The Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2),29 one of the most widely used and researched tests of all time, is used quite extensively with chronic pain patients. Figure 10.1 shows that the use of the MMPI for pain is quite extensive, as evidenced by citations in the literature on the use of MMPI with pain
Decade (% pain to total)
Decade (% pain to total)
Figure 10.1 Pain and the Minnesota Multiphasic Personality Inventory (MMPI) by decade.
patients, with the most recent decade of data indicating that 12 percent of all MMPI citations are pain related. The MMPI is a 566-question, true-false test that evaluates the presence of psychopathology through three validity scales (the degree to which respondents may be trying to distort their true persona), and clinical scales, ten of which are most commonly used: hypochondriasis, depression, hysteria, psychopathic deviance (history of antisocial behavior and nonconformance), paranoia, psychasthenia (obsessive-compulsive tendencies as well as anxiety), schizophrenia, hypomania, masculinity-femininity, and social introversion. Two additional scales used with chronic pain patients are the Low Back Pain Scale and the Dorsal Scale. Careful examination of the pattern or "profile" of scale scores, particularly those above a T score of 70, enables the experienced clinician to evaluate the degree of psychological distress experienced by the patient and enables the prediction of behaviors, as well as treatment compliance and responsiveness.
The most common profile of chronic pain patients is the "conversion V'': elevations of the hypochondriasis, depression, and hysteria scales. Individuals whose profiles reflect greater psychopathology tend to display more severe pain symptoms.30 Problems with utilization of the MMPI with chronic pain patients are its length (over two hours to complete it), and its strong orientation to psychopathology (which suggests to pain patients that they are being perceived as "crazy'' and their pain is in their head). A criticism that has been directed at the use of the MMPI with chronic pain patients is that there is an overlap of symptoms of chronic pain with MMPI items which can lead to erroneous estimates of psycho-pathology.30 For example, five items on the MMPI reflect the presence and severity of rheumatoid arthritis. These items code on scales 1, 2, and 3 (hypochondriasis, depression, and hysteria). Responses to these items reflected disease activity rather than emotional distress.
The MMPI-2, the recent revision of the MMPI, has reduced some of the psychiatric bias, and has also updated the normative samples. While some pain centers administer the MMPI or MMPI-2 as part of the standard evaluation protocol, some pain centers reserve it for patients with suspected major psychopathology or treatment refractory patients.
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