Multidimensional Pain Inventory Profiles Research Articles

Psychosocial coping profiles after pain rehabilitation: associations with occupational performance and patient characteristics

Purpose The aims of the present study were to assess: (i) changes in coping by use of Multidimensional Pain Inventory profiles from baseline to follow-up, (ii) associations between Adaptive Coper (AC) profiles at follow-up and improvements in occupational performance (by Canadian Occupational Performance Measure COPM) and (iii) ability to predict AC profiles at follow-up by participants’ baseline characteristics. Method Data at baseline, discharge and follow-up from 525 participants in a pain rehabilitation program were analyzed with multivariate statistics. Results AC profiles increased and Dysfunctional (DYS) profiles decreased at follow-up. Clinically relevant improvements on COPM were associated with having an AC profile at follow-up. Being Nordic born, having longer education, an AC profile and higher baseline scores on satisfaction with performance predicted an AC profile at follow-up. Conclusions Pain rehabilitation seems to result in sustainable and favourable coping strategies at follow-up, and improved occupational performance is associated with favourable coping at follow-up. Outcomes need to be measured independently of improved coping strategies and improvements of participant’s individual goals such as difficulties to perform their most meaningful occupations. Patients at risk for unfavourable coping strategies may need modified interventions.Implications for RehabilitationMore participants reported a beneficial coping, MPI profile, in a long-term perspective after a pain rehabilitation program.Improvements on occupational performance prioritized as meaningful by each of the participants are related to adequate coping strategies at follow-up.The associations between improved occupational performance and beneficial coping profiles need to be better understood.Patients with worse initial occupational performance may need modified pain rehabilitation interventions to improve their coping strategies.

Does Classification of Chronic Musculoskeletal Disorder Patients Into Psychosocial Subgroups Predict Differential Treatment Responsiveness and 1-Year Outcomes After a Functional Restoration Program?

The objectives of this study: (1) to assess whether Multidimensional Pain Inventory (MPI) profiles predicted differential responses to a functional restoration program (FRP) in chronic disabling occupational musculoskeletal disorder (CDOMD) patients; (2) to examine whether coping style improves following FRP; and (3) to determine whether discharge MPI profiles predict discharge psychosocial and 1-year socioeconomic outcomes. Consecutive CDOMD patients (N=716) were classified into Adaptive Coper (AC, n=209), Interpersonally Distressed (ID, n=154), Dysfunctional (DYS, n=310), and Anomalous (n=43) using the MPI, and reclassified at discharge. Profiles were compared on psychosocial measures and 1-year socioeconomic outcomes. An intent-to-treat sample analyzed the effect of drop-outs on treatment responsiveness. The MPI classification significantly predicted program completion (P=0.001), although the intent-to-treat analyses found no significant effects of drop-out on treatment responsiveness. There was a significant increase in the number of patients who became AC or Anomalous at FRP discharge and a decrease in those who were ID or DYS. Patients who changed or remained as DYS at FRP discharge reported the highest levels of pain, disability, and depression. No significant interaction effect was found between MPI group and time for pain intensity or disability. All groups improved on psychosocial measures at discharge. DYS patients had decreased work retention and a greater health care utilization at 1 year. An FRP was clinically effective for CDOMD patients regardless of initial MPI profiles. The FRP modified profiles, with patients changing from negative to positive profiles. Discharge DYS were more likely to have poor 1-year outcomes. Those classified as Anomalous had a good prognosis for functional recovery similar to ACs.

MPI Profile Classifications and Associated Clinical Findings Among Litigating Motor Vehicle Collision Patients

The purpose of this study was to examine differences in precollision, pericollision, and postcollision clinical variables across litigating motor vehicle collision (MVC) patients who were classified as Dysfunctional (DYS), Interpersonally Distressed (ID), or Adaptive Copers (ACs) based on Multidimensional Pain Inventory (MPI) profile classifications. A sample of 240 MVC patients who sustained serious physical injuries and experienced MVC-related chronic pain completed the MPI and provided responses to a semistructured psycholegal interview designed to elicit injury-related and pain-related symptoms and treatments, determine the presence and impact of precollision experiences, and render psychiatric diagnoses and ratings of psychological disability. A significant multivariate effect of MPI profile group on postcollision variables was revealed, with the DYS and ID groups reporting more pain sites than the AC group and the DYS group receiving more recommendations for treatment than the AC group. Larger proportions of the DYS and ID groups were diagnosed as experiencing major depressive disorder than the AC group. A rating of total psychological disability was applied most often to members of the ID group, with partial psychological disability applied most often to members of the DYS group, and no psychological disability applied most often to members of the AC group. This study extends the MPI literature by establishing the usefulness of the measure in determining those reports of MVC-related pain and emotional distress that are most likely to be associated with postcollision psychological disability. The current study supports the usefulness of MPI profile classifications in identifying MVC patients who are likely to require and benefit from intensive psychological and other rehabilitative interventions.

Changes in multidimensional pain inventory profile after a pain rehabilitation programme indicate the risk of receiving sick leave benefits one year later.

To determine whether coping profile changes after rehabilitation, assessed with the Multidimensional Pain Inventory (MPI), can predict which persons disabled by chronic musculoskeletal pain will be in receipt of sick leave benefits in the long term. Study of MPI data from 2,784 patients (709 men and 2,075 women) collected from the Swedish Quality Register for Pain Rehabilitation (SQRP) before and at the end of rehabilitation and compared with independent sick leave data for 1 year later. After rehabilitation there was a significantly decreased share of Dysfunctional profiles (DYS) among both men (44% before, 31% after) and women (39% before, 26% after), but an increased share of Adaptive Coper profiles (men 15% before, 24% after, women 14% before, 24% after). The number of patients on full-time sick leave decreased significantly among men (from 57% to 46%) and women (from 57% to 50%). Persons with a DYS profile after rehabilitation had a low probability of having no or part-time sick leave. The number of persons with DYS profiles decreased after rehabilitation. Those with other profiles had less full-time sick leave one year later than those with DYS profiles, indicating that leaving the DYS profile is a positive prognostic sign long-term. Furthermore, the gender differences observed suggest the need to tailor rehabilitative strategies differently for men and women.

The Clinical Utility of the Multidimensional Pain Inventory (MPI) in Characterizing Chronic Disabling Occupational Musculoskeletal Disorders

The Multidimensional Pain Inventory (MPI) was designed to help capture unique characteristics of chronic pain patients. The present study examined the proportion of subgroups classified by the MPI in a chronic disabling occupational musculoskeletal disorder (CDOMD) patient cohort, and described characteristics of MPI profile groups in terms of other psychosocial variables. A cohort of 1,270 CDOMD patients undergoing an interdisciplinary functional restoration program was studied. Before the start of the program, all patients received a standard psychosocial assessment battery. A MPI computer program scored and identified pre-defined MPI subgroups: Adaptive Coper (AC); Interpersonally Distressed (ID); and Dysfunctional (DYS). The distribution of MPI profiles for CDOMD patients was similar with those of highly disabled patients, with the largest proportion of patients having the DYS profile (44 %), followed by AC (33 %) and ID (23 %). The DYS profile group showed the highest level of pain severity, and psychosocial distress; the ID group had a moderate level; and the AC profile group had the lowest level. Higher rates of psychiatric disorders were also found in the DYS and ID groups. The DYS profile group was less likely to complete the treatment program. The present study further demonstrated the clinical utility of the MPI classification in a large cohort of CDOMD patients, indicating that the MPI profiles successfully distinguish among patients who may require extra psychosocial attention to achieve successful treatment gains and program completion.

Readiness for Change Predicts Outcomes of Functional Rehabilitation Following Motor Vehicle Accident

Previous research has found pre-treatment motivational readiness to engage in pain self-management to be associated with completion of a rehabilitation program. This preliminary study examined this relationship, as well as the ability of pre-treatment readiness to change to predict clinical decisions of post-treatment functional work capacity. The sample consisted of 106 individuals involved in a tertiary functional rehabilitation program for motor vehicle accident (MVA) survivors. The Multidimensional Pain Inventory (MPI) and Pain Stages of Change Questionnaire (PSOCQ) were completed prior to treatment. Hierarchical logistic regression analyses revealed that PSOCQ profile scores (P = 0.008), including higher individual PSOCQ contemplation (OR = 5.30; P = 0.017) and action (OR = 5.16; P = 0.049) scores, significantly increased the likelihood of completing the functional rehabilitation program. Clinical decisions about functional work capacity were predicted by MPI profile scores (P = 0.001), and this model was significantly improved by the addition of PSOCQ scores (P = 0.037). Lower MPI interference (OR = 5.41; P = 0.002), and higher MPI affective distress (OR = 2.81; P = 0.010), MPI support (OR = 1.72; P = 0.027), and PSOCQ action (OR = 5.35; P = 0.038) scores were significant predictors of clinicians' decisions regarding functional work capacity in the final model that identified 88% of those judged capable of returning to work and 63% of those who were judged not capable of returning to work. This preliminary study suggests that readiness to self-manage pain is an important predictor of both completion of functional rehabilitation program and clinicians' decisions regarding functional work capacity after an MVA. The latter outcome appears to be more complex, influenced both by motivational readiness to engage in pain self-management and cognitive-behavioral adaptation to pain.

Using data from Multidimensional Pain Inventory subscales to assess functioning in pain rehabilitation

The aim of this study was to examine whether Multidimensional Pain Inventory (MPI) subscale score changes can be used for monitoring interdisciplinary cognitive behavioural pain rehabilitation programmes, using the Psychological General Well-Being (PGWB) index as an independent variable of rehabilitation outcome. Data from 434 consecutively referred patients disabled by chronic pain were analysed. The intervention was a 4-week interdisciplinary pain rehabilitation group programme (5 h/day), based on biopsychosocial and cognitive behavioural principles. Mean PGWB total scores improved after rehabilitation (P<0.0001) with clinically relevant effect sizes for patients with 'dysfunctional' and 'interpersonally distressed' MPI profiles. Substantial correlations (r=0.7-0.3; P<0.001) were found between the changes in PGWB total scores and four of the MPI subscale scores. These were combined into a composite variable ['pain severity', 'interference', 'life control' (given reversed scores) and 'affective distress'], and were labelled as the Pain Rehabilitation Index. The subscales, 'support' and 'general activity level', were omitted, as changes were ambiguous with respect to functioning. 'Dysfunctional' and 'interpersonally distressed' profile patients showed a marked improvement in Pain Rehabilitation Index after rehabilitation (effect sizes of 0.77 and 0.43; P<0.0001, respectively). Conversely, the 'adaptive copers' may have deteriorated somewhat (effect size -0.28; P=0.036). We propose that scores from four MPI subscales are integrated and the difference pre-post rehabilitation is used to indicate composite rehabilitation outcomes, making it possible to interpret all included MPI subscales in the same direction. Psychometric evaluation of the index is warranted.

Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients

The purpose of the study was to examine whether patients' psychosocial profiles differ depending on if the location of pain is in the masticatory muscles, the temporomandibular joint, or both. Eligible participants were 491 consecutive patients examined according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Among these a total of 225 adult TMD patients had at least one pain-related TMD diagnosis and were therefore included in this study and completed the multidimensional pain inventory (MPI). Patients diagnosed with myogenous pain only (n = 103), patients with joint pain only (n = 56), and patients with both (n = 66) were compared with respect to depression, somatization, jaw disability, pain intensity and chronicity, and MPI scores and profiles. The MPI profiles were analyzed using a multivariate analysis of variance and Hotelling's T(2) test. Although patients with joint pain were significantly more impaired in jaw function, no significant differences in depression, in somatization or in the 11 scales of the MPI were observed. The location of pain in TMD patients is not a major factor for the prediction of psychosocial profiles. Therefore, clinical TMD diagnoses alone form an insufficient basis for tailored behavioural or psychological management.

Searching for an assessment instrument to determine temporomandibular disorder pain profiles for the purposes of primary health care

The objective was to study the utility of the graded chronic pain (GCP) scale of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the purpose of recognizing TMD pain profiles in primary health care. The GCP scale was used to gather data from 93 consecutive TMD patients seeking treatment in a primary health care setting. The GCP data were compared with pain profiles assessed by scales similar to the more complicated multidimensional pain inventory (MPI). The scales used were able to produce the similar 'dysfunctional profiles' in the TMD patients as the original MPI scale in the sample of chronic pain patients. Also, the original MPI profiles of 'adaptive copers' and 'interpersonally distressed' were produced with distinctive features. The GCP grades distributed almost identically among the subgroups produced by the pain profiles. Most grade I patients were classified as adaptive copers (82--86%), most grade II patients were interpersonally distressed (59%) and all except one of the grade III patients were classified as dysfunctional (83%). The results seem to support the main assumption of our study that the GCP scale is a simple screening tool suitable for identifying primary care TMD patients with various types of pain profiles.

A preliminary study of multidimensional pain inventory profile differences in predicting treatment outcome in a heterogeneous cohort of patients with chronic pain.

The objective was to evaluate whether the Multidimensional Pain Inventory (MPI) is effective for predicting response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Changes in patients' profiles to a predominantly adaptive coping status after treatment also were assessed. A prospective study was conducted of patients with an array of pain conditions. A standard evaluation battery, including measures of self-reported pain and disability, psychosocial functioning, helpfulness of the program, and medication use, was used for all patients before and after treatment. The MPI status of patients was evaluated and differential response to treatment was assessed. Sixty-five consecutive patients with chronic pain were evaluated before and immediately after participation in an interdisciplinary pain treatment program. This heterogeneous pain-condition cohort was also differentiated on the basis of the MPI to evaluate potential differential response to treatment. Results revealed significant improvement among these patients with chronic pain when a comprehensive interdisciplinary pain-management program was administered. This improvement was seen across the variety of outcomes evaluated, including narcotic medication use. Most important, the MPI subgroup classification did not significantly predict the degree of positive treatment outcome; all subgroups improved. Although there were major differences in psychosocial functioning before treatment, the MPI was not found to significantly predict response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Thus, a comprehensive interdisciplinary treatment program may achieve its full effectiveness across a wide array of pain/disability-related outcome variables, regardless of initial MPI profile categorization.

The Multidimensional Pain Inventory profiles in patients with chronic cancer-related pain: an examination of generalizability

This study examined the generalizability of the non-malignant pain patient profiles based on the Multidimensional Pain Inventory (MPI) to patients with cancer-related pain. Data were collected from 112 cancer patients. In total, 107/112 patients completed the MPI. Of the 96% of patients classified, only 60% were classified by the three main profiles. In this sample, there were 47.7% ( n=51) Adaptive Copers, 9.3% ( n=10) Dysfunctional, 2.8% ( n=3) Interpersonally Distressed; 32.7% ( n=35) Anomalous; 3.8% ( n=4) Hybrid; and 3.8% ( n=4) Unanalyzable. Because of the significantly lower pain severity, interference and affective distress scores, the Anomalous group could be considered Highly Adaptive. Given that 80% were classified as either Adaptive or Anomalous, these findings suggest that while the MPI-based profiles do apply, a two profile classification system may be more suitable for cancer patients than the usual three. In particular, the low proportion of patients classified as Interpersonally Distressed may reflect important differences in social support for cancer patients compared with non-cancer patients. Whereas the MPI-based profiles are consistent across non-malignant pain problems, it appears that the nature of cancer may affect the MPI-based profile classification system more than non-malignant pain problems do.

Improving the rate of classification of patients with the multidimensional pain inventory (MPI): clarifying the meaning of "significant other".

The Multidimensional Pain Inventory (MPI) has been used widely to assess the psychosocial adaptation in chronic pain patients. The MPI can also be used to classify patients into one of three primary subgroups. However, studies have reported that anywhere from 3% to 30% of patients are unclassifiable, mostly attributable to an excessive number of missing responses to questions. The purpose of this study was to examine the reasons for the large number of missing responses and subsequently to reduce the number of patients who cannot be classified within one of the three primary MPI subgroups. Two versions of the MPI were evaluated on two samples of patients (N = 147; and N = 143) with persistent pain being evaluated by the Workers Compensation Board of British Columbia, Canada. One version used the published MPI instructions and the second modified the instructions to clarify the meaning of the term "significant other." In addition, patients were required to designate a significant other who would serve as the anchor for all responses related to a significant other. Approximately 18% of patients could not be classified within one of the three primary profiles and were determined to be unanalyzable using the MPI standard classification procedure. Most patients who could not be classified had excessive missing data to those questions asking about support received from "significant other." Almost all of these patients with missing data were unmarried and living alone. Modifying the instructions of the MPI to specify the meaning of the term "significant other" resulted in an almost threefold (6.3% vs. 18%) reduction in the percentage of patients whose responses could not be analyzed and consequently classified into one of the three primary MPI subgroups. The revised instructions did not lead to any difference in the actual distribution of patients assigned to one of the three profiles. Thus, using the modified instruction did not alter the proportion of patients assigned to one of the three primary groups. Modification of the MPI instructions clarifying the definition of a significant other can greatly reduce the number of patients who are classifiable within one of the three primary MPI profiles. Thus, the modified instructions of the MPI (hence the MPI-M) have a significant advantage over the original version. The mean scores on the individual scales of the MPI and the MPI-M are comparable. Moreover, the results demonstrate that the proportion of the previously unanalyzable patients classified within one of the three primary subgroups is comparable to the original proportion of patients assigned to each of the primary subgroups. Thus, it may not be necessary to reestablish the norm scores based on the modified instructions. Future studies and clinicians who wish to use the MPI for the purpose of classifying patients on the basis of psychosocial and behavioral factors should make use of the MPI-M that incorporates the clarification of the meaning of "significant other."