Chapter 6 Psychological Evaluation and Testing

Question 1

Key components of a psychological evaluation for chronic pain

Answer 1

The clinical interview including behavioral observation and the use of standardized
testing instruments

Question 2

The clinical interview addresses multiple

aspects of what?

Answer 2

Individual’s cognitive, medical, educational,

social, employment, and psychiatric history

Question 3

Why is the clinical interview the cornerstone of the psychological
evaluation?

Answer 3

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

Question 4

What is the important objective of the interview ?

Answer 4

to identify any psychiatric conditions that might exacerbate pain or complicate treatment, such as psychosis, substance dependence, or a personality disorder

Question 5

What information does observation of pain behaviors provide?

Answer 5

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.

Question 6

Brief Pain Inventory (BPI)

Answer 6

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.

Question 7

Seven Areas of Brief Pain Inventory (BPI)

Answer 7

general activity, mood, walking ability, normal work including outside the home and housework, relations with other people, enjoyment of life, and sleep

Question 8

Pain Disability Index (PDI)

Answer 8

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

Question 9

Sickness Impact Profile (SIP)

Answer 9

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

Question 10

Roland-Morris

Disability Questionnaire

Answer 10

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

Question 11

Chronic Disability Index (CDI)

Answer 11

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

Question 12

Oswestry Low Back

Pain Disability Questionnaire,

Answer 12

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.

Question 13

Negative Affect

Answer 13

the assessment
of negative affect, such as depression and anxiety, as well as negative cognitions is an essential component of pain assessment

Question 14

Beck Depression Inventory (BDI)

Answer 14

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

Question 15

Center for Epidemiological Studies Depression

Scale (CES-D)

Answer 15

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

Question 16

Zung Depression Inventory

Answer 16

which may be more appropriate for medical populations and offers the advantages of allowing a lower reading level and interview based
administration

Question 17

Beck Anxiety Inventory (BAI)

Answer 17

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

Question 18

Pain Anxiety Symptoms Scale (PASS)

Answer 18

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

Question 19

Closely interconnected with negative affects among individuals
with chronic pain are

Answer 19

negative cognitions—habitually maladaptive
ways of perceiving and thinking about situations— which can lead to a cascade of negative emotions and
behaviors

Question 20

Catastrophizing

Answer 20

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

Question 21

Survey of Pain Attitudes–Revised

Answer 21

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

Question 22

Pain Beliefs and

Perceptions Inventory

Answer 22

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

Question 23

Pain Catastrophizing Scale

Answer 23

designed to measure individuals’ tendencies to focus on pain-related thoughts and exaggerate the significance of painful stimuli

Question 24

Kinesiophobia

Answer 24

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

Question 25

Tampa Scale of Kinesphobia

Answer 25

17 items and assesses excessive fear of

physical activity related to the perceived threat of pain

Question 26

Fear-Avoidance Beliefs Questionnaire

Answer 26

16 items that measure beliefs concerning the
risk of harm from general physical activities and also
from work-specific activities

Question 27

Locus of control

Pain Locus of Control scale

Answer 27

an individual’s belief about his or her ability to influence outcomes in life. As applied
to chronic pain, locus of control refers to the extent to which patients believe they can influence or ameliorate
the intensity and impact of their pain experience

Question 28

Coping

Answer 28

Coping involves the use of diverse strategies and techniques

in an effort to manage a variety of stressors, including pain.

Question 29

Coping Strategies

Questionnaire

Answer 29

50-item measure assessing the extent to which patients engage in a variety of cognitive
and behavioral coping strategies when they experience pain,
including diverting attention, reinterpreting pain sensations,
coping self-statements, ignoring the pain, praying or hoping, increasing activity, and perceiving a measure of control over the pain

Question 30

Chronic Pain Coping Inventory

Answer 30

65-item scale focused on behavioral strategies of coping that might be encouraged, or discouraged, in a multidisciplinary pain treatment program, including guarding, resting, asking for assistance, relaxation, task persistence, exercise/ stretch, seeking social support, coping self-statements, and medication use

Question 31

Minnesota Multiphasic Personality Inventory

(MMPI) and its successor, the MMPI-2

Answer 31

instrument for measuring

psychopathology and personality variables.

Question 32

The MMPI-2

Answer 32

is a measure with 567 true/false items, yielding three core validity scales and 10 clinical scales. The validity scales
determine the patient’s response set and motivation. The 10 clinical scales tap such dimensions such as concern with bodily symptoms, depression, defensive strategies,
rebelliousness and antisocial tendencies, suspiciousness,
worry and anxiety, and odd thinking. In addition to the primary clinical scales, the MMPI-2 has numerous subscales
that measure more specific symptoms, traits, and behaviors, including: anger, family problems, social alienation, addiction potential, and negative treatment indicators

Question 33

Millon Clinical Multiaxial Inventory–III

Answer 33

has 175 true/false items, yielding 14 personality disorder scales (e.g., avoidant, dependent, passive-aggressive, and
histrionic) and 10 clinical syndrome scales (e.g., anxiety, somatoform, mood disorders, and substance abuse). While
originally developed for psychiatric populations, the scale
has been used with pain populations to assess levels of
psychopathology and predict back surgery outcomes

Question 34

Symptom Checklist-90-Revised (SCL-90-R)

Answer 34

a shorter instrument that has been used for assessing psychopathology
among chronic pain patients. With 90 items,
the SCL-90-R assesses nine different types of psychological disturbance and yields three global measures of
distress

Question 35

Two Comprehensive medical and psychological evaluations included in screening for
substance use and abuse

Answer 35

CAGE and AUDIT

Question 36

CAGE

Answer 36

The most widely used, the CAGE, is typically administered verbally and is comprised of four
screening questions:
(1) Have you ever tried to Cut down on
your alcohol or drug use?
(2) Do you get Annoyed when people comment on your drinking or drug use?
(3) Do you
feel Guilty about things you have done while drinking or using drugs? (4) Do you need an Eye opener to get started
in the morning?
A positive response to two or more of these
questions is indicative of substance abuse.

Question 37

Multidimensional Pain Inventory (MPI)

Answer 37

multidimensional
measures used in the evaluation of pain and its emotional and behavioral correlates. 56-item measure assesses psychosocial, cognitive, and behavioral aspects of pain, including pain severity and interference; activity levels, including household chores
and work; family relationships and social activities; pain specific
support from spouse or partner; perceived life
control; and negative affect. This measure is valuable in its ability to assess multiple dimensions of pain, its relative brevity, and its demonstrated sensitivity to treatment
effects. In addition, the MPI provides overall classification of people’s coping styles as being “dysfunctional,” “interpersonally
distressed,” or “adaptive coper.

Question 38

Millon

Behavioral Health Inventory (MBHI)

Answer 38

its successor is the Millon Behavioral Medicine Diagnostic (MBMD)
With 150 items, the MBHI assesses multiple relevant domains, including coping styles (e.g., introversive, inhibited, confident, cooperative) and psychogenic attitudes (e.g., recent stress, premorbid pessimism, somatic anxiety)

Question 39

Millon Behavioral Medicine Diagnostic (MBMD)

Answer 39

165 true/false items, the
MBMD assesses a wide range of domains, including: negative
health habits (e.g., smoking, inactivity, alcohol, and drug use), psychiatric indications (e.g., anxiety, depression), coping styles, stress moderators (e.g., future pessimism, social isolation, and pain sensitivity), and treatment prognostics
(e.g., problematic compliance, utilization excess, and
medication abuse)

Question 40

Battery for Health Improvement–II

Answer 40

designed to assess the biopsychosocial variables relevant for pain patients. Normed on patients in physical rehabilitation and chronic pain treatment settings, the BHI-II has 217 items and offers information about several domains of functioning, including physical symptoms (e.g., somatic, pain, and
functional complaints); affective functioning (e.g., depression,
anxiety, and hostility); personality and behavior problems
(e.g., substance abuse and chronic maladjustment); and
psychosocial issues (e.g., family dysfunction, violence history,
and doctor dissatisfaction)

Question 41

European Federation of IASP Chapters consensus document on neuromodulation treatment of pain that established psychosocial exclusion criteria for
spinal cord stimulators (SCS) implantation

Answer 41

(1) major psychiatric disorders (active
psychosis, severe depression or hypochondriasis, and somatization
disorder); 
(2) poor compliance and/or insufficient
understanding of the therapy; 
(3) lack of appropriate social support; 
(4) drug and alcohol abuse; and 
(5) drug-seeking behavior

Question 42

Additional risk factors to assess for

SCS implantation

Answer 42

Additional risk factors to assess include unrealistic expectations for pain treatments, cognitive deficits that
impair ability to understand, or manage, an implantable device, presence of active suicidal or homicidal intentions, severe sleep disturbance, the presence of personality disorders, and pain-related litigation

Question 43

Psychological evaluation prior to SCS several goals

Answer 43

These evaluations have several goals,
including
(1) screening for major psychopathology and
cognitive impairments, (2) assessing treatment expectations and ability to follow through on post intervention
care and rehabilitation, (3) recommending interventions to address psychosocial factors that may impede optimal outcome,
(4) educating the patient as to the procedure and
their role in maximizing treatment outcome, and (5) identifying the individual’s psychosocial strengths that aid in recovery

Question 44

Pseudoaddiction

Answer 44

it is not a true signal of opiate misuse, as much as it reflects inadequate pain relief

Question 45

Pain Medication Questionnaire

and the Screener and Opiate Assessment of Patients with Pain–Revised

Answer 45

Self-report measures to

assist in this assessment are in the early stages of development of addiction

Question 46

behavioral observations and standardized testing can be utilized for exaggeration ad malingering

Answer 46

(1) inconsistencies between physical
findings and the patient’s self-presentation,
(2) overly
impaired performance, (3) lack of specific diagnostic signs of impairment,
(4) nonorganic physical findings,
(5) evidence derived from psychological testing