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Biomedical subjects

D C Turk

Publications and source records attributed to D C Turk.

At least 55 records · Page 3Linked to original sources
PubMed1996

Pain, disability, and physical functioning in subgroups of patients with fibromyalgia.

OBJECTIVE: To investigate (1) whether patients with fibromyalgia (FM) could be subgrouped on the basis of psychosocial and behavioral responses to pain, and (2) the relationships among pain severity, perceived disability, and observed physical functioning, as measured by cervical spinal mobility. METHODS: 117 patients with FM received a comprehensive examination, underwent physical performance tasks during the evaluation, and completed self-report inventories. RESULTS: About 87% of the patients could be classified into the Multidimensional Pain Inventory clustering groups identified and validated in patients with a range of chronic pain problems (Dysfunctional, Interpersonally Distressed, and Adaptive Copers). Although the 3 groups exhibited comparable levels of physical functioning, the Dysfunctional and Interpersonally Distressed patients reported higher levels of pain, disability, and depression. Interpersonally Distressed patients also reported significantly lower levels of marital satisfaction than the other 2 subgroups. There were significant associations between pain severity and perceived disability, and pain severity and physical functioning, defined by spinal mobility tests. The relationship between disability and physical functioning did not reach statistical significance. Correlational analyses by subgroups revealed a significant association between patient perceived disability and physical functioning in the Adaptive Copers, but not the Dysfunctional or Interpersonally Distressed patients. CONCLUSIONS: Patients with FM can be classified into 3 subgroups based on psychosocial and behavioral characteristics. These subgroups show substantial differences in clinical presentation of their symptoms. Although the results should be considered preliminary due to the narrow range of physical functioning, the differential relationships between perceived disability and physical functioning across cluster groups suggest the importance of FM syndrome as a heterogeneous disorder. Treating patients with FM as a homogeneous group may compromise research results, impede understanding of the mechanisms underlying this condition, and deter development of effective treatment.

Adult↗
PubMed1995

Perspectives of chronic pain: an evaluative comparison of restrictive and comprehensive models.

The authors compare theoretical perspectives of chronic pain using a restrictive comprehensive categorization. Four of the perspectives (mind-body dualism, psychological, radical operant--behavioral, and radical cognitive) are categorized as restrictive. The other 4 perspectives (International Association for the Study of Pain, gate control, nonradical operant--behavioral, and cognitive-behavioral) that incorporate multiple facets are categorized as comprehensive. On the basis of empirical support, practical application, and issues concerning potential research design problems, the restrictive perspectives could be rejected for not providing a model in which chronic pain can be thoroughly investigated. The comprehensive perspectives, however, demonstrate greater potential for serving that role. Nonetheless, the need for additional theory development by the comprehensive perspectives is noted.

Chronic Disease↗
PubMed1995

Psychosocial and behavioral characteristics in chronic headache patients: support for a continuum and dual-diagnostic approach.

The present study attempted to identify psychological differences among different headache diagnoses defined by IHS criteria as well as psychological differences by headache intensity and frequency. Differences between diagnostic categories reflected characteristics used to assign diagnoses, namely the constancy of pain and distracting behaviors of significant others due to isolating behavior from photophobia and phonophobia. A rating of headache intensity and frequency was a more powerful predictor of psychological ratings than diagnosis. Diagnosis was related to headache frequency but not intensity. The results suggest that a continuum diagnosis based on severity can be useful in conceptualizing headaches, and a dual-diagnostic system integrating headache characteristics with perceptions and coping ability would be helpful in determining treatment options.

Adult↗
PubMed1995

The relationship of locus of control and psychosocial-behavioral response in chronic headache.

It has been suggested that patients' perceptions of the impact chronic headache has on their lives as well as perceived control of their headaches may be associated with the intensity, duration, and exacerbation of pain they experience. The present study examined associations among International Headache Society (IHS) diagnostic category, pain characteristics such as severity and duration, perceived impact and control of headaches, and adaptive response. Two hundred twenty-five patients with migraine, tension-type, or combined migraine and tension-type headache served as subjects. General activity level was related to IHS diagnosis, with migraine headache patients reporting that they are more active than tension-type headache patients (F(2, 196) = 5.69, P < .01). Headache locus of control was not significantly related to IHS diagnosis, however external headache locus of control was significantly related to headache intensity (r = .32, P < .001, r = .25, P < .001), as well as to patients' perceptions of the extent to which pain interfered with various domains of their lives (r = .33, P < .001, r = .28, P < .001), and adaptive response (F(6, 402) = 4.68, P < .001). It appeared that perceived control over headaches and perceived impact of headaches were not related to IHS diagnostic category and were not strongly related to each other, but were related to headache severity.

Adult↗
PubMed1995

A dual-diagnostic approach assesses TMD patients.

The understanding and treatment of patients with temporomandibular disorders, or TMDs, have been impeded by the lack of a consensually agreed-on classification system on which to make a differential diagnosis. A number of classification systems for these patients have been proposed. Some are based primarily on whether symptoms are myogenic or arthralgic--somatically based; some investigators have suggested that patients be differentiated on the basis of psychological characteristics. It has been suggested recently that patients be classified along two dimensions--physical and psychological. This article summarizes research describing the development of a psychosocial classification of TMD patients that can be used with the physical axis of the recently proposed research diagnostic criteria for classification of TMD patients. It also presents preliminary evidence supporting the clinical utility of the psychosocial classification.

Dental Research↗
PubMed1994

Demand characteristics underlying differential ratings of sensory versus affective components of pain.

In several investigations, differential ratings of sensory and affective components of pain can be explained by the expectations conveyed to subjects to provide different ratings for each pain component under conditions where they could readily recall their ratings. In Experiment I, such demand characteristics were controlled in one group by having subjects rate each pain component in a separate session 1 week apart, so as to minimize recall. This group failed to differentiate between sensory and affective pain; however, another group with demand characteristics left uncontrolled, provided disparate and parallel functions for the two pain components. These results imply that recall during concurrent ratings of the two pain components contributes to a spurious separation of ratings for each component. In the second study, with demand characteristics controlled, a medication placebo led to ratings of affective pain that were significantly lower than those for sensory pain, and a divergence between the functions for each component. This offers an approach to the veridical separation of sensory and affective components of pain.

Analysis of Variance↗
PubMed1994

Detecting depression in chronic pain patients: adequacy of self-reports.

Depression, a complex psychobiological syndrome, has been found to be prevalent among individuals with chronic pain problems. It has been repeatedly recommended that chronic pain patients be routinely screened for depression. Many self-report questionnaires have been used to screen for depression although few have addressed potential limitations of using a self-report questionnaire to identify depressed chronic pain patients. Among the most serious problems is an over-diagnosis since typical neurovegetative symptoms of depression often resemble patients' medical/physical conditions. Some have suggested that the physical items should be replaced and others have suggested that a higher cut-off criteria for diagnosing depression should be used. In this study, the validity of the Center for Epidemiological Studies-Depression (CES-D) scale was examined to determine (a) its sensitivity, specificity, and positive, and negative predictive value with chronic pain patients, (b) the biasing effect of somatic items, and (c) the optimal cut-off score for diagnosing depression. The results support the predictive validity of the CES-D and suggest that a cut-off score of 19 should be used for diagnosing depression in chronic pain patients rather than the standard cut-off point of 16. Interestingly, the removal of the somatic items did not enhance the effectiveness of the CES-D. The discriminatory ability of somatic items with the total assessment of depression is discussed.

Adult↗
PubMed1994

Diagnosing recurring headaches: IHS criteria and beyond.

Current classification systems for diagnosing recurring headaches utilize sets of specific criteria. To determine the usefulness of these criteria in the practical application of diagnosing headache patients, 698 headache specialists were asked to review four case vignettes of headache patients and assign a diagnosis. They also ranked International Headache Society (IHS) criteria along with other features commonly used in the diagnosis of headaches in order of importance. There was no difference in ranked importance for the specific criteria posed by the IHS compared with commonly used criteria not included within the IHS system. A large majority of the respondents combined IHS features with other associated features not used in the IHS system as the basis of diagnostic assignment. These results raise a question about the acceptance and utilization of the IHS system as a basis for diagnoses. They also suggest that there is a need to educate health care providers about the appropriate use of the current IHS criteria to increase reliability of headache diagnosis.

Female↗
PubMed1993

Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders.

To assess the differential efficacy of two commonly used treatments for temporomandibular disorders (TMD), intraoral appliances (IAs) and biofeedback (BF), separately and in combination, two studies were conducted. The first study directly compared IA treatment, a combination of biofeedback and stress management (BF/SM), and a waiting list control group in a sample of 80 TMD patients. Both treatments were determined to be equally credible to patients, ruling out this potential threat to the validity of the results obtained. The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment, but at a 6-month follow-up the IA group significantly relapsed, especially in depression, whereas the BF/SM maintained improvements on both pain and depression and continued to improve. The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients. The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone, particularly in pain reduction, at the 6-month follow-up. These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained.

Adolescent↗
PubMed1992

Sensory and affective components of pain: separation and synthesis.

It has become increasingly accepted that pain is not simply a sensation generated by nociceptors, but a perceptual phenomenon with particular emotional qualities. The purpose of this article is to bring together vastly different streams of research on the divisibility of pain into sensory and affective components. Empirical evidence for this divisibility is drawn from recent studies using multivariate statistics, signal detection theory, and unidimensional scaling. An important conclusion is that separable though pain components may be, they are not necessarily independent. In critiquing previous research, new criteria are derived for partitioning pain into sensory and affective components. Finally, speculations are offered as to how these same components might be synthesized on the basis of theories of perceptual organization.

Affective Symptoms↗
PubMed1992

Noninvasive approaches to pain control in terminal illness: the contribution of psychological variables.

Pain is a common problem for patients with terminal illnesses. The major efforts to control pain for these patients have focused on the appropriate uses of analgesic medication to reduce the sensory aspect of the pain experienced. There are a number of studies in the chronic pain literature, however, that have implicated the important role of a number of psychological factors in the maintenance and exacerbation of pain. Among the most important variables identified are expectancy, anxiety, perceived controllability, self-efficacy, symptom preoccupation, operant conditioning, classical conditioning, and observational learning. In this paper, these psychological variables are examined and their applicability to patients who have pain associated with terminal illnesses is discussed as well as the implications of these variables for complementary treatment with analgesic medications are described.

Conditioning, Classical↗
PubMed1992

Facilitating the use of noninvasive pain management strategies with the terminally ill.

In this paper a number of issues that appear to transcend the range of noninvasive interventions described in this volume are examined. Specifically, we raise the important issue of barriers to treatment. Among those discussed are patients', their significant others', as well as health care providers' conceptualizations of and biases regarding pain and pain control. We emphasize that it is important not only to focus on the details of the specific techniques described but also on how most effectively to present information. We note that it is important to customize any noninvasive intervention to the specific needs of the patient and their significant others. We provide some suggestions as to how this might be accomplished. Finally, we discuss some attitudes and beliefs held by health care providers that may inhibit their use of the full range of noninvasive techniques that are available for managing pain.

Attitude of Health Personnel↗
PubMed1990

On the putative uniqueness of cancer pain: do psychological principles apply?

A large volume of evidence has supported the important role of psychological principles and variables related to the perception of, and response to, nociceptive stimulation. On the basis of this research, a number of psychological interventions have been developed and used successfully with pain patients. Despite the evidence, there has been a tendency for practitioners to neglect the contributing role of cognitive, affective, and behavioral factors in reports of pain by cancer patients. Cancer seems to hold a unique status in medicine and society at large. In this paper, the cancer pain literature is briefly reviewed and evidence is presented for various psychological determinants of the pain report and response that may be extended to pain associated with cancer. The implications of these data for understanding and treatment of cancer patients are described.

Arousal↗
PubMed1990

Chronic pain in old and young patients: differences appear less important than similarities.

Two studies compared physical and psychosocial characteristics of elderly and younger chronic pain patients. No age differences were found during intake for the number of physical coping strategies. Elderly patients named fewer cognitive strategies. No age differences were detected in the percentage of patients offered treatment, who agreed to enter treatment, or who completed treatment. Although older patients more frequently had abnormal physical findings, there were no significant differences on measures of self-reported activity, pain severity, life interference, emotional or worry reactions in response to pain. Both age groups had comparable scores on measures of social support and perceptions of how others react to their pain. The present research suggests that there are relatively few factors distinguishing pain patients based on age. Moreover, age should not be a significant factor to consider when offering patients multidisciplinary treatment for chronic pain that focuses on psychological as well as physical modalities.

Activities of Daily Living↗
PubMed1990

Customizing treatment for chronic pain patients: who, what, and why.

Despite advances in the understanding of pain mechanisms and innovative strategies to assess pain patients, there continues to be a substantial proportion of patients who do not appear to benefit from treatment interventions available. One possible explanation for these results is the tendency to treat chronic pain patients as a homogeneous group with generic treatments--adherence to "patient and treatment uniformity myths." Following from the traditional medical model, several attempts have been made to identify specific subgroups of patients exclusively on the basis of physical factors. In addition, a number of studies have attempted to empirically identify subgroups of pain patients using standard psychiatric assessment instruments (e.g., MMPI, SCL-90) and, recently, cognitive measures and measures of pain behaviors. These different approaches and the assessment instruments used are reviewed, and the limitations are described. Alternative strategies to classify subgroups of pain patients based on combinations of physical, psychosocial, and behavioral measures (i.e., multiaxial strategies) are presented. The efforts to classify homogeneous subgroups of chronic pain patients are reviewed, and the potential utility of customizing therapeutic interventions to patient characteristics is discussed.

Chronic Disease↗