The Pain Catastrophizing Scale: Development and validation.

In Study I, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (n?=?15) or noncatastrophizers (n?=?15) on the basis of their PCS scores and participated in a cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Catastrophizing, anxiety and pain during dental hygiene treatment

OBJECTIVES: This study examined the relations between catastrophizing, dental anxiety, and pain during dental hygiene treatment. METHODS: Participants were 78 (32 men, 46 women) consecutive referrals to the Dalhousie University Dental Clinic. All patients were scheduled for a scaling procedure performed by senior dental hygiene students. Following treatment, patients completed the Pain Catastrophizing Scale and the Dental Anxiety Scale - Revised, and were asked to rate the degree of pain they experienced during the scaling procedure. RESULTS: Regression analyses revealed that age and the rumination subscale of the Pain Catastrophizing Scale were significant predictors of pain, even when controlling for gender, and oral hygiene status. CONCLUSIONS: The findings suggest that excessive focus on pain sensations may be one of the mechanisms by which catastrophizing leads to increased pain. The clinical challenges will be to develop cost- and time-effective means of identifying individuals who catastrophize and to implement interventions to reduce their level of distress.     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing agreement between measurements recorded on a ratio scale in sports medicine and sports science

In the literature, it is usual to find women and younger subjects reporting higher levels of dental anxiety than men and older subjects. Fear of pain was found to be the most important predictor of dental anxiety and issues of control were also related to such anxiety. Therefore, it was predicted that gender and age differences would be reflected in attitudes to pain and control. Subjects were randomly selected from the voters' list in metropolitan Toronto and mailed a questionnaire with a request for cooperation in a study of their thoughts, feelings, and behaviour regarding dental treatment. The questionnaire included demographic data, measures of dental anxiety and painful experiences as well as the Pain Anxiety Symptoms Scale and the Iowa Dental Control Index. The results supported the main predictions. In addition, attitudes to pain and control were found to be complex phenomena with characteristic gender differences.     

L'échelle de dramatisation face à la douleur PCS-CF: Adaptation canadienne en langue fran?aise de l'échelle Pain Catastrophizing Scale.

This study examined the psychometric properties of the PCS-CF, a French-Canadian adaptation of the Pain Catastrophizing Scale (Sullivan, Bishop & Pivik, 1995). One hundred and twenty undergraduate students (83 women; 37 men) completed the PCS-CF and measures of anxiety and depression prior to immersing their hand in ice water for 1-minute. A subset of 39 participants (28 females; 11 males) also completed a second pain task involving an ascending series of electrocutaneous stimulations. Participants' verbal and non-verbal pain behaviours during and immediately after the immersion task were recorded and subsequently independently coded. Reliability analyses revealed that the PCS-CF total score and subscale scores have a high degree of internal consistency and test-retest reliabilities that are comparable to the original Pain Catastrophizing Scale. PCS-CF scores were associated with higher levels of self-reported pain during the ice water immersion task and decreased pain tolerance during electrocutaneous stimulation. Individuals with elevated PCS-CF scores also displayed a more diverse repertoire of pain behaviours than their low PCS-CF counterparts. Previous findings that catastrophizing scores are able to discriminate criterion groups of males and females were also replicated. Given the highly correlated factors obtained in analyses of the dimensionality of the PCS-CF, the structure suggested by the authors of the original scale is only partially supported. However, the results taken together suggest that the PCS-CF is both a reliable and valid measure of the pain catastrophizing construct that is psychometrically comparable to the original PCS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term course of tear gland function in patients with keratoconjunctivitis sicca and Sj?gren''s syndrome

The reliability and validity of a Confidence of Dental Hygienist in Child Management Scale were examined. Forty-eight dental hygiene students, nine dental staff, and thirty-one dentists were subjects for the reliability and validity scale. The acceptable level of the reliability on the Scale was shown by internal consistency and stability. The confidence scores of the clinician's group were significantly higher than the confidence scores of the students. The reliability and validity of the Confidence Scale were established. Next, we evaluated the effect of behavioral science training, using videotape feedback and role playing on twelve dental hygiene students. Six students received the training, the other six students, the controls, had no training. The confidence scores of the training group were significantly higher than those of the control group, demonstrating that the training was effective for dental hygiene students.     

A dental fears typology of oral surgery patients: Matching patients to anxiety interventions.

Two studies are described in which dental patients were administered the Dental Fear Survey (DFS) and then received 1 of 5 anxiety reduction interventions to prepare them for extraction of 3rd-molar teeth. Interventions included standard clinic treatment, oral premedications, and several relaxation-based procedures. Dependent variables were self-reported and observer-rated distress. In the 1st study (N?=?231), cluster analyses of the DFS subscales revealed that patients could be subtyped as low-fear, high-fear, or cue-anxious patients who admitted fear only in response to specific stimuli. Dental fear subtypes were distinguishable by situational cognitions reported, and fear subtype interacted with anxiety intervention to predict distress. These results were replicated in the 2nd study (N?=?150). The results are seen as supportive of a multidimensional view of dental anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of the iatrosedative process for treating dental fear

The iatrosedative process is an interpersonal-cognitive technique by which fearful patients are calmed by the behavior, attitude, and communicative stance of the dentist. The process consists of an iatrosedative interview and a clinical encounter. In our study, 58 fearful dental patients were assigned to 1 of 3 treatment groups. The Corah Dental Anxiety Scale was administered at admission to the clinic, immediately after the iatrosedative interview or standard interview, and again after the first and second clinical encounters. Participants who received the iatrosedative interview had a significantly greater reduction in dental anxiety after the interview than those who received the standard interview. After the two clinical encounters, however, the difference in anxiety reduction between the two groups was not significant. In addition, there was no significant difference in anxiety reduction between iatrosedative participants who had the same dentist for both the interview and the clinical encounter and participants who had different dentists for each part of the study. It is concluded that an iatrosedative interview is more effective than a standard dental interview in decreasing anxiety.     

Changes in CD8 and CD4 lymphocyte subsets, T cell proliferation responses and non-survival in the very old: the Swedish longitudinal OCTO-immune study

Styles of catastrophic thinking about pain have been related to an inability to divert attention away from pain. We investigated whether pain catastrophizers displayed high attentional interference during a threatening low-intensity electrocutaneous stimulus (ES). In Experiment 1, 44 undergraduates performed a tone discrimination task whilst experiencing several times an ES on the left or right arms. Tones were also presented 250 ms and 750 ms after ES onset. Participants were threatened that a high-intensity painful stimulus would occur at one site. As predicted, pain catastrophizers displayed pronounced task interference immediately after threat stimulus onset. In Experiment 2, threat was induced in 36 undergraduates by informing them that an ES excites pain fibres. Again, catastrophizers had marked interference immediately after onset. The results are discussed in terms of how catastrophizing amplifies somatosensory information and primes fear mechanisms.     

To lump or to split? Comparing individuals with traumatic and nontraumatic limb loss in the first year after amputation.

Objective: To compare individuals with traumatic (TE) vs. nontraumatic (NTE) amputation etiology on pain, psychological, and social variables over the first 12 months postamputation, and to explore changes in mean levels of and correlations between these variables over time. Participants: There were 111 adults with newly acquired limb loss. Settings: A VA medical center and a Level I trauma hospital in a large metropolitan area. Main Outcome Measures: Characteristic Pain Severity, Pain Interference, Patient Health Questionnaire depression module, Posttraumatic Stress Disorder Checklist, Social Constraints Scale, Aversive Emotional Support Scale, Centers for Disease Control and Prevention single item Social Support measure, single item loneliness measure. Results: The NTE group was significantly older, had lower income, and had greater medical comorbidity, preamputation pain, and physical disability. The etiology groups did not differ significantly in mean levels of outcome variables except that the TE group reported greater aversive emotional support at 6 and 12 months. The TE group demonstrated a quadratic change in pain interference, with highest levels at 6 months and a linear increase in social constraints. Both etiology groups showed a linear increase in PTSD symptoms over time. Correlations between physical, psychological, and social distress were observed earlier in the year for the NTE group. Conclusion: Despite significant demographic and preamputation experience differences, few differences in outcomes emerged by etiology group in the first year after amputation. Findings suggest that the year after amputation may be a time of greater change for those with traumatic amputation compared to those with nontraumatic amputation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of hypnotic susceptibility, suggestions for analgesia, and the utilization of cognitive strategies on the reduction of pain.

96 undergraduates were stratified in terms of hypnotic susceptibility (high, medium, and low) on the Harvard Group Scale of Hypnotic Susceptibility, Form A. Ss next had 1 arm immersed in ice water for a 60-sec pretest and, afterward, were assigned to 1 of 4 treatments: (a) hypnosis plus analgesia suggestion, (b) hypnosis alone, (c) suggestion alone, or (d) no hypnosis—no suggestion. Ss were retested in ice water and then interviewed about their experiences during the retest. High susceptibles reported the use of more cognitive strategies during the retest and showed greater pretest-to retest pain magnitude reductions than did low susceptibles. Similar effects occurred for Ss given, as opposed to not given, a suggestion. The hypnosis variable, however, failed to affect either strategy use or pain magnitude. Strategy use facilitated pain reduction only for Ss who did not worry about and did not exaggerate the unpleasantness of the situation (i.e., noncatastrophizers). The few Ss who showed dramatic pretest-to-retest reductions in pain magnitude (50% reduction or more) were all high-susceptible noncatastrophizers who used one or more cognitive strategies. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of psychosocial features of employment status on emotional distress in chronic pain and healthy comparison samples

This study examined the extent to which measures of psychosocial features of employment status predict emotional distress in chronic pain (n = 83) and healthy comparison (n = 88) samples. Participants completed measures of emotional distress, pain severity, psychosocial features of employment status, and demographic data. After controlling for length of current unemployment, number of pain sites, and level of current pain severity, psychosocial measures (structured and purposeful time use, perceived financial security, skill use, social support form formal sources) were significant predictors of emotional distress in the chronic pain sample. Similar results were obtained for the healthy comparison sample. Structured and purposeful time use emerged as the most significant individual predictor of emotional distress for both samples. Findings are discussed in terms of their potential implications for treating chronic pain patients and the need to develop multidimensional measures that assess features of employment status within chronic pain samples.     

Shifts in attention biases in response to acute pain induction: Examination of a model of "conversion" among repressors.

Unlike most people, those who are characterized by a repressive coping style report high levels of physical (sensory) pain but low levels of emotional distress (affective pain), which is a discrepancy that may suggest a “conversion” process. In two studies, we tested an attention allocation model, proposing that repressors direct attention away from threatening negative affective information and toward nonthreatening physical pain information during emotionally arousing (painful) situations. In Study 1, 84 participants underwent a cold pressor and then recovered. Repressors reported greater pain during recovery than low- and high-anxious participants, but they reported lower distress than high-anxious participants. Repressors reported significant and large discrepancies between high pain and low distress, whereas these differences were less pronounced for other groups. In Study 2, 77 participants underwent an ischemic pain task while performing a modified dot-probe task with sensory and negative affective pain words as stimuli. Repressors showed increasing biases away from affective pain words and toward sensory pain words as the pain task continued, whereas low- and high-anxious participants did not show these shifts in attention. The results support the notion that conversion among repressors may involve a process by which attention is directed away from emotional distress during noxious stimulation and is focused instead on sensory information from pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some variables affecting dentists' assessment of patients' distress.

43 2nd-yr dental students estimated the pain, anxiety, and distress of 43 patients who received a simple filling. Measures included a dental experience questionnaire and the Self-Monitoring Scale. Dentist's estimates of patient pain accounted for 36% of the variance in patient self-report responses. Dentist accuracy was unaffected by patients' degree of self-monitoring. Dentists' accuracy in assessing overall patient discomfort was significantly lower in that segment of the treatment that was most stressful for the dentists. This finding was interpreted as an attentional overload on processing ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional Distress in Nonmetropolitan Persons Living With HIV Disease Enrolled in a Telephone-Delivered, Coping Improvement Group Intervention.

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N=329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What do people want from dentistry? An action research approach

Issues surrounding access to dentistry will be presented from information gathered during an action research project targeting three population groups. This project was conducted by students in the Dental Hygiene Degree Completion Program at the University of British Columbia and by the dental hygiene diploma students at Camosun College. In contrast to typical empirical dental studies which are validated by statistical presentation, action research uses an interview process and qualitative analysis to identify what people really think, believe and do. College students, independent-living seniors, and low-income families were interviewed to determine how they accessed dental care, how they liked their dental visits, and how they preferred to receive dental health information. Cost, convenience and fear of pain were significant factors which influenced whether people attended the dental office. Caring dental health providers, comfort and pleasant physical surroundings were important features of a dental office visit. Dental health practices, such as brushing and flossing, were predominantly learned from the dental profession at the dental office, through school programs, or from parents at home. This data challenged our previous assumptions about these groups. As the goal of this type of research is "action", the information gathered will lead to action plans at the community and professional level.     

Relationships between dental hygienists' career attitudes and their retention of practice. Part II. From the results of the Ohio Dentist and Dental Hygiene Surveys

This article utilizes findings from the Ohio Dental Hygiene Survey and Ohio Dentist Survey to uncover what specific dental hygiene attitudes exist relative to employment and what factors have led to job termination and to re-entry. Ohio dental hygiene employees are most satisfied with patient relationships, co-worker relationships, and flexible working hours. The dental hygienists are least satisfied with fringe benefits, financial growth, and career creativity. Salary, benefits, nor career longevity were significant factors in determining satisfaction. Dental hygienists who were not working when surveyed, said they would consider returning to practice if a better salary were available, if they could find part-time work, if there were a good wage scale with benefits, or if their own financial need changed. Thirty-six percent of the non-practitioners said they would not ever consider returning to practice due to working conditions, establishment of a new career, or inadequate compensation. Dentist employers stated that they were satisfied or very satisfied with their dental hygienists' patient care and contribution to the practice.     

Pain coping strategies in osteoarthritis patients.

The present study investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic knee pain. Fifty-one patients completed the Coping Strategies Questionnaire (CSQ), the McGill Pain Questionnaire, the Arthritis Impact Measurement Scale (AIMS), and the Symptom Checklist-90 Revised (SCL-90R). Medical status variables included roentgenograph (x-ray) findings, obesity measures, disability status, and chronicity of pain. Factor analysis of the CSQ revealed two factors (Coping Attempts, Pain Control and Rational Thinking) that accounted for 60% of the variance in CSQ responses. Regression analyses controlling for demographic and medical variables identified the Pain Control and Rational Thinking factor as a significant predictor of the outcome measures. Patients scoring high on this factor had lower pain levels, better health status, and lower levels of psychological distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cluster Analysis and Chronic Pain: An Empirical Classification of Pain Subgroups in a Spinal Cord Injury Sample.

Objective: To determine the existence of homogeneous spinal cord injury (SCI) pain subgroups. Design: Prospective longitudinal design. Participants: Persons with traumatic onset SCI (N = 1,334) with self-reported pain, pain interference, and depression. Outcome Measures: Pain (Numerical Rating Scale); pain interference (item from the Short Form-12); and depression (Brief Patient Health Questionnaire). Results: Multivariate clustering revealed 4 SCI pain subgroups: low pain (low pain intensity, pain interference, and depression); positive adaptation to pain (high pain intensity, low pain interference and depression); minimal distress (high pain intensity, high pain interference, and low depression); and chronic pain syndrome (high pain intensity, pain interference, and depression). Conclusions: The characteristics of homogeneous SCI pain subgroups may be important for clinicians to consider in treatment planning and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social-cognitive processes as moderators of a couple-focused group intervention for women with early stage breast cancer.

Objective: The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention (CG) for women diagnosed with early stage breast cancer. Design: Participants (N = 238) were randomly assigned to 6 sessions of a couple-focused group versus usual care. Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression. Main Outcome Measures: The primary outcome measures for this study were psychological distress and psychological well-being. Results: Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression, emotional processing, and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being. Conclusion: The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)