Chapter 6 Psychological Evaluation and Testing Flashcards
KEY POINTS 1. Psychological evaluations for pain and disability typically include psychological testing and an interview. 2. Key domains for assessment include pain-related disability, negative affect, pain-related cognitions, coping strategies, psychopathology, and substance use. 3. Multidimensional instruments offer the potential of assessing selected key domains as well as social factors. 4. When interventional pain therapy is being considered, it is advisable to obtain a specialized psyc
Key components of a psychological evaluation for chronic pain
The clinical interview including behavioral observation and the use of standardized
testing instruments
The clinical interview addresses multiple
aspects of what?
Individual’s cognitive, medical, educational,
social, employment, and psychiatric history
Why is the clinical interview the cornerstone of the psychological
evaluation?
due to the subjective nature of the pain
experience and the relatively limited set of standardized psychological measures that have normative data for chronic pain patients
What is the important objective of the interview ?
to identify any psychiatric conditions that might exacerbate pain or complicate treatment, such as psychosis, substance dependence, or a personality disorder
What information does observation of pain behaviors provide?
the person’s overall pain experience, coping, and the extent
of pain-related disability. Pain behaviors—such as ability to sit through the interview, verbal complaints and other
sounds (e.g., grunting and moaning), facial expressions (e.g., grimacing, wincing), and bodily gestures (e.g., bracing when changing positions, moving in a distorted fashion)— are noted during the interview.
Brief Pain Inventory (BPI)
was developed to measure pain severity
and pain-related interference in patients diagnosed with
cancer, osteoarthritis,and neuropathic pain.
an 11-point numeric rating
scale (where 0=no interference and 10= interferes completely) to assess pain-related interference.
Seven Areas of Brief Pain Inventory (BPI)
general activity, mood, walking ability, normal work including outside the home and housework, relations with other people, enjoyment of life, and sleep
Pain Disability Index (PDI)
It consists of seven questions assessing disability due to pain in the following domains: family/home, recreation, social activities, occupation, sexual behavior, self-care, and life support activities. Each item is rated on an 11-point scale (0= no
disability to 10= total disability) and the responses are summed. The PDI is also sensitive to change following
pain treatment
Sickness Impact Profile (SIP)
behaviorally based
checklist of 136 yes/no items, measuring psychosocial and
physical dysfunction across 12 categories of functioning: sleep and rest, eating, work, home management, recreation and pastimes, ambulation, mobility, body care and movement, social interaction, alertness behavior, emotional behavior, and communication
Roland-Morris
Disability Questionnaire
With only 24 questions, it was developed from a subset of SIP items and tailored for more focused use with chronic low back pain patients. This measure has become one of a
select group of standard outcome measures in the back pain literature
Chronic Disability Index (CDI)
a short (nine-item) yes/no checklist covering nine general activities that are typically difficult for people with back pain, such as walking, sleeping, putting on footware
Oswestry Low Back
Pain Disability Questionnaire,
a brief scale that provides a percentage score reflecting the amount of restriction that pain imposes on the individual. Scores have been shown to
be sensitive to treatment.
Negative Affect
the assessment
of negative affect, such as depression and anxiety, as well as negative cognitions is an essential component of pain assessment
Beck Depression Inventory (BDI)
multiplechoice
measure that asks individuals to endorse descriptive statements in 21 areas of depressive symptomatology, such
as sadness, energy level, concentration, guilt, and suicidal
ideation
Center for Epidemiological Studies Depression
Scale (CES-D)
originally developed for use in general population epidemiologic studies. Respondents are asked
to report the frequency with which they have experienced each of 20 symptoms during the past week on a 4-point scale
Zung Depression Inventory
which may be more appropriate for medical populations and offers the advantages of allowing a lower reading level and interview based
administration
Beck Anxiety Inventory (BAI)
developed to assesses
anxiety and discriminate it from depression.The scale consists of 21 items, each describing a common symptom
of anxiety. The respondent is asked to rate how much he or she has been bothered by each symptom over the past week on a 4-point scale ranging from 0 to 3
Pain Anxiety Symptoms Scale (PASS)
The PASS uses a 6-point scale and asks respondents to rate the frequency with which they experience several dimensions of anxiety, including somatic, cognitive, fear, and escape/ avoidance concerns
Closely interconnected with negative affects among individuals
with chronic pain are
negative cognitions—habitually maladaptive
ways of perceiving and thinking about situations— which can lead to a cascade of negative emotions and
behaviors
Catastrophizing
a strong anticipation of pain and reinjury or negative thoughts regarding pain-related experience, referred to as catastrophizing can lead to fear-related
avoidance of activity. These fears can produce a negative
reinforcement loop supporting the persistence of avoidance behaviors and functional limitations
Survey of Pain Attitudes–Revised
57-item instrument utilizing a 5-point Likert scale, assessing seven pain-specific attitudes, including perceptions of pain control, disability, and harm, as well as beliefs surrounding pain medication, the role of emotions in their pain experience, and the expectation that other people should be more
supportive of their pain concerns
Pain Beliefs and
Perceptions Inventory
16 items that tap three
dimensions of pain-related beliefs: future expectancies about pain and its persistence, the nature of pain and its
symptomatology, and self-blame surrounding pain
Pain Catastrophizing Scale
designed to measure individuals’ tendencies to focus on pain-related thoughts and exaggerate the significance of painful stimuli
Kinesiophobia
term for excessive fear of pain and reinjury with physical movement, which can lead to avoidance behaviors and may serve to exacerbate and maintain pain-related disability