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Relaxation, Hypnosis, Distraction and Placebo |
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USE OF GROUP HYPNOSIS AND OF THE SELF-HYPNOSIS WITHIN A MULTIDISCIPLINARY PROGRAM FOR THE TREATMENT OF CHRONIC PAIN Boris Araos*. Lorena Tiznado*, Hugo Salinas*, Norberto Bilbeny, Spon: C. Paeile, INMED, Santiago, Chile. Aim of Investigation: To evaluate a preliminary view of the use of the group hypnosis and self-hypnosis within a Multidisciplinary Program for the Treatment of Chronic Pain Methods: The emotional, anxious or depressive symptoms associated with the pain as well as the psychological and social areas affected by the pain were studied in 23 patients during a four week period Multidisciplinary Program for the Treatment of Chronic Pain. They were evaluated with pre and post treatment measurements, by different questionnaires. In sessions of 1 hour duration, the patients were hypnotized in a group form, with techniques that included hypnoanesthesia, analgesia, displacement, dissociation, redefinition in trance, reinforcement of psychological limits, and alleviate distress symptoms. The patients were also trained in two self-hypnotic techniques. At the end of each session, the patients reported the sensations experienced during the hypnotic session. Results: 21 patients experienced classic hypnotic phenomenon's, such as analgesia, anesthesia, amnesia, dissociation, sensorial alterations, time distortion, age regression and ideodinamic responses. A statistical analysis of the results showed a significant reduction in the levels of suffering, depressive and anxious symptoms associated with chronic pain. The patients that practiced the self- hypnotic experienced a better relief than those who did not do it. Conclusions: The Group Hypnosis is useful within a Multidisciplinary Program for the relief of chronic pain, the suffering and the emotional distress associated with it. It appears to us that self-hypnosis reinforces the effects of the heterohypnosis, by means of sustaining the results for a longer period. TREATMENT OF WORK RELATED MUSCULO-SKELETAL DISORDERS [WMSD] PATIENTS WITH HYPNOSIS AND SELF-HYPNOSIS. H. F. G. Barboza, F. Puentes, T. Y. Lin, C. A. Alcencio, M. J. Teixeira, J. A. Figueiro, Pain Clinic and Division ofPM &R. Univ ofSao Paulo Medical School. Rua Conselheiro Brotero 1539, cj 12, Cep 01232-010 Sao Paulo Brazil. Aim of Investigation: The purpose of this study is the presentation of some clinical features and the results of hypnosis in the treatment of patients presenting WMSD. Methods: 20 WMSD patients with incapacitating pain despite previous treatments, as physical therapies, analgesics, psychotropics, acupuncture, infiltration of trigger points, neural blocks and psychological interventions were treated. All underwent musculo-skelecty and neurological examination, evaluation of the characteristics of pain, VAS, Hamilton and State-Trait Anxiety Inventory test, and pressure dolorimetry for measurement of tenderness of trigger points [TPs] before and after the sessions. Audiotaping for relaxation, hypnotic inductions and suggestion through visual imagery of reduction of pain intensity and sensory substitution were the procedures performed. All were taught about self- hypnosis. Results: The average of VAS was 5.3 at the beginning of the sessions, and 2.2, after 4 sessions (p <0,001 *). The pain intensity became less than 50% of the initial VAS in 74% of the patients. The average of pressure threshold dolorimetry before the sessions was 3.1 kg/cm2 and after, 4.1 kg/cm2 (p < 0.05*). Conclusion: The hypnotic analgesia is an effective instrument for pain control in WMSD patients. THE HYPOALGESIC EFFECT OF 3D VIDEO ON COLD PRESSOR PAIN: IMPORTANCE OF INFORMATION AND REPRODUCIBILITY OF EFFECTS. BoBentsen'*. Peter Svensson2'3, Ann Wenzel'*. 'Dept of Oral Radiology, Royal Dental College, Univ ofAarhus, DK-8000, Aarhus C, Denmark, ^ept of Prosthetic Dentistry and Stomato-gnathic Physiology, Royal Dental College, Univ ofAarhus, Denmark and centre for Sensory-Motor Interaction, Univ ofAalborg, Denmark. Aim of Investigation: To use a new 3D video technique for distraction and to compare the importance of different types of information on a painful stimulus. Secondly, to study the reproducibility of the hypoalgesic effect in the same population after 4 weeks. Methods: A cold pressor test (chilled water 1-2 °C was used as the painful stimulus. Subjects immersed their hand into the water for 3 minutes and scored the intensity of pain and unpleasantness on 100-mm visual analogue scales (VAS). A neutral movie transmitted through 3D video glasses (I-Glasses™, Virtual i-0™, Seattle, USA) was used for distraction. Thirty-three volunteers (21 females, 12 males, median age 23 yrs, range 19-27) were randomised into three groups who received different information of the effect of 3D video on pain and unpleasantness: one group received positive information with emphasis on a good hypoalgesic effect, one group neutral information, and the third group received negative information. Each volunteer took the cold pressor test in two randomised trials (video and control) after the information was given and then again after 4 weeks. Results: There were no significant differences in VAS scores between the three groups, neither in the video trials nor in the control trials (P>0.06). The pooled data indicated a significant effect of 3D video on pain (median 41 mm, range 6-86 mm) compared to control (median 55 mm, range 4-89 mm, P<0.03), but no effect on unpleasantness. The results were reproducible after 4 weeks. Conclusions: In this study it was not possible to manipulate the hypoalgesic effect of 3D video glasses by different information to the subjects. The effect of 3D video glasses was also robust after 4 weeks. COMPARED EFFECTIVENESS OF HYPNOSIS AND RELAXATION IN REDUCING OSTEOARTHRITIS PAIN Mane-ClaireGay*'. Pierre Philippot*2, Olivier Luminet*2 (Sponsor: Herbette Gwenola). 'Psychology Dept, 200, av de la Repub-lique, 92001 Nanterre cedex, France, e-mail: marie-claire.gay@u-panslO.fr, Psychology Dept, Catholic Univ ofLouvain, CLIS, 10, Place du Cardinal Mercier, 1348 Louvain- La- Neuve, Belgium. Aim of Investigation: To determine whether hypnosis and relaxation are effective in reducing osteoarthritis pain and to examine the potential modulating effect of imagery skills on treatment response. Method: 36 participants with gon- and coxarthritis took part in an 8-week session and were randomly assigned to one of the 3 following conditions: hypnosis (involving imagery), relaxation and control (no treatment). Imagery skills that are supposed to affect therapeutic response and belief in treatment efficacy were assessed before the treatment. Before, during and immediately after the treatment, and in a 6-month follow-up period, all subjects received questionnaires assessing self reported pain intensity and medication. Results: Hypnosis reduced more than 50 % osteoarthritis pain after 4 week training sessions and led to an extensive reduction in pain medication. The pain improvement was maintained up to the 6-month follow-up and always significantly different from the control and relaxation conditions, relaxation is less effective with regard to the therapeutic answer delay and the reported pain. For both conditions, treatment is the main predictor until the 3-month follow-up, while the treatment and cognitive style interaction become the most important predictors at the 6-month follow-up. Conclusion: The differences between the hypnosis and relaxation conditions suggest that the active component of hypnosis cannot be reduced to a placebo effect or to a mere effect of muscle relaxation. The fact that the treatment benefits observed cannot be explained by the participants belief in the efficacy of the treatment procedure also militates against such an effect. Concerning the implication of individual cognitive skills in the therapeutic response, our results show that an imagining cognitive style reinforces the effects of both hypnosis and relaxation and is consequently particularly important for the long-term maintenance of treatment benefits. SUPPRESSIVE COPING AND DELAYED PAIN: ANOTHER EXAMINATION Malcolm H Johnson. Connie Oates, Steven Humphries, School of Psychology, Massey Univ, Palmerston North, New Zealand. Aim of Investigation: To investigate whether cognitive procedures that involve suppression of pain sensation produce slowed recovery and subsequent increases in pain sensitivity that are independent of pain tolerance. Methods: In a partial replication ofCioffi and Holloway (1993), cold pressor stimulation (CP) to tolerance or a maximum of 180 sec. was administered to four groups totaling 74 volunteers instructed to use different coping procedures. Coping strategies were: suppression of the pain, a visual detection distractor, the visual distractor with a response, and no coping instructions. Recovery from the cold pressor was assessed using 8 visual analog pain scales (VA) at 20 sec. intervals after stimulation. Additionally, changes in pain report to the administration of potassium iontophoresis before and after CP were measured. Results: CP time was not altered by the coping procedures. However recovery from CP was related to CP time dependent upon coping group. Individuals in the two distraction groups who had longer exposure to CP had higher VA scores in the later assessments. When CP time was controlled for, participants in the distraction with a response group showed greater reduction in pain report following iontophoretic potassium administration than either the control or the suppression group members. Conclusions: These data suggest that the amount of exposure to the CP may better predict recovery than the coping strategy used, with longer exposure to CP being associated with slowed recovery from the CP for the participants in the distraction groups. In contrast, when CP exposure is controlled for, distraction with a response was associated with reductions in pain report following potassium iontophoresis. Reference: Cioffi, D., & Holloway, J. (1993). The delayed costs of suppressed pain. Journal of Personality and Social Psychology, 64, 274-282. PHANTOM LIMB PAIN AND HYPNOSIS: A CASE REPORT M. Pavy*, P. Picard. D. Vemay*, A. Eschalier, Consultation Douleur - Hopital Fontmaure, 63407 Chamalieres, France Aim of Investigation: A wide variety of treatments has been proposed to treat phantom limb pain (PLP) most of which are doomed to failure. The hypnotic suggestion ofanalgesia can reduce spontaneous and evoked pain sensation in a variable proportion of "responsive" individuals. We report a case of a post traumatic, phantom upper limb pain, which was poorly responsive to anticon-vulsants, antidepressants and TENS. For one year the patient carried out one monthly hypnotic procedure. The painful phantom limb was mentally described in somatic and sensory detail, then hypnotic suggestion ofanalgesia was performed using sensations of heat, of color, and repetitive and detailed movement of the phantom limb. Results: During the procedure, VAS (0-10 scale) decreased from 8 to 2. At the end of the 12 sessions, the patient stopped all medications, she returned to her agriculture work, and went on regularly with hypnosis, at least once a day. Conclusion: According to Melzach's assumption, of a neuromatrix underlying PLP, and those more recent of a cortical reorganization in PLP. Hypnosis may participate in the remodeling of the functional architecture of the cortex in response to nervous system damage and serve as an adaptive compensatory mechanism by restoring activity in a zone deprived of its afferent support. IBS MANAGEMENT USING GUT DIRECTED HYPNOSIS OR GENERAL HYPNOSIS MA Serewel, Pain Clinic and Hypnotherapy Clinic, Leighton Hospital, Crewe CW1 4QJ, UK Aim of Research: To find out whether hypnosis and relaxation used with ego strengthening routine produces the same outcome as that of gut directed hypnosis in conjunction with general hypnosis/relaxation and ego strengthening routine. Method: Thirty patients with IBS symptoms referred from the gas-troenterology clinic to the hypnotherapy clinic divided randomly into two groups. Group one received six sessions ofautogenic relaxation and hypnosis with ego strengthening routine. The second group received 6 sessions of the same management in addition to gut directed hypnosis. Results: Since IBS is a poly-symptomatic disorder a convention has evolved for combining the result from multiple symptoms total score. By comparing the two results we see that at the beginning of the second session of treatment, there is already a noticeable improvement of the aggregate score for the three symptoms pain, constipation and diarrhea. On the fourth week there was a steep rise in the number of symptom-free weeks in group one. In group two we find less dramatic improvement and fewer numbers of patients with improvement in their symptoms. Conclusion: The Study shows that hypnosis with a gut directed approach can improve IBS symptoms more readily than hypnosis without gut directed method, with 80% improvement with gut directed in comparison to 60% with no gut directed approach. It is very difficult to know why. Hypnosis is still unknown and any explanation will leave us with more questions than answers, but the end result corresponds favourably with the studies done in this field. EFFICACY OF HYPNOTIC ANALGESIA ON THE FACE AND THE LEG AND ITS ASSOCIATION WITH THE MASSETERIC INHIBITORY PERIOD AND THE R.III REFLEXES. Yair Sharav. Michael Tal, Dept of Oral Diagnosis, Oral Medicine and Radiology, and Dept of Anatomy, School of Dental Medicine, Hebrew Univ and Haddassah, Jerusalem, Israel Aim of Investigation: (1) Is there a differential effect of hypnotic analgesia on pain sensation and pain unpleasantness in the face and the leg? (2) Will hypnotic analgesia affect differentially the Mas-seteric Inhibitory Period (MIP) and the R-III nociceptive reflexes? (3) Is hypnotic analgesia more effective than hypnotic relaxation, and would it interact differentially in high- and low-hypnotisable subjects? Methods: Hypnotic relaxation (HR) and hypnotic analgesia (HA) were induced in 8 high- (HH) and 7 low-hypnotisable (LH) subjects. Pain intensity and unpleasantness were rated on a visual analogue scale. The MIP and the biceps lemons R-III reflex activity were recorded concomitantly. Results: Hypnotic analgesia was effective only in HH but not in LH subjects. In HH subjects only HA but not HR was effective in pain reduction; more so in the face (ANOVA, F = 3.469, P = 0.003) than in the leg (F = 2.730, P = 0.016). R-III area under the curve was reduced in HH but not in LH subjects, and only under HA (F ” 4.431, P = 0.018). However, 3 out of 8 HH and 2 out of 7 LH subjects demonstrated excitation rather than inhibition of the R-III reflex under HA. MIP late depression (ES2) was reduced under HA in HH subjects but this change was not significant. Conclusions: Under hypnosis HA is significantly more effective than HR in producing analgesia. This analgesia is effective in HH but not in LH subjects. Hypnotic analgesia is more effective on the face than on the leg. Pain unpleasantness is more responsive to hypnotic analgesia than pain intensity. While R-III is more responsive to HA than the MIP, its reduction is not consistent in all responsive subjects. Acknowledgment: Supported by the David and Hedy Epelbaum Fund for Pain Research. MUSIC AND RELAXATION INSTRUCTIONS AS PAIN-RELIEVING FACTORS IN PATIENTS WITH CHRONIC PAIN. Guenther Bematzky. Franz Wendtner*, Hans Adam*, Patrick Ber-natzky*, Gunter Leiner*, and Rudolf Likar, (SPON: M. Wittels) Herbert von Karajan Centrum Vienna, and Salzburg Univ, Hell-brunnerstrasse 34, A-5020 Salzburg, Austria Aim of Investigation: This study aimed at demonstrating the significance of the receptive effect of music alone or in combination with spoken relaxation instructions in patients suffering from chronic pain. Methods: 74 patients of both sexes, who underwent a three-week physical therapy because of chronic pain in the dorsal region, were randomly assigned to four different groups: group 1 (music and relaxation instructions), group 2 (music only), group 3 (relaxation instructions only), group 4 (no intervention). The pain score was determined by means ofVAS (visual analog scale), the depression score by means of ADS (general depression scale), and the anxiety score by means of FESV (questionnaire about how patients deal with pain), each at the beginning, several times during the three-week period, and at the end of the therapy. Results: For all intervention methods, a highly significant reduction of pain (gr. 1: p<0.003; gr. 2: pO.001; gr. 3: p<0.007), anxiety (gr. 1: p<0.000; gr. 2: p<0.000), and depression (gr. 1: p<0.001; gr. 2: p<0.000) could be ascertained at different times. Furthermore, an increase in subjective and objective mobility in groups 1 and 2 could be demonstrated. In group 4 (without intervention), no significant difference with regard to all investigated criteria was found. Conclusion: The study results show that music, and the combination of music and relaxation instructions, respectively, can contribute substantially to reducing pain and its accompanying negative emotions and cognitions and help enhance therapy effectiveness. Acknowledgments: Supported in part by a grant from the Herbert von Karajan Centrum Vienna, Oberbank Salzburg, Research Institute Gastein Tauemregion and Univ Salzburg. THE EFFECTS OF MUSIC ON PARAMETERS OF EXPERIMENTALLY PRODUCED PAIN Susan L. Baker. Juanita F. Keck, Indiana Univ School of Nursing, Indianapolis, Indiana, USA Aim of Investigation: To investigate the effect of self-selected music on parameters of pain including pain intensity and distress, plasma beta-endorphin levels, and physiological pain responses. Methods: Subjects experienced three experimental conditions including pain alone via electrical stimulation, music alone, and a combination of pain and music. Pain intensity and distress were measured by self-report using an 11 -point numerical scale. Pain response was measured by heart rate, respiratory rate and oxygen saturation level. Beta-endorphin was measured by radioimmunoas-say. Results: A significant difference in pain intensity was identified between use of music with pain and pain alone (F=14.45; p=.001). In addition, significant reductions in intensity over time were indicated (F=13.44; p=.001) between the two treatment conditions. Significant differences in distress between the two treatment conditions (F=10.86; p=.003) and across time (F=7.88; p=.001) were found. Listening to music alone reduced heat rate (F=16.56; p=.001) and respiration rate (F= 12.68; p=.001) over time. Analysis of plasma beta-endorphin levels and oxygen saturation levels demonstrated no significant differences. Conclusions: The findings support the ability of music to decrease perceptions of pain, however, the theoretical prediction that plasma beta-endorphin is evoked by music was not supported. The study provides evidence that music activates a physiological and psychological mechanism of pain relief. It is suggested that beta-endorphin levels in the CNS be tested by PET scan to measure any changes in the neurohormone with the musical intervention. Acknowledgments: Supported by Indiana Univ Hospital General Clinical Research Center PHS M01 RR750, Astra USA, Inc., Indiana Univ School of Nursing. THE MUSIC AS AN ALTERNATIVE THERAPY TO TAKE CARE OF WOMEN WITH FIBROMYALGIA. Eliseth Ribeiro Leap Dobbro. Maria Julia Paes da Silva*, Univ of Sao Paulo, Sao Paulo, Brazil. Aim of Investigation: The selected erudite music starting from a predetermined repertory was investigated in this study as alternative therapy in the women care with fibromyalgia. Methods: Forty women were submitted for two musical sessions. The pain as well as the physiological parameters indicative of slackness: heart rate, respiratory rate, trapezius and frontalis muscle electromyograpchic, systolic and diastolic blood pressure and cutaneous temperature and all of these parameters were completed by patient's perception about musical experience and were appraised before and after each musical session for verification of produce alterations in their results. Results: Among observed physiological signs, the respiratory rate, the electromyographic, the cutaneous temperature and the systolic blood pressure presented alterations statistically significant on two sessions. The pain valued by Visual Analogic Scale presented significant reduction after musical session for most of patients, ratified by McGill Pain Questionnaire in all pain extensions that the instrument proposes to analyse. Conclusions: The perception of musical experience related by investigated women have evidenced the powerful from this Nursing intervention (95% from those women referred that they have liked very much this therapeutic approach) besides pain relief, many subjective aspects have emerged such as alterations of mood state, facility of introspection, visualization of images and esthetics sensations, among others aspects have demonstrated that their utilization and comprehension to must be amplified. THE EVALUATION OF A COGNITIVE BEHAVIOURAL PAIN MANAGEMENT PROGRAMME WITH TRAINING IN RELAXATION VERSUS SELF-HYPNOSIS FOR CHRONIC FACIAL PAIN. Maria Koutantji. David Oakley*, Charlotte Feinmann, School of Health Policy & Practice, Univ of East Anglia, Norwich, UK, Psychology Dpt & Eastman Dental Inst, London WC1X 8LD, Univ College London, London UK Aim of Investigation: To evaluate the effectiveness of an outpatient cognitive behavioural (CB) pain management programme for facial pain and to compare relaxation to self-hypnosis as treatment adjunct procedures. Methods: Fifty-one chronic facial pain patients participated in a 6 sessions pain management programme. A mixed model design was employed with CB treatment with relaxation or self-hypnosis as the between subjects factor and time of measurement (mean of 2 baselines vs end of treatment) as the repeated measure. One year follow up measures at 3monthly intervals are also being collected. Results: The end of treatment results showed that irrespective of treatment group, patients showed significant post-treatment improvements on pain severity, interference, life control and affective distress scores of the Multidimensional Pain Inventory, and they perceived their significant others as more solicitous and as displaying more distracting behaviour in relation to their pain. There were also significant post-treatment improvements on measures of depression, anxiety, disease and health-related beliefs. There were no between groups differences on any of the above measures. Follow up findings will also be discussed. Conclusions: A CB pain management programme is effective in facilitating improvements on various aspects of facial pain experience and the use of hypnosis as a treatment adjunct procedure was equally effective as that of relaxation. Acknowledgments: The study was undertaken at the Eastman Dental Institute, London UK. Our thanks to all participants and the clinical and administrative staff for their assistance. RELAXATION: MORE IS BETTER Michael Corcoran. Amanda C de C Williams, Maja Goedschalk*. INPUT Pain Management Unit, St Thomas' Hospital, London SE1 7EH, UK. Aim of Investigation: To investigate the use of relaxation techniques by chronic pain patients before and after cognitive behavioural pain management. Methods: 165 patients were assessed before treatment, at the end of treatment, and one and nine months later. A structured questionnaire sampled methods used, cues (e.g. pain, tension, sleep), frequency of use, and efficacy. Methods taught were categorised as breathing-based, visualisation, focussing, or other. Results: Before treatment, nearly 40% of patients used no relaxation techniques; those who did largely used audiotapes or breathing methods. They rated effectiveness low, but better for helping sleep and reducing anxiety and tension than pain. After treatment, 56% of patients said they relaxed more than once every 24 hours; this was associated with using more cues to relax (mean difference 1.1, CI 0.6-1.6). The breathing-based technique was most used, followed by visualisation, both to help anxiety and sleep, and when pain increased. Patients' ratings of relaxation efficacy increased following treatment from a median of 4 to 6 on an 0-10 point scale, and was greatest for those relaxing more than once/24 hours (X^IO.96, p<0.03), for whom it rarely failed (X2=69.\0, p<0.0001). Efficacy was not associated with particular cues to relax, but with use of a wider range of techniques (X2=l9.7S, p<0.005), particularly breathing-based techniques (X2=15,34, p<0,.0005). Conclusions: Teaching patients to use a variety of relaxation techniques, and to do so at least daily, including in relation to pain, is associated with greater patient-rated benefit. COPING WITH CANCER PAIN THROUGH THEATER ARTS. E. Melgar*, SPON: (A. Yap), Cancer Inst, St. Luke's Medical Center, E. Rodriguez Ave., Cathedral Heights, Quezon City, Philippines Aim of Investigation: To investigate an alternative but creative mode of psychological therapy for women with cancer to enable them to deal with the physical and emotional pains associated with cancer and their treatment. Methods: Seventeen women with cancer (six of whom were on stage four) and two female caregivers participated in a 3-day intensive Workshop on Expression and Theater Arts conducted by the Cultural Center of the Philippines. Following this was a 1-day brainstorming session among the workshop participants conducted by the scriptwriter; to surface personal issues, common pains and problems that should to be highlighted in the script. Thereafter, patients who agreed to perform in the play went through a 5-month rehearsal while others assisted on the production side. Finally, the play entitled "SENS OP TUMOR" (Sense of Tumor) was shown to the public during the National Cancer Consciousness Week. Results: None of the patients who participated in the workshop and rehearsals complained of severe physical pain that warranted hos-pitalization. Three of the patients organized and headed a cancer support group in their respective localities after the project ended. Some 600 doctors, nurses and lay people from various provinces attended the opening night. Four TV channels and 3 national dailies covered the performance. Three local magazines featured the patients who appeared in the play. Conclusion: A close collaboration between health caregivers and the theater arts professionals gave birth to a creative expressive program which benefited patients in terms of regaining their self esteem, rekindling their sense of purpose in life and gaining skills in self-expression. A similar program, of lesser magnitude could be replicated in the future by other cancer support groups in the country. Acknowledgments: Supported by Dept of Health, St. Luke's Cancer Institute and the Cultural Center of the Philippines. NON SPECIFIC EFFECTS OF BLINDED INFUSIONS OF NORMAL SALINE IN CHRONIC PAIN PATIENTS Angela Mailis. Margarita Umana*, Shannon Roe*, Comprehensive Pain Program, The Toronto Hospital and Univ of Toronto, Toronto, Ontario Canada M5T 2S8. Aim of Investigation: To study the types and occurrence ofnon specific treatment effects in a population of chronic pain patients during normal saline (NS) infusions. Methods: The responses to single-blinded infusions of normal saline under ambiguous suggestions have been prospectively collected in 324 consecutive patients admitted to a tertiary care pain centre for multiple investigations via a) standardized paper records and b) videotaping. Results: The following responses were observed in 2/3 of all patients (62.3%) listed in descending rank order in brackets: a) Incidental responses (generalized body warming or burning in the IV arm) in 41.1% ofNS responders; b) Nocebo (non pain related such as orobuccal complaints, dizziness, confusion, sedation, visual disturbances, agitation and respiratory difficulties and pain related such as new pains, increase in previous pain, expansion in pain areas, increased allodynia, decreased range of movement, increased pinprick hyperalgesia and deep pain) in 52% ofNS responders, and c) Placebo (non pain related such as euphoria and pain related such as decrease in subjective pain, allodynia, deep pain and pin prick hyperalgesia and range of movement improvement) in 48.5% of NS responders. Finally, 37.6% ofNS responders had a mixture of incidental, nocebo and placebo responses. Conclusions: In this large study 2/3 of all chronic pain patients administered IV normal saline under ambiguous suggestions reported very high incidence of incidental, placebo and nocebo effects. Further analysis based on underlying physical pathology and personality profiles is expected to provide insight into the mechanisms and patterns of non-specific treatment effects. PSYCHOMETRIC CORRELATES OF PLACEBO AND NOCEBO RESPONSES. Keith Nicholson*, Angela Mailis. Ann Taylor*, Comprehensive Pain Program, The Toronto Hospital, Western Division, 4BFell-174, Toronto, Ontario, M5T 2S8, Canada Aim of Investigation: To investigate the relationship between (a) psychometric measures of personality and adaptation to chronic pain, (b) pain related variables and (c) placebo and nocebo responses on administration of saline. Methods: A consecutive series of 334 patients admitted to an in-patient pain program for detailed investigation were administered single blind saline controlled infusions of sodium amytal in addition to a battery of psychological tests. Results: A composite measure of placebo response was associated with elevations on the Millon Clinical Multiaxial Inventory - II (MCMI-II) Social Desirability and Dependency subscales (p < .05). A composite measure of nocebo response was associated with elevations on the Minnesota Multiphasic Personality Inventory - 2 (MMP1-2) Hypochondriasis (p < .0001), Depression (p < .001) and Hysteria (p <0001) subscales plus the MCM1-2 Delusional Disorder (p < .01) subscale. Several other commonly used psychometric measures in the assessment of chronic pain were unrelated to placebo or nocebo response. More detailed analyses including further psychometric measures and the relationship of response to underlying pathology will be presented. Discussion: The differential pattern of psychometric results associated with placebo-nocebo responding indicates that patients with strong dependency needs and desire to please will respond positively while patients with more explicit conversion of negative affect and somatic preoccupation will respond negatively to perceived intervention. Further detailed analyses may shed more light on the production of placebo and nocebo responses. AN INVESTIGATION OF THE ROLE OF EXPERIMENTER PRESENCE AND PERFORMANCE FEEDBACK IN THE PLACEBO EFFECT USING A MODEL OF EXPERIMENTAL COLD PAIN. Angela Scott*2, Denis Martin'. "Queen Margaret College, Duke St, Edinburgh EH6 8HF,Scotland. ^alkirk Royal Infirmary, Falkirk FK1 5QE, Scotland. Aim of Investigation: To investigate the importance of the experimenter presence and performance feedback in the placebo response using experimental cold pain. Methods: Ethical approval was obtained from Queen Margaret College Ethics Committee. Following their written informed consent sixteen female volunteers (17-21 yrs; mean 17.5) were randomly selected from a population of 1st and 2nd year physiotherapy students. During sham Transcutaneous Electrical Nerve Stimulation, all subjects underwent the cold pressor test under each of 4 experimental conditions on separate occasions- A experimenter present/feedback; B experimenter present/no feedback, C experimenter absent/feedback, D experimenter absent/no feedback. Feedback was given by subjects viewing a clock while testing. The conditions were ordered in the sequences ABCD, BCDA, CDAB and DABC to which the subjects were randomly allocated. The experimental conditions were compared on time to first report of pain (threshold) and time to voluntary withdrawal from cold pain (tolerance). Two separate one-way repeated measures ANOVAs were used to analyse the data. Results: Means and standard deviations (in seconds) were threshold: A 35.7(10.8), B 35.6 (7.3), C 30.9 (8.4), D 27.6 (8.5); tolerance: A 225.5 (37.2), B 194.6 (35.9), C 194.5 (38.4), D 179.7 (36.7). Statistical analysis indicated that there were significant differences among the conditions for both threshold (p<0.01) and tolerance (p<0.001). Post-hoc analysis suggested that for both measures scores were significantly higher with the experimenter present in conjunction with feedback. The significance of experimenter presence and feedback in isolation was not so clear. Conclusions: The study provides interesting initial results about potential factors involved in eliciting placebo responses in pain. The model used proved responsive to manipulation of placebo conditions. This model will enable further investigation into the placebo effect in a controlled experimental environment. 9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p.593 - 597
9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p.593 - 597 |
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