Somatic Perception Research Articles

Anxiety symptom interpretation: A potential mechanism explaining the cardiorespiratory fitness–anxiety relationship

BackgroundHigher cardiorespiratory fitness is associated with lower trait anxiety, but research has not examined whether fitness is associated with state anxiety levels and the interpretation of these symptoms. The aim of this paper was to (1) reexamine the association between cardiorespiratory fitness and general anxiety and (2) examine anxiety intensity and perceptions of these symptoms prior to an acute psychological stress task. MethodsParticipants (N=185; 81% female; Mage=18.04, SD=0.43 years) completed a 10-minute Paced Serial Addition Test. General anxiety was assessed using the anxiety subscale of the Hospital Anxiety Depression Scale. Cognitive and somatic anxiety intensity and perceptions of symptoms was assessed immediately prior to the acute psychological stress task using the Immediate Anxiety Measures Scale. Cardiorespiratory fitness was calculated using a validated standardized formula. ResultsHigher levels of cardiorespiratory fitness were associated with lower levels of general anxiety. Path analysis supported a model whereby perceptions of anxiety symptoms mediated the relationship between cardiorespiratory fitness and levels of anxiety experienced during the stress task; results remained significant after adjusting for general anxiety levels. Specifically, higher levels of cardiorespiratory fitness were positively associated with more positive perceptions of anxiety symptoms and lower levels of state anxiety. LimitationsA standard formula rather than maximal testing was used to assess cardiorespiratory fitness, self-report questionnaires were used to assess anxiety, and the study was cross-sectional in design. ConclusionsResults suggest a potential mechanism explaining how cardiorespiratory fitness can reduce anxiety levels.

Abstract 12322: Physical Symptoms and Depression Interact in Predicting Quality-of-Life in Heart Failure

Introduction: Quality-of-life (QOL) is an important patient-oriented outcome in heart failure (HF). The interaction effect of physical symptoms and depression in predicting QOL in HF, however, is not well understood. Hypothesis: There is a strong interaction effect between physical symptom and depression in predicting QOL among adults with moderate to advanced HF. Methods: This was a secondary analysis of combined data collected during two prospective cohort studies of symptoms among adults with moderate to advanced HF. Physical symptoms were measured with the Heart Failure Somatic Perception Scale subscale (HFSPS), and depression was measured with the Patient Health Questionnaire-9 (PHQ-9). QOL was measured with the visual analog scale (VAS) of the EQ-5D. Results: The average age of the sample (n=291) was 56.7±13.3 years, and most were male (61.9%). A majority of subjects were classified as New York Heart Association Class III HF (56.4%), and most had non-ischemic etiology (65.2%). Average VAS score on the EQ-5D was 54.27±22.54. Both HFSPS scores (β = -0.58 ± 0.12, p<0.001) and PHQ9 scores (β = -1.77 ± 0.38, p<0.001) were significantly related to VAS scores. There was a significant interaction effect of HFSPS scores and PHQ9 scores in predicting VAS scores (Figure 1; interaction effect: β = 0.02 ± 0.01, p<0.05; model: R2 = 0.28, F(3,265) = 35.18, p<0.001). Conclusions: Physical symptoms and depression have strong independent and interactive effects in predicting QOL in HF, indicating that both should be considered concurrently when managing QOL among adults with HF.

Abstract 13604: Physical and Affective Symptom Clusters Are Strongly Associated in Heart Failure

Introduction: The syndrome of heart failure (HF) is a constellation of both physical and affective symptoms. How physical and affective symptom clusters are associated, however, is not well understood. Hypothesis: There is a strong association between physical symptom clusters and affective symptom clusters among adults with moderate to advanced HF. Methods: This was a secondary analysis of combined data collected during two prospective cohort studies of symptoms among adults with moderate to advanced HF. Physical symptoms of dyspnea and wake disturbances were measured with the Heart Failure Somatic Perception Scale Dyspnea subscale (HFSPS-D) and the Epworth Sleepiness Scale (ESS), respectively. Affective symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Brief Symptom Inventory Anxiety subscale (BSIANX), respectively. Physical and affective symptoms were clustered separately using latent mixture modeling and then compared using cross classification modeling and traditional comparative statistics (i.e. student’s t, Kendall’s tau-b and chi-square tests). Results: The average age of the sample (n=291) was 56.7±13.3 years, and most were male (61.9%). A majority of subjects were classified as NYHA Class III HF (56.4%), and most had non-ischemic etiology (65.2%). Two physical symptom clusters (severe physical (26.3%) and mild physical (73.7%); dyspnea t=7.35, p<0.001; wake disturbances t=16.80, p<0.001) and two affective symptom clusters (severe affective (21.2%) and mild affective (78.8%); depression t=22.1, p<0.001; anxiety t=7.87, p<0.001) were identified in a model with good fit (entropy=0.80). Subjects with severe physical symptoms were more likely to have severe than mild affective symptoms, and those with mild physical symptoms were more likely to have mild than severe affective symptoms (χ2=106.8, p<0.001; tau b=0.62). Conclusions: There is a strong association between physical and affective symptom clusters among adults with moderate to advanced HF that may be helpful in identifying adults with HF at risk for multiple, co-occurring symptoms.

Reimplantation surgery in patients with implantable cardioverter defibrillators: A qualitative study

ObjectiveThe purpose of this study was to examine the experience of recurrent surgery for patients with implantable cardioverter defibrillators (ICD). BackgroundDevice replacement is typically required every 4–7 years due to battery depletion. Furthermore, recurrent surgery may be related to lead malfunction or pocket infection. MethodsEthnographic methods were used for data collection with 23 ICD reimplanted recipients, 12 men and 11 women, 26–85 years of age. Data were analyzed using a with-in case and cross-case method. ResultsThree major themes were identified: Anticipation regarding implantation with three sub-themes of logistics and social considerations, decisions regarding replacement, and financial considerations. Relinquishing control and somatic changes frame perceptions related to the operative and postoperative periods. ConclusionsThe frequency of ICD reimplantation differentiates it from other surgical interventions. Perceptions varied according to past experiences and present day social, financial, and somatic differences. Recipients are resolved to life-long surgery aided by their trust in health care professionals.

Reliability and Validity of the Farsi Version of the Somatosensory Amplification Scale.

Background:The somatosensory amplification scale (SSAS) is a 10-item self-report instrument designed to assess a tendency to experience normal somatic and visceral sensations as intense, noxious, and disturbing.Objectives:The present study investigated the reliability and validity of the SSAS, developed by Barsky et al. (1988), in the Iranian population.Materials and Methods:The study was carried out on 240 patients with functional gastrointestinal disorders and 30 healthy persons selected by convenience sampling from 2013 to 2014. The patients completed the SSAS, the somatization subscale of the symptom checklist-90-revised (SCL-90-R som), and the modified somatic perception questionnaire (MSPQ), whereas the healthy persons completed just the SSAS.Results:Exploratory factor analysis indicated that the one-factor solution, accounting for 29.42% of the variance, explained that the SSAS items were represented by one global dimension. The SSAS had acceptable internal consistency (α = 0.78) and good test-retest reliability (r = 0.80). The item-to-scale correlations varied from 0.17 to 0.55. Item 2 had the lowest item-total score correlation (r = 0.17), and the α coefficient for the SSAS exceeded when this item was deleted. The convergent validity of the SSAS with somatization was shown with a significant correlation between the SSAS, SCL-90-R som (r = 0.36), and MSPQ scores (r = 0.52). Discriminant validity analysis showed no significant difference in the SSAS between the patient and control groups (P > 0.05) and non-specificity of the SSAS for patients.Conclusions:In sum, the SSAS has acceptable reliability and validity for the Iranian population and the scale measures the same the original scale, namely somatosensory amplification.

Simulating extreme environments: Ergonomic evaluation of Chinese pilot performance and heat stress tolerance

High-temperatures in the cockpit environment can adversely influence pilot behavior and performance. To investigate the impact of high thermal environments on Chinese pilot performance in a simulated cockpit environment. Ten subjects volunteered to participate in the tests under 40°C and 45°C high-temperature simulations in an environmentally controlled chamber. Measures such as grip strength, perception, dexterity, somatic sense reaction, and analytical reasoning were taken. The results were compared to the Combined Index of Heat Stress (CIHS). CIHS exceeded the heat stress safety limit after 45 min under 40°C, grip strength decreased by 12% and somatic perception became 2.89 times larger than the initial value. In the case of 45°C, CIHS exceeded the safety limit after only 20 min, while the grip strength decreased just by 3.2% and somatic perception increased to 4.36 times larger than the initial value. Reaction and finger dexterity were not statistically different from baseline measurements, but the error rate of analytical reasoning test rose remarkably. Somatic perception was the most sensitive index to high-temperature, followed by grip strength. Results of this paper may help to improve environmental control design of new fighter cockpit and for pilot physiology and cockpit environment ergonomics research for Chinese pilots.

Association between symptom duration and intensity, disability, range of motion and modified pain perceptions amongst chronic low back pain patients

Background: Chronic low back pain (CLBP) is a multi-factorial condition which remains a costly health issue. However, our understanding of the association between commonly used outcome measurements (OM) and symptom behaviour is limited for this low back pain subgroup. Previous research has reported moderate to weak correlations between symptom behaviour, range of motion (ROM), and modified pain perceptions in general low back pain populations. However, longer symptom duration and resulting psychological factors in the CLBP population support the hypothesis that different associations exist between self-reported OM and ROM than in the general population. Purpose: To investigate the association between pain intensity on the visual analogue scale (VAS), range of motion, symptom duration (months), the Oswestry disability Index (ODI), the Roland Morris disability questionnaire (RM) and the Modified Somatic Perception Questionnaire (MSPQ) at baseline in a CLBP population. Methods: A cross-sectional study was conducted with CLBP patients (>12weeks with or without leg pain) (n=147) recruited from a hospital CLBP clinic. Participants completed the VAS, ODI, RM and MSPQ, and a physiotherapist measured ROM of the lumbar spine using a standard tape measure protocol. Data was analysed using SPSS statistical analysis software (version 20) (SPSS inc., Chicago, IL). Independent sample analysis was conducted to assess for significant differences (p<0.05) between genders, and Pearson product-moment correlation coefficients were calculated to identify potential correlations between all baseline OM. Results: Across all the OM, only lumbar extension ROM differed significantly between genders (u=1897, p=0.024). Correlation analysis showed that the disability OM of ODI and RM were not correlated. Weak correlations were reported between the RM and MSPQ scores (r(145) = 0.39, p<0.001), the VAS and ODI (r(145) = 0.39, p <0.001), and lumbar rotation to the right and symptom duration (r(145) = 0.18, p=0.031). Conclusion: The assumption that increased self-reported pain intensity may be associated with limited spinal movement and elevated modified somatic pain perceptions in CLBP patients was not supported by this study. Neither did this study indicate strong associations between psychological factors and self-reported disability. Except for right rotation, symptom duration was also not associated with any ROM, pain, disability, or modified somatic pain perception measures. Pain intensity was weakly correlated with disability on the ODI, and the MSPQ was weakly correlated with the RM score, which supports similar findings in previous research. The results suggest that pain levels do not dictate patient disability status, and that strong associations between psychological factors and self-reported disability are not substantiated. Implications: Absence of strong association between the OM highlights that clinicians should view multiple OM in the context of the patient presentation, rather than in isolation. The ODI may be a more reliable indicator of pain related functional status than the RM. Whereas the RM may be more appropriate when used in conjunction with the MSPQ.

Surgical Site Infection after Primary Degenerative Lumbar Spine Surgeries and Its Effect on Long-Term Outcome

Introduction Surgical site infection (SSI) is one of the most serious complications after spinal surgery. Predisposing factors as well as the long-term consequences of the SSI treated according to the current guidelines are less reported. Aims of the study were to analyze the risk factors for SSI in patients requiring routine lumbar surgery because of disc degeneration cohort and to determine the impact of SSI on long-term outcome. Reliability of the results was tested using a prospectively recruited validation cohort. Materials and Methods A total of 1,030 patients ( N = 1,030) were included in the study. All patients underwent one or two-level decompression or instrumented lumbar fusion. Patients completed self-reported health status measurement questionnaires—Oswestry Disability Index (ODI), Core Outcome Measurement Index (COMI), Zung Depression Scale (ZDS), and Modified Somatic Perception Questionnaire (MSPQ)—and visual analog scale for pain at baseline and 2 years after the surgery. SSI was defined according to the latest Centers for Disease Control and Prevention (CDC) guideline and treated according to the current recommendation of the National Orthopedic and Infectious Diseases Societies. Effect of baseline characteristics, comorbidities, pain history, and surgical data on the occurrence of SSI was determined in uni- and multivariate logistic regression models. The performance of the final multivariate regression model was assessed by measuring its discriminative ability (c-index) in ROC analysis. Five-point Likert scale on self-reported outcome was classified into two categories (“good” and “poor” result) and influence of SSI on outcome was also analyzed. SPSS 20.0 statistical program package was used for analyses where p &lt; 0.05 was considered significant. Results The incidence of SSI in the test cohort was found 3.5% and 3.9% in the validation cohort. The significant ( p &lt; 0.001) multivariate regression model predictive for the occurrence of SSI contained the patient's age, body mass index (BMI), and the presence of some comorbidities, such as diabetes, ischemic heart disease, arrhythmia, liver disease, and autoimmune disease. The c-index of the model was 0.71, showing good discriminative ability and it was confirmed by the data of the independent validation cohort (c = 0.72). There was no significant difference in changes of mean scores of pain and outcome questionnaires comparing patients with and without SSI (pain: p = 0.42, ODI: p = 0.79, COMI: p = 0.79). The self-reported overall outcome of the index procedure was not influenced by the occurrence of SSI (chi-square = 3.35, df = 1, p = 0.067). Conclusions No significant difference was found in the incidence of SSI in one- and two-level noninstrumented and instrumented lumbar degenerative surgeries. Predisposing factors for SSI were older age, higher BMI, and the presence of certain comorbidities. Analyzing the long-term outcome of surgical treatment, no significant difference was found if the SSI was treated according to the recent guidelines. Our predictive model for SSI was validated on an independent prospective cohort.

A Cluster-Based Method for the Preoperative Identification of Lumbar Degenerative Patients having Higher Risk for Poor Global Outcome

Introduction Surgery for lumbar disc degeneration has been shown to yield poor results in 10 to 45% of the patients. Evidence-based clinical tools for preoperative risk estimation would be very important to identify the “at-risk” patients. Several factors referring on the patients' symptoms, psychosocial issues, and medical history were previously published as significant individual risk factors on outcome, but there is low number of reports on integrative models with advanced statistics. The aim of this study was to identify significant outcome predictors and clinically different subgroups in patients surgically treated because of lumbar degenerative disc disease. Patients and Methods A total of 750 consecutive patients indicated for one- or two-level lumbar decompression/microdiscectomy or fusion surgery (TLIF) were recruited into the study. Patients with previous lumbar surgery or nondisc degeneration-related phenotype were not included into the analysis. Patients completed a questionnaire booklet containing the Oswestry disability index (ODI), visual analogue scales on low back (LBP), and leg pain (LP), Zung depression scale (ZDS), and the Modified Somatic Perception Questionnaire (MSPQ) before the surgery and 2 years after the surgery. Five-point Likert scale on self-reported outcome of the surgery was classified into two categories (“good” and “poor” outcome) and effect of preoperative parameters on that was determined applying uni- and multivariate logistic regression models. Two-step agglomerative cluster analysis was used to determine the best fit cluster structure of the cohort entering the significant outcome predictors into the model. Multivariate analysis of variance (MANOVA) and Fischer test were used to analyze the clinical clusters and their canonical discriminant functions. Chi-square tests were applied to investigate the clinical outcome in the different clusters. Results Four different preoperative parameters; number of spinal levels treated, severity of low back pain, duration of pain, and distress (calculated from ZDS and MSPQ scores) were proved to be significant predictors on surgical outcome in the final multivariate regression model ( p &lt; 0.001). The four parameters identified four different subgroups in patients with good cluster quality. Clinical outcome was significantly different in the four preoperative patient-clusters (poor outcome in 5.1, 12.4, 20.9, and 25.6% of subjects, chi-square = 29.3, df = 3, p &lt; 0.001). Conclusion Preoperative parameters of the patients with lumbar disc degeneration have got significant influence on the midterm surgical outcome. Outcome predictors determine different patient clusters with different risk for poor outcome. Advanced statistical approaches are advised to use in the future for patient stratification and risk estimation.

Affective Temperaments and Somatization Among Unipolar Depression Patients and Healthy Controls

Introduction Literature describes important comorbidity rates between somatization and mood disorders. Furthermore, there are data suggesting an association between affective temperament and somatization traits in healthy subjects. Objective In the present observational study, we investigated affective temperaments and somatization aspects in clinical and healthy samples. Aim The study focused on differences between unipolar depressive inpatients (DEP) and controls (C). Method We administered to 20 DEP and 20 C following questionnaires: Mini International Neuropsychiatric Interview (MINI), 17-item Self Rating Depression Scale (SDS), Hypomania check list 32(HCL-32), Self Rating Anxiety Scale (SAS), DCPR diagnostic criteria for psychosomatic research, Brief TEMPS-A, Modified Somatic Perception Questionnaire (MSPQ), Somatosensory Amplification Scale-SSAS. DEP and C were matched for age, sex and marital status. Result About temperaments, ANOVA showed that DEP were more cyclothymic (p Conclusion Our data suggest that DEP present an important affective temperamental dysregulation. Relative to somatization aspects, DEP show a greater vulnerability than C.

Health perceptions and symptom burden in primary care: measuring health using audio computer-assisted self-interviews.

To assess the relationships among somatic symptoms and health perception measures in data collected from the implementation of audio computer-assisted self-interview (ACASI) technology in a primary care clinic of a safety-net healthcare system. We approached 2,848 English- or Spanish-speaking patients to complete an ACASI-administered survey before their clinic appointment between April 2011 and July 2012. We administered the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health-10 assessing General Self-Rated Health (GSRH), Global Physical and Mental Health; Memorial Symptom Assessment Scale (MSAS) assessing symptom burden; and the Patient Health Questionnaire-2 (PHQ-2). We calculated population attributable fractions (PAF) of symptoms on poorly perceived health. Participation rate was 90 %, but 51 % of observations were analyzable. Mean age was 57 years; 53 % were non-Hispanic black; and 20 % completed the survey in Spanish. All but 2 % reported at least one symptom most commonly lack of energy (87 %) and pain (83 %). The MSAS was well correlated with PHQ-2 (r = 0.65) and Global Physical Health (r = -0.65), but less with GSRH (r = -0.49). All negative health perception measures were largely attributable to lack of energy and pain, while depression-range PHQ-2 was attributable also to less prevalent symptoms including decreased appetite and sexual disinterest. Symptom burden was less correlated with GSRH than with other measures of poor health perception. Fatigue and pain contributed the highest PAF to all measures of perceived poor health. Success with collecting PROMs in a resource-limited clinical setting demonstrates that the implementation of ACASI technology is feasible.

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.

The severity of irritable bowel syndrome or the presence of fibromyalgia influencing the perception of visceral and somatic stimuli.

BackgroundFibromyalgia Syndrome (FMS) is a frequent comorbidity in Irritable Bowel Syndrome (IBS) patients with a higher functional bowel disorder severity index (FBDSI). We tested the possibility that mild to severe IBS patients without FMS would have a graduated visceral and somatic perception, and the presence of FMS would further enhance somatic, but conversely attenuate visceral perception.Our aim was to study visceral and somatic sensitivity in mild IBS patients and in severe IBS patients with or without FMS.MethodsEleven mild IBS and 19 severe IBS with and without FMS patients were studied. Somatic and visceral stimuli were applied in each patient by means of electrical stimulations at active and control sites and by means of an electronic barostat in the rectum. Thresholds for discomfort and perception cumulative scores were measured.ResultsMild and severe IBS patients without FMS demonstrated a significantly lower somatic perception cumulative score than severe IBS patients with FMS at active site. Conversely only severe IBS patients without FMS had significantly lower visceral thresholds for discomfort than mild IBS patients and severe IBS patients with FMS.ConclusionsThe presence of co-existing FMS or greater FBDSI affects somatic and visceral perception in a graded fashion across IBS patients.

A Clinical Intervention in Chronic Pain and Insomnia with a Combined Model of Treatment: A Test of Concept

Co-occurring chronic pain and insomnia are common in a clinical setting. Cognitive–behavioral theoretical (CBT) frameworks exist for both conditions independently. The purpose of this study was to address the problem of co-occurring chronic pain and insomnia with an integrated CBT model based on empirical support. One-hundred eleven individuals (age range 21–65 years) meeting the general criteria for chronic pain and insomnia were included in this study. Participants completed a demographic form, the Dysfunctional Beliefs and Attitudes about Sleep—16-item version, Insomnia Severity Index, Sleep Hygiene Index, Sleep Associated Monitoring Index, Pain Catastrophizing Scale, Pain Disability Questionnaire, Modified Somatic Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support. Significant positive bivariate relationships were observed for pain catastrophizing (PC) and dysfunctional beliefs and attitudes about sleep (DBAS), as well as somatic awareness and sleep-associated monitoring. Two backward stepwise regression models were utilized to determine a model for predicting insomnia severity and pain disability respectively using a combination of sleep and pain-associated measures. Insomnia severity was predicted by DBAS, PC, and somatic awareness. Pain disability was predicted by PC, DBAS, depression, and social support. Maladaptive thought patterns related to pain and insomnia and associated features appear to have a synergistic effect on both insomnia severity and pain disability and support a combined cognitive–behavioral model.

Preoperative Opioid Use as a Predictor of Adverse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery.

Opioids are commonly used for preoperative pain management in patients undergoing spine surgery. The objective of this investigation was to assess whether preoperative opioid use predicts worse self-reported outcomes in patients undergoing spine surgery. Five hundred and eighty-three patients undergoing lumbar, thoracolumbar, or cervical spine surgery to treat a structural lesion were included in this prospective cohort study. Self-reported preoperative opioid consumption data were obtained at the preoperative visit and were converted to the corresponding daily morphine equivalent amount. Patient-reported outcome measures were assessed at three and twelve months postoperatively via the 12-Item Short-Form Health Survey and the EuroQol-5D questionnaire, as well as, when appropriate, the Oswestry Disability Index and the Neck Disability Index. Separate multivariable linear regression analyses were then performed. At the preoperative evaluation, of the 583 patients, 56% (326 patients) reported some degree of opioid use. Multivariable analyses controlling for age, sex, diabetes, smoking, surgery invasiveness, revision surgery, preoperative Modified Somatic Perception Questionnaire score, preoperative Zung Depression Scale score, and baseline outcome score found that increased preoperative opioid use was a significant predictor (p < 0.05) of decreased 12-Item Short-Form Health Survey and EuroQol-5D scores, as well as of increased Oswestry Disability Index and Neck Disability Index scores at three and twelve months postoperatively. Every 10-mg increase in daily morphine equivalent amount taken preoperatively was associated with a 0.03 decrease in the 12-Item Short-Form Health Survey physical component summary and mental component summary scores, a 0.01 decrease in the EuroQol-5D score, and a 0.5 increase in the Oswestry Disability Index and Neck Disability Index score at twelve months postoperatively. Higher preoperative Modified Somatic Perception Questionnaire and Zung Depression Scale scores were also significant negative predictors (p < 0.05). Increased preoperative opioid consumption, Modified Somatic Perception Questionnaire score, and Zung Depression Scale score prior to undergoing spine surgery predicted worse patient-reported outcomes. This suggests the potential benefit of psychological and opioid screening with a multidisciplinary approach that includes weaning of opioid use in the preoperative period and close opioid monitoring postoperatively. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants.

The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries.

Can brief measures effectively screen for pain and somatic malingering? Examination of the Modified Somatic Perception Questionnaire and Pain Disability Index

Background contextRecent rise in fraudulent disability claims in the United States has resulted in psychologists being increasingly called upon to use psychological tests to determine whether disability claims based on psychological or somatic/pain complaints are legitimate. PurposeTo examine two brief measures, Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI), and their ability to screen for malingering in relation to the Bianchini et al. criteria for malingered pain-related disability published in The Spine Journal (2005). Study designExamined brief self-report measures between litigating and nonlitigating pain samples. Patient sampleWe compared 144 disability litigants, predominantly presenting a history of musculoskeletal injuries with psychiatric overlay, with 167 nonlitigating pain patients who were predominantly in treatment for chronic back pain issues and other musculoskeletal conditions. Outcome measuresModified Somatic Perception Questionnaire, Pain Disability Index, Minnesota Multiphasic Personality Inventory-2 Restructured Form, Test of Memory Malingering, Letter Memory Test, Victoria Symptom Validity Test, Structured Interview of Reported Symptoms-second edition, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders somatoform disorders module. MethodsWe examined a sample of 144 individuals undergoing compensation-seeking evaluations in relation to 167 nonlitigating pain patients. ResultsGroup differences on both the MSPQ and PDI were calculated, as well as sensitivities, specificities, and positive and negative predictive powers for both measures at selected cutoffs. ConclusionsThe results suggest that both the MSPQ and PDI are useful to screen for pain malingering in forensic evaluations, especially the MSPQ, which performed the best in differentiating between the groups.

Somatic Awareness and Symptom Attribution in Ischemic Stroke Patients

Patient delay in seeking treatment for stroke symptoms is a major factor in morbidity and mortality due to stroke. Every 4 minutes, someone dies of a stroke, and 54% of those deaths occur before the patient reaches the hospital. The aim of this study was to determine the relationship of somatic awareness and symptom attribution to treatment-seeking behaviors in ischemic stroke patients. This was a descriptive, correlational pilot study. This study was carried out in three tertiary-care hospitals in Philadelphia, Pennsylvania, and Binghamton, New York. Twenty patients diagnosed with ischemic stroke were included. The Modified Somatic Perception Questionnaire measured somatic awareness, and the Symptom Interpretation Questionnaire measured symptom attribution. There was no relationship identified between somatic awareness or symptom attribution and treatment-seeking behaviors. Significance was identified, using t-test comparisons, between physical attribution scores and insurance status (p = .038) and family history of stroke (p = .026). Significant correlations, r = .386 and r = .433, respectively, were identified between somatic awareness and symptom attribution and education. Somatic awareness and symptom attribution were not found to be significantly correlated to time to care. These results must be tempered with the knowledgethat the data were derived from a small sample and that some data were missing due to a lack of recall. Significance was identified, in a comparison of the group means, involving insurance status and family history of stroke, to somatic awareness and symptom attribution. Significant correlation was identified between education and these factors. Future research involving these factors, using a revised methodology, should be considered.

Evaluation of alexithymia, somatosensory sensitivity, and health anxiety levels in patients with noncardiac chest pain.

Objective. Noncardiac chest pain (NCCP) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas. The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic. Methods. Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study. All participants performed self-report based health anxiety inventory (HAI), somatosensory amplification scale (SAS), and Toronto alexithymia scale (TAS). Results. The patient group had significantly higher scores on the SAS, HAI-1, and HAI-T scales compared to controls (P < 0.001, P = 0.006, and P = 0.038, resp.). SAS, HAI-1, and HAI-T scores were significantly higher in female patients than male (P = 0.002, 0.036, and 0.039, resp.). There were significant differences in all TAS subscale scores between two groups. Patients, who had total TAS score more than 50, also presented higher levels of health anxiety (P = 0.045). Conclusions. Anxiety, somatic symptoms, and the exaggerated sense of bodily sensations are common in patients with NCCP. These patients unnecessarily occupy the cardiology outpatient clinics. These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments.

Validity of pain drawings for predicting psychological status outcome in patients with recurrent or chronic low back pain

Objectives:To investigate the association between baseline pain drawings and future psychological status, and estimate the prognostic value of pain drawing assessment for predicting somatization, distress, and depression at one-year follow-up, in patients with recurrent or chronic low back pain (RCLBP).Methods:This was a multi-center prospective cohort study of 138 patients with RCLBP. Participating patients completed at baseline and one-year follow-up: a blank pain drawing; the Modified Somatic Perceptions Questionnaire; modified Zung Depression Scale; and Distress and Risk Assessment Method. Pain drawings were analyzed quantitatively using the Pain Sites Score (PSS) and Simple Body Region (SBR) method. The association between baseline pain drawing assessment and one-year psychological status was estimated using correlation and Relative Risk (RR) statistics.Results:We obtained complete data from 81 patients (59%). Psychological status and pain drawings did not differ significantly between completers and non-completers. Pain drawing area at baseline was associated with depression and somatization at one-year follow-up (Spearman’s Rho 0·25, P = 0·022; 0·31 P = 0·006, respectively). Stronger associations resulted from analyses using the PSS, compared with the SBR. Patients with abnormal PSS pain drawings at baseline had significantly greater RR of depression (RR 6·1, 95% CI 1·1, 33·5), somatization (RR 4·1, 95% CI 1·7, 9·9) and distress (RR 6·8, 95% CI 1·9, 25·3) at one-year follow-up.Discussion:These results provide the first evidence that abnormal baseline pain drawings predict greater risk of abnormal psychological states or poor psychological outcome at one-year follow-up, in patients with RCLBP.