Effects of warming imagery aimed at trigger-point sites on tissue compliance, skin temperature, and pain sensitivity in biofeedback-trained patients with chronic pain: a preliminary study

The Effects of Guided Imagery (GI) on Allergic Subjects' Responses to Ragweed-Pollen Nasal Challenge: An Exploratory Investigation

This study investigated the effects of guided imagery (GI) on allergic subjects' responses to ragweed-pollen nasal challenge. Complete data was obtained for fourteen subjects ranging from twenty-one to sixty-two years of age. Nasal challenges were performed before and after GI. Dependent variables consisted of two biochemical mediators obtained from nasal secretions and two subject-reported measures of symptoms, respectively: TAME (tosylarginine methyl ester)-esterase; histamine; severity of symptoms (e.g., nasal congestion); and numbers of sneezes. An experimental group ( n = 7) participated in a three-week program of GI designed to promote relaxation, psychosynthesis, and modulation of immunological activity at the cellular level. A posttreatment, between-groups analysis of the experimental group and a no-contact control group ( n = 7) determined that treatment significantly suppressed TAME-esterase release ( p < .03). Thereafter, the control group participated in the treatment program, and a posttreatment, within-group analysis also indicated significantly suppressed TAME-esterase release ( p < .05). A two-week, follow-up nasal challenge administered to the experimental group indicated maintenance of suppressed TAME-esterase release ( p < .03) and reduced severity of symptoms ( p < .05).

The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain

A large number of studies have provided evidence for the efficacy of psychological and other non-pharmacological interventions in the treatment of chronic pain. While these methods are increasingly used to treat pain, remarkably few studies focused on the exploration of their neural correlates. The aim of this article was to review the findings from neuroimaging studies that evaluated the neural response to distraction-based techniques, cognitive behavioral therapy (CBT), clinical hypnosis, mental imagery, physical therapy/exercise, biofeedback, and mirror therapy. To date, the results from studies that used neuroimaging to evaluate these methods have not been conclusive and the experimental methods have been suboptimal for assessing clinical pain. Still, several different psychological and non-pharmacological treatment modalities were associated with increased pain-related activations of executive cognitive brain regions, such as the ventral- and dorsolateral prefrontal cortex. There was also evidence for decreased pain-related activations in afferent pain regions and limbic structures. If future studies will address the technical and methodological challenges of today's experiments, neuroimaging might have the potential of segregating the neural mechanisms of different treatment interventions and elucidate predictive and mediating factors for successful treatment outcomes. Evaluations of treatment-related brain changes (functional and structural) might also allow for sub-grouping of patients and help to develop individualized treatments.

How a Better Understanding of Spontaneous Mental Imagery Linked to Pain Could Enhance Imagery-Based Therapy in Chronic Pain

Therapy with mental images is prevalent in the field of chronic pain, and this has been the case for centuries. Yet few of the recent advances in the cognitive behavioural understanding of spontaneous (i.e. intrusive) mental imagery have been translated to this field. Such advances include imagery as a component of a psychopathological process, as an emotional amplifier and as a cognitive therapeutic target in its own right. Hence very little is known about the contents, prevalence and emotional impact of spontaneous mental imagery in the context of chronic pain. This article discusses the evidence in favour of spontaneous imagery being a potentially important part of patients' pain experience, and makes a case, based on neurophysiological findings, for imagery having an impact on pain perception. Furthermore, it presents how mental imagery has been used in the treatment of chronic pain. A case report illustrates further how spontaneous negative imagery linked to pain can be distressing, and how this might be addressed in therapy. Additionally, the case report demonstrates the spontaneous use of coping imagery, and raises a discussion of how this might be enhanced.

Long-term maintenance of increased exercise involvement following a self-management intervention for housebound older adults with arthritis

Background

Sustained maintenance of health behaviors is a determinant of successful symptom reduction strategies for older adults with arthritis. This study examined whether or not short-term improvements in exercise involvement were maintained 8 months following a home-based arthritis self-management intervention as well as the moderating role of individual characteristics in the maintenance of behavior change.

Methods

Of the 113 housebound older adult participants at pre-intervention, 97 completed the post-intervention interview, and 80 completed the 8-month post-intervention interview.

Results

Some post-intervention improvements in exercise involvement were maintained 8 months later. More specifically, weekly exercise frequency, particularly regarding walking frequency, and variety of exercise activities were still significantly greater in the experimental group than in the control group 8 months following the completion of the intervention. No moderating influences were observed for any of the individual characteristics.

Conclusion

We conclude that gains in exercise involvement achieved through a self-management intervention can be maintained 8 months following the intervention.

Active warming during emergency transport relieves acute low back pain

STUDY DESIGN

Prospective randomized blinded trial in a prehospital emergency system.

OBJECTIVES

To evaluate the effects of external active warming on acute back pain during rescue transport to hospital.

BACKGROUND DATA

Acute low back pain is one of the complaints that most often entails a visit to the physician or use of the emergency system. Superficial (e.g., hydrocolloid packs) and deep heating (e.g., ultrasound) can relieve acute low back pain in a clinical setting. Recent data showed significant benefit for patients in pain from minor trauma treated by active warming during emergency transport. Accordingly, we tested the hypothesis that active warming would reduce pain and anxiety in patients with acute low back pain being transported to a hospital.

METHODS

A total of 100 patients were included in our study. We selected only those suffering from acute pain > 60 mm on a visual analog scale in the lower back. Patients were randomly assigned to two groups: active warming with a carbon-fiber electric heating blanket (Group 1) versus passive warming with a woolen blanket (Group 2) during transfer to hospital. RESULTS.: Pain scores on arrival at the hospital differed significantly between Group 1 and Group 2 (P < 0.01). In Group 1, pain reduction from 74.2 +/- 8.5 mm VAS to 41.9 +/- 18.9 mm VAS (P < 0.01) was noted between departure from the emergency site and arrival at the hospital. Pain scores remained practically unchanged in Group 2 (73.3 +/- 11.9 mm VAS and 74.1 +/- 12.0 mm VAS).

CONCLUSIONS

Active warming reduces acute low back pain during rescue transport.

Anti-aging medicine--the good, the bad, and the ugly

Complementary and alternative medicine has flourished since the beginning of time because of a human need to postpone the aging process and to reverse disease. Complementary and alternative medicine sells, because in some cases it works as well or better than mainstream medicine. In addition, many practitioners of complementary medicine understand Hippocrates' aphorism: "It is more important to know the person that has the disease than the disease the person has." It is important to recognize that spending time with the patient is often as therapeutic as drugs. CAM offers patients the time, touch, attention, and level of personal interaction that are increasingly uncommon in contemporary medical care. There is a major need for large and appropriately designed studies to test the effectiveness of complementary techniques. As in other areas of health care, studies in the elderly are consistently lacking. With the growing interest in CAM, it is important for medical providers to keep an open mind--to both the potential benefits and potential harms of alternative treatments. When treatments are shown to be dangerous or ineffective, we must educate the public and work to remove these therapies from the market place. When treatments are proven effective, Western and Eastern medical providers must work together with patients to provide the most appropriate and comprehensive health care.

Strategies for autoregulation of peripheral skin temperature

The present study examined different mental strategies for effective and rapid regulation of skin temperature in adjacent areas. In the main study, subjects (N = 10) were asked to achieve mentally a maximal temperature difference between the right index and the right little fingers within 25 minutes. In a control group (N = 10), possible effects of a temperature-influencing device (cold and warm water bags on the left hand) on the right index and little fingers were examined. Because results were impressive, a series of similar studies was conducted. The results demonstrate the efficacy of mental strategies for a differential thermoregulation of adjacent skin areas (between 1 and 3 cm). Possible explanations and implications are discussed.