This review article examines the role of emotional distress and other aspects of suffering in the cognitive impairment that often is apparent in patients with chronic pain. Research suggests that pain-related negative emotions and stress potentially impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral component of the neural system that mediates the impact of pain-related distress on cognitive functions, such as the allocation of attentional resources. A maladaptive physiologic stress response is another plausible cause of cognitive impairment in patients with chronic pain, but a direct role for dysregulation of the hypothalamic-pituitary-adrenocortical axis has not been systematically investigated.

Forty patients scheduled for dental extraction surgery were given either specific or general preparatory information, and this information was presented in either a personalized or relatively impersonal fashion using nonverbal cues. Changes in state anxiety over the course of the experiment were accounted for by individual differences in the Dental Anxiety Scale. The most important determinant of adjustment during surgery was the congruence between specificity of information received and individual differences in preference for information as measured by the Information subscale of the Krantz Health Opinion Survey (KHOS; Krantz, Baum, & Wideman, 1980). Findings with the KHOS and the Dental Anxiety Scale are examples of the growing importance of situation-specific personality-trait measures. The finding that high levels of presurgery anxiety are associated with poor adjustment is discussed in terms of Janis's (1958) model. Patients' perceptions of information-giver hostility and dominance were also significantly (inversely) related to adjustment; the differential impact of informational versus interpersonal variables is discussed in terms of moderating characteristics of health care settings.

Forty-six patients about to undergo preprosthetic oral surgery were presented with either a problemfocused, emotion-focused, or mixed-focus stress management intervention. The mixed-focus intervention produced the best overall response to surgery; the emotion-focused intervention produced the lowest adjustment levels. The Krantz Health Opinion Survey Information scale was the best overall predictor of response to surgery in conjunction with treatments. Better adjustment and satisfaction and lower self-reported pain were obtained when high information-preference subjects were given a problem-focused intervention and when low information-preference subjects were given an emotion-focused intervention; responses were relatively poor when mismatches occurred. Differences in relative use of problem-to emotion-focused coping as measured by the Ways of Coping Checklist were unrelated to adjustment or satisfaction, but differences in problem-focused coping were the best predictors of pain response in conjunction with treatments. Preoperative anxiety level was inversely related to adjustment and satisfaction and was directly related to pain, with the affective-unpleasantness component of pain primarily accounting for this association.A growing number of studies are examining the effectiveness of interventions designed to enhance the coping stalls of persons exposed to stressful medical and surgical procedures. In a metaanalysis of the overall efficacy of attention coping strategies versus avoidant coping strategies, Suls and Fletcher (1985) concluded that both attention and avoidance facilitated adaptation as compared with a no instruction condition but that there was no evidence for the superiority of one strategy over the other (see also Thompson, 1981) and that, given the size of the literature on stress and coping, relatively few studies had directly compared attention with avoidance strategies. In some studies, attention and avoidance strategies have been combined in multiple component treatment packages with experimental designs that have not allowed one to separate out the effects of each component (Auerbach & Kilmann, 1977). It has further been noted (Anderson & Masur, 1983;Auerbach, Martelli, & Mercuri, 1983) that in health care settings, patients in the typical standard-care-only or attention-placebo control groups receive unknown and unmeasured components of problem-focused intervention (typically through provision of varying degrees and types of information by the medical staff) and nonspecific This article is based on a dissertation by the first author that was supervised by the second author and submitted in partial fulfillment for the requirements of the PhD in clinical psychology at Virginia Commonweahh University.

This review article examines the effect of chronic pain on neuropsychological functioning. Primary attention is given to studies that include patient groups without a history of traumatic brain injury (TBI) or neurologic disorders. Numerous studies were identified that demonstrate neuropsychological impairment in patients with chronic pain, particularly on measures assessing attentional capacity, processing speed, and psychomotor speed. Despite suggestive findings, further studies are needed to clarify the variables that mediate the impact of pain on neuropsychological functioning and the unique role of various symptoms often associated with chronic pain.

The effect of age on pain sensitivity is unclear. Some studies suggest a loss of pain perception with age, whereas other studies indicate either no change or an increase in pain sensitivity with age. The present study assessed perceived intensities of six levels of painful contact thermal stimuli (43 degrees C, 45 degrees C, 47 degrees C, 48 degrees C, 49 degrees C, and 51 degrees C). Magnitude estimation procedures were used, and participants were instructed to provide separate ratings for the perceived sensory intensity and the perceived unpleasantness (affective intensity) of the thermal stimuli during separate sessions. Middle-age adults showed the lowest sensory sensitivity and greatest affective pain ratings. Although results indicate a significant but small tendency for older adults to underrate low and overrate higher intensity contact heat compared with younger adults, similarities in pain perception were stronger than differences among the age groups.