A STEP TOWARD A TAXONOMY OF CHRONIC PAIN BEHAVIOR

The present investigation outlined a preliminary strategy for the development of a taxonomy of chronic pain behavior with a low back pain population. Subjects included 31 chronic low back pain patients who were videotaped in a series of five activity and interviewing situations. Situations contained components of functional activity (walking, bending, etc.), exercise, and a question format wherein patients described aspects of their pain and general activities and interests. After completing videotaped tasks, subjects were asked to nominate behaviors that displayed pain. Additionally, a significant other was asked to nominate pain behavior. Finally, four physicians were asked to review abbreviated versions of the videotapes and also perform pain behavior nominations. In addition to nominations, all judges also were asked to conduct ratings of tension and pain level for each videotaped sequence. Nominations were compiled by two classifiers for the purpose of developing the preliminary taxonomy. Relationships between the various measures then were addressed. Results of data analyses revealed that nominations could be classified reliably. Additionally, results demonstrated that frequency of nominated pain behaviors differed across the five situations and across judge categories. Two self-report measures of disability also revealed a significant positive correlation with patient ratings, although physician and significant other ratings did not demonstrate the same significant relationship. Alternatively, quantity of pain behavior nominations showed a significant positive correlation with physician ratings. In this regard, tentative conclusions were drawn about the potentially important role of patient pain ratings versus the possible role of ratings by significant others and physicians in the assessment of disability. Additionally, data compiled from the relationship of quantity of nominations suggested the potential importance of employing physicians and significant others as observors of pain behavior. A final and primary focus of this investigation dealt with the importance of refining the taxonomy system for classifying chronic pain behavior. Analyses of the individual nomination codes also suggested the relationship of specific code use to particular videotaped situations and particular judge categories

A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain

OBJECTIVE: Chronic pain is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a chronic pain population.METHOD: Participants with chronic pain lasting ≥ 3 months; DSM-IV major depressive disorder (MDD), dysthymic disorder, or depressive disorder not otherwise specified; and a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) score ≥ 6 were randomly assigned to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and cognitive-behavioral therapy elements to an actively depressed chronic pain population. We analyzed an intent-to-treat (ITT) and a per-protocol sample; the per-protocol sample included participants in the MBCT group who completed at least 4 of 8 sessions. Changes in scores on the QIDS-C₁₆ and 17-item Hamilton Depression Rating Sale (HDRS₁₇) were the primary outcome measures. Pain, quality of life, and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.RESULTS: Nineteen participants (73%) completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n = 40) revealed no significant differences. Repeated-measures analyses of variance for the per-protocol sample (n = 33) revealed a significant treatment × time interaction (F₁,₃₁ = 4.67, P = .039, η²p = 0.13) for QIDS-C₁₆ score, driven by a significant decrease in the MBCT group (t₁₈ = 5.15, P &lt; .001, d = &gt;1.6), but not in the control group (t₁₃ = 2.01, P = .066). The HDRS₁₇ scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.CONCLUSIONS: MBCT shows potential as a treatment for depression in individuals with chronic pain, but larger controlled trials are needed.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01473615.</p