The Clinical journal of pain
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Case Reports Comparative Study
Hypnosis and chronic pain. Two contrasting case studies.
Some of the theoretical and technical problems associated with the use of hypnosis for chronic pain are discussed in the context of two similar case studies, one of which had an unsuccessful outcome. Different hypnotic strategies are discussed which depend on a careful, direct evaluation of the role of secondary gain and depression in maintaining the pain in the two patients. ⋯ Self-hypnotic procedures are described stressing the development of mastery and self-control over pain. Differences in the kinds of hypnotic intervention that are appropriate when secondary gain or depression are central to the pain problem, compared to the more direct techniques available when they are not, are discussed.
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Over a 3 1/2-year period, a series of 20 chronic pain patients with back pain and with documented organic difficulties were treated by means of implanted spinal cord stimulation. Short-term treatment outcome was found to be significantly related to diagnosis, with single nerve root injury and mononeuropathy patients having better treatment outcomes than arachnoiditis patients with multiply injured nerve roots. Outcome was not related to the psychological evaluation, or age, sex, number of previous pain surgeries, pain location, the Minnesota Multiphasic Personality Inventory, or the Pain Assessment Index. Implications for patient selection are discussed.
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Biofeedback, progressive muscle training, and relaxation tape home practice were implemented in an attempt to decrease knee pain in a subject diagnosed with osteoarthritis. Pain journal data suggested that the subject's pain levels decreased significantly during training and for 2 years posttraining. ⋯ One possible explanation for these changes was the home practice of her relaxation tape, as increased practice was inversely related to decreased pain. This clinical case report provided some preliminary information on the potential efficacy of psychological procedures in osteoarthritis pain management.
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There continues a significant debate over the best contemporary method for treating trigeminal neuralgia. Glycerol injection into the trigeminal cistern has been used in a consecutive series of 200 patients. A total of 80% of the patients have had good or excellent pain relief. ⋯ A recurrence rate of 24% has been the single largest disadvantage of the procedure. Reinjection is usually successful in treatment of recurrence. The combination of efficacy, minimal and temporary neurologic dysfunction, and low complication rate make this procedure, in our opinion, the procedure of choice for the first step, when surgical treatment is required.
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Comparative Study
The subjective experience of acute pain. An assessment of the utility of 10 indices.
Sixty-nine postoperative patients indicated the severity of their pain using eight measures designed to assess pain intensity and two designed to measure pain affect. The utility and validity of the 10 measures were evaluated according to two criteria: (a) the magnitude of the relationship between each scale and a linear combination of the pain measures, and (b) relative rates of incorrect responding. ⋯ The 11-point Box Scale (BS-11) of pain intensity demonstrated the strongest relationship to a linear combination of all of the measures employed and was responded to correctly by each subject in the sample. All else being equal, these results suggest that the BS-11 scale may be the most useful clinical index of pain intensity among postoperative patients.