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Hypnosis for pain and neuromuscular rehabilitation with multiple sclerosis: Case summa y, literature Review, and Analysis of Outcomes
Abstract
Videotaped treatment sessions in conjunction with 1-month, 1-year, and 8-year follow-up allow a unique level of analysis in a case study of hypnotic treatment for pain and neuromuscular rehabilitation with multiple sclerosis (MS). Preparatory psychotherapy was necessary to reduce the patient's massive denial before she could actively participate in hypnosis. Subsequent hypnotic imagery and posthypnotic suggestion were accompanied by significantly improved control of pain, sitting balance, and diplopia (double vision), and a return to ambulatory capacity within 2 weeks of beginning treatment with hypnosis. Evidence regarding efficacy of hypnotic strategies included (a) direct temporal correlations between varying levels of pain relief and ambulatory capacity and the use versus nonuse of hypnotic strategies, (b) the absence of pharmacological explanations, and (c) the ongoing presence of other MS-related symptoms that remained unaltered. In conjunction with existing literature on hypnosis and neuromuscular conditions, results of this case study strongly suggest the need for more detailed and more physiologically based studies of the phenomena involved.
... The clinician may also bring into the suggestions ideas about the patient's values and life goals, and link them to what is known about adaptive pain coping (e.g., maintaining an appropriate level of activity, focusing on life goals other than just pain reduction, increasing participation in distracting and healthy activities, appropriate activity pacing), and adaptive pain attributions (see Dane, 1996;Patterson & Jensen, 2003). To the extent that any experience of pain is associated with memories that contribute to pain and suffering, links to more comforting memories via age regression can be created (see, for example, Crasilneck, 1995;Lu, Lu, & Kleinman, 2001;and Abrahamsen, R., Baad-Hensen. ...
... Such suggestions can easily be incorporated into any hypnotic analgesia treatments that also include the other suggestions listed above. But such suggestions need not be limited to persons with phantom limb pain or CRPS-1 (see Dane, 1996, for an example of the use of this type of suggestion in a patient with MS). Asking patients to experience themselves as moving comfortably and easily presumably produces cortical activity and connections associated with pain-free movement. ...
Although there remains much to be learned, a great deal is now known about the neurophysiological processes involved in the experience of pain. Research confirms that there is no single focal "center" in the brain responsible for the experience of pain. Rather, pain is the end product of a number of integrated networks that involve activity at multiple cortical and subcortical sites. Our current knowledge about the neurophysiological mechanisms of pain has important implications for understanding the mechanisms underlying the effects of hypnotic analgesia treatments, as well as for improving clinical practice. This article is written for the clinician who uses hypnotic interventions for pain management. It begins with an overview of what is known about the neurophysiological basis of pain and hypnotic analgesia, and then discusses how clinicians can use this knowledge for (1) organizing the types of suggestions that can be used when providing hypnotic treatment, and (2) maximizing the efficacy of hypnotic interventions in clients presenting with pain problems.
... Many studies have focused on the effectiveness of hypnosis in reducing pain, anxiety, and depression and improving a patient's quality of life in chronic diseases, such as cancer, stroke, and neurodegenerative diseases. 19,20,21,20 By applying hypnotherapy, a therapist can help patients with chronic conditions reduce negative emotions, can induce analgesia, and can encourage them to continue the rehabilitative treatment. 20,22 Some studies have described the effectiveness of hypnotherapy or hypnosis for chronic-pain conditions for people with MS, [23][24][25] to reduce fatigue 26,27 and stress and to improve quality of life. ...
Context:
Stress and chronic pain are the factors that most influence the quality of life and well-being of people with MS, and 90% of adults with MS suffer from persistent fatigue. These symptoms can be associated with other disorders such as depression, and drug treatments provide inadequate comfort for most people with them.
Objective:
The study intended to examine the impact of hypnosis and hypnotherapy in the management of symptoms of people with multiple sclerosis (MS), such as stress, chronic pain, an inferior quality of life, and a lack of psychological well-being.
Design:
The research team performed a systematic narrative review by searching the PubMed and Web of Science databases, including review articles and other studies for additional citations.
Setting:
The study was conducted at our Scientific Institute for Research (IRCCS) in Messina.
Results:
Only 14 of 121 publications met the inclusion criteria and were selected. Hypnotic treatment is an effective therapy that has beneficial impacts on the intensity of perceived pain, psychological well-being, mood disorders, and fatigue, and in addition, it significantly improves physical functioning in MS patients. The same effects haven't been obtained with other nonpharmacological techniques.
Conclusion:
Hypnosis is an appropriate psychological therapy for the management of MS patients' symptoms.
... [11][12][13][14] Among these interventions, guided imagery, consisting of visualization and imagination with the goal of evoking a state of relaxation or a specific outcome (myelin repair or tumor attack), and, which can engage different senses (visual, tactile, kinesthetic, olfactory, etc.) has been shown to be effective in treating anxiety, improving mood and improving QoL in patients with MS. 12,14 Another such intervention is hypnosis, which consists of a relaxed state of focused, inward attention; during hypnosis, peripheral awareness is reduced, hypnotic phenomena are present (hallucination, catalepsy, amnesia or anesthesia) and usually, a specific therapeutic outcome is addressed (e.g., pain management or solving psychological problems). 11 Hypnosis has been shown to be effective at replicating the improvement gained from therapy sessions, 15 improving physical function, alleviating symptoms, 16,17 improving mood and disease expectancy, 18 and reducing pain in patients with MS. 13,19 On the other hand, hypnoanalysis, which consists of obtaining information from the unconscious mind, has rarely been reported 20,21 and includes ideomotor questioning about physical or psychological problems, regression, and restructuring of negative past events. 20 To date, this technique has not yet been used to identify possible causes and/or solutions of chronic diseases. ...
Background:
To date, no studies have used hypnosis to examine and manage the potential emotional causes of multiple sclerosis (MS) in the scientific field; therefore, we decided to compare the effectiveness of hypnoanalysis and guided imagery for determining and manage these emotional causes.
Methods:
Fifteen participants with severe MS were included and assigned into 2 groups: hypnoanalysis and guided imagery. In the hypnoanalysis group, the participants underwent 10 hypnotic sessions to understand events related to the cause of the disease, which were restructured (the events were modified by adding the psychological resources that each involved person needed); in addition, other techniques were used to investigate the causes and solutions according to the participants' unconscious. The guided imagery group received 10 group sessions of body relaxation and guided imagery, which were recorded for practice at home. Outcome measures, namely, disability (the Expanded Disability Status Scale, EDSS), quality of life (QoL, measured with the SF-36) and number of relapses, were evaluated 4 months previous the intervention, at baseline, post-intervention, and 3 months later.
Results:
Hypnoanalysis revealed that stressful events and psychoemotional maladaptive patterns acted as causal, detonating, or aggravating factors of disease, and psychoemotional changes were the most frequent and varied solutions. No changes were observed in disability between the two groups. The guided imagery group showed an improvement in 2 subscales of QoL when compared with the hypnoanalysis group (which disappeared at the follow-up); this difference is probably due to the increased number of sessions and probably due to psychoemotional maladaptive patterns being more frequently mentioned than difficult circumstances in life and/or unsolved past events. However, the techniques used in hypnoanalysis were effective in understanding the potential emotional causes of MS, which showed high intra- and inter-participant consistency.
Conclusions:
The daily use of guided imagery overcame the restructuring of negative past events to improve QoL in patients with MS.
Trial registration:
ACTRN12618002024224 (retrospectively registered).
... It is a noninvasive intervention and free of side effects which helps to improve the quality of life of patients (Bo et al., 2018). The results of various studies indicated that the self-hypnosis training may reduce symptoms of disease and severity of pain in patients suffering from multiple sclerosis and chronic pain (Dane, 1996;Jensen et al., 2005;Spiegel & Spiegel, 2004). ...
Multiple sclerosis is a chronic, demyelinating disease of the central nervous system mainly affecting young adults. In addition to physical problems, the patients suffer from many psychological problems affecting their psychological well-being. The aim of the present study was to determine the effectiveness of group-based cognitive hypnotherapy on the psychological well-being of patients suffering from multiple sclerosis. This study was designed as a clinical trial with a pretest-posttest control group. From 60 patients diagnosed with multiple sclerosis referred to Beheshti hospital in Yasuj, Iran, 45 patients who met the inclusion criteria were selected by the convenience sampling method. The patients were randomly assigned to intervention (23 individuals) and control (22 individuals) groups through stratified random allocation. After completing the Ryff Scales of Psychological Well-Being, the intervention group attended eight sessions of group-based cognitive hypnotherapy on a weekly basis. The control group did not attend any intervention sessions. At the end of the eight intervention sessions, both groups completed the Ryff’s Scale of Psychological Well-being again. The collected data were analyzed using the SPSS software (Version 23). Analysis of Covariance (ANCOVA) and two-way Analysis of variance (ANOVA) tests were used in order to compare the groups. The results indicated that cognitive hypnotherapy had a significant effect on the total score of psychological well-being (F (45, 1) = 6.07, p = .018, η2 = 0.12) and the dimension of environmental mastery (p < .05). Therefore, it is recommended to use hypnotherapy to promote the psychological well-being of patients suffering from multiple sclerosis.
... Hypnosis and self-hypnosis training have been shown to be effective for many chronic pain conditions (Elkins, Jensen, & Patterson, 2007;Jensen, Day, & Miro, 2014;Jensen & Patterson, 2014), including individuals with MS and chronic pain (Dane, 1996;Hosseinzadegan, Radfar, Shafiee-Kandjani, & Sheikh, 2017). Preliminary evidence also suggests that hypnosis may reduce fatigue (Defechereux et al., 2000;Mendoza et al., 2016;Montgomery et al., 2014). ...
This pilot study evaluated the possibility that 2 interventions hypothesized to increase slower brain oscillations (e.g., theta) may enhance the efficacy of hypnosis treatment, given evidence that hypnotic responding is associated with slower brain oscillations. Thirty-two individuals with multiple sclerosis and chronic pain, fatigue, or both, were randomly assigned to 1 of 2 interventions thought to increase slow wave activity (mindfulness meditation or neurofeedback training) or no enhancing intervention, and then given 5 sessions of self-hypnosis training targeting their presenting symptoms. The findings supported the potential for both neurofeedback and mindfulness to enhance response to hypnosis treatment. Research using larger sample sizes to determine the generalizability of these findings is warranted.
... Evidence for the potential benefit of hypnotherapy for persons with MS pain began with case reports and case series (Dane, 1996;Sutcher, 1997). These reports were followed by controlled trials evaluating specific effects on chronic pain apart from possible effects of placebo or therapist attention. ...
Pain is common in patients with multiple sclerosis. This study evaluated self-hypnosis for pain control in that population. A randomized clinical trial was conducted on 60 patients, who were assigned to either a control group or to a self-hypnosis group, in which patients performed self-hypnosis at least 10 times a day. All patients were trained to score the perceived pain twice daily on a numerical rating scale and also reported the quality of pain with the McGill Pain questionnaire. Repeated-measures analysis showed a significant difference between the groups; pain was lower in the self-hypnosis group but was not maintained after 4 weeks. Self-hypnosis could effectively decrease the intensity and could modify quality of pain in female patients with multiple sclerosis.
... Hypnosis might be an effective intervention in the case of chronic pain associated with Multiple Sclerosis (Grade of recommendation: D) (Dane, 1996;Jensen et al., 2009aJensen et al., ,b, 2011Tierno et al., 2014). Preliminary evidence supports the use of hypnosis in the treatment of pain in various neurological conditions, including Amyotrophic Lateral Sclerosis (Palmieri et al., 2012;Kleinbub et al., 2015), Parkinson's Disease (Elkins et al., 2013), Guillain-Barré Syndrome (Fowler and Falkner, 1992), neuropathic pain due to HIV (Dorfman et al., 2013), and Post-Polio Syndrome (Hammond, 1991) (Grade of recommendation: GPP). ...
Background: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams.
Objectives: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases.
Methods: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions.
Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive—Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post—Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache.
Conclusions: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.
... We are aware of only a few case studies of hypnotic treatment for pain in persons with MS. For example, Dane (1996) described a patient with MS who was able to maintain stable pain control and some neuromuscular rehabilitation gains for 3 months after hypnotic treatment via the use of regular self-hypnosis practice. The portion of treatment that targeted pain included suggestions for putting pain into the background and for numbing any painful areas. ...
... In addition, three uncontrolled case reports and case series have reported benefits following hypnotic treatment in patients with MS and chronic pain. In the first of these, Dane (1996) described a patient with MS who was able to maintain stable pain control and some neuromuscular rehabilitation gains for 3 months after hypnotic treatment that also included regular self-hypnosis practice. Similarly, Sutcher (1997) reported benefits from hypnotic treatment in 3 patients with MS, 1 who received treatment specifically targeting pain. ...
Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.
... R. Hilgard & LeBaron, 1984), reflex sympathetic dystrophy (Gainer, 1992), acquired amputation (Chaves, 1986; Siegel, 1979), childbirth (Haanen et al., 1991), spinal cord injury (M. Jensen & Barber, 2000), sickle cell anemia (Dinges et al., 1997), arthritis (Appel, 1992; Crasilneck, 1995), temporomandibular joint disorder (Crasilneck, 1995; Simon & Lewis, 2000), multiple sclerosis (Dane, 1996; Sutcher, 1997), causalgia (B. Finer & Graf, 1968), lupus erythematosus (S. ...
Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.
... There are a number of reasons why it may be an efficacious form of relaxation therapy for people with MS. Together with previous research that has documented the psychosocial benefits of relaxation for people with MS, there are also a number of case reports that have indicated that heterohypnosis may positively influence some psychophysiological problems in MS (Dane, 1996). In addition, AT does not require a conscious active effort to relax the muscles and, thus, may be a viable relaxation technique for people with potential neurological and muscular dys- function. ...
This study was a pilot project to explore the effect of an autogenic training program (AT; a relaxation intervention) on the health-related quality of life (HRQOL) and well-being for people with multiple sclerosis. Participants either met weekly for sessions in AT for 10 weeks (n = 11) or were assigned to the control group (n = 11). The AT group was also asked to practice the technique daily at home. Scales designed to measure HRQOL and aspects of well-being (mood and depressed affect) were taken preintervention and at week 8 of the 10-week program. ANCOVAs using a measure of social support and pretest scores as covariates revealed that at the posttest the AT group reported more energy and vigor than the control group and were less limited in their roles due to physical and emotional problems. Future research should involve studies conducted over an extended period, together with sufficiently sized samples to explore the effect of frequency of practice of relaxation training on HRQOL and well-being for people with multiple sclerosis.
... We are aware of only a few case studies of hypnotic treatment for pain in persons with MS. For example, Dane (1996) described a patient with MS who was able to maintain stable pain control and some neuromuscular rehabilitation gains for 3 months after hypnotic treatment via the use of regular self-hypnosis practice. The portion of treatment that targeted pain included suggestions for putting pain into the background and for numbing any painful areas. ...
Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment.
Integrative models of health care have garnered increasing attention over the years and are currently being employed within acute and secondary health care services to support medical treatments in a range of specialities. Clinical hypnosis has a history of working in partnership with medical treatments quite apart from its psychiatric associations. It aims to mobilise the mind–body connection in order to identify and overcome obstacles to managing symptoms of ill health, resulting in overall improved emotional and physical well-being. This article aims to encourage the use of hypnotherapy in physical health care by highlighting the effectiveness of hypnosis as an adjunct to medical treatment and identifying barriers preventing further integrative treatments.
Psychological treatment is targeted on pain cognition, e.g., catastrophizing, pain-related beliefs and coping, and social factors. In particular, catastrophizing is a predictor of a worse outcome for neuropathic pain, including CP [1]. Emotional and cognitive factors (e.g., anxiety, depression, and anger or, vice versa, positive emotions) are known to alter the perceived intensity of pain (the “salience”) but also the associated autonomic responses. Pain of longer durations, depression, anger, helplessness, and pain magnification, especially in single males, are independent predictor factors of suicidal ideation. On the other hand, women affected by CPSP use spiritual and religious activities as a coping strategy and perceive their emotional state as the cause of their pain [2]. In line with this finding, there is a significant positive correlation between spiritual well-being and both pain self-efficacy and satisfaction with life in SCI patients [3]. Importantly, elevated impulsive and neurotic personality tendencies and depressed mood are indicators of heightened risk of pain medication misuse [4].
The history of hypnosis is rich in its examination of mind-body interactions. Early reports of mesmeric cures extolled its ability to heal physical illness, psychosomatic disorders were analyzed and treated through hypnotic sessions, and subsequent papers provided numerous examples of its promise for reducing surgical and other forms of pain. As technology evolved, researchers also became increasingly well equipped to study the physiological concomitants of both the hypnotic state and hypnotic suggestions. This article, in an attempt to address the issue of hypnosis and mind-body interactions, presents a summary of research on the potential for hypnosis to alter physiological processes in response to hypnotic suggestions. It reviews the literature on hypnosis and the body and that covers the use of hypnosis both in changing physiological systems and in treating physical symptoms or conditions. Furthermore, it assesses the evidence as a whole and offer recommendations for future investigations.
Two premier hypnotherapists collaborate on a new edition of this award-winning text, a collection of techniques and information about hypnosis that no serious student or practitioner should be without. A thorough and practical handbook of various hypnotherapeutic measures, it contains illustrative examples and logically argued selection methods to help practitioners choose the ideal method for a needed purpose. Section by section, it breaks out the various methods and phenomena of hypnosis into easily digested chunks, so the reader can pick and choose at leisure. An excellent practical guide and reference that is sure to be used regularly. The authors have a wide and longstanding experience on the subject and thus can stay on clinically approvable methods.
Chronic pain is a significant concern for many individuals with spinal cord injury (SCI). However, few effective treatments have been found for SCI-related pain. The current study sought to explore whether persons with SCI-related pain would respond to hypnotic suggestion for pain relief, and to examine possible moderators of this response. Twenty-two individuals with SCI-related pain rated their 6-month average and least pain on 0-10 scales of pain intensity. They also rated their current pain intensity and pain unpleasantness on 0-10 scales at eight subsequent time points: immediately before a hypnotic induction, immediately after the induction, after each of five hypnotic suggestions, and at the end of the entire session after awakening. Eighty-six percent of the participants reported decreases in pain intensity and pain unpleasantness from pre-induction to post-induction. Significant omnibus analyses of variance followed by pairwise comparisons indicated statistically significant decreases in pain intensity and unpleasantness from pre-to post induction for both pain intensity and pain unpleasantness, and an additional decrease in pain intensity following the analgesia suggestion. In addition, although not specifically suggested, the decrease in pain that subjects experienced during the hypnotic session persisted after they were instructed to awaken. The ability of the subjects to decrease pain intensity to levels lower than the least pain they had experienced during the past six months was associated with hypnotic responsiveness, while the decrease in pain intensity from pre-induction to post-analgesia suggestion was associated with 6-month average pain. These preliminary findings indicate that hypnotic interventions have the potential to benefit many individuals with SCI-related pain, and that controlled trials of hypnotic analgesia with this population are warranted.
We wanted to find out if psychotherapy may influence the course of the physical aspects of multiple sclerosis and the consequences of psychotherapy for coping processes. 46 patients diagnosed with multiple sclerosis who had chosen to undergo a 1-yr. group psychotherapy treatment were compared with a control group of 24 multiple-sclerosis patients without such treatment. They were given the Giessen test (personality test), the Achievement Capacities Questionnaire by Kesselring, an intensive interview as well as the content analysis scales of verbal behavior by Gottschalk and Gleser. The various tests were carried out at each of four times of measurement with a 2-yr. follow-up. There were significant changes in the area of relationships and aggressive loosening (interview) between the Therapy and Control groups. Several changes were also found with regard to physical symptoms (Achievement Capacities Questionnaire) in the Therapy group compared to the Control group, e.g., increases in physical mobility and decreases in care of the body. The decreases appear to be a known effect of therapy with psychosomatic disorders. We interpret it psychoanalytically as resistance against releasing anxiety of counter-cathected motives which multiple sclerosis helps to keep unconscious. In a follow-up, the Therapy group showed greater optimism and physical improvements, e.g., decrease in feeling cold and lack of energy. Some positive changes appeared in both groups, such as, for example, an improvement of cognitive impairment (Gottschalk & Gleser). It appears that the attention from the research itself may have affected both groups because some members of both groups were in contact and hence the Control group was also informed about the research project and its underlying hypothesis.
The literature was reviewed to identify variables that contribute or serve as barriers to employment for people living with multiple sclerosis (MS). The underlying pathology and progression of MS was described along with the new trends in medical management that have changed the course of the disease. We concluded that employment is associated with perceived quality of life for people living with MS, that people with MS are disproportionately unemployed given their educational and vocational histories, and that health care and rehabilitation professionals may not adequately advocate for and support continuing employment for their clients with MS.
Chronic pain is considered to be a complex phenomenon, involving an interrelation of biological, psychosocial and sociocultural factors. Currently, no single treatment or therapy can address all aspects of this pathology. In our expert tertiary pain centre, we decide to assess the effectiveness of four treatments for chronic pain classically proposed in our daily clinical work: physiotherapy; psycho-education; physiotherapy combined with psycho-education; and self-hypnosis/self-care learning.
This study included 527 chronic pain patients, with a mean duration of pain of 10 years. Patients were allocated either to one of the four pre-cited treatment groups or to the control group. Pain intensity, quality of life, pain interference, anxiety and depression were assessed before and after treatment.
This study revealed a significant positive effect on pain interference and anxiety in patients included in the physiotherapy combined with psycho-education group, after 20 sessions spread over 9 months of treatment. The most prominent results were obtained for patients allocated to the self-hypnosis/self-care group, although they received only six sessions over a 9-month period. These patients showed significant benefits in the areas of pain intensity, pain interference, anxiety, depression and quality of life.
This clinical report demonstrates the relevance of biopsychosocial approaches in the improvement of pain and psychological factors in chronic pain patients. The study further reveals the larger impact of self-hypnosis/self-care learning treatment, in addition to a cost-effectiveness benefit of this treatment comparative to other interventions.
© 2015 European Pain Federation - EFIC®
Psychotherapy, and in particular hypnotherapy, affects the brain, as well as the thoughts and beliefs processed by the brain, through the process of neuroplasticity and neurogenesis. The brain is constantly adapting to new information and new circumstances, e.g., modifying patterns of connection between different parts of the brain and reorganizing neural pathways and functions (neuroplasticity), as well as developing new neurons (neurogenesis). We will be looking at very specific ways that hypnosis and hypnotherapy influence these changes, and at some of the dysfunctional conditions that they can be helpful in managing or repairing, such as addictions, ADHD, autism, chronic pain, depression, and sleep disorders. First we begin with an overview of the unconscious functions at work, day and night, in our physical, emotional, and mental life: resting-state networks, especially the default mode network; vagal nervous system and heart-rate variability; ultradian and circadian rhythms; reward and stress networks; and the mirror neuron network. The default mode network is vital to our sense of self and sense of agency, moral sensitivity, organizing memory to reconstruct the past, simulating the future such as inner rehearsal and daydreaming, and imagination such as free association, stream of consciousness, and taking other people's perspective. We provide suggestions for "brain-friendly" psychotherapy. "[M]ost people do not know that most mental processes are autonomous." 1 "All mental states have correlates in the brain and any change in our attitudes, beliefs, cognitive styles, preferences and modes of interaction must therefore be accompanied by changes in the brain." 2 "Whether it is called symptom relief, differentiation, ego strength, or awareness, all forms of therapy are targeting dissociated neural networks for integration." 3 A fundamental assertion of this article is that "hypnosis can change the nervous system for the better." 4 Hypnosis affects the brain, as well as the thoughts and beliefs processed by the brain, through the process of neuroplasticity and neurogenesis. The _____________________________ * 3716 – 274th Ave SE Issaquah, WA 98029 800-326-4418
It is the restoration of the physical and psychological functional capacities of individuals who have suffered functional losses because of traumatic injury or illness that is at the essence of rehabilitation. The rehabilitation process is a bio-psychosocial endeavor as well as a model of holistic health through its interdisciplinary nature. Rehabilitation is also about learning to adapt to disability and achieve accommodation for deficits. One of the primary contributions of hypnosis to rehabilitation is its potential for facilitating change and accelerating learning. In this article, the phenomenon of hypnosis will be discussed to provide the reader with a basic understanding of what hypnosis is and how it can be used in mind-body medicine and specifically how it can be used in rehabilitation. The research will be discussed as well as the psychophysiological correlates of the hypnotic state. How hypnosis has been used with various medical conditions (stroke, amputation, etc) or functional problems (ambulation, ADLs, etc) is reviewed as well as how hypnosis can facilitate the patient’s attainment of rehabilitation goals. An argument is made that self-hypnosis allows patients to develop an experience of “self” that reflects mastery and competence. An extensive reference list is provided for the serious student.
Objective: To illustrate the value of modifying relaxation training techniques according to level of spinal cord injury. Participants and Setting: Six individuals receiving psychological services on an inpatient spinal cord injury unit. Procedure: Psychological assessment and interdisciplinary team consultation were used to develop individualized relaxation training protocols. Results: Staff observations and patient self-reports revealed improvements in various behavioral and affective factors (e.g., reduced pain, increased participation in therapy, diminished depression). Conclusions: Clinicians should consider level of spinal cord injury and individual differences when selecting relaxation techniques. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
BACKGROUND: Multiple sclerosis is the most common demyelinating disorder among young adults. The disease is frequently accompanied by psychiatric disturbances, of which depression is the main cause of impaired quality of life. The lifetime risk of depression among patients with multiple sclerosis is as high as 50%, and the risk of suicide is greatly increased in this subgroup. Surprisingly, despite advances in the treatment of depression, little research focusing on depressed patients with multiple sclerosis has been published. It is important that neurologists know how to approach the depressive co-morbidity.
REVIEW SUMMARY: Psychotherapy, electroconvulsive treatment, pharmacotherapy, and light therapy are, alone or in combination, the treatments for depression. The emerging trend in neurological patients and patients with multiple sclerosis is to combine support group therapy and pharmacological interventions as the first-line treatment for depression. Based on tolerability and pharmacokinetic studies, the use of serotonin-specific reuptake inhibitors is recommended for patients with multiple sclerosis. Electroconvulsive therapy is efficient, but more research is needed to explore possible contraindications for this procedure, such as active lesions.
CONCLUSIONS: This review allows the neurologist to better understand the approach to treatment of patients with multiple sclerosis suffering from co-morbid depression. The use of pharmacotherapy is encouraged so that quality of life, rehabilitation efforts, and risk of suicide are improved. There is urgent need for large-scale studies using the newer antidepressants now available in the United States and Europe.
(C) Williams & Wilkins 1998. All Rights Reserved.
This chapter is intended to provide a comprehensive overview of hypnosis and its clinical applications. The chapter will review the history and will shed some light on current scientific theories regarding the hypnotic process based recent neuroimaging, electrophysiological and neurochemical understanding. It will particularly discuss a proposed model to understand the clinical hypnotic process, as well as how hypnosis is viewed by members of different cultures. It will discuss a practical way of assessing hypnotizability, the hypnotic induction profile. The correlation between hypnotizability, personality style and DSM-IV diagnostic categories will be discussed as the basis to develop treatment strategies for a wide range of psychosomatic and medical disorders, as well as selected psychiatric problems.
Fifteen adults with multiple sclerosis were given 16 sessions of treatment for chronic pain that included 4 sessions each of 4 different treatment modules: (a) an education control intervention; (b) self-hypnosis training (HYP); (c) cognitive restructuring (CR); and (d) a combined hypnosis-cognitive restructuring intervention (CR-HYP). The findings supported the greater beneficial effects of HYP, relative to CR, on average pain intensity. The CR-HYP treatment appeared to have beneficial effects greater than the effects of CR and HYP alone. Future research examining the efficacy of an intervention that combines CR and HYP is warranted.
Smallest space analysis (SSA) was used to examine structural aspects of the Creative Imagination Scale (CIS), Harvard Group Scale of Hypnotic Susceptibility, Form:A (HGSHS:A), and Stanford Scale of Hypnotic Susceptibility, Form C (SHSS:C). Correlation matrices for each of the instruments came from published studies of other investigators. The SSA on the CIS suggested the presence of 1 facet, focus of processing, with 2 subsets of items: somato-sensory and imagination sensory. The combined 22-item matrix SSA showed that the CIS and HGSHS:A items regionalized separately. The item configuration suggested 1 facet, nature of suggestions including 3 subsets: direct motor items of the HGSHS:A, challenge-inhibition items of the HGSHS:A, and the cognitive items of the CIS. The SSA for the SHSS:C suggested 2 facets, containing 2 elements each: processing focus of suggestions (cognitive-sensory and motor-sensory) and nature of suggestions (direct and challenge-inhibition). A general mapping sentence is offered with possible implications.
This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS? The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region. Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation. These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.
The common medical treatments of neuropathic pain, medication and nerve blocks, are often only partially effective in providing significant and long-term pain relief. Patients suffering chronic pain often fall prey to associated emotional suffering, functional impairment, and difficulties in multiple areas of their lives, including family disruption, social withdrawal, and vocational disability. An interdisciplinary approach to pain management draws on the skills of physical and occupational therapists, pain psychologists, biofeedback specialists, and vocational counselors. It focuses on both pain management and functional restoration, and should be considered standard treatment for chronically painful conditions. Interdisciplinary pain management views the patient as an active agent, responsible for learning and applying self-management techniques for controlling pain, with the staff assuming a teaching and consulting role. Although much more labor intensive, interdisciplinary pain management is more effective over time in managing chronic pain, in preventing unnecessary emotional and physical impairment, and in controlling overall medical costs.
HYPNOTIC techniques have been used in medical practice in different situations, mainly for pain control and anxiety relief 1-6 and to reduce stress symptoms such as tachycardia or shivering. 7 In burn victims, Crasilneck et al. showed that hypnosis could stimulate emotional recovery, mobility, and wound healing. 8 Hypnosis could also reduce by one third the incidence of postoperative nausea and vomiting in women undergoing breast surgery. 9 In the case we report, hypnotic psychotherapy resulted in hastened weaning from mechanical ventilation as well as to reestablishment the day-night sleep cycle.
We wanted to find out if psychotherapy may influence the course of the physical aspects of multiple sclerosis and the consequences of psychotherapy for coping processes. 46 patients diagnosed with multiple sclerosis who had chosen to undergo a 1-yr. group psychotherapy treatment were compared with a control group of 24 multiple-sclerosis patients without such treatment. They were given the Giessen test (personality test), the Achievement Capacities Questionnaire by Kesselring, an intensive interview as well as the content analysis scales of verbal behavior by Gottschalk and Gleser. The various tests were carried out at each of four times of measurement with a 2-yr. follow-up. There were significant changes in the area of relationships and aggressive loosening (interview) between the Therapy and Control groups. Several changes were also found with regard to physical symptoms (Achievement Capacities Questionnaire) in the Therapy group compared to the Control group, e.g., increases in physical mobility and decreases in care of the body. The decreases appear to be a known effect of therapy with psychosomatic disorders. We interpret it psychoanalytically as resistance against releasing anxiety of counter-cathected motives which multiple sclerosis helps to keep unconscious. In a follow-up, the Therapy group showed greater optimism and physical improvements, e.g., decrease in feeling cold and lack of energy. Some positive changes appeared in both groups, such as, for example, an improvement of cognitive impairment (Gottschalk & Gleser). It appears that the attention from the research itself may have affected both groups because some members of both groups were in contact and hence the Control group was also informed about the research project and its underlying hypothesis.
Pain is a major issue in the care of Multiple Sclerosis patients. It is present in more than half of the cases and it adopts many aspects, which frequently ruin the patients quality of life. Most of them do not receive appropriate treatments, as clinicians are more oriented towards controlling the immuno-pathogenic process of the disease than coping with symptomatic consequences of the lesions. Any clinical form of the disease may include pain and no clinical criteria have been correlated with the occurrence of pain: neither age, nor gender, nor MS subtypes nor severity of the handicap; almost all MS cases will complain of pain at a time or another of their evolution. A key issue is to make a precise diagnosis of the type or types of pain that any patient reports: is pain due to a central neuropathic or a nociceptive pathogenesis. Treatments will depend upon these two main pain mechanisms and will use different agents according to each type: antispastic, antiepileptic, anti-inflammatory, opioids.... Pain has to be taken in consideration in every MS patient and adapted treatment strategy must be prescribed.
Although clinicians typically possess considerable interest in research, especially about which interventions do and do not work, all too often they dismiss the notion that they themselves can make viable scientific contributions to the outcome literature. This derives from an unfortunate assumption that the only true experiment is a between-groups experiment. There is another form of true experiment that is perfectly compatible with real-world clinical practice: the single-case time-series design. Intensive and systematic tracking of one or a few patients over time can yield viable inferences about efficacy, effectiveness, and, under some circumstances, mechanism of change. This paper describes how clinicians working with hypnosis can carry out such research. The rationale and essential features of time-series studies are outlined; each design is illustrated with actual studies from the hypnosis literature; and new methods of statistical analysis, well within the statistical competence of practitioners, are described.
Clinically significant pain has been found in as many as 65% of persons diagnosed with multiple sclerosis (MS). Acute pain conditions include trigeminal neuralgia, painful optic neuritis, and Lhermitte's syndrome. Chronic pain conditions such as dysesthesias in the limbs, joint pain, and other musculoskeletal or mechanical pain problems develop as a function of spasticity and deconditioning associated with MS. These painful conditions may respond to pharmacological, surgical, rehabilitation, and psychological interventions. However, unresolved pain, associated disability, and affective distress are common. In addition, efforts to manage MS and its associated symptoms, for example, may inadvertently cause osteoporosis and headache or other symptoms that may exacerbate pain and pain-related disability. Conversely, efforts to manage pain may have negative effects on the symptoms of MS (e.g., increased fatigue). A multidimensional approach to assessment and management that is guided by a comprehensive biopsychosocial model is recommended. Such an approach needs to consider the exacerbating nature of MS, MS-related pain, and interventions aimed at their management. Suggestions for future research on MS-related pain conclude the article.
Hypnosis is useful in the rehabilitation setting to help patients master skills, to increase their sense of self-efficacy and self-esteem and, in general, to facilitate and accelerate their rehabilitation program. I used hypnosis with three patients where patient behaviors and beliefs were interfering with the rehabilitation treatment goals set by the patient and the health care team. Collectively, these cases demonstrate the use of hypnotic techniques in diagnosing and treating problems with patient compliance and assisting patients to gain greater benefit from their rehabilitation regimen.
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Hypnosis was employed as a research tool to create experimentally conditions which allowed investigation of an otherwise unattackable problem––the separation of psychological and organic effects of brain injury. 9 Ss were administered 6 tests commonly employed to identify organic brain damage, under 4 conditions: (a) normal waking; (b) pure hypnosis; (c) hypnosis, with a hypnotically hallucinated conversion hysteria in which paralysis was developed on the basis of guilt and identification; and (d) hypnosis, with a hypnotically hallucinated organic brain trauma leading to the same paralysis. Ratings of organicity under Condition d were substantially higher than those under the other 3 conditions (which differed little among themselves), indicating that signs of organic brain damage may appear in association with experimentally produced catastrophic anxiety, in the absence of the damage itself. (23 ref.)
In order to accelerate rehabilitation of patients with peripheral nerve lesions, hypnosis was employed to encourage them voluntarily to move those muscles with weak re-innervation and to achieve the best possible activity of the affected muscle' groups. By measuring muscle force and endurance and by observing the electrical activity of the affected muscles, it was found that the activity of the affected muscles was much better while patients were in hypnosis than when they were in the waking state. The patients were able to contract even paretic muscles having only weak re-innervation with such strength, that clinically perceptible contraction of the muscles and movement of paretic extremities occurred. Such early and improved activation is very important for prevention of much permanent damage.
A 41 year old male patient with a history of mutism on an organic basis for a year and a half failed to respond to speech retraining efforts. Comprehension was good and motivation poor. With the aid of hypnosis, he was induced to vocalize. Following vocalization, oral speech retraining progress was steady. Retraining efforts in writing met with repeated failure.
: A phantom limb is universally experienced after a limb has been amputated or its sensory roots have been destroyed. A complete break of the spinal cord also often leads to a phantom body below the level of the break. Furthermore, phantom breasts, genitals and other body areas occur in a substantial number of people after surgical removal or denervation of the body part. The most astonishing feature of a phantom limb (or other body area) is its incredible "reality" to the person. An examination of phantom limb phenomena has led to a new theory. It is proposed that we are born with a widespread neural network-the neuromatrix-for the body-self, which is subsequently modified by experience. The neuromatrix imparts a pattern-the neurosignature-on all inputs from the body, so that experiences of one's own body have a quality of self and are imbued with affective tone and cognitive meaning. The theory is presented with supporting evidence as well as implications for research.
(C)1989 American Society of Regional Anesthesia and Pain Medicine
We studied six patients who developed spontaneous hemibody pain following lesions of the parietal lobe. The pain was characterized as burning or icelike, and was associated with impairment of pin and temperature appreciation. Computed tomographic scanning showed that the common area of involvement in all cases was the white matter deep to both the caudal insula and the opercular region of the posterior parietal cortex. We suggest that disruption of the interconnections between these cerebral cortical areas (including the second somatosensory representation, SII) and the thalamus, particularly the intralaminar and ventroposterior nuclei, may be responsible for producing a thalamocortical disconnection syndrome with spontaneous pain as its clinical manifestation.
e of amputation. Furthermore, there was precise one-to-one correspondence between these points and those on the phantom limb. (3). (ii) Sensations were referred most often to the hand, especially to the digits with an overrepresentation of the thumb and "pinky." This may reflect the high cortical magnification of these areas. (iii) The referred sensations were modality-specific; for example, a drop of warm water trickling down the face was felt as "warm water trickling down"in the phantom hand. (iv) Reference fields were somatotopically organized. we suggest that this is a direct consequence of the remapping observed by physiologists (1). (v) There was a vivid persistence of short-term "memory" of complex sensations; when we gripped and released the finger adjacent to the amputated finger the patient felt the phantom finger being "gripped," and this sensation persisted for 7 or 8 seconds in the phantom. (v1) Reorganization was relatively rapid. In one patient, our study was carried out
The treatment of MS is far from satisfactory. Patients and their families should be provided with a chance to learn about the illness and their emotional and social needs should be addressed by knowledgeable and supportive staff (e.g., neurologists, psychologists, psychiatrists, social workers, physiotherapists, occupational therapists, and dietitians). Patients who are in remission should be encouraged to enjoy an active life, and to seek prompt medical attention and rest if they develop symptoms of an infection. They should contact their physician at times of apparent disease activity so that intercurrent infections can be properly identified and treated and so that ACTH or corticosteroids can be started if warranted. Currently, there appears to be little evidence that immunosuppressive drugs significantly affect the natural history of the disease. These agents should be administered only in the setting of controlled clinical trials by physicians experienced with their use. Whenever possible, patients with progressive disease should be offered a chance to participate in controlled clinical trials. Failing this, corticosteroids can be tried and repeated in patients who seem to benefit but prolonged steroid use should be avoided. Most of the complications of MS can be managed with some success. While we await a better understanding of the factors that contribute to disease activity, both definitive treatment and treatment of complications will continue to be directed by the results of carefully designed and properly controlled, randomized clinical trials.
Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient's severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self-hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors.
Twenty-seven chronic pain patients were assigned to one of three treatment groups: hypnosis, cognitive-behavioral, and an attention control. Hypnosis and cognitive-behavioral treatments were identical with the exception of the hypnotic induction. Scores on the McGill Pain Questionnaire (MPQ) and the Activity Log (Fordyce, 1976) were collected at pretreatment, posttreatment, and follow-up intervals. Analyses of changes showed significant increases in activity and decreases in pain intensity for the cognitive-behavioral treatment. Changes for the hypnosis treatment were noted only on the MPQ. Changes for both groups were sustained on the 1-month follow-up. Results of ANCOVAs showed that the cognitive-behavioral treatment resulted in significantly lower pain rating scores than those in the control treatment, but no significant differences were observed between the behavior and hypnosis groups. Findings support the superiority of the cognitive-behavioral treatment on behavior measures and equivalence to hypnosis on subjective measures.
Effects of hypnotic alterations of perception on amplitude of somatosensory event-related potentials were studied in 10 highly hypnotizable subjects and 10 subjects with low hypnotizability. The highly hypnotizable individuals showed significant decreases in amplitude of the P100 and P300 waveform components during a hypnotic hallucination that blocked perception of the stimulus. When hypnosis was used to intensify attention to the stimulus, there was an increase in P100 amplitude. These findings are consistent with observations that highly hypnotizable individuals can reduce or eliminate pain by using purely cognitive methods such as hypnosis. Together with data from the visual system, these results suggest a neurophysiological basis for hypnotic sensory alteration.
The damaging effect of an oxygen free radical generating system, i.e. ultraviolet irradiation, on human immunoglobulin G (IgG) was studied. The free radical altered IgG was analysed by a high performance liquid chromatograph equipped with a TSK G 3000 SW-column. Gel filtration of 120 min UV-irradiated IgG resulted in three clearly distinguished peaks corresponding to polymer IgG (MW greater than 500 kD), dimer IgG (MW 300 kD) and monomer IgG (MW 150 kD). Analysis of oxygen free radical altered and aggregated IgG by SDS-PAGE and subsequent silver-staining revealed inter- and intra-molecular reduction (by beta-mercaptoethanol)-resistant cross-links between IgG-molecules were formed. Comparison of amino acid analyses of native IgG with oxygen free radical aggregated polymer IgG showed significant reductions in tyrosine- (7.0%) and histidine- (6.5%) content. These findings suggest that tyrosine and histidine are involved in covalent cross-linking between IgG-molecules caused by oxygen free radicals. These alterations on IgG induced by free radical-activity might render it antigenic, and could initiate the production of rheumatoid factors (RF).
Step duration, measured in hemiparetic patients walking on a circular path, showed that step duration of the affected foot is usually longer. Functional electrical stimulation of the peroneal nerve in the swing phase of the step (eliminating foot drop) shortened step duration in the majority of cases. Hypnosis induced by the verbal fixation technique was used in hemiparetic patients (a) to ascertain whether the patient's mobility would increase during hypnosis and to determine (in positive cases) whether this approach might be used to predicting the effect of rehabilitation performed by classical methods; (b) to use hypnosis as a method of auxiliary treatment. The general finding was that the extent of movements of the hemiparetic upper extremity considerably improved during and immediately after hypnosis. This effect could be observed both at the level of severe impairment (at the beginning of treatment) and during the later stages when mobility greatly improved due to rehabilitation and recovery.
The purposes of this article are 1) to review the sports and motor-learning literature regarding the effects of mental imagery and mental practice on physical skills and 2) to explore the feasibility of using them as adjunctive techniques in physical therapy. In the area of sports, evidence exists that mental practice can improve motor skills. Research that supports a mind-body relationship is cited, in addition to research using mental imagery from the areas of medicine, biofeedback, psychoneuroimmunology, and physical therapy. Variables that influence the outcome of mental practice such as vividness, kinesthetic imagery, and combining physical and mental practice are examined, and two major variables associated with ineffective results are identified. The advantages and disadvantages of using mental imagery for physical therapy patients are discussed with the conclusion that mental imagery has the potential to be a viable technique for physical therapists.
It has been a common teaching that pain is rare in multiple sclerosis (MS). Our observation of a group of patients with long standing disease suggests that pain is in fact a common symptom. We have shown by means of a questionnaire that 82% of our patients with chronic MS suffered some form of pain and 64% suffered from pain which could be attributed to a neurologic lesion due to the patients' MS.
The frequency distribution of pain complaints and its relation with disability are determined in 83 multiple sclerosis (MS) patients. According to their origin, these pain complaints were divided into tendinoskeletal, neurogenic and psychogenic pains. The Mc Gill Pain Questionnaire (MPQ) was administered to these pain patients and appeared to be a good instrument to evaluate their pain. Furthermore, the descriptive value of the MPQ enables us to differentiate three different pain patterns in the neurogenic pain group: persistent pain, painful tonic spasms and paroxysmal pain.
Synopsis
There is a need for a method, useful both to the clinician and to the research worker which can assess both the ‘quantity’ and the ‘quality’ of daily life. In this paper two ‘diary’ methods are described for obtaining accounts of daily activities, social contacts and patterns of interaction from people diagnosed as having multiple sclerosis. The information obtained is compared with that derived from a major decennial national survey of the population aged over 4 years and from a selected group of matched non-patient controls. The paper is divided into two parts, each concentrating on one of the techniques. The first is a postal 24-hour written account; the second a detailed tape-recorded interview known as the ‘Standard Day Interview’. Difficulties and advantages in using these approaches to assess both the quantitative and the qualitative changes during disabling illness are discussed and proposals for developing the methods are presented. Indications of substantive variation in the use of time by samples drawn from the ‘healthy’ and from populations with multiple sclerosis are reported.
An attempt was made to assess the effects of 'catastrophic anxiety' on the functioning of brain damaged persons. Organically, brain damaged children were placed randomly in either a control group, a relaxation group, or a hypnosis group. All Ss were given a pretest and a posttest on the Bender Gestalt (BG) and a subtest of the WAIS. On the WAIS, the hypnosis group performed significantly better than the other two groups. On the BG, there were similar differences between groups when those Ss who were less susceptible to hypnosis were not included in the analysis. There was a highly significant correlation between hypnotic susceptibility and improvement on the dependent measures.
We reviewed 317 patients with multiple sclerosis (MS) and found that the incidence of clinically significant pain, excluding headache and paresthesia, was 28.8%. Successful treatment requires recognition of the pathophysiology of the pain syndromes encountered in MS. Antidepressant drugs have been of particular value in the treatment of chronic pain in these patients.
Chronic low back pain (CLBP) presents a problem of massive dimensions. While inpatient approaches have been evaluated, outpatient treatment programs have received relatively little examination. Hypnosis and relaxation are two powerful techniques amenable to outpatient use. Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis (n = 9) or Relaxation (n = 8) treatments. Following pretreatment assessment, all subjects attended a single placebo session in which they received minimal EMG feedback. One week later the subjects began eight individual weekly treatment sessions. Subjects were assessed on a number of dependent variables at pretreatment, following the placebo phase, one week after the completion of treatment, and three months after treatment ended. Subjects in both groups showed significant decrements in such measures as average pain rating, pain as measured by derivations from the McGill Pain Questionnaire, level of depression, and length of pain analog line. Self-Hypnosis subjects reported less time to sleep onset, and physicians rated their use of medication as less problematic after treatment. While both treatments were effective, neither proved superior to the other. The placebo treatment produced nonsignificant improvement.
Mechanisms of hypnotic analgesia were investigated by examining changes in the R-III, a nociceptive spinal reflex, during hypnotic reduction of pain sensation and unpleasantness. The R-III was measured in 15 healthy volunteers who gave VAS-sensory and VAS-affective ratings of an electrical stimulus during conditions of resting wakefulness, suggestions for hypnotic analgesia, and attempted suppression of the reflex during non-hypnotic conditions. The H-reflex was also measured to monitor and control for general changes in alpha-motoneuron excitability. Hypnotic sensory analgesia was related to reduction in the R-III after controlling for changes in the H-reflex (R2 = 0.51, P < 0.003), suggesting that hypnotic sensory analgesia is at least in part mediated by descending antinociceptive mechanisms that exert control at spinal levels in response to hypnotic suggestion. The relationship between hypnotic affective analgesia and reduction in R-III approached significance (R2 = 0.26; P = 0.053). Reduction in R-III was 67% as great and accounted for 51% of the variance in reduction of pain sensation. In turn, reduction in pain sensation was 75% as great and accounted for 77% of the variance in reduction of unpleasantness. The results suggest that 3 general mechanisms may be involved in hypnotic analgesia. The first, implicated by reductions in R-III, is related to spinal cord antinociceptive mechanisms. The second, implicated by reductions in pain sensation over and beyond reductions in R-III, may be related to brain mechanisms that serve to prevent awareness of pain once nociception has reached higher centers, as suggested by Hilgard.(ABSTRACT TRUNCATED AT 250 WORDS)
The nature, prevalence, and course of cognitive and emotional disturbances in multiple sclerosis (MS) are described in this article. Mild to moderate cognitive impairment is common in MS and may be more incapacitating than physical symptoms for some patients. Although existing neurologic and neuroimaging procedures can detect some cognitively impaired patients, they lack sensitivity. Development of a brief neuropsychological screening battery, suitable for routine clinical use, is an important objective that may be achieved in the near future.
We performed yearly MRI analyses on 327 of the total 372 patients in a multicenter, randomized, double-blind, placebo-controlled trial of interferon beta-1b (IFNB). Clinical results are presented in the preceding companion paper. Baseline MRI characteristics were the same in all treatment groups. Fifty-two patients at one center formed a cohort for frequent MRIs (one every 6 weeks) for analysis of disease activity. The MRI results support the clinical results in showing a significant reduction in disease activity as measured by numbers of active scans (median 80% reduction, p = 0.0082) and appearance of new lesions. In addition, there was an equally significant reduction in MRI-detected burden of disease in the treatment as compared with placebo groups (mean group difference of 23%, p = 0.001). These results demonstrate that IFNB has made a significant impact on the natural history of MS in these patients.
Hypnosin was used with 19 cerebral palsy patients to determine its value in the treatment of this condition. Four patients demonstrated definite benefit; however, in general, the results were not remarkable. The positive results noted in four patients were: (1) improved epeech and writing ability; (2) improved walking ability; (3) decreased of pain in hyperesthetic feet; (4) personality improvement from a marked shyness, to an increased sociableness.
- Ramachandran V. S.