Browsing by Subject "Pain Perception"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Item Biopsychosocial Factors Associated with Temporomandibular Joint Disorders(2010-11-02T18:11:03Z) Jimenez, Carmen Amanda Riel; Gatchel, Robert Ph.D.The present study represents a continuation of research that has focused on the treatment of acute temporomandibular joint disorders (TMDs) using non-surgical interventions. This study follows previous studies of Wright and colleagues (2004), Gatchel and colleagues (2006), and Stowell and colleagues (2007). Data were collected from 221 patients at community dental practices. Patients were subsequently assigned to one of three treatment groups based on baseline measurements: Low-Risk/ Non-Intervention (LR/NI), High-Risk/ Biobehavioral Treatment (HR/BB), and High-Risk/ Self-Care Treatment (HR/SC). The current study primarily investigated the biopsychosocial differences between temporomandibular joint disorder (TMD) diagnoses. Findings suggested that participants with a combined diagnosis of myofascial pain disorder (MPD) and other disorders reported more pain, psychosocial dysfunction, depression, and somatization compared to participants with no diagnoses. In terms of functional performance, findings indicated that participants with a combination of MPD and other disorders reported more pain while chewing. However, no differences were found in particle size breakdown, broadness, or difference in weight. This study also examined whether high-risk participants reported higher rates of perceived stress. Findings indicated that there were no significant differences between the amounts of perceived stress. Finally, the present study examined the benefits of a biobehavioral treatment compared to a self-care treatment regimen from baseline to one-year follow-up. Preliminary findings suggested that, over time, participants had a reduction in self-reported pain and an increase in psychosocial functioning regardless of their treatment group assignment. Preliminary findings revealed that the number of visits to health care providers for jaw-related pain did not differ among treatment groups. Due to the small number of participants that had reached the one-year time point at the time of analysis, six-month analyses were also conducted. Findings suggested that all participants, regardless of treatment group, reported less pain and less psychosocial dysfunction at the six-month follow-up. Additionally, there was a significant difference found between HR participants and LR/NI participants. However, no significant differences were found between HR/BB and HR/SC treatment. In terms of visits to health care providers for jaw pain, no significant differences were found between HR/BB and HR/SC treatment groups at the six-month time point.Item Comparing Distribution-Based and Anchor-Based Minimal Clinically Important Difference Values for Temporomandibular Disorder(2011-10-03T15:30:19Z) Ingram, Megan Elizabeth; Gatchel, Robert J.The current study is a continuation of studies by Gatchel and colleagues. Data were collected from 101 patients at several community dental clinics. Based on the patients' initial evaluations, they were randomly assigned to one of three treatment groups: Low Risk/Non-intervention Group; High Risk/Biobehavioral Group; or High Risk/Self-Care Group. This study attempted to better understand and objectively quantify meaningful symptom relief by determining the minimal clinically important difference (MCID) for temporomandibular joint disorder (TMD). Despite limitations and controversy with determining the most appropriate method, this information will play an important role in determining treatment effectiveness for not only TMD, but for other pain conditions as well. The most commonly referenced methods for determining meaningful change are the distribution- and anchor-based approaches. Distribution-based minimal detectable change (MDC) values were calculated using the formula 95% CI=1.96 x Square Root(2) x SEM, while the anchor-based approach minimal clinically important change (MCID) values were calculated using a Receiver Operating Curve (ROC). Both mean particle size and broadness of distribution served as two separate functional anchors, and normal range and .5 SD as two separate cutoff methods. Despite some variability, the MCID values were relatively consistent with the MDC values regardless of method, anchor, or cutoff for both the Physical Component Scale (PCS) and Mental Component Scale (MCS) of the SF-36. The Characteristic Pain Inventory and Graded Chronic Pain Scale showed a narrow range of variation within the MCID values; however, the MCID values calculated were significantly higher than the MDC values reported for the same measures. Findings indicated that the PCS component of the SF-36 provided stronger evidence of clinically meaningful change. The PCS resulted in asymptotic values closer to .1 (at the 90% confidence interval) with areas under the curve that better fit the model compared to the other subjective measures (considered fair at .701 when using the normal range and .740 when using .5SD for the Biobehavioral Group). Additionally, broadness of distribution resulted in more clinically meaningful changes as a result of better metric values when comparing the biobehavioral versus the self-care groups. [Keywords: minimal clinically important difference; temporomandibular disorder; minimal detectable change, TMD; outcome measure]Item Evaluation And Treatment Of A Heterogenous Group Of Chronic Pain Patients: Assessing The Effect Size Of Outcome Measures(2007-08-08) Worzer, Whitney; Stowell, Anna W.The aim of the present study was to evaluate an array of psychometric tests administered to a heterogeneous group of chronic pain patients at pre- and post- treatment to determine the effect sizes of the measures. The sample included patients (N=312) who participated in an interdisciplinary treatment program, which included medical, psychological, psychiatric, and physical therapy components. This sample was narrowed to include only those who completed treatment (n=262). Subjects were evaluated on a variety of physical/functional, psychosocial, and coping measures, including the Visual Analog Scale (VAS), Million Visual Analog Scale (MVAS), Oswestry Low Back Pain Disability Questionnaire (OSW), Pain Medication Questionnaire (PMQ), Medical Outcomes Survey 36-Item Short Form Health Survey (SF-36), Beck Depression Inventory-II (BDI-II), and Multidimensional Pain Inventory (MPI). Paired sample t-tests were conducted to evaluate each measure for pre- to post-treatment change. These measures were further analyzed using Cohen's d (1992) to obtain the effect size. Results indicated that the instruments showing the greatest effect size were the VAS (d= 1.27) and the MVAS (d=0.94), both within the large effect size range. The OSW (d=0.67) showed a medium effect size, while the SF-36/PCS (d=0.19) had the lowest effect size of the physical measures. Results indicated a medium effect size for psychosocial measures. The PMQ (d=0.79) BDI-II (d=0.72) and the SF-36/MCS (d=0.62). The MPI exhibited an extremely low effect size (d=0.03). The heterogeneous population was also broken down into three categories of pain diagnoses including musculoskeletal, all other single pain diagnoses (e.g. headache, neuropathy, reflex sympathetic dystrophy, firbomyalgia), and multiple diagnoses (more than one type of pain). Overall, this study offers information on the effect sizes of different measures in order to facilitate the decision making process when selecting assessment tools to use with chronic pain populations, and supports the use of multiple assessment measures.