Biomedical subjects

Francis J Keefe

Publications and source records attributed to Francis J Keefe.

87 records · Page 5Linked to original sources

PubMed1988

The relationship of locus of control to pain coping strategies and psychological distress in chronic pain patients.

Although behavioral scientists have long been interested in how an individual's locus of control relates to coping and adjustment, basic information remains to be gathered on the relevance of locus of control to adaptation to persistent pain. This study examined the relationship of locus of control orientation to pain coping strategies and psychological distress in chronic pain patients. Subjects were 62 chronic pain patients. All patients were administered: (1) the Multidimensional Health Locus of Control Scales to assess locus of control, (2) the Coping Strategies Questionnaire to evaluate pain coping strategies, and (3) the Symptom Checklist-90 Revised to assess psychological distress. Correlational analyses revealed that patients who viewed outcomes as controlled by chance factors such as fate or luck tended to rely on maladaptive pain coping strategies and rated their abilities to control and decrease pain as poor. They also exhibited greater psychological distress. Regression analyses indicated that patients having a chance orientation toward locus of control were more likely to report depression, anxiety, and obsessive-compulsive symptoms and to have higher overall levels of psychological distress. Chance locus of control also predicted greater reliance on diverting attention and praying/hoping in dealing with their pain. In addition, patients high on chance locus of control reported feeling helpless to deal effectively with their pain problem. Clinicians evaluating chronic pain patients need to be aware that patients who view outcomes as controlled by external factors such as chance may have deficits in pain coping strategies and may report greater psychological distress than patients who do not have this locus of control orientation.

Adaptation, Psychological↗

PubMed1987

Osteoarthritic knee pain: a behavioral analysis.

This study used behavioral assessment techniques to analyze pain in osteoarthritis (OA) patients. Eighty-seven OA patients having chronic knee pain served as subjects. Pain behavior was evaluated using a standard observation method and functional impairment was assessed using the Arthritis Impact Measurement Scales. Data analysis revealed that pain and limitations in physical activities were the most common functional impairments and that the most frequently observed pain behavior was guarded movement. Predictive analyses indicated that disability support status and scores on a Pain Control and Rational Thinking factor of the Coping Strategies Questionnaire (CSQ) were predictive of functional impairment. Patients receiving disability support payments were much more functionally limited than those not receiving this financial support. Patients scoring high on the Pain Control and Rational Thinking factor of the CSQ were much less functionally impaired, walked a 5 m course more rapidly and moved from a standing to a sitting or reclining position more quickly than patients scoring low on this factor. The implications of these results for behavioral treatment of OA knee pain are discussed.

Adaptation, Psychological↗

PubMed1987

Social support and pain behavior.

Research has shown that social support is generally associated with better adaptation to chronic disease. However, the role that social support plays in adjustment to chronic pain syndromes has received less research attention. The present study was designed to examine the relation of high versus low levels of social support to pain behavior in chronic pain patients. Fifty-one patients with chronic pain completed the Social Support Questionnaire (SSQ) and the McGill Pain Questionnaire. Patients were also observed using a standard observation system to assess pain behaviors. In order to compare pain behaviors displayed by subjects with high versus low levels of social support, a median split was performed on the 2 dimensions of the SSQ: satisfaction with support, and availability of people for support. The results indicated that pain behavior varied as a function of level of satisfaction with social support. Individuals reporting high satisfaction with social support exhibited significantly higher levels of total pain behavior and higher levels of individual pain behaviors such as guarding, rubbing, and bracing. There was no significant difference in total pain behaviors between those high versus low in terms of level of availability of support. There also were no differences between high versus low social support groups in total pain ratings as measured by the McGill Pain Questionnaire. The results are discussed in terms of an operant conditioning perspective on social support. Individuals who are satisfied with the quality of their social support may be satisfied because they receive positive reinforcement from the social environment when they engage in pain behavior.

Adaptation, Psychological↗

PubMed1986

Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients.

Pain behavior and pain coping strategies were systematically measured in a group of 32 chronic low back pain (LBP) and 32 myofascial pain dysfunction (MPD) syndrome patients. Both groups reported high levels of psychological distress on the SCL-90R. The LBP patients were significantly less active, took more narcotic and sedative-hypnotic medications, and showed higher levels of motor pain behavior (guarding, rubbing, and bracing) than the MPD patients. The LBP patients used attention diversion, and praying or hoping as pain coping skills to a much greater extent than the MPD patients. The relationship of these findings to prior research is described, and future research needs in this area are identified.

Activities of Daily Living↗

PubMed1986

Development of an observation method for assessing pain behavior in rheumatoid arthritis patients.

Four studies examined the reliability and validity of a behavioral observation method for the assessment of pain associated with rheumatoid arthritis (RA). The major purpose of experiment 1 was to evaluate the interobserver reliability of the observation method. Two observers recorded the frequencies of pain behaviors displayed by 20 RA patients. Each of 3 types of reliability estimates indicated that the pain behavior could be reliably observed. The purpose of experiment 2 was to examine the concurrent validity of the observation system by correlating 53 patients' self-reports of pain with the frequencies of their pain behaviors. Significant and positive correlations were found between patients' total pain behavior and 3 self-report measures of pain and functional disability. Furthermore, unlike the self-reports of pain, total pain behavior was only minimally related to self-report of depression. Experiment 3 was performed in order to assess the observation method's construct validity. Naive observers viewed video recordings of 25 RA patients and made global estimates of patients' pain severity and unpleasantness. Highly significant and positive correlations were found between these global estimates and total pain behavior. In experiment 4, the pain behaviors of 11 RA patients were recorded prior to and immediately following cognitive-behavioral treatment for the reduction of RA pain. There was a significant decrease in total pain behavior from pretreatment to posttreatment. The data indicate that the observation method provides a reliable, valid, and relatively objective measure of RA patient pain behavior. Future validation studies of the observation method are discussed.

Adult↗

PubMed1986

Angina pectoris in type A and type B cardiac patients.

The type A behavior pattern is characterized by excessive competitive drive, a sense of time urgency, enhanced aggressiveness, hostility and a persistent desire for recognition. Type A behaviour is widely recognized as a risk factor in coronary heart disease. This study investigated whether type As and Bs differ in their experience of pain and pain coping efforts. A group of type A (n = 35) and a group of type B (n = 19) cardiac disease patients served as subjects. All subjects underwent diagnostic treadmill testing and were compared on a variety of pain measures. There were no differences between type As and Bs in age, sex, presence of state or trait anxiety or severity of cardiac disease. Type A patients, however, were much more likely than type Bs to be classified on the New York Heart Association (NYHA) functional angina scale as having more severe pain and functional limitation. Type As were also less likely to use pain coping strategies to deal with their pain. Those who assess pain and functional impairment in cardiac patients using the NYHA scale should be aware that type A personality characteristics may affect their assessments. Type A patients who tend to make little use of pain coping strategies may benefit from systematic training in pain control methods. Additional research is needed to examine whether type A-B differences in pain and pain coping strategies may affect risks of coronary morbidity and mortality.

Adaptation, Psychological↗

PubMed1985

Behavioral assessment of head and neck cancer pain.

Behavioral evaluations of pain were carried out on a sample of 30 head and neck cancer patients before, at the midpoint, and at the end of their treatment. Observations of patients' behavior as they carried out functional activities revealed that patients tended to display their pain primarily through facial expression and to a lesser extent through guarded movement. During the period of treatment there were significant increases in the number of simple daily activities that increased pain, in the time spent sitting each day, and in the number of patients using narcotics. There was also a strong tendency for patients to lose weight and to use a greater number of pain relieving methods. A behavioral dysfunction index based on scores on each of the behavioral measures was clearly related to pain ratings. Measures of pain taken before treatment were highly predictive of behavioral dysfunction index scores recorded at the completion of cancer treatments.

Carcinoma, Squamous Cell↗

PubMed1985

An objective approach to quantifying pain behavior and gait patterns in low back pain patients.

Patterns of walking and concomitant pain behavior were compared in a group of chronic low back patients (n = 18) and normal controls (n = 18). Subjects were asked to walk a 5 m course. A transducer placed in the subjects' shoes produced a force proportional signal that permitted measurement of walking parameters. Subjects were videotaped in order to record the occurrence of 5 specific pain behaviors: guarding, bracing, rubbing the painful area, grimacing, and sighing. Data analysis revealed significant differences in walking patterns of the patients and controls. Patients walked more slowly, took shorter steps and did not show the symmetrical gait patterns evident in normal controls. Patients also exhibited much higher levels of pain behavior. The gait of patients receiving disability payments or taking narcotics differed significantly from those who were not. Patients receiving disability payments had significantly longer stride lengths and swing time than patients not receiving disability/financial compensation payments. Patients taking narcotics showed longer single limb support time for the left leg than those who were not. By combining objective measures of gait and motor pain behaviors, clinicians and researchers may be able to more objectively evaluate factors that may affect patient behavior and measure the effects of interventions designed to modify behavior.

Adult↗

PubMed1984

A study of psychophysical scaling in chronic pain patients.

Chronic pain patients were asked to psychophysically scale two sets of word descriptors (intensity and unpleasantness) using a crossmodality matching procedure with line length and numerical estimates. In 22 patients (group I) descriptor scaling was performed once, in another 20 patients (group II) the procedure was repeated 3 times. 72.7% of patients in group I obtained a correlation of 0.9 or higher when scaling intensity descriptors, but only 18.2% obtained this correlation when scaling unpleasantness words. In group II, an average of 85% of patients reliably scaled intensity words, but only 50% could do so for the unpleasantness descriptors. Patients who reliably judged unpleasantness descriptors generally exhibited a higher level of psychological distress (SCL-90 R). Numerical estimates assigned by patients to individual word descriptors showed a smaller range than obtained from experimental pain studies. There was unequal spacing of values of adjacent descriptors with clustering of words in the low and high ends of the continuum and large gaps in midrange. Results indicate that chronic pain patients in general show a higher incidence of impairment in rendering proportional judgments than a healthy population. In addition, they are more likely to judge pain reliably on an intensity than on an unpleasantness dimension. The difference in performance between scales persists in spite of training and could not be explained by medical history, drug intake, or demographic characteristics. Patients who are unable to render reliable judgments are easily identified. For optimal clinical use words clustering close together should be combined and additional words should be added describing midrange intensities. Conversely, psychophysical scaling techniques may be used to calibrate category or analogue scales of pain.

Adult↗

PubMed1984

Direct observation of pain behavior in low back pain patients during physical examination.

Trained observers measured the occurrence of 5 behaviors (guarding, bracing, rubbing, grimacing, and sighing) in a group of 80 low back pain patients undergoing physical examination. Bracing was frequently displayed, rubbing, guarding, and grimacing were moderately frequent and sighing was infrequent. Pain behaviors were much more likely to occur when patients were moving than when they were in a static position. The rate of guarding, bracing, and total pain behavior was predicted by physical examination findings and/or number of prior operations. Patients having longer pain histories were also more likely to show guarded movement. Topics for future research in this area are identified, and the utility of behavioral observation for clinicians is discussed.

Adult↗

PubMed1983

The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment.

Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.

Adaptation, Psychological↗

PubMed1981

Behavioral treatment of chronic low back pain: clinical outcome and individual differences in pain relief.

The response of 111 chronic low back pain patients to a comprehensive behavioral treatment program emphasizing relaxation procedures is examined. Over the course of treatment, significant reductions were obtained on measures of subjective tension, EMG activity, and pain. Many patients also decreased their intake of analgesic/narcotic agents and reported an increase in activity level. In order to examine individual differences in pain relief, the 28 patients who had the greatest decreases in pain were compared to those who had the least decreases in pain. Patients who had the best outcome in terms of pain relief were significantly more likely to show improvements in other outcome measures. In addition, these patients rated their pain initially as more severe, had continuous pain for fewer years, and were less likely to be on disability or to have had multiple surgical procedures. These results are discussed in the light of recent data from other behavioral treatment studies with chronic low back pain patients and implications for behavioral assessment and treatment are discussed.

Adult↗

PubMedDate not supplied

Memory for pain: the relationship of pain catastrophizing to the recall of daily rheumatoid arthritis pain.

OBJECTIVE: The assumption that individuals are capable of accurately recalling past painful experiences has been a fundamental tenet of a number of cognitive-behavioral theories of pain, including the gate control theory. However, there has been very little research on the topic in the past, and the results have often been contradictory. A general conclusion that can be drawn is that memory for pain is variable, and there is need to identify what factors contribute to this variability in memory for pain. The current study examined the relation of catastrophizing to the recall of persistent pain associated with rheumatoid arthritis. METHODS: Participants in this study were 45 individuals with persistent pain due to rheumatoid arthritis. Each participant was asked to complete a daily pain diary for a period of 30 days. Participants were subsequently asked to recall the pain they experienced over the entire period of time rather than provide a single, average rating. RESULTS: The results of a series of hierarchical regression analyses indicated that level of catastrophizing was related to the recall of both pain intensity and pain variability. This relation was statistically significant even after controlling for actual pain and variability and other background variables. CONCLUSIONS: Participants who scored higher on catastrophizing demonstrated better accuracy in the recall of general pain intensity and pattern over a 30-day diary period. The results of the study are discussed in terms of future studies as well as their potential clinical importance.

Adaptation, Psychological↗

PubMedDate not supplied

Changing face of pain: evolution of pain research in psychosomatic medicine.

OBJECTIVE: This article provides an overview of how psychosomatic research on pain has evolved over the past 60 years as exemplified by studies published in Psychosomatic Medicine. METHODS: Each issue of Psychosomatic Medicine from 1939 to 1999 was reviewed to identify papers that dealt with pain, painful medical conditions, or pain management. A total of 150 papers were identified and grouped into seven categories: 1) case studies; 2) studies of personality traits and other individual differences; 3) psychophysiological studies of pain; 4) studies using pain induction techniques; 5) studies examining the relation of relation of race, ethnicity, and culture to pain; 6) studies of pain unique to women; and 7) studies examining treatments for pain. RESULTS: A substantial number of studies on pain and painful conditions were published in the Journal in the 1940s and 1950s, and that number has almost doubled in the most recent full decade of the Journal. Within the pain area, however, the topics of interest to psychosomatic researchers have been, and continue to be, quite diverse. Although publications on certain methods or topics (eg, psychodynamic case studies, physiological correlates of pain) have decreased over time, publications on other topics (eg, personality traits and individual differences) have remained relatively constant, and publications on still other topics (eg, studies using pain induction techniques; studies of race, ethnicity, and culture; women's pain; and treatment studies) have flourished recently. CONCLUSIONS: Considered overall, the results of our review suggest that the face of pain research published in PM has changed considerably in the past 60 years. Given the ongoing commitment of psychosomatic researchers to this area, we expect this evolution to continue in the years to come.

Female↗

PubMedDate not supplied

Psychosocial issues confronting young women with breast cancer.

The current paper reviews the literature regarding psychosocial issues confronting young women with breast cancer. The findings indicate that younger women with breast cancer experience a lower quality of life after cancer compared to older women. In part, this lower quality of life results from the effects of medical treatment. The effects of surgery and removal of the breast result in more negative feelings regarding body image, particularly for young women. With systemic treatment, many younger women experience the sudden onset of menopause, with the attendant symptoms of hot flashes, decreased sexual desire, and vaginal dryness. These physical effects along with a variety of relationship issues contribute to a high level of sexual concerns for young women. From a psychosocial perspective, breast cancer affects both females and their male partners. Both partners experience psychological distress including depression and anxiety. Within the relationship, emotional support from the partner is important in women's adjustment. In terms of psychosocial interventions for breast cancer, findings suggest that the most frequently employed interventions, which treat the woman without her partner, are not optimal. Initial findings provide encouraging evidence that couple-based psychosocial interventions for women and their partners might be of particular assistance to both partners.

Adaptation, Psychological↗