Educational achievement and pain disability among women with chronic pelvic pain.

OBJECTIVE: This study examined the relationship of level of educational (LOE) achievement to pain experience, affective disturbance, and perceived disability among women with chronic pelvic pain presenting for pain treatment. METHODS: 187 patients completed a battery of self-report inventories assessing pain, psychological status, and functional ability. Educational attainment was stratified across five levels from "less than high school" to "graduate/professional school." RESULTS: Significant inverse associations were found between lower educational achievement and more severe pain, somatic preoccupation, emotional suffering and guardedness, and functional impairment. No differences were obtained across the groups for age, duration of pain, or symptoms of depression. CONCLUSIONS: These data provide support for the importance of socioeconomic factors, particularly LOE, in furthering our understanding of the morbidity observed among women suffering chronic pelvic pain.

Use of the McGill Pain Questionnaire to compare women with vulvar pain, pelvic pain and headaches.

OBJECTIVE: To assess differences between women with three distinct types of chronic pain conditions using a modified McGill Pain Questionnaire. STUDY DESIGN: Data by self-administered questionnaire were collected on patients presenting to the University of Michigan Medical Center with chronic vulvar pain (144 patients), pelvic pain (198 patients) or headaches (130 patients). Data for analysis included: patient demographics, duration of pain and modified McGill Pain Questionnaire scores. Univariate and multivariate analyses were performed. RESULTS: Patients with vulvar pain had more formal education (P < .001), were more likely to be married (P < .001) and were less likely to be African American (P = .003) as compared to those with chronic pelvic pain and headaches. Chronic pelvic pain patients were younger than those in the other two groups (P = .002), and headache patients were likely to have had their chronic pain for a shorter duration than those with vulvar or pelvic pain (P < .001). Patients with vulvar pain had lower total scores on the McGill Pain Questionnaire as well as on the four subsets of variables: affective, sensory, cognitive and miscellaneous indexes (P < .001). They also chose fewer words to describe their symptoms from the 20-word lists (P < .001) and had lower average scores in each of the 20 categories as compared to the other two groups (P < .0001). Controlling for age, ethnicity and marital status did not alter this significance. CONCLUSION: Patients with vulvar pain were a unique groups when compared to other chronic pain populations. Evaluation of the demographics and McGill Pain Questionnaire scores confirmed the distinct qualities of women with vulvar pain.

Chronic myofascial pain: knowledge of diagnosis and satisfaction with treatment.

OBJECTIVE: To examine the relation between pain patients' knowledge of pain diagnosis and their satisfaction with pain treatment. It was hypothesized that myofascial pain (MP) patients would be less knowledgeable regarding their diagnosis and less satisfied with the results of pain treatment. DESIGN: Cross-sectional. SETTING: Multidisciplinary pain clinic. PATIENTS: Patients (n=65) were divided into two groups after multidisciplinary assessment: MP patients (n=30) and a mixed group of chronic pain patients (MCP) (n=35) with neurologic or rheumatologic disorders. MAIN OUTCOME MEASURES: Patient self-report of their knowledge of pain diagnosis and scores on standardized measures of pain intensity, depressive symptoms, and functional disability. RESULTS: MP patients were significantly less accurate in identifying their diagnosis and the source of their pain and were more likely to believe they suffered a physiologic disturbance "more serious and different" than their physicians had suggested. MP patients were also significantly more dissatisfied with the treatment for pain by physicians and reported particular dissatisfaction with the informational aspects of physician-patient communication. No group differences were obtained for measures of pain severity, depression, disability, pain duration, or compensation/litigation status. CONCLUSION: MP patients appear to have less accurate beliefs regarding their pain symptoms and express more dissatisfaction with physician efforts to treat their pain. These findings emphasize the importance of patient education as a component of chronic pain intervention, particularly for MP patients.

The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain.

Recent studies have reported a high prevalence of symptoms of post-traumatic stress disorder (PTSD) among individuals with chronic pain. Studies suggest that persons with pain and PTSD also display higher levels of affective disturbance. In the present study we examined self-reports of pain, affective disturbance, and disability among pain patients with and without symptoms of PTSD. Patients without PTSD symptoms were further subdivided into persons whose pain was the result of an accident or insidious in onset. Thus, three groups were examined: (1) persons with accident related pain and high PTSD symptoms (Accident/High PTSD); (2) persons with no or few symptoms of PTSD whose pain was accident related (Accident/Low PTSD); and (3) patients whose pain was not accident related and did not have PTSD symptoms (No Accident). No Accident patients were older than persons with accident related injuries, and both accident related pain groups were more likely than No Accident patients to be involved in litigation or receiving compensation. Thus, these variables were controlled for in the statistical analyses. Self-report of pain was also included as a covariate in the analyses examining group differences in affective disturbance and disability. Accident/High PTSD patients displayed higher levels of self-reported pain compared to the other two groups. The Accident/High PTSD group also had the highest levels of affective disturbance. Both accident groups tended to report greater disability compared to patients whose pain was not accident related. These findings suggest that PTSD symptoms in chronic pain patients are associated with increased pain and affective distress. Accident related pain, even without the presence of PTSD symptoms, appears to be associated with greater disability. The results indicate that the identification and treatment of PTSD symptoms in refractory pain patients may be a critical albeit subtle factor in the effective management of suffering and disability in this population.

Reducing inappropriate behaviors of developmentally disabled adults using antecedent aerobic dance exercises.

The effects of aerobic dance exercise on inappropriate behaviors of two developmentally disabled adults were observed in a day activities center. The experimental phase, in which the subjects engaged in exercise with seven other individuals on Monday, Wednesday, and Friday of each week, was preceded and followed by baseline phases in which subjects did not exercise and in which there were no contingencies in effect for the dependent variables. Exercises consisted of those commonly used in exercise dance classes. Observations occurred during 15 minute periods immediately before and following exercise while subjects engaged in regular classroom activities. Observations also occurred in the same time periods on no-exercise days during all phases. Behaviors observed included inappropriate vocalizations, repetitive movements, and off-task. Results indicate for both subjects a decrease in each of the inappropriate behaviors as a result of exercise.

Management of inappropriate behaviors of trainable mentally impaired students using antecedent exercise.

The effects of several levels of exercise on inappropriate behaviors of four trainable mentally impaired students were observed. Treatment conditions, which occurred as the first daily activity, included: Phase I, daily alternating conditions of warm-up exercises and jogging at a moderate rate for a short distance; Phase II, daily alternating conditions of no-exercise periods and jogging at a vigorous rate for a moderate distance; and Phase III, jogging at a vigorous rate for a moderate distance on consecutive days. For one student two additional conditions occurred, Phase IV, long-distance jogging on consecutive days at a vigorous rate and Phase V, consecutive days of no exercise. Observations of three inappropriate behaviors of each student occurred immediately after, 1 hour after, and 2 hours after each exercise period. Results indicate a decrease in all three inappropriate behaviors for three of four students and an inverse relationship between the level of exercise and the amount of inappropriate behavior for three of four students. Improvements over existing studies are discussed with suggestions for future research.