Reprinted with Permission
The P-3 (Pain Patient Profile) test “comes close to meeting all the requirements” of a pain physician for the psychological evaluation of patients, according to Laxmaiah Manchikanti, MD, et al., in an April, 2002 article in Pain Physician, the journal of the American Society of Interventional Pain Physicians
Authors Manchikanti, Pampati, Beyer, Damron, and Barnhill from Pain Management Center of Paducah, Paducah, KY, conducted research to evaluate the psycho logical status of chronic low back pain patients in an interventional pain management setting in comparison to individuals without a history of pain or psycho pathology. The researchers used the P-3 assessment to gather empirical data. In the article, the authors review research results and address the utility of the P-3 assessment for pain physicians.
Manchikanti selected the P-3 assessment after careful consideration of a pain physician’s needs for performing patient psychological evaluations. Referring to the considerable research literature, Manchikanti writes, “patient evaluation of psychological profile should be useful for classifying individual patients, determining treatment strategies, and predicting treatment response, apart from developing a better understanding of the psychological mechanisms mediating the [patient’s] pain experience.”
According to Manchikanti, a pain physician needs an objective psychological test that:
While acknowledging that services of a psychologist or psychiatrist should be used to perform a comprehensive psychological evaluation, Manchikanti found that as a brief screener, the P-3 assessment nearly meets all the requirements of a pain physician. The P-3 test, developed in 1993 by C.D. Tollison, PhD, and J.C. Langley, DC, consists of 44 items that collectively help the physician to assess the pain patient’s somatization, generalized anxiety disorder, and depression. According to Manchikanti, these are the three psychological factors most common in patients suffering chronic low back pain. A validity scale is also provided.
Referring to previous research results, Manchikanti explains that personality factors offer little clinical relevance for physicians working with patients with chronic pain. In contrast, the results of this study support previous research results that clearly indicate that anxiety, depression, and somatization often influence and are associated with chronic low back pain.
Results of Manchikanti et al.’s research as reported in the Pain Physician article indicate that: 30% of chronic low back pain patients reported depression versus 5% of the control group; 20% of the pain group reported generalized anxiety disorder versus 0% of the control group; and 20% of the pain group reported somatization versus 0% of the control group.
In the article, Manchikanti reviews the advantages the P-3 assessment offers to pain physicians.
Joseph F. Jasper, MD, from Advanced Pain Medicine Physicians, Tacoma, WA, reacted to the Manchikanti et al. article in a letter to the editor published in the July, 2002, issue of Pain Physician. Jasper writes,
“What is most important is the apparent utility of the P-3 test as a tool for rapidly and affordably assessing the chronic pain patient, and perhaps the acute/subacute pain patient….
“For those practices that routinely do not include psychological co-treatment, the test may help to early on identify individuals who would be better treated by or along with the psychologist.
”It promotes a less cumbersome way to assess the psychological status of patients,” Jasper continues. “I fore see this could be an important tool for interventional pain practices. Many pain clinics have found the psychology costs outweigh revenue. The P-3 may help preserve and promote psychological assessment of chronic pain patients.”
Manchikanti’s data supports his statement that “in a significant number of patients, there is a physical problem associated with emotional issues.” He suggests most, if not all, patients with chronic low back pain presenting to interventional pain management clinicians should be evaluated for psychopathology.