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HYPNOTIC ANALGESIA IN PERSONS WITH DISABILITIES
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assessment of average pain intensity was obtained. Measures of average
pain intensity were subsequently also obtained by phone interview
during the 1-week interval just after treatment (posttreatment) and
again 3 months after treatment (3-month follow-up).
Secondary-outcome measures included (a) pain unpleasantness, (b)
pain interference, (c) depressive symptoms, and (d) perceived control
over pain. Pain unpleasantness was assessed using the same proce-
dures and time intervals used to assess average pain intensity (i.e., by
phone interview, assessed four times during each 7-day assessment
window, with the four measures averaged into a single composite mea-
sure of pain unpleasantness), except that the endpoint descriptors for the
pain unpleasantness 0–10 NRS were 0 =
not bad at all
and 10 =
the most
intense bad feeling possible for me
(Price, McGrath, Rafii, & Buckingham,
1983). Support for the validity of measures that use these endpoints to
assess pain unpleasantness comes from research illustrating that
responses to such measures are distinct from 0-to-10 measures of pain
intensity (Price, Barrell, & Gracely, 1980).
Pain interference with activities was assessed using a modified ver-
sion of the Pain Interference Scale from the Brief Pain Inventory (BPI;
Cleeland & Ryan, 1994; Daut, Cleeland, & Flannery, 1983). The original
version of this scale asks respondents to rate the degree to which pain
interferes with seven daily activities, including general activity, mood,
walking ability, normal work, relations with other people, sleep, and
enjoyment of life. For use in the current study, we modified the BPI in
two ways. First, we changed Item 3 (“Walking ability”) to read “Mobility,
that is, your ability to get around,” to be more appropriate for the
participants in the current study, many of whom cannot walk. Second,
in order to gain a broader perspective of the extent to which pain inter-
fered with important activities, the current study added three items:
self-care, recreational activities, and social activities. The BPI interfer-
ence items are averaged to produce a total composite pain interference
score. The original BPI Pain Interference scale has demonstrated validity
through its strong association to pain severity across a number of sam-
ples of individuals with cancer and other diseases (Daut et al., 1983;
see also Cleeland & Ryan, 1994), and the modified version of this scale
has demonstrated validity in samples of persons with disabilities
through its strong association with pain intensity and even stronger
association with measures of physical disability (Tyler, Jensen, Engel, &
Schwartz, 2002). The modified BPI was administered once, by telephone,
during each assessment window.
Depressive symptoms were assessed using the 20-item Center for
Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977). The
CES-D has demonstrated good reliability and validity as a measure of
depression in a wide range of populations (e.g., Weissman, Sholomskas,
Pottenger, Prusoff, & Locke, 1977), including patients with chronic pain