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Measuring response to clinical pain
S173 THE ADAPTIVE FUNCTION OF THE DREAMING PROCESS AND THE [ 2O8 Slide EXPERIENCE OF CHRONIC PAIN. S.R. Lancey, R. Greenberg*, and I Thu 15:00 D.L. Bachrach, VA Medical Cent--~r,Bo-~on, MA 02130, U.S.A. I Theatre A Aim of Investigation: Research has consistently shown tha~ the deprivation of rapid eye movement (REM) sleep relieves the symptoms of certain depressions significantly. Since depression is heavily implicated in chronic pain syndromes, this study was designed to explore: (1) whether REM deprivation will reduce the intensity of the pain experience and, if so, (2) whether this relationship will be affected by personality characteristics. Methods: Two groups of eight, male, low back pain patients were selected based on their medical and personality profiles (as defined by MMPI profile types): Group l was composed of "somatization-V" (I-3/3-I) patients and Group 2 was composed of "normal limits" patients. Each patient spent 13 consecutive nights in the sleep laboratory where they were REM-deprived (REMD) one night and awakened an equal number of times in non-REM sleep stages on another. Several measures of the pain experience, (including magnitude matching, were obtained on each of the following mornings. Results: Following REMD, the "somatic" profile group experienced significantly less pain while the "normal limits" group experienced significantly more pain. This relationship was exactly reversed when patients were awakened from non-REM sleep. Conclusions: The reduction of the pain experience with the "somatic" profile group and the intensification of the pain experience for the "normal limits" group indicates that the adaptive function of the dreaming process extends to chronic pain syndromes. Implications for the dynamic involvement of depression in the pain experience are discussed as well as for selective use of antidepressant medication in the treatment of chronic pain. i
THE SIGNIFICANCE OF COGNITIVE VS. PHYSIOLOGICAL FACTORS IN 209 Slide THE SELF-REGULATION OF PAIN. D. DeGood & R. TaRt*. Pain Thu 15:15 Clinic, Department of Anesthesiology, University of Thentre A Virginia, Charlottesville, VA 22908, USA Aim: The role of somatic and autonomic activation levels in the selfregulation of pain is unclear. Presumably, changes in pain perception and tolerance which may accompany biofeedback, autogenic, or other self-regulatory training procedures could be a result of cognitive changes as well as physiological changes. This question was explored within the context of a self-regulation program by examining the relationships between selfreported levels of pain and physiological activation. Method: Fifty benign chronic pain outpatients participated in an eightsession program combining EMG biofeedback, autogenic instructions, and behavioral counseling. Pain rating scales were kept by the patient throughout the study, and within-session physiological measures included frontalis EMG, fingertip temperature, heart rate, and respiration rate. Results: Correlations between weekly average pain ratings and withinsessions nhysiologieal measures were calculated for the weeks/sessions I, !5, and ~. The single significant correlation involving baseline physiological measures was between higher temperature and less pain at sessions 5 (r=.38) and 8 (r=.L~1). By contrast, the single significant correlation involving within-session physiological change was between EMG reductions (ore to host session) and lesser pain at sessions ~ (r=.36) and 8 (r=.iSO). Discussion: The finding that the within-session ability to self-red,ulate EMG level, rather the% baseline level of EMG, related to self-reported pain argues against the lik~ihood that absolute level of frontalis area muscle tension played a significant role in the pain. Conceivably, this EI4G control-pain reduction relationship was mediated by cognitive factors such as feelings of mastery and consequent positive expectan~cies.
THE SIGNIFICANCE OF COGNITIVE VS. PHYSIOLOGICAL FACTORS IN 209 Slide THE SELF-REGULATION OF PAIN. D. DeGood & R. TaRt*. Pain Thu 15:15 Clinic, Department of Anesthesiology, University of Thentre A Virginia, Charlottesville, VA 22908, USA Aim: The role of somatic and autonomic activation levels in the selfregulation of pain is unclear. Presumably, changes in pain perception and tolerance which may accompany biofeedback, autogenic, or other self-regulatory training procedures could be a result of cognitive changes as well as physiological changes. This question was explored within the context of a self-regulation program by examining the relationships between selfreported levels of pain and physiological activation. Method: Fifty benign chronic pain outpatients participated in an eightsession program combining EMG biofeedback, autogenic instructions, and behavioral counseling. Pain rating scales were kept by the patient throughout the study, and within-session physiological measures included frontalis EMG, fingertip temperature, heart rate, and respiration rate. Results: Correlations between weekly average pain ratings and withinsessions nhysiologieal measures were calculated for the weeks/sessions I, !5, and ~. The single significant correlation involving baseline physiological measures was between higher temperature and less pain at sessions 5 (r=.38) and 8 (r=.L~1). By contrast, the single significant correlation involving within-session physiological change was between EMG reductions (ore to host session) and lesser pain at sessions ~ (r=.36) and 8 (r=.iSO). Discussion: The finding that the within-session ability to self-red,ulate EMG level, rather the% baseline level of EMG, related to self-reported pain argues against the lik~ihood that absolute level of frontalis area muscle tension played a significant role in the pain. Conceivably, this EI4G control-pain reduction relationship was mediated by cognitive factors such as feelings of mastery and consequent positive expectan~cies.