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Assessment based on the psychogenic perspective is directed toward identifying the personality factors or psychopathological tendencies that instigate and maintain the reported pain Traditional psychological measures such as the Minnesota Multiphasic Personality Inventory (MMPI) and the Symptom Checklist-90 (SCL90) are commonly used to evaluate chronic pain patients (Piotrowski, 1997) High scores in these instruments are considered to support the notion of psychogenic pain It is assumed that reports of pain will cease once the psychological problems are managed Treatment is geared toward helping the patient gain insight into the underlying maladaptive, predisposing psychological factors (eg, Beutler, Engle, Oro -Beutler, Daldrup, & Meredith 1986; Grzesiak, Ury, & Dworkin, 1996) Although the psychogenic pain notion is ubiquitous, empirical evidence supporting it is scarce A substantial number of chronic pain patients do not exhibit signi cant psychopathology.

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Moreover, studies suggest that in the majority of cases the emotional distress observed in these patients occurs in response to persistence of pain and not as a causal agent (eg, Okifuji, Turk, & Sherman, 2000; Rudy, Kerns, & Turk, 1988) and may resolve once pain is adequately treated (Wallis, Lord, & Bogduk, 1997) Not surprisingly, insightoriented therapy has not been shown to be effective in reducing symptoms for the majority of patients with chronic pain There are, however, some patients for whom such insight is essential before they are able to engage successfully in rehabilitation (Grzesiak et al, 1996) Secondary-Gain Model of Chronic Pain The secondary-gain model is an alternative to the psychogenic model.

discordant orchestra of psychotherapies, which may be integrative, but which continues the tradition of remaining separate from other progress in the field. In this chapter, an attempt has been made to point out briefly where these therapies overlap and resemble one another. Several of these models rely explicitly on Bowlby s (1980) classic work on attachment theory, while others seem implicitly to have incorporated this perspective. Several of these models also share Millon s (1990) evolutionary, survival-value-based approach to personality and psychopathology. Yet, there is little cross-referencing among approaches. Such lack of meta-integration among these explorers of new treatment may keep us all from reaching the goal of a truly integrative, synergistic treatment.

15.7.6.1 Overview of the PHY. The PHY of 802.14 supports asymmetrical bidirectional transmission of signals in a CATV HFC network. The network is point-to-multipoint, tree branch access network in the downstream direction, and multipoint-to-point, bus access network in the upstream direction. The downstream transmission originates at the headend node and is transmitted to all end-users located at the tips of the branches in the tree and branch network. An upsteam transmission originates from an end-user

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In object-oriented scripting, classes can receive properties and methods from each other according to a specific order; this is called inheritance. You can use inheritance to extend or redefine the properties and methods of a class. A class that inherits from another class is called a subclass. A class that passes properties and methods to another class is called a superclass. A class can be both a subclass and a superclass. For more information, see Using a built-in object on page 236 and Creating inheritance on page 241.

From this perspective, reports of pain in the absence of or in excess of physical pathology are attributed to the desire of the patient to obtain some bene t such as attention, time off from undesirable activities, or nancial compensation secondary gains In contrast to the psychogenic model, in the secondary-gain view, the assumption is that the patient is consciously attempting to acquire a desirable outcome Simply put, the report of pain in the absence of a pathological process is regarded as fraudulent (Bayer, 1984) Assessment of patients from the secondary-gain model focuses on identifying discrepancies between what patients say they are capable of doing and what they actually can do or from facial expressions that deviate from norm-based expectations (Craig, Hyde, & Patrick, 1991).