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presentation and course of chronic pain. 110 men with chronic low back pain were studied. The disability patients (unlimited compensation) were more likely to be using narcotics and sedatives and to display more pain behaviors. 51 patients provided follow-up data at 12 months following completion of treatment. No statistically significant differences were found among the 3 groups in terms of pain experience. medication or activity at this time.

The study suggests that unlimited compensation may be associated with greater medication use and more pain behaviors. The low yield to follow-up limits any further generalization from the data, but the authors believe that unlimited compensation may delay a return to work.

PSYCHOLOGY

Chronic back pain and rheumatoid arthritis: predicting pain and disability from cognitive variables. -~ I-1. Flor

and D.C. Turk, J. Behav. Med., 11 (1988). This study examined the relationship of situation-specific pain-related self-statements, convictions of

personal control, pain severity, and disability levels in chronic back pain and rheumatoid arthritis patients.

Data analyses revealed that the more general and the specific cognitive variables were more strongly related to pain and disability than disease-related variables. These variables combined explained between 32 and 60% of the variance in pain and disability respectively. These findings provide further support for

cognitive-behavioral formulations of the chronic pain experience.

Empirically derived Symptom Checklist 90 subgroups of chronic pain patients: a cluster analysis. R.N.

Jamison, D.L. Rock and W.C.V. Parris, J. Behav. Med., I1 (1988). This study applied cluster analysis procedures to identify homogeneous subgroups of chronic pain

patients responses to the Symptom Checklist 90 (SCL-90). Subjects were 453 chronic pain patients who had undergone physician evaluations and ratings of pain pathology and pain behavior. Three distinct replicable SCL-90 profiles were identified. These represented high, medium and low scores on the SCL-90-R instrument. While the subgroups failed to differ in demographic characteristics, compensation

status, or pain duration or ratings, patients in the high-profile subgroup showed the most emotional distress. reported the most interference with activities and had high ratings of pain behavior. The authors

conclude that the SCL-90 may be a useful method for assessing chronic pain patients.

The occurrence of maladaptive health-related behaviors and teacher-rated conduct problems in children of

chronic low back pain patients. ~ K. Richard, J. Behav. Med., 11 (1988).

This study examined children of chronic pain patients to determine whether they may exhibit learned

pain or illness behavior patterns. The study compared children of chronic low back pain patients to children of diabetic patients and a control group of children. The results indicated that children of the back pain patients exhibited a higher level of behavior the authors believed was learned through observation or interaction with a parent having low back pain than children in the diabetic or control groups.

Psychometric analysis of the audiovisual taxonomy for assessing pain behavior in chronic back pain patients.

C.L. Kleinke and A.S. Spangler, Jr., J. Behav. Med., 1 (1988). This study examined the characteristics of an audiovisual taxonomy for recording pain behavior.

Videotaped records of pain behavior were taken from 60 chronic back pain patients at the beginning and end of an inpatient multidisciplinary pain program. Data analyses revealed that a composite score from the taxonomy showed adequate frequency and reliability and was sensitive to treatment effects. The study

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also found a positive relationship of pain behavior to compensation status, obesity, number of prior surgeries and patient preferences for ice or heat as treatment modalities.

Overt pain behaviors: relationship to patient functioning and treatment outcome. - J.M. Romano, K.L. Syrjala, R.L. Levy, J.A. Turner, P. Evans and F.J. Keefe, Behav. Ther., 19 (1988) 191-201.

This article presents 2 studies that examined the relationship of pain behavior to patient functioning

and treatment outcome. Study 1 found that pretreatment levels of pain behavior in chronic low back pain patients were significantly correlated with patients’ ratings of pain, pain behavior and physical disability, but not psychosocial functioning. Study 2 found that pain behavior decreased significantly following an inpatient pain management program. Decreases in pain behavior were found to correlate with decreases in depression, but not with changes in self-reported pain or pain behavior. The authors conclude that their results support the need to use both observational and self-report measures to provide a comprehensive evaluation of chronic pain patients.

Depression among chronic pain patients: cognitive-behavioral analysis and effect on rehabilitation outcome.

~ R.D. Kerns and J.A. Haythornthwaite, J. Consult. Clin. Psychol., 56 (1988) 870-876. This study addressed 2 important issues. The first issue was whether reliable differences among

depressed, mildly depressed and non-depressed chronic pain patients can be identified. Multivariate

analyses revealed significant differences between these 3 patient groups on instrumental activities and coping skills, with more depressed individuals reporting lower levels of functioning. The second issue investigated was whether depression influenced participation in or outcome following a rehabilitation program. Data analysis revealed that depressed pain patients showed a greater tendency to drop out of treatment. Outcome did not differ as a function of depression among patients who completed treatment. The authors conclude that their results support a cognitive-behavioral model of depression secondary to chronic pain.

Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain. -

J.A. Turner and S. Clancy, J. Consult. Clin. Psychol., 56 (1988) 261-266. This is one of the few well-controlled treatment outcome studies comparing the efficacy of operant-be-

havioral and cognitive-behavioral treatments for chronic low back pain. Subjects were 81 mildly dysfunc-

tional chronic low back pain patients who were randomly assigned to the operant behavioral, cognitive behavioral or a waiting list control condition. The treatments were carried out in 8 session outpatient groups. Data analysis revealed that both treatment groups showed decreased physical and psychosocial

disability. The operant-behavioral patients showed greater pre-to-post treatment improvement as rated by patients and their spouses than did the cognitive-behavioral patients. At 6 and 12 month follow-ups the operant-behavioral patients showed a leveling off in improvement, whereas the cognitive-behavioral

patients showed continued improvement over the 12 months following treatment. At 12 month follow-up, patients in both treatments remained significantly improved and these 2 conditions did not differ from each other.

Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment

data. - D.C. Turk and T.E. Rudy, J. Consult. Clin. Psychol., 56 (1988) 233-238. This study described the development and cross-validation of an empirically derived classification

system for chronic pain patients. Two studies are presented. The first study identified 3 unique subgroups of chronic pain patients which the authors labeled as dysfunctional, interpersonally distressed, and minimizers/adaptive capers. The second study cross-validated these findings and confirmed the unique- ness and accuracy of the taxonomy. The authors suggest that the classification system they have developed has implications for treatment planning.