A comparison of clinically and empirically derived MMPI groupings in low back pain patients

Abstract

Two methods of grouping MMPI scales were employed with 271 patients who were attending a Back Clinic at a university hospital. One method involved clinically derived decision rules, while the other utilized a multivariate clustering procedure. Five subgroups of patients were identified with each method. Both procedures showed subgroup differences in terms of pretreatment pain intensity, activity limitations, McGill affective scores, and physician ratings of degree of functional impairment; the elevated subgroups showed more dysfunction. Follow‐up comparisons revealed that, regardless of the classification procedure used, the elevated subgroups showed poorer response to treatment. Only the clinically derived groupings had significant differences in chronicity of pain and total scores on the McGill Pain Questionnaire. On the other hand, only the statistically based system showed significant differences on age and marital status. Furthermore, only the statistical system identified subgroups of male patients that predicted follow‐up pain intensity decreases in a manner that indicated clinical usefulness.

MMPI-2 Characteristics in a Chronic Pain Population

“…Based on the findings by Keller and Butcher (1991), Love and Peck (1987), and others, Hypothesis 1 stated that the chronic pain population will produce higher mean basic scale and content scale profiles than found in a comparison sample matched for age and gender from the MMPI-2 normative sample. Based on findings reported by Crook, Rideout, and Browne (1984) ;Fow, Sittig, Dorris, Breisinger, and Anthony (1994);McCreary, Naliboff, and Cohen (1989); and Vendrig, Derkson, and May (1999) and the review by Prokop (1988), the second hypothesis proposed that pain intensity self-reports would be positively and significantly associated with the patient's age, gender, and MMPI-2 scores, with older patients, women, and individuals producing higher T-scores on MMPI-2 Basic Scales 1 and 3 reporting higher levels of pain. Based on the work of Keller and Butcher and others, the third hypothesis stated that MMPI-2 basic scale profiles for chronic pain patients would be dominated by 2-point code type patterns involving Scales 1, 2, and 3 and that basic scale profiles would also generally correspond to the four factor analysis clusters.…”

Psychological factors in the long-term prognosis of chronic low back pain patients

“…Bradley, Prokop, Margolis, and Gentry (1978) have presented one based on statistical analysis (multivariate clustering procedure). The subgroups identified by these authors have been replicated subsequently, both in other groups of LBP patients and in patients with multiple pain problems (McCreary, Naliboff, & Cohen, 1989). The other type of classification is based on clinical principles (Sternbach, 1974).…”

“…The clinically derived type of profile, on the other hand, has been more successful in predicting outcome (Long, 1981;McCreary, Turner, & Dawson, 1979;Trief & Yuan, 1983). McCreary et al (1989) have made the only comparison of clinically and statistically derived groupings in the same study group. They found that elevated subgroups of both types were related to higher pain intensity after treatment, but there was no connection with the ability to resume normal activities.…”

Psychopathology in Individuals with Post-Traumatic Headaches and Other Pain Types

“…Other studies have found that individuals with chronic pain are not solely characterized by an MMPI "conversion V" profile (18,19). McCreary et al (20) found that low back pain subjects could be placed into five groups based on psychopathology. Those subgroups with the most elevated scores revealed the poorest response to treatment (20).…”

“…McCreary et al (20) found that low back pain subjects could be placed into five groups based on psychopathology. Those subgroups with the most elevated scores revealed the poorest response to treatment (20). In an examination of chronic pain patients using the Symptom Checklist-90 (SCL-90), three profiles emerged representing high, medium, and low scores (21).…”