The focus of this research database is on how stress affects women's health, and options for treatment using mind-body therapies.  To obtain full summaries of the articles, see "How to Get Abstracts" below

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11182434 JA

Preoperative anxiety is a significant predictor of immediate postop pain, which predicts hospital stay pain, which predicts pain at home.

2000 J Psychosom Res 49;6:417-22

Kain, Z. N., Sevarino, F., Alexander, G. M., Pincus, S., and Mayes, L. C.

9494309 JA

Satisfaction with pain relief was most related to perception of having control over the pain.

1998 J Pain Symptom Manage 15;2:110-6

Pellino, T. A. and Ward, S. E.

11973007 Journal Article

This study of experimental subjects given a thermal test, suggests that in addition to biological gender differences, an individual's gender role expectation affects pain threshold and pain tolerance.

2002 Pain 96;3:335-42

Wise, E. A., Price, D. D., Myers, C. D., Heft, M. W., and Robinson, M. E.

10768721 JA

In a study on gender and pain, men anticipated more pain preop, but remembered it less postop than women.

2000 Eur J Oral Sci 108;2:99-103

Eli, I., Baht, R., Kozlovsky, A., and Simon, H.

9583753 JA

Postop patients who were more likely to report a worse than expected pain experience were younger women who had high preoperative pain, and high anxiety about possible risks and problems.

1998 Pain 75;2-3:177-85

Thomas, T., Robinson, C., Champion, D., McKell, M., and Pell, M.

9520247 RCT

"Pain can be produced in the absence of peripheral stimulation in settings of high expectancy for pain."

1998 Pain 74;2-3:327-31

Bayer, T. L., Coverdale, J. H., Chiang, E., and Bangs, M.

11991428 R,T

Review of pain and gender studies suggests that increased anxiety in women may be partly responsible for increased pain sensitivity.

2002 J Am Med Womens Assoc 57;2:91-4

Jones, A. and Zachariae, R.

11124005 RCT

Healthy female volunteers in a lab setting were able to tolerate pain longer when given success feedback, and felt pain more intensely when given failure feedback.

2000 Eur J Pain 4;4:335-46

van den Hout, J. H., Vlaeyen, J. W., Peters, M. L., Engelhard, I. M., and van den Hout, M. A.

Review of human and animal data on the genetic differences of the transmission and control of pain messages.

2000 Annu Rev Neurosci 23;777-811

Mogil, J. S., Yu, L., and Basbaum, A. I.

8118091 JA

Patients who were free from chronic pain and were undergoing thoracic surgery showed greater pain intensity if they had previously had a medical pain experience. Patients who reported their family members had poor pain tolerance experienced earlier and more severe pain. Patients who used an “avoidant” coping style experienced significantly longer duration of pain.

1993 Clin J Pain 9;4:266-71

Bachiocco, V., Scesi, M., Morselli, A. M., and Carli, G.

10479718 JA

In mice, tolerance levels to heat and cold pain were shown to be heritable through three generations.

1999 J Neurosci 19;18:RC25

Mogil, J. S. and Adhikari, S. M.

10525057 JA

Polymorphism in the serotonin receptor gene influenced morphine sensitivity in mice. [One way mood can influence effects of pain medication.]

1999 J Pharmacol Exp Ther 291;2:444-9

Hain, H. S., Belknap, J. K., and Mogil, J. S.

[Top]

Description of a direct pain pathway from the nervous system of the spinal cord to the brain limbic structures and thalamus, as well as a separate cortico-limbic pathway to the thalamus and cortex. These pathways directly affect emotions and memory involved with pain, in addition to the pathways involved with simple sensation.

2000 Science 288;5472:1769-72

Price, D. D.

10751964 R,T

In response to infection, inflammation or trauma, immune cells release proteins called proinflammatory cytokines, which create powerful pain facilitatory effects as well as an entire constellation of physiological, behavioral, and hormonal changes. These local cytokines also cause release of proinflammatory cytokines in the glial cells of the brain and spinal cord, causing exaggerated pain and a sensation of feeling "sick".

2000 Annu Rev Psychol 51;29-57

Watkins, L. R. and Maier, S. F

11236131 R,T

Memory T immune cells that are released by the body into inflamed tissue, release beta-endorphin onto receptors of peripheral sensory nerve endings. Article reviews studies on the immune system involvement in the site-directed control of inflammatory pain. Immunosuppression [which can also be caused by the elevated cortisol of stress] is associated with increased pain in patients.

2001 Clin Exp Pharmacol Physiol 28;3:230-2

Cabot, P. J.

11943821 CT

A painful stimulus resulted in a certain set of brain signal changes on functional MRI. Anticipation of the pain resulted in similar changes, but to the lesser intensity of 30-40%.

2002 J Neurosci 22;8:3206-14

Porro, C. A., Baraldi, P., Pagnoni, G., Serafini, M., Facchin, P., Maieron, M., and Nichelli, P.

11587773 R,T

Review of pain and the brain from a neuropsychophysiology standpoint; the inter-linking of physics (stimulus energy), physiology (brain activities) and psyche (perception).

2001 Int J Psychophysiol 42;2:147-59

Chen, A. C.

11923440 JA

When a painful stimulus was applied to volunteers who were asked to distract themselves from the pain, pain intensity scores were significantly lower, and fMRI showed increased activation in the periaqueductal gray area. This suggests that this area is a site for higher cortical control of pain modulation.

2002 J Neurosci 22;7:2748-52

Tracey, I., Ploghaus, A., Gati, J. S., Clare, S., Smith, S., Menon, R. S., and Matthews, P. M.

[Top]

11279850 R,T

Review of the literature shows that there are significant differences in pain sensitivity, physiologic response and metabolism of pain medications by gender.  Women experience more severe and longer lasting pain than men.  In response to a physical stressor, women feel more intense pain, but men have a higher rise in blood pressure.

1998 J Gend Specif Med 1;1:28-30

Sun, L. S.

Women are disproportionately represented in receiving treatment for many pain conditions; they report more severe pain, more frequent pain, and pain of longer duration. Women also report lower pain thresholds and tolerance.

2000 J Orofac Pain 14;3:169-84; discussion 184-95

Dao, T. T. and LeResche, L.

11710147 R,T

Review of gender differences to pain show that women have lower pain thresholds and lower tolerance for pain, and respond to analgesics differently than men.

2000 Pain Manag Nurs 1;3 Suppl 1:8-15

Vallerand, A. H. and Polomano, R. C.

9696477 CT

Cerebral blood flow was measured in male and female volunteers who were given painful stimuli. Women rated pain more intensely than men, and those results corresponded with significantly increased more blood flow to the prefrontal cortex, insula and thalamus than in men. These differences may be due to gender, perceived pain intensity, or both.

1998 Pain 76;1-2:223-9

Paulson, P. E., Minoshima, S., Morrow, T. J., and Casey, K. L.

10692605 CT

Postop, women felt pain more intensely than men, but men were more bothered by constant low levels of pain. Women experienced worse pain during the day, and the men in the evening.

2000 Pain 85;1-2:79-85

Morin, C., Lund, J. P., Villarroel, T., Clokie, C. M., and Feine, J. S.

7478686 JA

Female experimental subjects reported greater pain than males to a pressure stimulus, and also showed greater pupil dilation in response to high level pain than men. "The fact that gender differences in pain perception can be demonstrated using an autonomic indicator of pain that is beyond voluntary control, suggests that these differences reflect low-level sensory and/or affective components of pain rather than attitudinal or response-bias factors."

1995 Pain 61;3:435-9

Ellermeier, W. and Westphal, W.

10817845 R

Reproductive hormone effects on both peripheral and central nervous system pain transmission pathways are discussed, to help explain the significant differences in the experience of pain between men and women.

2000 Neurosci Biobehav Rev 24;4:485-501

Fillingim, R. B. and Ness, T. J.

11021338 CT

When women at difference phases of the menstrual cycle and men underwent experimentally induced pain, men tolerated significantly greater pain than women, and women tolerated more pain in the second half of the cycle (luteal) than in the first half (follicular).

2000 Integr Physiol Behav Sci 35;2:132-41

Hellstrom, B. and Lundberg, U.

10584975 R

Pharmacological gender differences in bioavailability, distribution and metabolism are reviewed. These findings have significant importance in pain therapy, glucose management, and arrhythmia susceptibility.

1999 Int J Clin Pharmacol Ther 37;11:529-47

Beierle, I., Meibohm, B., and Derendorf, H.

11535108 R,T

Review of studies delineating the gender differences in efficacy and potency of pain medications, as well as newly emerging studies on individual genetic differences in alleles that control pain sensation variability.

2001 Pharmacogenomics 2;3:177-94

Flores, C. M. and Mogil, J. S.

10910505 R,T

Gender differences in opioid receptors “arise from seemingly fundamental and ubiquitous differences in endogenous pain inhibitory circuitry”.

2000 Anesthesiology 93;2:539-47

Kest, B., Sarton, E., and Dahan, A.

11046213 JA

In women, morphine (adjusted for weight and other variables) was more potent than in men, but had a slower onset and offset time.

2000 Anesthesiology 93;5:1245-54; discussion 6A

Sarton, E., Olofsen, E., Romberg, R., den Hartigh, J., Kest, B., Nieuwenhuijs, D., Burm, A., Teppema, L., and Dahan, A.

11859684 JA

Gender and ethnicity show significant differences in drug metabolism pathways.

2002 J Gend Specif Med 5;1:25-33

Anderson, G. D.

[Top]

Review of psychological factors in coping, quality of life, and disability in chronic pain.

2002 J Consult Clin Psychol 70;3:678-90

Turk, D. C. and Okifuji, A.

11255208 R,T

Review of studies looking at the effects on pain of stress, negative emotional states, catastrophizing, fear, emotional regulation, and treatment seeking.

2001 J Clin Psychol 57;4:587-607

Keefe, F. J., Lumley, M., Anderson, T., Lynch, T., Studts, J. L., and Carson, K. L.

10342410 JA

"The lack of belief in one's own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extend to which individuals with chronic pain become disabled and/or depressed." Intensity of pain also has a strong impact on the development of disability and depression.

1999 Pain 80;3:483-91

Arnstein, P., Caudill, M., Mandle, C. L., Norris, A., and Beasley, R.

8722731 JA

Of 113 depressed chronic pain patients, women had significantly more body image distortion and significantly higher levels of fatigue than men. Article discusses how these findings influence coping activities and reactions of others.

1996 Clin J Pain 12;1:23-9

Novy, D. M., Nelson, D. V., Averill, P. M., and Berry, L. A.

In chronic pain patients attending a multidisciplinary pain program, those who perceived greater control over their pain, who catastrophized less, and who believed less that they were disabled, showed decreased disability, pain intensity and depression.

2001 J Consult Clin Psychol 69;4:655-62

Jensen, M. P., Turner, J. A., and Romano, J. M.

10511417 JA

The experience of anger was assessed in 96 chronic pain patients. Overall, anger was reported in 70%, and was significantly related to perceived disability. 74% were angry with themselves, which significantly correlated with pain and depression. 62% were angry with health care professionals.

1999 J Psychosom Res 47;1:1-12

Okifuji, A., Turk, D. C., and Curran, S. L.

10204741 CT

Two independent dimensions of helping chronic pain patients cope with their situation are decreasing anxiety and increasing acceptance.

1999 Pain 80;1-2:283-9

McCracken, L. M., Spertus, I. L., Janeck, A. S., Sinclair, D., and Wetzel, F. T.

11790473 JA

Chronic pain patients were more easily influenced by operant conditioning factors than controls, and this susceptibility may add to the maintenance of the chronic pain. problem.

2002 Pain 95;1-2:111-8

Flor, H., Knost, B., and Birbaumer, N.

11888719 JA

The most important factor in chronic pain patients who were experiencing pain but still satisfied with their pain management, was the quality of the patient-provider relationship in shaping patient expectations.

2002 J Pain Symptom Manage 23;3:211-20

Dawson, R., Spross, J. A., Jablonski, E. S., Hoyer, D. R., Sellers, D. E., and Solomon, M. Z.

11889646 CT

As chronic pain patients have decreasing quality of life, their descriptions of their pain increases in the number of words chosen, and affective and sensory pain descriptors.

2001 J Orofac Pain 15;1:36-46

Mauro, G., Tagliaferro, G., Montini, M., and Zanolla, L.

11731067 JA

In studying memory deficits in chronic pain patients, those patients who had greater fear related to the pain, and more catastrophic beliefs about their condition, had significantly greater impairment. Theory proposed that the attention given to these factors took away from the attention necessary for the memory task.

2001 Pain 94;3:305-13

Grisart, J. M. and Van der Linden, M.

11353723 R,T

Review of the subject of late onset pain, which may develop gradually or suddenly, even years after a provoking event. Resolution of the pain can follow many scenarios; memory of the former pain and threshold triggering factors may be particularly important in treatment.

2001 Brain 124;Pt 6:1067-76

Schott, G. D.

12078631 R,T

"Pain assessment is difficult because of the complex interaction between environment, patient and practitioner variables." Literature suggests that health professionals have a tendency to underestimate pain, and that the greater clinical experience the practitioner has, the greater will be the underestimation.

2001 Scand J Caring Sci 15;2:174-80

Solomon, P.

[Top]

Detailed description of the physiology of pain. Different types of pain, such as inflammatory, neuropathic and cancer-induced have unique and highly distinct sets of neurochemical changes in the nervous system, requiring different treatment strategies. Multiple areas of the brain cortex are activated by chronic pain, and "both the area and extent of activation are expanded and reorganized in humans with persistent pain."

2001 Nat Rev Neurosci 2;2:83-91

Hunt, S. P. and Mantyh, P. W.

The nervous system exhibits a range of responses according to different conditions, called "neural plasticity". Inflammation results in a hypersensitive state, modulated by certain receptors, ion channels and transmitters specific to inflammatory pain.

2001 Br J Anaesth 87;1:3-11

Kidd, B. L. and Urban, L. A.

12000016 R,T

Neuropathic pain, following damage to the peripheral or central nervous system, is associated with abnormal activity in certain brain structures that are involved with pain perception. These areas have been shown to be highly modifiable by emotions, expectations, and cognitive interventions such as hypnosis and attention. Such processes may reduce clinical pain, or further promote central mechanisms in the transition from acute to persistent pain.

2001 Ann N Y Acad Sci 933;130-41

Rainville, P., Bushnell, M. C., and Duncan, G. H.

12000018 R,T

Pain perception is far more complex than being in direct proportion to the extent of an injury. Pain stimulation sensitizes central neural structures, which can cause expansion of the pain field, and persistence of the pain, and is influenced by the "memory" effects of past experiences.

2001 Ann N Y Acad Sci 933;157-74

Melzack, R., Coderre, T. J., Katz, J., and Vaccarino, A. L.

10846153 R,T

Multiple mechanisms contribute to neural plasticity--the capacity of neurons to change their function, chemical profile, or structure. Authors discuss "distinct forms of plasticity, termed activation, modulation, and modification, that by increasing gain, elicit pain hypersensitivity."

2000 Science 288;5472:1765-9

Woolf, C. J. and Salter, M. W.

10097003 JA

The initiation and maintenance of persistent pain involves initial nervous system central sensitization and then ongoing central sensitization driven by damaged peripheral tissue. Both peripheral and central sources of pathology need to be targeted for treatment.

1997 Behav Brain Sci 20;3:404-19; discussion 435-513

Coderre, T. J. and Katz, J.

11126640 MA

Article reviews PET scan, fMRI and cerebral blood flow data of significant differences for acute vs. chronic pain. Collectively, these areas simultaneously reflect the sensory, cognitive and affective dimensions of pain.

2000 Neurophysiol Clin 30;5:263-88

Peyron, R., Laurent, B., and Garcia-Larrea, L.

10522734 R,T

The small association between the experience of chronic pain and the extent of physical pathology implies other factors are operating. This article discusses the changes to the sympathetic nervous system and neurochemical factors as well as direct and indirect effects of behavioral, cognitive and affective factors.

1999 Acta Anaesthesiol Scand 43;9:885-8

Turk, D. C.

11591852 CT

In patients with complex regional pain syndrome, sympathetic arousal (being startled, mental stressors) led to adrenergic super-sensitivity with augmented vasoconstriction. Normal inhibitory influences of pain were compromised compared to controls.

2001 Neurology 57;7:1296-303

Drummond, P. D., Finch, P. M., Skipworth, S., and Blockey, P.

11459920 JA

When an arm amputee imagined finger movements, functional MRI showed brain activation in the appropriate motor area.  When he imagined that these movements were painful, areas of the insula and thalamus were also activated, showing that these areas are involved in processing of pain-related experiences.

2001 Neurocase 7;3:255-60

Rosen, G., Hugdahl, K., Ersland, L., Lundervold, A., Smievoll, A. I., Barndon, R., Sundberg, H., Thomsen, T., Roscher, B. E., Tjolsen, A., and Engelsen, B.

12036311 CT

Patients with chronic pain evidenced disturbed decision making and memory processing compared to periodic or no pain patients.

2002 Eur J Pain 6;3:239-44

Demirci, S. and Savas, S.

[Top]

"How individuals perceive pain, and hence how clinicians treat it, depends upon a wide variety of psychosocial factors, including mood, age, gender, expectations, social support, and perceptions of control. Even the manner with which [health professionals] interact with patients can minimize the pain experience and ultimately impact compliance and recovery rates." Article reviews nonpharmacologic techniques, including distraction, imagery, relaxation, biofeedback and hypnosis.

1997 J Hand Ther 10;2:183-91

DePalma, M. T. and Weisse, C. S.

8656544 R

Consensus statement from the National Institute of Health: "The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain...One barrier to the integration of behavioral and relaxation techniques in standard medical care has been the emphasis solely on the biomedical model as the basis of medical education...Physicians will have to be educated on the efficacy of these techniques. They must also be willing to educate their patients about the importance and potential benefits of these interventions and to provide encouragement for the patient through training processes."

1996 JAMA 276;4:313-8

11198743 R,T

Neuropathic pain is a pathological entity unto itself; chronic pain transforms into a dysfunction of the nervous system that serves no apparent biological purpose. It is "distressing, poorly understood and under-treated". Pain receptors become hypersensitive, and do not respond to usual pain medication. Treatment needs to be multimodal, and may include tricyclic antidepressants or anticonvulsants (which modify pain neurotransmitters), local anesthesia, capsaicin (topical chili pepper extract), several other drugs such as ketamine, transcutaneous electrical nerve stimulation, temporary blocks with steroids/guanethidine, neurolysis, sugery, and psychological/behavioral therapy with relaxation, distraction, physiotherapy and rehab programs.

2000 Hosp Med 61;11:760-6

Smith, T. E. and Chong, M. S.

12048414 JA

65 consecutive heterogeneous chronic pain patients all significantly improved with an interdisciplinary treatment program, regardless of initial assessment.

2002 Clin J Pain 18;3:139-43

Gatchel, R. J., Noe, C. E., Pulliam, C., Robbins, H., Deschner, M., Gajraj, N. M., and Vakharia, A. S.

10998711 JA

Review of the efficacy and cost benefits of interdisciplinary pain management programs which include biologic, cognitive, affective, behavioral, and social factors.

2000 Curr Rev Pain 4;1:18-23

Gardea, M. A. and Gatchel, R. J.

10763578 R,T

Review of psychological management procedures, including relaxation and cognitive therapy, as well as pharmacologic measures. Summary of how a chronic pain patient views her illness, with suggestions for anticipating and helping patients cope with the milieu of their disease.

2000 N J Med 97;3:63-7

Weitz, S. E., Witt, P. H., and Greenfield, D. P.

9172207 RCT

Volunteers who were taught to use pain-incompatible imagery significantly increased pain tolerance.

1997 Percept Mot Skills 84;3 Pt 1:939-43

Neumann, W., Kugler, J., Pfand-Neumann, P., Schmitz, N., Seelbach, H., and Kruskemper, G. M.

2150881 JA

Using imagery of warmth (lying on beach, warm campfire, jacuzzi), patients were able to increase muscle relaxation and decrease pain at trigger points.

1990 Percept Mot Skills 71;3 Pt 2:1163-70

Albright, G. L. and Fischer, A. A.

11480162 RCT

College volunteers listened to imagery tapes with different variables of positive vs. negative affect, and external vs. internal images (i.e. relating to their bodies vs. the outside environment). The greatest pain tolerance was obtained with positive external imagery: "Imagine that you are in a meadow. You feel comfortable and content. The air about you feels good...the sun is shining and you are happy to be there."

2001 Appl Psychophysiol Biofeedback 26;2:117-26

Alden, A. L., Dale, J. A., and DeGood, D. E.

9543032 R,T

Review of the use of relaxation techniques in the management of chronic pain, showed that while several studies showed positive results, there were extensive methodological problems. Recommendations for future research are made.

1998 J Adv Nurs 27;3:476-87

Carroll, D. and Seers, K.

3761232 JA

Pain patients were asked to chose 5 scenes of pleasant imagery. They chose the one they thought would help them the best, and the therapist chose one he felt was most appropriate. For acute pain patients, the therapist chosen imagery led to more significant reduction in pain symptoms, while both were equally effective for chronic pain patients.

1986 J Psychosom Res 30;4:481-8

Raft, D., Smith, R. H., and Warren, N.

11951305 JA

Article includes a step-by-step approach to teaching patients how to use guided imagery at home to help decrease pain and anxiety.

2000 Home Healthc Nurse 18;8:524-30; quiz 531

Ackerman, C. J. and Turkoski, B.

9718255 RCT

Pain tolerance was increased for normal volunteers who watched a humorous film, as well as those watching a longer film, regardless of subject.

1998 Pain 76;3:365-75

Weisenberg, M., Raz, T., and Hener, T.

Review of brain changes involved with hypnotic control of pain intensity.

2001 J Neurophysiol 86;1:402-11

Hofbauer, R. K., Rainville, P., Duncan, G. H., and Bushnell, M. C.

11166472 CT

In healthy volunteers, hypnosis can selectively (at different points of the body) alter pain sensation in highly susceptible subjects.

2001 Pain 89;2-3:167-73

Benhaiem, J. M., Attal, N., Chauvin, M., Brasseur, L., and Bouhassira, D.

10568858 CT

High, mid and low hypnotizable subjects displayed significant reductions in pain using either deep relaxation, dissociated imagery or focused analgesia. The high hypnotizables did so even more significantly than the others, and also exhibited significant changes in brain potential patterns.

1999 Pain 83;3:499-508

De Pascalis, V., Magurano, M. R., and Bellusci, A.

2247321 JA

In highly hypnotizable subjects, hypnosis can, within a few seconds, significantly alter pain thresholds. Findings were associated with changes in brain potential measurements.

1990 Pain 42;2:243-51

Arendt-Nielsen, L., Zachariae, R., and Bjerring, P.

9646886 CT

Patients who were highly hypnotizable had less pain tolerance and were more apt to have had dissociative experiences.

1998 Biol Psychiatry 44;1:69-71

Agargun, M. Y., Tekeoglu, I., Kara, H., Adak, B., and Ercan, M.

8917161 CT

Chronic pain patients were all significantly sensitive to a laboratory stress, but high hypnotizables were super sensitive, and took longer to normalize. This group of patients may experience more somatic symptoms.

1996 J Nerv Ment Dis 184;10:628-35

Wickramasekera, I., Pope, A. T., and Kolm, P.

11577900 CT

While hypnosis and distraction were both able to significantly decrease pain perception, they had different brain potential measurements.

2001 Psychophysiology 38;5:768-76

Friederich, M., Trippe, R. H., Ozcan, M., Weiss, T., Hecht, H., and Miltner, W. H.

10769981 MA

Meta analysis of twenty years of use of hypnosis for pain, applicable to all levels of hypnotic ability, revealed "a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management...overall results suggest broader application of hypnoanalgesic techniques with pain patients." Non-hypnotic psychological treatments, which included relaxation, breathing, imagery, autogenic training, cognitive behavioral training, etc. were also reviewed, and results were generally equivalent.

2000 Int J Clin Exp Hypn 48;2:138-53

Montgomery, G. H., DuHamel, K. N., and Redd, W. H.

10342902 JA

Half of chronic pain patients take 1-5 drugs, and 40% abuse drugs while seeking pain relief. Only 1% of these patients utilize hypnosis. Case report of a woman with chronic pain syndrome due to automobile accident, who at various times was given 13 different medications, and was seen for almost a year in orthopedic, neurology, rheumatology, surgery, pain and general medicine clinics without relief. She taught herself self-hypnosis from a book in the library, and within 7 months was virtually free of pain and physical limitations. Her mental imagery was of transforming her pain into a lake, that she then gradually reduced in size.

1999 South Med J 92;5:521-3

Nickelson, C., Brende, J. O., and Gonzalez, J.

9439103 JA

Although hypnosis is valuable in the treatment of pain, it is frequently absent in pain management programs. This may be due to misconceptions on the part of staff and patients, plus unfortunate historical antecedents. Authors encourage an eclectic model of hypnotic interventions for chronic pain patients, viewing them as a set of skills rather than a "special state". Specific hypnosis skills for pain may include direct suggestion of pain relief, suggestion and imagery related to numbing and insensitivity, the transformation of the pain into a more bearable sensation, and displacement of the pain to another part of the body.

1998 Int J Clin Exp Hypn 46;1:62-76

Alden, P. and Heap, M.

8582777 R,T

Review of use of hypnosis in chronic pain, as well as the neurophysiology of hypnoanalgesia.

1996 Int J Clin Exp Hypn 44;1:33-51

Holroyd, J.

10911675 R,T

Detailed step-by-step analysis of use of hypnosis with chronic pain patients. Author suggests four specific applications: 1) assessment of hypnotizability, 2) development of individualized pain coping strategies, 3) direct suggestion, cognitive reframing, hypnotic metaphors, and pain relief imagery, and 4) brief psychodynamic reprocessing. Suggestions are made for different strategies to use depending on degree of hypnotizability, utilizing imagery for the "4 A's of pain management" --avoidance, alteration, alleviation and awareness. Patients with all levels of hypnotizability can benefit from hypnosis with regard to mood and suffering, but high hypnotizables benefit most from hypnotic pain relief.

2000 Am J Clin Hypn 43;1:17-40

Eimer, B. N.

51 chronic pain patients who had not improved with traditional medical care reported significantly reduced medical symptoms and mood disturbances with a mindfulness meditation stress reduction program.

1982 Gen Hosp Psychiatry 4;1:33-47

Kabat-Zinn, J.

8133409 JA

Music therapy can decrease pain perception by distraction, change in mood, increased control, use of prior skills and relaxation. Use of music therapy and pain is reviewed with case histories.

1993 J Palliat Care 9;4:42-8

Magill-Levreault, L.

10484830 R,T

Chronic pain affects 80 million Americans, and costs approximately $70 billion per year. Article reviews the use of aromatherapy as a relaxing agent as well as a pharmacologically active ingredient.

1999 Altern Ther Health Med 5;5:42-51

Buckle, J.

9893315 RCT

Patients with complex regional pain syndrome reported significant transient reduction in pain as well as long-term reduction in anxiety with qigong training.

1999 Altern Ther Health Med 5;1:45-54

Wu, W. H., Bandilla, E., Ciccone, D. S., Yang, J., Cheng, S. C., Carner, N., Wu, Y., and Shen, R.

1723397 R,T

Chronic pain patients benefited from self-awareness, relaxation, changed context of pain, increased control, life-style improvements, and social support provided by yoga.

1991 Int J Psychosom 38;1-4:76-81

Nespor, K.

10963909 JA

Case report of a chronic pain patient (facial pain) successfully treated with electrode implantation in the thalamus. Article discusses cerebral blood flow changes with and without stimulation.

2000 Pain 87;3:295-302

Kupers, R. C., Gybels, J. M., and Gjedde, A.