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Objective: The goal of this study was to examine the relative importance of global affective distress, self-report of depressive symptoms, and presence or absence of major depression to the experience of chronic pain. Setting: A multidisciplinary pain program at a university medical center was the setting for this study. Patients: Subjects in this study were 211 consecutive patients with chronic pain. Outcome Measures: Pain duration, compensation, and litigation status were controlled for in the statistical analyses, as each correlated significantly with at least one of the measures of affect. Global affective distress was assessed using the Global Severity Index (GSI) from the Brief Symptom Inventory. The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale were used as measures of self-report of depressive symptoms. Presence or absence of major depression was based on DSM-IV criteria. Results and Conclusions: The GSI, Beck Depression Inventory, and Center for Epidemiological Studies Depression Scale were significantly correlated with each measure of the experience of pain, although clinical depression was only significantly related to self-reported disability and negative thoughts about pain. The self-report measures of depression maintained their relation to the dependent measures when the somatic items from the scales were removed, suggesting that the relations were not spuriously due to the influence of pain symptoms on the scales. When examining the unique contribution of each variable to the experience of pain (by simultaneously controlling for the other measures of affect), the GSI was uniquely related to the sensory and affective components of pain. Self-report of depressive symptoms was more highly related to a measure of the evaluative component of pain and uniquely related to self-reported disability and negative thoughts about pain. The results are discussed within the context of theoretical models of the relation between pain and affect, and suggestions for future research are presented.

This study examined the relative contribution of two aspects of pain-related fear to functional disability among 133 persons with chronic pain, predominantly chronic back pain: 1) beliefs that pain represents damage or significant harm to the body and 2) beliefs that activities that cause pain should be avoided. Pain-related fear was assessed using the Tampa Scale for Kinesiophobia, Version 2 (TSK-2). Factor analysis in the present study replicated the two-factor solution found in a previous investigation, representing the two dimensions of pain-related fear noted above. Activity avoidance was significantly associated with the percent of maximum expected weight lifted from floor to waist and waist to shoulder during Progressive Isoinertial Lifting Evaluation (PILE). Fear of damage or harm to the body was only significantly related to the floor to waist lift. When controlling for demographic, physiologic, and other psychological variables, only activity avoidance continued to significantly predict performance on both lifts of the PILE. Although it has been proposed that deconditioning may mediate the relationship between activity avoidance and disability, this was not supported in the present investigation. The results highlight the importance of pain-related fear, particularly activity avoidance, in the assessment of functional activity among persons with chronic pain.

Practice effects were examined over four administrations of the immediate (I) and delayed (II) portions of three subtests of the WMS-R: Logical Memory (LM), Verbal Paired Associates (VPA), and Visual Reproduction (VR). A repeated measures ANOVA revealed that large and significant (p < .001) increases occurred in the General Memory (GM) and Delayed Recall (DR) indices and in the LMI, LMII, and VPAI subtests (Effect Sizes [ESs] = 0.70-0.87). Small but significant (p < .001) increases occurred in VRI (ES = 0.24) and VRII (ES = 0.43). The greatest increase in scores occurred at the first retest session, whereas increases of smaller magnitudes occurred at Sessions 3 and 4. Ceiling effects occur in subtests (VPAII, VRI, and VRII) on which individuals score most of the total possible points at the first testing session; this makes interpretation of practice effects difficult. Test-retest reliability coefficients, mean change scores from Session 1 to Session 2, standard errors of prediction, and 95% confidence intervals are presented. These score changes need to be taken into consideration when interpreting performance at retest.

Differential effects of practice over four administrations of the WAIS-R were examined as a function of Full Scale IQ at initial testing (N = 36). Twelve education-matched normal adults represented each of three groups: Low-Average (80—90), Average (95—105), and High-Average (110—120) Full Scale IQ. Participants were tested at 2-week intervals. Repeated measures analysis of variance indicated that Average and High-Average groups made greater gains across retest intervals than did the Low-Average group (p < .002). Across groups, gains were greater at the first retest than at the second or third retest (p < .001). A Scale × Time interaction indicated disproportionate gain in Performance IQ versus Verbal IQ, particularly at the first retest (p < .001). Previous exposure to the WAIS-R dramatically alters performance: Traditional interpretations regarding expected gain and profile analysis are not valid at retest.

The relationship between Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ and performance on measures of memory was examined in 64 adults tested twice at a 2-week interval. Repeated measures analyses of variance revealed that individuals with Low-Average WAIS-R Full Scale IQ scores performed significantly more poorly than did individuals with Average and High-Average Full Scale IQs on memory measures including the Wechsler Memory Scale-Revised (WMS-R) General Memory and Delayed Recall indices, as well as California Verbal Learning Test (CVLT) Total Words. Learning Slope, and Discriminability. Although all three groups demonstrated significant practice effects on each memory measure, group differences in performance persisted at retest. Multiple regression analyses revealed that WAIS-R factor scores Verbal Comprehension and Freedom from Distractibility accounted for up to 42% of the variance in WMS-R and CVLT indices. Moreover, WAIS-R performance at initial testing accounted for 22-41% of the variance in memory performance at retest. These results are discussed in the context of the construct stabilities of intelligence and memory, as well as the psychometric precision of the tests used to measure these constructs.

Acute myocardial infarction (AMI) often is unrecognized (i.e., a patient fails to notice or report the event to the physician, or the physician fails to diagnose it). Psychosocial differences between patients with recognized and unrecognized AMI have not been examined. We compared 40 patients who sought treatment for a documented 3 AMI with 30 patients who were found on routine electrocardiogram to have had an AMI for which they did not seek medical care. Patients with unrecognized AMI showed greater “alexithymia,” or deficient psychologic awareness (p = 0.04; Alexithymia Provoked Response Interview), and a greater belief that chance factors determine their health (p = 0.004; Multidimensional Health Locus of Control Scale). Patients with unrecognized AMI were less likely to have angina, yet did not differ from those with recognized AMI with regard to demographics, smoking, systemic hypertension, diabetes mellkitus, AMI location, depression, or hypochondriasis. We hypothesize that deficient psychologic awareness may impede AMI symptom perception or recognition, and that the belief in chance or fate as determining health may inhibit treatment-seeking.