Comparison

of operant

behavioral

and cognitive-behavioral

group treatment

for chronic

low back pain. -

J.A. Turner and S. Clancy, J. Consult. Clin. Psychol., 56 (1988) 261-266. This is one of the few well-controlled treatment outcome studies comparing the efficacy of operant-behavioral and cognitive-behavioral treatments for chronic low back pain. Subjects were 81 mildly dysfunctional chronic low back pain patients who were randomly assigned to the operant behavioral, cognitive behavioral or a waiting list control condition. The treatments were carried out in 8 session outpatient groups. Data analysis revealed that both treatment groups showed decreased physical and psychosocial disability. The operant-behavioral patients showed greater pre-to-post treatment improvement as rated by patients and their spouses than did the cognitive-behavioral patients. At 6 and 12 month follow-ups the operant-behavioral patients showed a leveling off in improvement, whereas the cognitive-behavioral patients showed continued improvement over the 12 months following treatment. At 12 month follow-up, patients in both treatments remained significantly improved and these 2 conditions did not differ from each other. Toward

an empirically

data. - D.C. Turk

derived

taxonomy

of chronic

pain patients:

integration

of psychological

assessment

and T.E. Rudy, J. Consult. Clin. Psychol., 56 (1988) 233-238. This study described the development and cross-validation of an empirically derived classification system for chronic pain patients. Two studies are presented. The first study identified 3 unique subgroups of chronic pain patients which the authors labeled as dysfunctional, interpersonally distressed, and minimizers/adaptive capers. The second study cross-validated these findings and confirmed the uniqueness and accuracy of the taxonomy. The authors suggest that the classification system they have developed has implications for treatment planning.