Multidimensional Pain Inventory Research Articles

Test of Memory Malingering (TOMM) Scores are not Affected by Chronic Pain or Depression in Patients with Fibromyalgia

Neuropsychologists routinely give effort tests, such as the Test of Memory Malingering (TOMM). When a person fails one of these tests, the clinician must try to determine whether the poor performance was due to suboptimal effort or to chronic pain, depression, or other problems. Participants were 54 community-dwelling patients who met American College of Rheumatology criteria for fibromyalgia (FM). In addition to the TOMM, they completed the Beck Depression Inventory–Second Edition, Multidimensional Pain Inventory–Version 1, Oswestry Disability Index–2.0, British Columbia Cognitive Complaints Inventory, and the Fibromyalgia Impact Questionnaire. The majority endorsed at least mild levels of depressive symptoms (72%), and 22% endorsed “severe” levels of depression. The average scores on the TOMM were 48.8 (SD = 1.9, range = 40–50) for Trial 1, 49.8 (SD = 0.5, range = 48–50) for Trial 2, and 49.6 (SD = 0.9, range = 45–50) for Retention. Despite relatively high levels of self-reported depression, chronic pain, and disability, not a single patient failed the TOMM. In this study, the TOMM was not affected by chronic pain, depression, or both.

(924): Response set on self-report measures among people with whiplash associated disorders

Self-report scales for assessing chronic pain patients are typically construed as assessing distinct constructs (eg, anxiety, fear of movement, catastrophizing). The possibility that these scales might tap a general response set rather than unique constructs has received little attention. Individuals (n=215) with neck pain following motor vehicle collisions completed several self-report measures: Pain Anxiety Symptoms Scale (PASS), Negative Affect scale of the Positive and Negative Affect Scale (PANASN), Center for Epidemiologic Studies-Depression scale (CESD), Pain Catastrophizing Scale (PCS), Affective Distress (MPIAd) and Pain Severity (MPIPs) Scales of the Multidimensional Pain Inventory, and Tampa Kinesiophobia Scale (TSK).

Sex Differences in Pain Drawing Area for Individuals With Chronic Musculoskeletal Pain

Cross-sectional. To (1) determine the association between pain severity and pain drawing area for men and women; (2) determine if sex differences exist in pain severity or pain drawing area; (3) determine the relative influence of pain severity, anatomical location of pain, personality, and psychological coping factors on pain drawing area for men and women. Pain drawings have been postulated to assist in clinical decision making regarding classification and treatment of musculoskeletal pain. Prior studies have been ambiguous on this topic, possibly because they have not considered if sex differences exist for pain drawing area. One hundred twenty-six subjects referred to a multidisciplinary chronic pain clinic with chronic musculoskeletal pain were included in this study. Subjects completed a pain drawing, the Multidimensional Pain Inventory (MPI), the Coping Strategies Questionnaire (CSQ), and the Minnesota Multiphasic Personality Inventory (MMPI-2). Pearson correlations investigated the associations of pain severity and pain drawing area, independent t tests investigated sex differences in pain severity and pain drawing area, and multiple regression investigated factors that influenced pain drawing area. P a in severity w as positively correlated with pain drawing area for men (r = 0.38, P = .003) and women (r = 0.23, P = .052), accounting for approximately 14% and 5% of the total variance, respectively. There was no significant sex difference in pain severity ratings, but women reported a significantly larger area of symptoms on the pain drawings (effect size, 0.61; P = .002). The sex difference in pain drawing area was consistent across different anatomical locations of pain. In women, the final regression model accounted for 39% (P < .001) of the variance in pain drawing area, with anatomical location of pain (beta = .42, P < .001) and hypochondriasis (beta = .31, P = .005) as the only unique predictors in the final model. In men, the regression model accounted for 27% (P = .003) of the variance in pain drawing area, with pain severity (beta = .32, P = .021) and a coping style of ignoring pain (beta = -.32, P = .018) as the only unique predictors in the final model. Women had larger pain drawing area and this area was significantly associated with anatomical location of pain and hypochondriasis. Men had smaller pain drawing area and this area was associated with pain severity and a coping style of ignoring pain. These findings suggest that clinicians interpreting pain diagram area should consider the sex of the individual.

Helplessness and loss as mediators between pain and depressive symptoms in fibromyalgia

This study evaluated the contribution of condition-specific helplessness and loss to depression in fibromyalgia (FM). Two models were tested. The first model examined whether loss, measured by the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Interference Scale, would mediate the relationship between disability and depression. The second model determined whether condition-specific helplessness and loss would mediate the relationship between pain and depression with disability controlled. Eighty patients with confirmed diagnoses of FM were recruited throughout Southern California from general medical clinics, newspaper advertisements, and rheumatology practices. The study design was cross-sectional, using self-report, observational, and interview measures. A composite measure of depression was adopted, consisting of the Center for Epidemiological Studies-Depression Scale and the Hamilton Rating Scale for Depression. Hierarchical multiple regression analyses were conducted using a path analytic framework to examine each model. In Model 1, loss fully mediated the relationship between disability and depression. In Model 2, condition-specific helplessness mediated the relationship between pain and depression, but the contribution of loss was not significant. The findings confirm the importance of helplessness and demonstrate that the cognitive meaning of having FM plays a more central role in predicting depressive symptomatology than illness-related stressors, such as pain or disability.

Chronic pain and head injury following motor vehicle collisions: a double whammy or different sides of a coin

Chronic pain and head injury are common and burdensome sequelae of motor vehicle collisions. The aim of this study was to compare differences in physical injury and functional impairment, psychological distress and pain coping in head injured and non-head injured chronic pain persons subsequent to motor vehicle collisions. Two groups of 54 participants matched in terms of age, gender, and years of formal education underwent a psychological-legal assessment. As part of the assessment, participants completed the Multidimensional Pain Inventory, Sickness Impact Profile, Minnesota Multiphasic Personality Inventory-2, and Coping Strategies Questionnaires. Select scales from questionnaires were combined and underwent multivariate analyses of covariance to test the effects of pain sites at the time of psychological-legal assessment (low, high) and head injury status (head injured and non-head injured chronic pain). Overall, some differences between the two groups were noted but the results did not strongly support the hypothesis that head injured chronic pain participants have a greater physical or psychological burden than non-head injured chronic pain participants. The results suggest the import of assessing and managing pain sites and pain severity in persons injured in motor vehicle collisions.

Pain After Spinal Cord Injury: An Evidence-based Review for Clinical Practice and Research

Background/Objectives: To examine the reliability, validity, sensitivity, and practicality of various outcome measures for pain after spinal cord injury (SCI), and to provide recommendations for specific measures for use in clinical trials.Data Sources: Relevant articles were obtained through a search of MEDLINE, EMBASE, CINAHL, and PubMed databases from inception through 2006.Study Selection: The authors performed literature searches to find articles containing data relevant to the reliability and validity of each pain outcome measure in SCI and selected non-SCI populations.Data Extraction: After reviewing the articles, an investigator extracted information utilizing a standard template. A second investigator reviewed the chosen articles and the extracted pertinent information to confirm the findings of the first investigator.Data Synthesis: Taking into consideration both the quantity and quality of the studies analyzed, judgments on reliability and validity of the measures were made by the two investigators. Based upon these judgments, recommendations were formulated for use of specific measures in future clinical trials. In addition, for a subset of measures a voting process by a larger group of SCI experts allowed formulation of recommendations including determining which measures should be incorporated into a minimal dataset of measures for clinical trials and which ones need revision and further validity and reliability testing before use.Conclusions: A 0-10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI, while the 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain. The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI. Brush or cotton wool and at least one high-threshold von Frey filament are recommended to test mechanical allodynia/hyperalgesia while a Peltier-type thermotester is recommended to test thermal allodynia/hyperalgesia. The International Association for the Study of Pain (IASP) or Bryce-Ragnarsson pain taxonomies are recommended for classification of pain after SCI, while the Neuropathic Pain Scale (NPS) is recommended for measuring change in neuropathic pain and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) for quantitating neuropathic and nociceptive pain discrimination.

An examination of the psychometric structure of the Multidimensional Pain Inventory in temporomandibular disorder patients: a confirmatory factor analysis

BackgroundThis paper seeks to analyse the psychometric and structural properties of the Multidimensional Pain Inventory (MPI) in a sample of temporomandibular disorder patients.MethodsThe internal consistency of the scales was obtained. Confirmatory Factor Analysis was carried out to test the MPI structure section by section in a sample of 114 temporomandibular disorder patients.ResultsNearly all scales obtained good reliability indexes. The original structure could not be totally confirmed. However, with a few adjustments we obtained a satisfactory structural model of the MPI which was slightly different from the original: certain items and the Self control scale were eliminated; in two cases, two original scales were grouped in one factor, Solicitous and Distracting responses on the one hand, and Social activities and Away from home activities, on the other.ConclusionThe MPI has been demonstrated to be a reliable tool for the assessment of pain in temporomandibular disorder patients. Some divergences to be taken into account have been clarified.

Emotional Distress and Medication Use in Two Acute Pain Populations: Jaw and Low Back

The present study was undertaken to compare emotional distress and functional ability between two common pain populations--acute jaw pain (JAW; n = 135) and acute low back pain (LB; n = 71). Patient groups were evaluated and compared on a variety of biopsychosocial measures, including the Beck Depression Inventory (BDI), Multidimensional Pain Inventory (MPI), Characteristic Pain Intensity (CPI), and Ways of Coping Questionnaire. Specific diagnoses were assessed using the Structured Clinical Interview of the Diagnostic and Statistical Manual (DSM-IV)--I and II, and rates of Axis I and II diagnoses in these groups were further compared to base rates in the general population. Additionally, medication usage was evaluated to determine group differences. Results revealed that JAW patients had lower BDI and CPI scores, as well as a higher level of functioning on the Global Assessment of Functioning assessed by the DSM-IV. Both acute pain groups also had significantly more Axis I and II disorders than the general population. Additionally, it was found that the JAW group used more benzodiazepines, while the LB group used more schedule II narcotics. A logistic regression model created from these variables found a six-factor model, composed of the CPI, MPI coping style anomalous, Ways of Coping problem-solving, Global Assessment of Functioning, anxiety disorders, and Cluster C personality disorder diagnoses, that differentiated the JAW from the LB group. Overall, these findings suggest that the differences identified between these two groups should be considered in developing tailored treatments for individuals with acute low back and jaw pain.

Temperament and Character Personality Dimensions in Patients With Nonspecific Musculoskeletal Disorders

The aim of this study was to investigate temperament and character dimensions in a group of patients with nonspecific musculoskeletal disorders and to show how personality is related to pain and psychologic distress in pain patients. A total of 78 patients with musculoskeletal disorders were compared with a matched control group of 118 nonpatients. The Temperament and Character Inventory, the Symptom Check List, and the Multidimensional Pain Inventory were used. The pain patients differed significantly from the controls and exhibited a personality profile with high harm avoidance and low self-directness, which indicate that patients with nonspecific musculoskeletal pain disorders can be characterized as being cautious, insecure, and pessimistic. In addition, they can be described as having difficulties in accepting responsibility, lack of long-term goals, chronically low self-esteem, and struggle with identity. This is probably a salient characteristic of patients with chronic pain. The results also showed that personality dimensions had a stronger correlation to psychologic distress than to pain. The result indicated that harm avoidance probably is an important personality trait in anxiety states. The results underline the importance of using instruments assessing personality and psychologic symptoms in patients with nonspecific musculoskeletal disorders both as diagnostic tools and in treatment planning.

Coping, Pain Severity, Interference, and Disability: The Potential Mediating and Moderating Roles of Race and Education

Researchers have demonstrated that certain types of pain coping are correlated with less pain severity and disability and that there are differences between Caucasians and African-American pain patients in their use of specific coping strategies. However, the extent to which racial group differences exist in the associations between pain coping strategies and pain severity, interference, and disability is unclear. Furthermore, the role of education in these associations is uncertain. We recruited a diverse community sample of individuals with chronic pain and their spouses to examine this issue (N = 105). Participants completed the Coping Strategies Questionnaire, Multidimensional Pain Inventory, and Sickness Impact Profile. Results showed that African-American participants reported significantly more pain severity, interference, and disability and reported using diverting attention and prayer and hoping pain-coping strategies significantly more often than Caucasian participants; however, only the racial group difference in prayer and hoping remained when controlling for education. We also examined whether race and education interacted with coping strategies in relating to pain and disability. Significant three-way interactions were found for physical and psychosocial disability, suggesting that educational level should be included in analyses exploring racial group differences. The results suggest the need for pain treatments that take into account the educational and cultural context of pain. Perspective This article demonstrates that demographic variables such as race and education should be considered together when evaluating the effectiveness of coping with pain. The findings have the potential to enhance research and clinical practice with diverse groups.

Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial

To test the hypothesis that acupuncture improves symptoms of fibromyalgia. We conducted a prospective, partially blinded, controlled, randomized clinical trial of patients receiving true acupuncture compared with a control group of patients who received simulated acupuncture. All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture. We measured symptoms with the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory at baseline, immediately after treatment, and at 1 month and 7 months after treatment. The trial was conducted from May 28, 2002, to August 18, 2003. Fifty patients participated in the study: 25 in the acupuncture group and 25 in the control group. Total fibromyalgia symptoms, as measured by the FIQ, were significantly improved in the acupuncture group compared with the control group during the study period (P = .01). The largest difference in mean FIQ total scores was observed at 1 month (42.2 vs 34.8 in the control and acupuncture groups, respectively; P = .007). Fatigue and anxiety were the most significantly improved symptoms during the follow-up period. However, activity and physical function levels did not change. Acupuncture was well tolerated, with minimal adverse effects. This study paradigm allows for controlled and blinded clinical trials of acupuncture. We found that acupuncture significantly improved symptoms of fibromyalgia. Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety.

Delta‐9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief

ABSTRACTObjective: Fibromyalgia (FM) is a chronic pain syndrome characterized by a distinct mechanical hyperalgesia and chronic pain. Recently, cannabinoids have been demonstrated as providing anti-nociceptive and anti-hyperalgesic effects in animal and human studies. Here, we explored in nine FM patients the efficacy of orally administered delta-9-tetrahydrocannabinol (THC) on electrically induced pain, axon reflex flare, and psychometric variables.Research design and methods: Patients received a daily dose of 2.5–15 mg of delta‐9-THC, with a weekly increase of 2.5 mg, as long as no side effects were reported. Psychometric variables were assessed each week by means of the West Haven-Yale Multidimensional Pain Inventory (MPI), Pittsburgh Sleep Quality Index (PSQI), Medical outcome survey-short form (MOS SF‐36), the Pain Disability Index (PDI), and the Fibromyalgia Impact Questionnaire (FIQ). In addition, patients recorded daily, in a diary, their overall pain intensity on a numeric scale. Each week, pain and axon reflex flare was evoked experimentally by administration of high intensity constant current pulses (1 Hz, pulse width 0.2 ms, current increase stepwise from 2.5–12.5 mA every 3 minutes) delivered via small surface electrodes, attached to the volar forearm skin.Main outcome measures: Daily pain recordings by the patient, experimentally induced pain, and axon reflex flare recorded by a laser Doppler scanner.Results: Five of nine FM patients withdrew during the study due to adverse side effects. Delta‐9-THC had no effect on the axon reflex flare, whereas electrically induced pain was significantly attenuated after doses of 10–15 mg delta‐9-THC ( p < 0.05). Daily-recorded pain of the FM patients was significantly reduced ( p < 0.01).Conclusions: This pilot study demonstrated that a generalized statement that delta‐9-THC is an analgetic drug cannot be made. However, a sub-population of FM patients reported significant benefit from the delta‐9-THC monotherapy. The unaffected electrically induced axon reflex flare, but decreased pain perception, suggests a central mode of action of the cannabinoid.

Internal Consistency, Stability, and Validity of the Spinal Cord Injury Version of the Multidimensional Pain Inventory

Widerström-Noga EG, Cruz-Almeida Y, Martinez-Arizala A, Turk DC. Internal consistency, stability, and validity of the spinal cord injury version of the Multidimensional Pain Inventory. Objective To evaluate the internal consistency, stability, and construct validity of a spinal cord injury (SCI) version of the Multidimensional Pain Inventory (MPI-SCI). Design Interview. Setting Veterans Affairs medical center and university-based institute. Participants Community sample of persons with SCI and chronic pain (N=161). Interventions Not applicable. Main Outcome Measure The MPI-SCI. Results The internal consistency of the MPI-SCI subscales ranged from fair (.60) for affective distress to substantial (.94) for pain interference with activities. The subscales of the MPI-SCI (ie, life interference [ r=.81], affective distress [ r=.71], solicitous responses [ r=.86], distracting responses [ r=.85], general activity [ r=.69], pain interference with activities [ r=.78], pain severity [ r=.69], negative responses [ r=.69]) showed adequate stability. In contrast, the stability of the support ( r=.59) and the life control subscales ( r=.31) was unacceptably low. All MPI-SCI subscales with the exception of the perceived responses by significant others subscales showed good convergent, discriminant, and concurrent validity. Conclusions The MPI-SCI appears to be a reasonable measure for evaluating chronic pain impact after SCI. In clinical trials, however, supplementary instruments should be included to assess changes in affect, social support, and perceptions of life control.

Sleep Quality and the Role of Sleep Medications for Veterans with Chronic Pain

The purpose of this study was to investigate the nature of sleep problems in veterans presenting to a pain clinic, factors that predict likelihood of being prescribed a sleep medication, types of medications prescribed, and the relationships between sleep medication use and sleep quality, pain, and depression. Participants were 201 consecutive patients referred to a Veterans Affairs outpatient pain clinic. They were administered the Pittsburgh Sleep Quality Index, Multidimensional Pain Inventory, and Beck Depression Inventory at intake and 2-month follow-up. Sleep and opioid medication prescriptions were also monitored. Pain severity did not predict global sleep quality; global sleep quality was not predictive of pain severity. Greater depression predicted both more severe pain and more sleep impairment. Having previously been prescribed such medications was the only significant predictor of being prescribed a sleep medication at the time of the 2-month assessment. For the 45% of participants on sleep medications, these medications were not associated with any significant change in pain factors or depression. However, sleep medication use was associated with worse global sleep quality, sleep duration, and sleep efficiency. Opioid prescription was not a significant predictor of sleep factors, pain-related variables, or depression symptoms. Results suggest depression may contribute more significantly to sleep problems than pain-related variables in this population. The data suggest the need for controlled, prospective studies of sleep medication to further investigate the impact of sleep medications on sleep components in patients with chronic pain.

Évaluation fonctionnelle de la douleur chronique chez le patient blessé médullaire

Objectives. – To evaluate pain and its impact on daily life activities in patients with spinal cord injuries. Methods. – Patients with chronic pain associated with spinal cord injuries were mailed 2 questionnaires: the multidimensional pain inventory for spinal cord injury, which includes a visual numeric scale for pain; and the quality of life questionnaire SF-36. Results. – Twenty-two of the 28 patients (women 9, men 19) who were mailed the questionnaires responded. The location of pain was, in decreasing order: lower limbs, upper limbs, trunk. The clinical type of pain was usually neuropathic, and the mean pain intensity was 7.2 ± 2.16. Eleven patients experienced sleep disturbances. In 17 patients, daily activities were limited because of pain (not counting 2 patients who were unable to answer because of hospitalization). Among 6 working patients (of 22), 5 experienced limitations in their job because of pain. SF-36 scores, which reflect psychological and physical health, were well below those of the general population. Discussion–conclusion. – Despite the small size of our population and lack of a French-language validation of the questionnaire, these preliminary results point out the important interference of chronic pain in functional autonomy and quality of life in patients with spinal cord injuries.

Partner Responses to Pain Behaviors Are Associated With Depression and Activity Interference Among Persons With Chronic Pain and Spinal Cord Injury

This study investigated the extent to which psychosocial factors (partner responses to pain behaviors, social support) are associated with pain-related activity interference and depressive symptom severity among individuals with spinal cord injury (SCI) and chronic pain. Seventy adults (45 men, 25 women) with SCI and pain and 68 partners completed Part II of the West Haven–Yale Multidimensional Pain Inventory, a measure of partner responses to pain behaviors. Individuals with SCI and pain also completed the Social Support Questionnaire–6, a modified Brief Pain Inventory Pain Interference Scale, and the Center for Epidemiological Studies–Depression scale. SCI subject ratings of partner responses to pain behaviors, but not partner ratings, were associated significantly with pain-related activity interference and depressive symptom severity. Negative partner response to pain behaviors explained the most variance in these 2 outcome measures. The results provide preliminary support for the importance of partner responses to pain behaviors in outcomes of individuals with chronic pain and SCI. Perspective Chronic pain is a significant problem for many persons with spinal cord injury. In this sample of individuals with spinal cord injury and pain, perceived partner negative responses to pain behaviors were associated positively with activity interference and depression. Decreasing negative partner responses to pain behaviors might be a potentially important clinical intervention in this population.

Clinically Significant Placebo Analgesic Response in a Pilot Trial of Botulinum B in Patients with Hand Pain and Carpal Tunnel Syndrome

We conducted a pilot trial to assess the effect of botulinum toxin B on palmar pain and discomfort in carpal tunnel syndrome (CTS) patients. Design. Randomized, double-blind, placebo-controlled. Twenty ambulatory CTS patients. Intervention. Botulinum toxin B or placebo injections into three hypothenar muscles anatomically linked or attached to the carpal tunnel and its tentorium, that is, the Opponens Digiti Minimi and Flexor Digiti Minimi, located with electromyography (EMG), and the Palmaris Brevis Muscle, anatomically located without EMG. New York City hospital. Outcomes were measured with numeric ratings, with higher scores indicating worse outcomes. Daily, subjects recorded their 0-10 numeric ratings of overall pain levels and pain-related sleep disturbances. During weekly telephone calls, they reported their 0-10 ratings for overall pain, pain-related sleep disturbance, and CTS-related tingling during the night and day as experienced over the preceding 24 hours. For each of four clinic visits, we averaged each subject's ratings of nine quality of life indicators from the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), each measured on a 0-6 numeric scale. Over the 13-week trial, compared to baseline scores, the following outcomes predominantly showed decreases of statistical significance (P < or = 0.050) or borderline significance (0.050 < P < or = 0.10) for weeks 2 through 8: overall pain per daily diary entries and per weekly telephone reports, and pain-related sleep disturbance in the placebo group per phone report and in the botulinum toxin B group per diary report. CTS painful night tingling and day tingling, as well as the average scores of the WHYMPI quality of life indicators, showed improvements with statistical or borderline significance for almost each follow-up week. Between-group analyses, however, demonstrated that at each follow-up week, there was no statistically significant difference between the two study groups regarding changes from baseline in any study outcome. Botulinum toxin B is not dramatically superior to placebo for the relief of CTS symptoms. Possible explanations of the improvements in each study group are explored.

Biographical, pain and psychosocial data for a South African sample of chronic pain patients

Objective: To gather biographical and pain data for a sample of South African patients visiting a specialist pain control unit. To investigate the role of various psychosocial variables in this sample’s chronic pain experience. Subjects and Method: 325 adult outpatients from a chronic pain unit completed a biographical questionnaire, the West Haven-Yale Multidimensional Pain Inventory, as well as various supplementary scales of the Minnesota Multiphasic Personality Inventory-2. Diagnostic data were also gathered for the sample. Descriptive statistics were calculated for the sample and t-tests were used to compare the current sample’s mean scores on the measuring instruments with those of American normative samples. Results: The South African sample displayed elevated levels of perceived pain-related functional limitations, as well as an increase in the frequency of psychopathology and emotional distress. However, the current sample also reported higher levels of social support and were inclined to be more socially and physically active when compared with individuals in other studies. Conclusion: Specific demographic and diagnostic tendencies appear evident in the current sample. Furthermore, South African chronic pain patients seem to exhibit similar, if not perhaps more pronounced, psychosocial profiles to a comparable American sample. Various suggestions for further research are also made.

Psychometric evaluation of multidimensional pain inventory (Swedish version) in a sample of elderly people

Objectives The aim was to psychometrically evaluate the Swedish version of the Multidimensional Pain Inventory (MPI-S) and the “brief screening version of MPI-S” for use in an elderly sample. Methods This study comprised 175 people aged 76–99 years reporting pain and in need of help to manage daily living. The instrument’s factor structures were investigated through factor analyses, convergent and discriminant validity were assessed through inter-scale correlations and correlations with items from SF-12. Reliability was assessed by Cronbach’s alpha. Results The full-length version of MPI-S did not, in general, show any satisfactory validity and reliability when used among elderly. It had acceptable convergent and discriminant validity, but the factor analysis did not show a good model fit. Low α values were found for most of the sub-scales. However, the brief screening version of MPI showed acceptable validity and reliability, except for rather low α values in sections 3 and 4. Conclusion The MPI-S instrument may not be very useful for measuring pain among frail elderly. The brief screening version may instead be a better alternative to the full version of the MPI-S. However, the small number of observations may be the reason to the lack of fit, and further studies are warranted.

Multilevel analysis of couple congruence on pain, interference, and disability

Couple congruence on ratings of pain severity and disability were examined using hierarchical linear modeling. Older community Individuals with Chronic Pain (ICPs) and their spouses completed the Multidimensional Pain Inventory (pain severity, interference, negative spouse responses to pain), Sickness Impact Profile (physical disability, psychosocial disability), and the Mood and Anxiety Symptom Questionnaire (psychological distress). Both spouses reported on ICPs' pain and disability as well as their own psychological distress. Spousal incongruence was observed on interference and physical disability such that ICPs reported greater disability than their spouses reported for them. No significant incongruence was observed in pain severity or psychosocial disability. Predictors of couples' mean ratings of pain and disability were identified. Specifically, couples in which the ICP was female reported higher couples' ratings of pain severity and interference. ICP distress was related to higher couples' ratings of all pain and disability variables whereas spouse distress was related to higher psychosocial disability ratings. ICPs' perceptions of negative spouse responses were also positively associated with couples' ratings of physical and psychosocial disability. In terms of congruence, ICP distress was associated with incongruence on interference, physical disability, and psychosocial disability whereas spouse distress predicted incongruence on pain severity, and interference. This study suggests that understanding couples' pain outcome ratings involves an awareness of factors that might influence their perceptions and behaviors.