Pain Behavior In Patients Research Articles

The influence of compensation on pain behavior and treatment outcome in low back pain patients

The influence of compensation on pain behavior and treatment outcome in low back pain patients

Development of a behavioral observation method to assess pain and wellness behaviors in bone marrow transplant patients

Development of a behavioral observation method to assess pain and wellness behaviors in bone marrow transplant patients

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.

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.

Spousal perpetuation of chronic pain behavior

The literature reviewed here demonstrates that spousal response to pain display can reinforce and thereby perpetuate the patient's pain behavior. Relationships characterized as “sick-role homeostatis” reflect a nexus of behavioral contingencies which are highly resistant to treatment. Though such relationships could developde novo subsequent to accident or injury, modeling and familial effects in chronic pain suggest a rich personal and family history of chronic pain learning experiences. Spousal reinforcement of pain behavior is greater in satisfied relationships and tends to involve contingent attention and caring rather than assistance or taking over tasks and chores. As the vast majority of pain patients and spouses report being satisfied with their marriages, spousal involvement in chronic pain treatment is critical.

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.

Psychiatry Development of an observation method for assessing pain behavior in chronic low back pain patients: Behav. Then, 13 (1982) 363–375

Pain: June 1984 - Volume 19 - Issue 2 - p 193-194 doi: 10.1016/0304-3959(84)90858-3

Medication usage, emotional disturbance, and pain behavior in chronic low back pain patients.

Examined chronic low back pain outpatients (N = 126) at a university hospital outpatient back clinic. Prior to their orthopedic examination, patients were given the MMPI, the Pain Experience Questionnaire (a modified form of the McGill Pain Questionnaire), and a medical history form that indicated onset of injury, number of surgeries, functional limitations, and use of medications. Four patterns of drug usage emerged with sufficient number to permit statistical analysis: (1) none; (2) aspirin-type medications; (3) single narcotics alone; and (4) narcotics combined with other medications. Group 4 patients scored significantly higher on the Hypochondriasis and Hysteria scales than the others, whereas Group 3 patients scored higher on the PD (acting out) scale. Group 4 patients reported more intense pain and chose more affective terms (punishing/terrorizing/sickening) in describing their pain than the other three groups. Group 1 patients reported significantly less limitation in walking, running, and climbing.

Development of an observation method for assessing pain behavior in chronic low back patients : F.J. Keefe and A.R. Block (Box 3926, Duke Univ. Medical Center, Durham, N.C., 27110, U.S.A.), Behav. Ther., 13 (1982) 363–375

Development of an observation method for assessing pain behavior in chronic low back patients : F.J. Keefe and A.R. Block (Box 3926, Duke Univ. Medical Center, Durham, N.C., 27110, U.S.A.), Behav. Ther., 13 (1982) 363–375

Development of an observation method for assessing pain behavior in chronic low back pain patients

Development of an observation method for assessing pain behavior in chronic low back pain patients

Behavior Modification of Chronic Pain

A treatment program for chronic pain is reported which focuses on modification of patient pain behavior. After an outpatient pain clinic screening by a multidisciplinary team, the patient with chronic pain (duration of 6 months or longer) is admitted for a 7--8 week inpatient program followed by a 4-week outpatient period. The first week of the inpatient program is used for evaluation of pain behaviors, recording use of pain medications, activity levels, and tolerance for special conditioning exercises. The program is aimed at extinguishing pain behaviors and use of pain medications, increasing activity level, reinforcing well behaviors, and returning patients to full active lives, normal for their sex and age. Of the 34 patients completing the program and returning to full active normal lives, 74% (25) have maintained this attained goal at the time of follow-up from 6 months to 7 years later.

Private Experience and Public Expectation on the Cancer Ward

A sociologist relates her experiences with staff and patients on a cancer ward. Within a short time the staff perceived her as a threat to their system of efficiency-oriented norms and regulations, a system which she, in turn, came to regard as an institutionalized defense against that-which-could-not-be-confronted. In becoming acquainted with the patients themselves, the phenomenon of pain was brought to the fore. The patient's existence sometimes was dominated by pain, and yet there were significant differences from one cancer patient to another in how they interpreted and related to pain. These variations included positive valuation of pain as a symbol of life. Ethnic differences in the interpretation of pain, especially between people from Latin and Anglo-Saxon backgrounds, were observed. In general, pain behavior in terminal patients was strongly colored by the individual's feelings concerning impending death. The observer also shares some of her personal feelings of the rhythms of hospital life and their impact upon the individual.