(925): Multidimensional Pain Inventory: Can it replace a comprehensive test battery?

(923) The difficulties of analyzing children’s pain at homeM Huth, D Van Kuiken, L Lin; Cincinnati Children’s Hospital Medical Center,Cincinnati, OHTonsillectomy is a common childhood surgery that most often occurs inan ambulatory setting. Children experience moderate to severe pain indays after tonsillectomy surgery and primarily rely on family caregiversfor pain management. Research to explore the pain management ofchildren in the home is needed. One method of gathering home data isthrough pain diaries. A secondary analysis was completed on diary datacollected in a previously reported RCT on the effect of guided imageryon postoperative pain. This diary data was not included in previousanalyses. This presentation will describe the challenges and the stepstaken to determine the best means of analyzing and interpreting diarydata completed in the first 24 hours after ambulatory tonsillectomysurgery. The diary included level of pain as measured with Oucher andFacial Affective Scale (FAS) instruments, and the amount of analgesicsused. The data was unbalanced with each diary having a different num-ber of entries at varying intervals. Also the issue of construct validity ofcause needed to be considered due to the use of analgesics. This wascomplicated by four different analgesics being administered in thehome. MANCOVA, repeated measure MANCOVA, and Hierarchical Lin-ear Modeling (HLM) were compared for strengths and limitations withthe data. In spite of finding no significant differences between groupsusing all methods, HLM was better able to address the difficulties withthis data. HLM provided a means to analyze this unbalanced data andcontrol for oral analgesics taken just prior to each pain measure. Byentering group membership in the second level of the model, differ-ences between groups were analyzed. In planning research that mea-sures pain in children at home, issues of control must be addressed. HLMcan address issues of incomplete data and confounder variables in re-peated measures studies.

G. Diagnosis, Assessment and ReviewsG01 - Assessment in Nonverbal Populations (Infants,Mentally Impaired, etc.)(924) A comparison of two behavioral pain scales with intu-

bated intensive care unit patientsA Purdum, Y D’Arcy; Suburban Hospital, Bethesda, MDPain assessment in critically ill, intubated patients presents a challengerelated to the acuity of the patient’s illness as well as the need forsedation. Since intubated patients cannot self-report their pain, the useof a behavioral assessment tool is one way to provide pain assessment.During a turn in bed, 30 intubated ICU patients had their pain assessedby two nurses using two behavioral pain scales, one using five behav-ioral criteria (Campbell), and one using similar criteria but adding a scalefor tolerance to intubation (Payen). The patients were divided into 3groups based on a Ramsey Scale sedation rating, mild, moderate, orheavy. The pain stimulus was a turn in bed which had been identified inthe Thunder II data as being equal to a 5/10 pain using the 0 to 10 painintensity scale. The primary medications being used for pain were fent-anyl and morphine, sedation was achieved with propofol. Since thePayen Behavioral Scale uses a 12 point scale, the pain ratings with thisscale were normalized to a 10 point format. Of the three groups theaveraged pain assessment scores which most closely matched the painstimulus were the Payen normalized scores of mild 5.3, moderate 6.2,heavy sedation 4.8. The Campbell pain scale had the best match for painassessment in the moderate sedation group at 5.4. Using SPSS 10.2 sta-tistical analysis package there was no significance for difference be-tween the two pain scales. Surprisingly, 8 patients in the group had nosedation or pain medication prior to turning. Clinically it would appearthat both the behavioral scales being studied provide a method forassessing pain in this group of patients, but overall, for all 3 groups thePayen normalized scale most accurately reflected the expected painrating from the pain stimulus.

G02 - Assessment of Disability(925) Multidimensional Pain Inventory: Can it replace a com-

prehensive test battery?P Davidson, M Davidson, D Tripp, L Fabrigar; Queen’s University, Kingston, ONThe Multidimensional Pain Inventory (MPI) is a self-report measure usedto assess important aspects of the chronic pain experience (e.g., painseverity, disability and activity, depression, anxiety, and support). It isbrief, and measures many pain dimensions that our clinic assesses withother instruments, but with fewer items and in less time. However, theMPI is a revision of an earlier instrument and has never been adequatelyvalidated. Psychometric studies have raised questions about the struc-ture and validity of MPI scales. This study assesses psychometric qualitiesof the MPI, and examines the extent to which it can replace a morecomprehensive battery. Factor structure, reliability, and validity of theMPI were examined. Participants (129 chronic pain patients aged 16 to91 years (M � 50.38)) completed the MPI and 8 criterion scales (McGillPain Questionnaire-SF, Pain Disability Index, Beck Depression Inventory,Beck Hopelessness Scale, Beck Anxiety Inventory, Tampa Scale of Kine-siophobia, Pain Catastrophizing Scale, Chronic Pain Coping Inventory).Exploratory factor analysis of the MPI yielded 4 mathematically plausiblesolutions but none of these were interpretable and none replicatedeither of the factor structures in the literature. Internal consistency es-timates of MPI scales produced varied results. Internal consistency wasacceptable for 10 of 12 scales, however, 2 scales demonstrated poorinternal consistency (alpha � .70 : activities away from home and socialactivities). Correlation of MPI scales with criterion scales revealed thatonly two MPI scales correlated well (rs .69) with criterion scales (inter-ference and affective distress). The MPI negative affect and interferencescales measure similar constructs to the Beck Depression Inventory, andPain Disability Index, respectively. The remaining 10 MPI scales appear tomeasure different constructs than the criterion scales. These issues withits factor structure and validity indicate that the MPI cannot completelyreplace a comprehensive assessment battery.

(926) Screening performance of the DASS and the HADS forsymptoms of depression and anxiety in back pain pa-tients referred for physiotherapy

G Pron, S Tervit; Trillium Health Centre, Toronto, ONThe objectives of this study were to a) compare two screening measuresfor anxiety and depression – the Hospital Anxiety Depression Scales(HADS) and the Depression Anxiety Stress Scale (DASS) and b) evaluatethe relationship between screening scores, patient’s perception of theirsymptoms and their desire for supportive interventions. The study in-volves a prospective survey of patients with back pain referred for phys-iotherapy in a multi-disciplinary outpatient based spine institute. Pa-tients completed a battery of instruments including the Depression,Anxiety, Stress Scale (DASS), Hospital Anxiety Depression Scales (HADS),Coping Strategies Questionnaire (CSQ) and the Oswestry Disability Scale(ODI). Patients were subsequently followed up with a structured tele-phone interview to determine their perception of their emotional dis-tress, coping and desire for supportive intervention. In the two monthstudy period, 61 (31F, 30M) patients were referred for physiotherapy.Completed instruments were available for 81% (n� 52) of the patients.Of the 24 patients (15F, 9M) interviewed so far, 6 (25%), all female,expressed a desire for supportive interventions. Patient average age was58.5 years (range 51-69 years), all had back pain for more than one yearand only a few (n�2) were taking prescription medication for pain. Inpatients requesting support - with the HADS, no cases were identified asabnormal for symptoms of depression and with the DASS, 3 cases wereidentified with symptoms of moderate or severe depression. For anxiety,1 case (also by the DASS) was identified as abnormal by the HADS and 4cases were identified with symptoms of moderate or severe anxiety withthe DASS. Among back pain patients referred for physiotherapy, femalepatients were more likely to report a desire for supportive interventionsfor symptoms of depression and/or anxiety. Agreement between HADSand DASS scoring for symptoms of depression and anxiety in back painpatients was low.

S81Abstracts