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874 CAUSALITY – A NEGLECTED ISSUE IN THE FIELD OF PAIN
S226
European Journal of Pain 2006, Vol 10 (suppl S1)
Abstracts, 5th EFIC Congress, Free Presentations
871 USING HYPNOSIS IN A CASE OF CHOLECYSTECTOMY, A CASE REPORT
F04 OTHER PSYCHOLOGICAL APPROACHES
A.O. Ozturk ° . Private Practice, Istanbul, Turkey
873 PUPIL DILATION RESPONSE TO NOXIOUS STIMULATION: EFFECT OF VARYING STIMULUS PATTERN
In this study, we aimed that hypnosis can be used as a method of pain control in pre, post surgical periods and during operation. We performed hypnosis on a cholecystectomy case who is 55 years old woman. She had a diagnosis with cholecystolithiasis and cholestasis. The patient was prepared for surgical operation by using hypnosis. This hypnosis method is called as Awareness Under Conscious Hypnosis (AUCH) contains three steps as MAYA (Making Acceptance with Your Awareness), induction and auto-hypnosis. Before or during operation no medicament was used for anesthesia and sedation. She did not feel any pain or discomfort during the incisions, tractions, cauterizations and sewing. She was painless with only hypnosis during and after operation. She was conscious, cooperative and quite happy during her surgery and sometimes she also volunteered to sing songs, tell stories. Her blood pressure was about 135/85 mmHg and heart rate was 80−90/bpm during the operation duration. She was painless, very comfortable in dressing and walking and had no restriction in her movements after operation. This condition continued while she was staying at the hospital. She well cured and went home in 40 hours whereas the usual curing time is about 4 days for this kind of operations. As it is seen in this case, hypnosis can be used as a reliable and effective method for pain control in surgical operations. This makes us eager to study on hypnosis in pain control.
872 HYPNOTHERAPY IN PSYCHOSOMATIC PAIN: A CASE STUDY S. Ramachandra1 ° , S.K.C. Chaturvedi2 . 1 Clinical Psychology (NIMHANS) Bangalore, Karnataka, 2 Psychiatry (NIMHANS) Bangalore, Karnataka, India Background and Aims: Mrs. P., aged 42 years reported psychosomatic body aches, pain, anxiety, depression, and disturbed sleep. She covered much of her face to conceal eczema and it had even spread to face, hands, and feet. Avoided mixing with others as they would look at her again and again. Duration was 6 years with an insidious onset. Initially medical treatment helped her but subsequently dosage had to be increased including steroids resulting in unbearable side effects. Feelings of depression became more pronounced. At this stage she opted for hypnotherapy as a possible intervention. Methods: Psychological assessment (Rorschach, T.A.T., DSSI, and SCT) revealed her to be an introtensive, having difficulty in interpersonal relationships, anxiety and depression with occasional suicidal ideas, and poor self-concept. Excessive worry about the body-image, (thought her face not the same as it used to be) loss of beauty due to eczema seemed to be the core factors for her manifested complaints. Therapeutic strategy consisted of trance induction, deepening the trance, suggestions with enhanced positive imagery to counter the negative feelings and poor selfconcept and posthypnotic suggestions. Results and Conclusions: Each successive hypnotherapy session resulted in better eye contact, tone of talking, and expressing herself confidently. Dark patches on her face were visibly lighter after 7−8 sessions. A total of 1 sessions were held with appreciable improvement and the level of medication was gradually reduced to a bear minimum. Steroids were completely withdrawn. 6 months’ follow up showed the level of improvement was maintained.
S. Oka1 ° , B. Kim1 , Y. Imamura2 , I. Nakajima3 , Y. Oi1 . 1 Department of Dental Anesthesiology, 2 Department of Oral Diagnosis, 3 Department of Pediatric Dentistry, Nihon University School of Dentistry, Tokyo, Japan Background and Aims: The pupil dilation response (PDR) to a painful stimulus is a subtle, event-related increase in pupil diameter that occurs following brief noxious stimulation. However, a central, unresolved issue is whether this PDR is a spinal sympathetic reflex or not. We speculated that PDR could be a brain-mediated response, and examined whether PDR amplitude is increased by unexpected stimuli compared to expected stimuli. Methods: In a double blind trial, eight healthy, female volunteers participated in this study. The subjects received the following four kinds of painful electrical stimuli patterns delivered to a finger tip to measure PDR, and “somatosensory” evoked potentials (SEP). A: Two types of pain stimuli with different intensities were separately loaded with 10-second intervals. B: Two types of pain stimuli with different intensities were randomly loaded with 10-second intervals. C: Two types of pain stimuli with different intensities were separately loaded with 5−20-second intervals. D: Two types of pain stimuli with different intensities were randomly loaded with 5−20-second intervals. Results: The amplitude of PDR to D significantly increased compared to that to A. However, no significant difference was noted in the amplitude between the response to D and responses to B and C. Conclusion(s): These findings indicate that the amplitude of PDR increases when the stimulus is not expected, even in response to the same pain stimulus. In this study, we concluded that PDR is not a spinal sympathetic reflex but a more complex brain response.
874 CAUSALITY – A NEGLECTED ISSUE IN THE FIELD OF PAIN R. W¨orz ° . Bad Sch¨onborn, Germany The analysis of cause-effect-relationships are achievements of the antique. Aristotle differentiated material, form, motion and final causes (causa materialis, formalis, efficiens, and finalis). In modern times, the works of I. Newton, G.W. Leibniz and D. Hume determined the concept of causality. The universal acceptance of the causality principle in its deterministic sense was revoked by quantum theory and chaos research. In the modern scientific discussion of the problem of pain and nociception in the 19th and 20th century, physical causation (causa efficiens) with the scientific approach of explanation and the orientation to the past dominated. Goal and purpose orientation (causa finalis) must be differentiated principally. It has a relation to the future and can be understood by empathy. In the case of simple, monocausal pain, the cause-effect-relationship can be recognized clearly. In pain syndromes with obscure pathogenesis, additional information must be detained. The causal verification or falsification is reached by active intervention. The most important measures are palpation, exertion of pressure and functional tests. Diagnostic local anaesthesia can contribute to the diagnosis, whilst the response to a certain therapy (ex juvantibus) only rarely has a diagnostic value. In chronic pain states, consciousness, biography and personality must be considered. In this case, the methodological approach is not only reduction but participation and understanding. A causal nexus can be found in single cases with sufficient certainty when the foregoing cause extends into its effect in a clear manner. In statistical evaluations, cross-sectional correlations can lead to conjectures about causal relationship. Prospective studies under variations of the conditions yield more information on the probability of causation as well as the recognition of risk factors.
European Journal of Pain 2006, Vol 10 (suppl S1)
Abstracts, 5th EFIC Congress, Free Presentations
871 USING HYPNOSIS IN A CASE OF CHOLECYSTECTOMY, A CASE REPORT
F04 OTHER PSYCHOLOGICAL APPROACHES
A.O. Ozturk ° . Private Practice, Istanbul, Turkey
873 PUPIL DILATION RESPONSE TO NOXIOUS STIMULATION: EFFECT OF VARYING STIMULUS PATTERN
In this study, we aimed that hypnosis can be used as a method of pain control in pre, post surgical periods and during operation. We performed hypnosis on a cholecystectomy case who is 55 years old woman. She had a diagnosis with cholecystolithiasis and cholestasis. The patient was prepared for surgical operation by using hypnosis. This hypnosis method is called as Awareness Under Conscious Hypnosis (AUCH) contains three steps as MAYA (Making Acceptance with Your Awareness), induction and auto-hypnosis. Before or during operation no medicament was used for anesthesia and sedation. She did not feel any pain or discomfort during the incisions, tractions, cauterizations and sewing. She was painless with only hypnosis during and after operation. She was conscious, cooperative and quite happy during her surgery and sometimes she also volunteered to sing songs, tell stories. Her blood pressure was about 135/85 mmHg and heart rate was 80−90/bpm during the operation duration. She was painless, very comfortable in dressing and walking and had no restriction in her movements after operation. This condition continued while she was staying at the hospital. She well cured and went home in 40 hours whereas the usual curing time is about 4 days for this kind of operations. As it is seen in this case, hypnosis can be used as a reliable and effective method for pain control in surgical operations. This makes us eager to study on hypnosis in pain control.
872 HYPNOTHERAPY IN PSYCHOSOMATIC PAIN: A CASE STUDY S. Ramachandra1 ° , S.K.C. Chaturvedi2 . 1 Clinical Psychology (NIMHANS) Bangalore, Karnataka, 2 Psychiatry (NIMHANS) Bangalore, Karnataka, India Background and Aims: Mrs. P., aged 42 years reported psychosomatic body aches, pain, anxiety, depression, and disturbed sleep. She covered much of her face to conceal eczema and it had even spread to face, hands, and feet. Avoided mixing with others as they would look at her again and again. Duration was 6 years with an insidious onset. Initially medical treatment helped her but subsequently dosage had to be increased including steroids resulting in unbearable side effects. Feelings of depression became more pronounced. At this stage she opted for hypnotherapy as a possible intervention. Methods: Psychological assessment (Rorschach, T.A.T., DSSI, and SCT) revealed her to be an introtensive, having difficulty in interpersonal relationships, anxiety and depression with occasional suicidal ideas, and poor self-concept. Excessive worry about the body-image, (thought her face not the same as it used to be) loss of beauty due to eczema seemed to be the core factors for her manifested complaints. Therapeutic strategy consisted of trance induction, deepening the trance, suggestions with enhanced positive imagery to counter the negative feelings and poor selfconcept and posthypnotic suggestions. Results and Conclusions: Each successive hypnotherapy session resulted in better eye contact, tone of talking, and expressing herself confidently. Dark patches on her face were visibly lighter after 7−8 sessions. A total of 1 sessions were held with appreciable improvement and the level of medication was gradually reduced to a bear minimum. Steroids were completely withdrawn. 6 months’ follow up showed the level of improvement was maintained.
S. Oka1 ° , B. Kim1 , Y. Imamura2 , I. Nakajima3 , Y. Oi1 . 1 Department of Dental Anesthesiology, 2 Department of Oral Diagnosis, 3 Department of Pediatric Dentistry, Nihon University School of Dentistry, Tokyo, Japan Background and Aims: The pupil dilation response (PDR) to a painful stimulus is a subtle, event-related increase in pupil diameter that occurs following brief noxious stimulation. However, a central, unresolved issue is whether this PDR is a spinal sympathetic reflex or not. We speculated that PDR could be a brain-mediated response, and examined whether PDR amplitude is increased by unexpected stimuli compared to expected stimuli. Methods: In a double blind trial, eight healthy, female volunteers participated in this study. The subjects received the following four kinds of painful electrical stimuli patterns delivered to a finger tip to measure PDR, and “somatosensory” evoked potentials (SEP). A: Two types of pain stimuli with different intensities were separately loaded with 10-second intervals. B: Two types of pain stimuli with different intensities were randomly loaded with 10-second intervals. C: Two types of pain stimuli with different intensities were separately loaded with 5−20-second intervals. D: Two types of pain stimuli with different intensities were randomly loaded with 5−20-second intervals. Results: The amplitude of PDR to D significantly increased compared to that to A. However, no significant difference was noted in the amplitude between the response to D and responses to B and C. Conclusion(s): These findings indicate that the amplitude of PDR increases when the stimulus is not expected, even in response to the same pain stimulus. In this study, we concluded that PDR is not a spinal sympathetic reflex but a more complex brain response.
874 CAUSALITY – A NEGLECTED ISSUE IN THE FIELD OF PAIN R. W¨orz ° . Bad Sch¨onborn, Germany The analysis of cause-effect-relationships are achievements of the antique. Aristotle differentiated material, form, motion and final causes (causa materialis, formalis, efficiens, and finalis). In modern times, the works of I. Newton, G.W. Leibniz and D. Hume determined the concept of causality. The universal acceptance of the causality principle in its deterministic sense was revoked by quantum theory and chaos research. In the modern scientific discussion of the problem of pain and nociception in the 19th and 20th century, physical causation (causa efficiens) with the scientific approach of explanation and the orientation to the past dominated. Goal and purpose orientation (causa finalis) must be differentiated principally. It has a relation to the future and can be understood by empathy. In the case of simple, monocausal pain, the cause-effect-relationship can be recognized clearly. In pain syndromes with obscure pathogenesis, additional information must be detained. The causal verification or falsification is reached by active intervention. The most important measures are palpation, exertion of pressure and functional tests. Diagnostic local anaesthesia can contribute to the diagnosis, whilst the response to a certain therapy (ex juvantibus) only rarely has a diagnostic value. In chronic pain states, consciousness, biography and personality must be considered. In this case, the methodological approach is not only reduction but participation and understanding. A causal nexus can be found in single cases with sufficient certainty when the foregoing cause extends into its effect in a clear manner. In statistical evaluations, cross-sectional correlations can lead to conjectures about causal relationship. Prospective studies under variations of the conditions yield more information on the probability of causation as well as the recognition of risk factors.