(847) Criterion, construct and concurrent validity of a norm-referenced measure of malingering in pain patients

P. Duhamel; Sudbury Regional Hospital, Sudbury, ONTwo separate studies were conducted to evaluate the criterion, concur-rent and construct validity of the Pain Symptom Ratings (PSR), a measureof malingering in pain patients. In the criterion validity study, patientsbeing evaluated in several clinics across Canada and the US were admin-istered the PSR, selected psychometric measures of symptom validity(e.g., MMPI-II subscales, Spinal Function Sort), and non-organic sign tests(e.g., Waddell’s sign, axial loading, superficial tenderness, etc.). Patientswere categorized into 3 groups for statistical comparisons. Those pre-senting with no organic signs, many non-organic signs, and elevatedscores on other psychometric measures of symptom validity were in-cluded in Group 1. Those with clear organic signs, no non-organic signs,and no elevations on other measures of symptom validity were includedin Group 2. Experimental subjects instructed to respond randomly to PSRitems were included in Group 3. A discriminant analysis, with PSR sub-scales as predictors and Group as the criterion, correctly classified 97.4%of the sample. In the concurrent and construct validity study, patientswho were being evaluated for admission to a chronic pain managementprogram were administered the PSR, McGill Pain Questionnaire, Person-ality Assessment Inventory, Health Locus of Control Questionnaire,Chronic Pain Grade, and Multidimensional Pain Inventory. Significantcorrelations were found between PSR subscales and conceptually similarsubscales of the other questionnaires. Factor analysis of raw subscalescores of all questionnaires provided support for the PSR’s convergentand divergent validity. PSR subscales also accounted for a significantproportion of variance in patients’ self-reported symptoms.

(848) Assessing pain associated with activities of daily livingin older adults

K. Koltyn, S. Flood, M. Umeda; University of Wisconsin-Madison, Madison, WIChronic pain is a major problem for many older adults, and it has beensuggested that pain can significantly restrict a person’s ability to per-form activities of daily living (ADL’s). The relationship between pain andlimitations in ADL’s, however, is not well understood, thus, the primarypurpose of this pilot study was to examine which ADL’s are impacted themost by pain. A secondary purpose was to compare various pain rating(PR) scales to assess pain associated with ADL’s. Twenty-six older adultsliving independently in the community (mean age � 74.5 yrs) completedquestionnaires assessing current pain and medical conditions. Also, par-ticipants rated the intensity of pain associated with the following ADL’s:dressing, bathing, standing, bending, walking, transferring in & out ofbed, lifting & lowering objects, and climbing stairs using five differentPR scales (VAS, NRS, VDS, BS-21, GBS). Results indicated that 62% werecurrently experiencing chronic pain with mild to moderate pain mostoften reported in the hands/fingers, knees, and hip joints. Pain wasreported to be most severe in the lower back and shoulder joints. Par-ticipants reported experiencing the least amount of pain for dressingand bathing with higher levels of pain reported for walking, climbingstairs, and lifting & lowering objects. Significant correlations were foundbetween all five PR scales ( r � 0.57-0.99) for the various ADL’s. It isconcluded that chronic pain in older adults is associated with mild tomoderate interference in ADL’s, particularly activities involving walking,climbing stairs, and lifting & lowering objects.

G03 - Acute Pain Service(849) Postoperative pain care among patients followed by an

acute pain management serviceP. McQuillan, R. Jamison, C. Gelnet, T. Girdharry, R. Polomano; Penn StateCollege of Medicine, Hersey, PA

Patient satisfaction with pain management should be routinely mea-sured to evaluate the effectiveness of epidural analgesia and identifyfactors that influence perceptions of satisfaction with pain care. As partof a performance improvement initiative, we evaluated pain intensitylevels, pre-operative expectations for pain control and the level of sat-isfaction with postoperative pain care provided by an Acute Pain Man-agement Service. Seventy-six consecutive patients were asked to com-plete the 13-item Brigham and Women’s Postoperative Pain PatientDischarge Questionnaire at the time that their epidural analgesia wasdiscontinued. Relevant pain management-related data were collectedon all patients. The majority of subjects (93.4%) received an epiduralinfusion with an opioid/local anesthetic combination; 9 (11.8%) of cath-eter placements were classified as difficult and 9.5% of patients experi-enced unexpected problems such as unilateral block or catheter dis-lodgement. Average age was 53.8 yr. SD 19 with 39 men and 34women in the sample. Overall scores were calculated for item sets re-lated to satisfaction with care, pain, nurse and physician treatment andconcern, and expected pain. Using linear regression analyses, we foundthat older patients experienced less pain and that chronic pain andpre-operative opioid use negatively affected pain intensity ratings(p�0.05). Greater pain in the “last 24 hrs” was associated with lowersatisfaction with pain care (p�0.05). When controlling for pain out-comes, difficult catheter placement, rather than unexpected problems,was related to poorer satisfaction with health care providers (p�0.05).Our findings showed that better pain control leads to higher levels ofpatient satisfaction. Pain experienced over the past 24 hours is morelikely to influence perceptions of overall satisfaction with pain control.Patients with chronic pain and pre-operative opioid use may experienceless satisfaction with their health care providers, which have implica-tions for exploring expectations of pain control prior to surgery.

G04 - Clinical Outcomes Measurement(850) Concurrent validity of the negative affect and fear

scales of the Pain Outcomes ProfileA. Campbell, M. Schatman; Pinnacle Rehab Options, Harrisburg, PAA variety of instruments for assessing chronic pain treatment outcomesexist. However, administration of multiple outcomes measures can beburdensome in terms of staff and client time. The Pain Outcomes Profile(POP) consists of twenty, 0-10 point, self-report items assessing painintensity; pain interference with mobility, activities of daily living (adl),and vitality; negative affect (NA) and pain-related fear of activity. Aprevious study indicated acceptable test-retest reliability for the mobil-ity, adl, negative affect and fear scales in a VA sample. To validate theNA and fear scales in a non-VA sample, the POP was administered to 203consecutive patients referred for comprehensive, interdisciplinary, out-patient pain treatment. Concurrent validation measures administeredpre-treatment included: the Tampa Scale of Kinesiophobia-Revised(TSK-R), the affective clusters of the McGill Pain Questionnaire (MPQ-A),the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory(BAI). Non-parametric correlational analyses supported the convergentand discriminant validity of the NA and fear scales of the POP. The fearscale was more highly correlated with the TSK-R, rs � .60, p � .01 thanwith the NA scale, rs � .33, p � .01, the BDI-II, rs � .37, p � .01, the BAI,rs � .31, p � .01 or the MPQ-A, rs � .20, p � .01, suggesting thatpain-related fear of activity is a distinct affective variable. The NA scalecorrelated strongly with the BDI-II, rs � .75, p � .01 and the BAI, rs � .68,p � .01, moderately with the MPQ-A, rs � .53, p � .01 and more weaklywith the TSK-R, rs � .35, p �.01. The negative affect and fear POP scaleswere not strongly correlated with other POP scales. This preliminaryanalysis suggests that the Pain Outcomes Profile provides a brief andvalid means of measuring important emotional aspects of the chronicpain experience.

S70 Abstracts