title: Multidimensional subgroups in migraine: differential treatment outcome to a pain medicine program.
abstract: OBJECTIVE
  The present study compared two different approaches for deriving patient profiles on their ability to predict treatment outcome to a pain medicine program for migraine headache.
  
  
  METHODS
  Using visual analog scale measures of pain intensity and functional limitations and the Beck Depression Inventory (BDI), as a measure of depression, 235 migraine patients were classified into statistical clusters. The same patients were also classified using the Multidimensional Pain Inventory (MPI) algorithm into three subgroups: Adaptive copers (AC), characterized by lower reported levels of pain intensity, life interference, and distress, as well as higher levels of perceived life control; interpersonally distressed (ID), characterized by more intermediate levels of pain, distress, and interference, with a predominant perception of inadequate support and punishing responses from significant others; and dysfunctional (Dys), characterized by high levels of pain severity, life interference, and distress and low levels of perceived life control and activity.
  
  
  RESULTS
  The results of the K-cluster analysis yielded a three-cluster solution: The low impact cluster, was characterized by low pain, low functional limitations and low depression and showed significant reductions in pre-to-posttreatment pain; the moderate impact cluster displayed higher levels of pain and functional limitations and low depression and showed only slight pre-to-posttreatment pain reduction; and the high impact cluster displayed the highest levels of pain, functional limitations, and depression and showed significant increases in pre-to-posttreatment pain. Unlike the K-clustered groups, MPI subgroups failed to differentially predict treatment outcome. When the K-clustered groups were crosstabulated with the MPI subgroups, the predictive validity of the MPI subgroups was enhanced.
  
  
  CONCLUSIONS
  This study questions the validity of the MPI subgroup classification algorithm. The results indicate that the K-clustering approach is more useful than the MPI in deriving meaningful patient clusters that differentially predict treatment outcome in a migraine population.
authors.affiliation: UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Davis
authors.forename: John L
authors.initials: JL
authors.lastname: Reeves
authors.forename: Steven B
authors.initials: SB
authors.lastname: Graff-Radford
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Hastie
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Naliboff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000523:psychology* / Q000628:therapy; D009483:Neuropsychological Tests; D010147:Pain Measurement; D011379:Prognosis; D016896:Treatment Outcome