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Background: Although a variety of national organizations such as the Canadian Pain Society, the American Pain Society and the Joint Commission on Accreditation of Health Care Organizations have advanced the idea that pain should be assessed on a routine basis, there is little evidence that systematic pain assessment information is used routinely by clinicians even when it is readily available., Objective: To determine whether systematic pain assessment information alters medical practitioners' clinical practices., Methods: A population of seniors with complex medical problems who were evaluated by case coordinators was studied. Case coordinators were assigned to either an experimental or control patient assessment condition. Control condition patients were assessed as usual. In the experimental condition, a psychometrically valid pain assessment battery as well as the Geriatric Depression Scale - Short Form (because depression and chronic pain are frequently comorbid) were integrated into the routine case coordination assessment. A summary of the results of the depression and pain assessments was subsequently sent to physicians via mail and fax. Patients were also given copies of the assessment summaries and were asked to discuss these with their physicians. Physicians' medication prescriptions were monitored over time through the database of the provincial ministry of health., Results: At the end of the study, no significant differences between experimental and control patients were found with respect to medications prescribed or patient self-reports of pain. Nonetheless, there was a significant relationship between Geriatric Depression Scale -- Short Form scores and pain medications prescribed for patients in the experimental condition. Moreover, indexes of overall pain intensity did not change significantly over time., Conclusions: The findings do not support the idea that the availability of systematic pain assessment information leads to change in clinician's medication practices. As such, educational interventions and public policy initiatives are needed to ensure that treatment providers do not only gather but also use pain assessment information.

Objective: The goal of multidisciplinary treatment for chronic pain is to help patients actively self-manage pain. In this study, we examined predictors of 2 measures of readiness to self-manage pain, namely the Precontemplation and Action subscales of the Pain Stages of Change Questionnaire. In particular, we examined the relative importance of experiences with pain and the primary care physician and beliefs about self-efficacy and pain control in predicting intention to self-manage pain (Precontemplation) and actual use of pain self-management strategies (Action)., Method: One hundred and two chronic pain participants, from 4 multidisciplinary rehabilitation centers, completed the Precontemplation and Action subscales. They also completed self-report questionnaires assessing pain severity, interference, depression, pain-related anxiety, perceptions of the patient-physician relationship, pain locus of control beliefs, and pain self-efficacy., Results: Considerable variance in Precontemplation scores (49%) was explained by the variables studied. Beliefs about powerful others controlling pain and perceptions of low internal control were particularly salient in the prediction of Precontemplation scores. Less variance was explained in Action scores (35%). Satisfaction with information provided by the physician was uniquely related to Action scores., Discussion: The results of the study are placed within the context of the Motivational Model of Pain Self-Management and provide insight into factors that are associated with motivation to self-manage pain. Future directions for research are discussed with respect to perceptions of pain control and satisfaction with information from physicians, constructs which have previously been overlooked in research on motivation to self-manage pain.

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.

Objective: The Coping with Health, Injuries, and Problems (CHIP) Scale is a self-report instrument that is designed for diverse patient populations to provide measures of emotion-focused (e.g., emotional preoccupation) and task-oriented (e.g., palliative, instrumental, distraction) responses to injury. The present investigation assessed the factor structure, reliability, and validity of the measure in patients (n = 203) with chronic musculoskeletal pain., Method: Patients were administered questionnaires, including the CHIP Scale, and measures of pain coping strategies, adjustment, and personality., Results: The factor structure, with one exception, was replicable, and the subscale reliabilities were acceptable. The subscales related in predictable ways to other similar questionnaires, to pain adjustment, and to personality., Conclusion: Overall, the CHIP Scale is both reliable and valid in assessing responses to chronic pain. Researchers and clinicians who want to use a psychometrically sound measure of response to illness that is applicable across diverse patient populations are encouraged to consider this measure.

The Illness Attitudes Scale (IAS) is a self-report instrument comprising nine subscales designed to assess fears, beliefs and attitudes associated with hypochondriasis and abnormal illness behaviour [Kellner (1986). Somatization and hypochondriasis. New York: Praeger.]. The purpose of the present study was to explore the factor structure of the IAS in a chronic pain sample as a preliminary step toward determining the use of this measure in this sample. Hypochondriacal tendencies have been postulated to play a role in maintaining and exacerbating responses to chronic pain and, therefore, appropriate measurement in this sample is important. In the present study, consecutive chronic pain patients presenting to a pain treatment program (N = 198) were administered the IAS. Principal component analysis with oblique (Oblimin) rotation identified that five factors best explain the measure in this population. These factors were (1) fear of illness, (2) effects of symptoms, (3) health habits, (4) disease phobia and conviction and (5) fear of death. The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986), as well as with the factor structure identified in a non-clinical sample [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a non-clinical population. Personality and Individual Differences, 18, 463-469.]. There were enough discrepancies, however, to suggest an alternative method for scoring the IAS with chronic pain patients. Implications for the use of the measure with chronic pain patients, as well as future research directions for exploring the utility of this measure with chronic pain patients, are discussed.

Accuracy and errors in judges' attempts to differentiate facial expressions that displayed genuine pain, no pain or were dissimulated (i.e., masked and exaggerated) were examined. Judges were informed that misrepresentations in the facial expressions were present and were asked to rate their confidence in classifying these expressions. Detailed, objective coding of the patients' facial reactions (e.g., brow lowering, mouth opening) were related to judges' decisions. Judges' classification decisions were better than chance, but there were many errors. Extreme expressions (i.e., no pain, and exaggerated expressions) were identified more accurately than genuine and masked expressions. Judges level of confidence was consistent with their level of accuracy. Judges consistently used rules of thumb based on specific facial cues when making judgments. Certain cues were effectively discriminative. Systematic training in the use of specific cues or the use of articulated decision rules may be helpful in improving judges' accuracy.

Previous research led to the conclusion that patient characteristics such as physical attractiveness and non-verbal expressiveness affected judgements of patient pain and distress. This study investigated whether this represents an intrusive bias or whether there indeed are psychological differences between physically attractive vs physically unattractive and expressive vs inexpressive pain patients. The findings led to the conclusion that both variables are related to the types of coping strategies pain patients use. Specifically, physically attractive and nonverbally expressive patients were found to be less likely to utilize passive coping strategies. Coping style also was found to be related to demographic characteristics of the patients. Theoretical reasons for the identified relationships are discussed as are the implications of these findings for the assessment of pain.

Explored the facial and cry characteristics that adults use when judging an infant's pain. Sixteen women viewed videotaped reactions of 36 newborns subjected to noninvasive thigh rubs and vitamin K injections in the course of routine care and rated discomfort. The group mean interrater reliability was high. Detailed descriptions of the infants' facial reactions and cry sounds permitted specification of the determinants of distress judgments. Several facial variables (a brow bulge, eyes squeezed shut, and deepened nasolabial fold constellation, and taut tongue) accounted for 49% of the variance in ratings of affective discomfort after controlling for ratings of discomfort during a noninvasive event. In a separate analysis not including facial activity, several cry variables (formant frequency, latency to cry) also accounted for variance (38%) in ratings. When the facial and cry variables were considered together, cry variables added little to the prediction of ratings in comparison to facial variables. Cry would seem to command attention, but facial activity, rather than cry, can account for the major variations in adults' judgments of neonatal pain.

Facial activity is strikingly visible in infants reacting to noxious events. Two measures that reduce this activity to composite events, the Neonatal Facial Coding System (NFCS) and the Facial Action Coding System (FACS), were used to examine facial expressions of 56 neonates responding to routine heel lancing for blood sampling purposes. The NFCS focuses upon a limited subset of all possible facial actions that had been identified previously as responsive to painful events, whereas the FACS is a comprehensive system that is inclusive of all facial actions. Descriptions of the facial expressions obtained from the two measurement systems were very similar, supporting the convergent validity of the shorter, more readily applied system. As well, the cluster of facial activity associated with pain in this sample, using either measure, was similar to the cluster of facial activity associated with pain in adults and other newborns, both full-term and preterm, providing construct validity for the position that the face encodes painful distress in infants and adults.