Anxiety Disorders: Robinson JP

Sullivan MD, Robinson JP. · Department of Psychiatry, University of Washington, 1959 Pacific Street, Box 356560, Seattle, WA 98195, USA. · Phys Med Rehabil Clin N Am. · Pubmed #16616273 No free full text.

Abstract: Antidepressants and anticonvulsants have been shown to be efficacious in the treatment of neuropathic pain, chronic headache, and other chronic pain conditions. They may be useful in the treatment of disorders in which central nervous system hypersensitivity con-tributes to pain. They provide valuable alternatives or adjuncts to the use of opioid medications in the treatment of chronic pain. Antidepressants have several potential roles in the treatment of chronic pain in addition to their analgesic effects. Specifically, they effectively address the sleep disturbance, depression, and anxiety that are common in patients with chronic pain.

Robinson JP, Burwinkle T, Turk DC. · Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA 98195, USA. · Arch Phys Med Rehabil. · Pubmed #17532901 No free full text.

Abstract: OBJECTIVES: To evaluate neuropsychologic test performance of people with whiplash-associated disorders (WADs) and to compare the performance of those who report cognitive symptoms (CS+) with those who do not (CS-). DESIGN: Cross-sectional analysis of a convenience sample. SETTING: Outpatient research center. PARTICIPANTS: People with recent WADs (N=203) who responded to advertisements to participate in a treatment study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed a history form including information about demographics, medical history, description of the collision, litigation status, a set of instruments designed to assess neck disability, pain severity, depressed mood, pain-related anxiety, and fear of potentially stressful neck movements and completed a generic 38-item symptom checklist that included items about memory and concentration problems. They also were administered the third revision of the Wechsler Memory Scale (WMS-III) and the Trail-Making Test (TMT). Participants were designated CS+ if they endorsed memory problems or concentration problems on the symptom checklist and CS- if they did not endorse either type of problem. RESULTS: CS+ and CS- participants performed equally well on the TMT and on all WMS-III indexes. Univariate analyses revealed that CS+ participants scored higher than CS- participants in neck disability, pain severity, depression, pain-related anxiety, and fear of neck movements. They also endorsed more items on the symptom checklist, including items (eg, skin rash) that had no obvious connection with WADs. In a multivariate analysis, CS+ versus CS- status was predicted only by the total number of items endorsed on the symptom checklist. CONCLUSIONS: Reports of memory or concentration problems appear to be indicators of heightened somatic vigilance rather than indicators of actual neuropsychologic deficits. Our results suggest that it is reasonable for physicians to defer neuropsychologic testing or advanced imaging studies on WAD patients who report cognitive symptoms but no other indicators of brain injuries and instead to rely on reassurance and education about the normal aftermath of motor vehicle collisions.

Burwinkle T, Robinson JP, Turk DC. · Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA. · J Pain. · Pubmed #15943960 No free full text.

Abstract: Chronic pain patients often report fears that movement will exacerbate their symptoms. The Tampa Scale of Kinesiophobia (TSK) was designed to assess fear of movement. Previous findings with the TSK showed inconsistent factor structures and varied measurement properties. The TSK was completed by a sample of 233 patients with fibromyalgia syndrome who were being evaluated for participation in a rehabilitation program. A principal components analysis initially derived a 5-factor solution. However, the factor structure accounted for less than 50% of the variance, and the internal consistency of the factors was below conventional standards (<0.70). A series of principal components analyses "forcing" different factor structures revealed that the best solution was a single factor solution that contained 4 of the original 17 TSK items, accounting for more than 50% of the variance with adequate internal consistency (alpha =0.71). Inspection of the content of these 4 items, however, suggests that this factor more likely represents catastrophic thinking, rather than fear of movement. Nevertheless, for patients with fibromyalgia syndrome, a 4-item TSK appears to retain the most acceptable factor solution while also maintaining adequate internal consistency. PERSPECTIVE: Although the TSK is one of the most commonly used measures of fear of movement, the present study using the TSK with a sample of patients with fibromyalgia syndrome suggests that the measurement properties of the TSK are problematic. Recommendations for use of the TSK are provided.