Browsing by Subject "Pain Management"
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Item Additional Validation of the Pain Medication Questionnaire in a Sample of Patients with Chronic Pain(2009-09-04) Buelow, Amanda; Silver, CherylThe present study represents an initial stage in the formal attempt to aid in developing a psychometrically sound, self-report screen tool used for assessing potential pain medication misuse risk. This study follows previous studies of Adams and colleagues (2004) and Holmes and colleagues (2006). The Pain Medication Questionnaire (PMQ), initially a 26-item instrument, was studied as a 23-item questionnaire designed to measure risk for opioid misuse. This revised PMQ showed good reliability and validity. This study also examined the ability of the revised PMQ to predict pain medication misuse in a heterogeneous sample of chronic pain patients. The PMQ was administered to 1,540 patients at a pain center that provided interdisciplinary pain management, including medication, psychological, and physical therapy disciplines. The risk of a patient's pain medication misuse, as predicted by the PMQ, was found to significantly decrease following interdisciplinary intervention. Cut-off scores were created from the distributed PMQ scores by assessing a frequency scatter plot and determined that those participants with scores below a 21 on the PMQ made up the lowest (L-PMQ) group, scores including and between 21 to 30 on the PMQ made up the middle (M-PMQ) group, and scores above 30 made up the highest (H-PMQ) group. A comparison using the H-PMQ and L-PMQ groups revealed that those participants in the H-PMQ group, after completing an interdisciplinary treatment program, had significantly decreased PMQ scores at post-treatment. In addition, the H-PMQ group was significantly associated with greater levels of non-compliance or drop out from treatment, early pain medication refill requests, and endorsement of having a history of alcohol abuse or history of rehab for alcohol or drugs. Finally, the present study also examined the relationship of total PMQ score with measures of physical impairment and perceived pain. Findings suggest that higher scores on the PMQ are minimally associated with higher levels of impairment of physical functioning and perceived pain.Item An Evaluation of the Predictive Validity of the Pain Medication Questionnaire With a Heterogeneous Group of Chronic Pain Patients(2006-08-11) Dowling, Leah Suzanne; Stowell, Anna W.The Pain Medication Questionnaire (PMQ) was initially developed by Adams and colleagues (2004) as a 26-item self-report assessment to screen for opioid medication misuse. The PMQ has demonstrated good reliability and validity, and was predictive of early termination from treatment and identified patients who demonstrated maximal benefit from interdisciplinary treatment (Holmes et al., 2006). This current study explored whether or not the initial PMQ score would accurately predict the development of aberrant opioid medication use behaviors relative to specific behavioral indices (i.e., request for early refills, use of a medication agreement) and a physician rating of medication misuse behaviors. Patients fell into two groups according to their initial score on the PMQ based on the median score of 25. Patients with higher PMQ (H-PMQ) scores reported greater levels of perceived disability and decreased physical and mental functioning. Total scores from the PMQ were moderately correlated with initial measures of physical and psychosocial functioning, and observed problematic medication use behaviors observed by physicians during evaluation. However, higher PMQ scores did not significantly predict the use of a medication agreement or requests for early refills. Five patients were identified from the H-PMQ group that demonstrated problematic opioid medication use that fell outside of the realm of early refill requests. These included utilizing leftover pain medications, taking narcotic medication prescribed to a family member, prescription forgery, and referral for detoxification. Although these patients varied on demographic variables, they each had a PMQ total score greater than 30. Indicating that although a PMQ total score ≥ 25 is indicative of problematic use, a score ≥ 30 suggests that a patient should be closely monitored when prescribed and opioid medication. Overall, this study demonstrated that a patient's self-report is significantly correlated with problematic behaviors observed by physicians. Therefore, when utilized in a busy clinic setting, the PMQ will aide in the identification of specific problematic behaviors and beliefs at the outset of treatment that may hinder successful treatment of a patient's pain condition.Item The Relationship Between MMPI-2 Profile Patterns and Treatment Efficacy in a Heterogeneous Pain Population: A Prospective Outcome Study(2007-08-08) Haggard, Robbie A.; Stowell, Anna W.In a prior study, Gatchel, Mayer, and Eddington (2006) demonstrated the utility of an MMPI-2 profile pattern, formerly known as the "Floating Profile", for use with identifying treating outcomes in the context of pain management. Re-termed the "Disability Profile", this profile pattern comprised a large proportion of the sample being studied, and demonstrated several negative treatment outcomes for patients who exhibited such a profile. This current study was an attempt at replicating these findings in a heterogeneous pain population, while also comparing four MMPI-2 profile patterns and five pain categories with various intake and outcome measures.Item Treatment of Early Intervention for Acute Low Back Pain Patients Utilizing a "Back-To-Work Transition" Component: A One-Year Prospective Study(2007-08-08) Holberg, Christine M.; Stowell, Anna W.This study built upon previous research by Gatchel et al. (2003) which utilized an algorithm developed by Gatchel et al. (1995), to identify what patients with ALBP were at high-risk for developing chronic pain and then implemented an interdisciplinary early intervention program in order to prevent the progression of ALBP to chronic low back pain (CLBP). The aforementioned authors were able to demonstrate the effectiveness of the early-intervention program as measured by decreases on a number of pain and disability-related measures as compared to "treatment as usual." In addition, they established the cost-effectiveness of such a program as compared to "treatment as usual" in terms of costs of medications, disability days, and healthcare utilization. The current study expanded upon the early-intervention program established by Gatchel et al. (2003) by adding a work transition component to better facilitate improved return-to-work and better work-related outcomes. In addition, the study set out to establish the effectiveness of the early-intervention and work transition component as well. After subjects were identified as being at high-risk for developing chronic pain, they were randomized into one of four treatment groups: early intervention (EI); early intervention with work transition (EI/W); work transition (NI/W); and non-intervention (NI), and followed-up for a period of 1-year. A limitation of the study was small sample size and resulting reductions A limitation of the study was small sample size and resulting reductions in statistical power. Despite this, the findings confirm prior studies that show early intervention with an acute pain population is important for achieving pain reduction, improved coping abilities, and return to work rates. Significant reductions in pain ratings were noted for the EI group from intake to 1-year. Overall, pain ratings for the EI, EI/W, and NI/W groups were observed to be comparable to one another and all were noted to be lower than NI group pain ratings at 1-year. In addition the EI, EI/W, and NI/W groups all demonstrated significant increases on a measure of coping that assesses an overall sense of control over physical well-being. Significant decreases and moderate decreases in functional disability were found for the EI group and EI/W group respectively from intake to 1-year. Results on a measure of obstacles to return-to-work indicated a moderately improved prognosis for return-to-work for the EI group at 1-year.