4 0 0 0 OA 学際的痛みセンターにおける慢性痛患者に対する催眠療法
- 著者
- 水谷 みゆき 牛田 享宏 西原 真理
- 出版者
- 日本疼痛学会
- 雑誌
- PAIN RESEARCH (ISSN:09158588)
- 巻号頁・発行日
- vol.32, no.3, pp.191-202, 2017-09-15 (Released:2017-09-26)
- 参考文献数
- 30
Chronic pain is a complex state that involves unpleasant emotion, autonomic responses, helplessness against pain and movement disorder, as well as the sensation of pain itself. These memorized responses influence the present experience and behavior of the patient. A single treatment option is not enough to treat such a complex clinical state. Thus, our facility has several treatment programs to fit individual patients’ needs. We applied an individualized hypnotic approach to 161 patients who had not shown satisfactory improvement and were considered suitable subjects for psychotherapy.A hypnosis session consisted of the introduction stage, which prepared the therapeutic contexts accommodated to the change in chronic pain as well as each patient’s history, and the induction stage, which mainly targeted non–pain body sensations. Among the patients who tried hypnosis, 71.1% experienced in–session analgesia (ISA), and 46.3% experienced out–of–session analgesia (OSA). The most of the first ISA was experienced before approximately the 10th session, and the most of the first OSA was experienced by approximately the 15th session after ISA.Based on the process and degree of analgesia, the number of sessions, the leaning rate of self–hypnosis, and the patients’ characteristics and experiences in the above process, we attempted to determine the conditions under which the patients were successfully engaged in hypnosis, the stage of changes in their chronic pain, and the inhibitory factors against analgesia. Despite clinical differences among the patients and their pain situations, their responses to the hypnosis implied the importance of achieving pain cessation through their own therapeutic efforts.
2 0 0 0 痛みセンターにおける慢性痛に対する心理療法の適用と有効性
1 0 0 0 OA 痛みセンターにおける慢性痛に対する心理療法の適用と有効性
- 著者
- 水谷 みゆき 鈴木 千春 大道 裕介 櫻井 博紀 森元 温子 西原 真理 牛田 亨宏 新井 健一 佐藤 純
- 出版者
- 日本疼痛学会
- 雑誌
- PAIN RESEARCH (ISSN:09158588)
- 巻号頁・発行日
- vol.27, no.3, pp.175-188, 2012-08-10 (Released:2013-02-19)
- 参考文献数
- 44
The effect of hypnotic intervention for the refractory chronic pain patients was examined along with the process of patients' selection and their psychological characteristics. The total 596 visit patients in the first year were statistically examined concerning duration of pain, scores of psychological distress (Hospital Anxiety and Depression Scale) and disability (Pain Disability Assessment Scale) at the initial visit and the treatment outcome at the end of the first year. The duration of chronic pain was significantly related to disability but not to psychological distress at the initial visit. At the end of the first year of multidisciplinary pain treatment, 44% of total patients were under treatment, 19% finished treatment (10% evidently improved and 9% accepted their pain), 12% were referred and 25% dropped out. The group of patients who were evidently improved was not different concerning the duration of pain, but significantly less anxious, less depressed and less disabled at the initial visit than the other groups. Among the 261 patients under treatment, 33 patients (5.6% of total patients) were introduced into individual psychological interventions in consideration of 1) poor outcome in pharmacological and physical treatments, 2) unstable treatment relationship and marked pain behaviors, 3) obvious psychological distress, 4) event-related fluctuations in pain. They were significantly more anxious and depressed at the initial visit, than those who were not introduced to psychological intervention. Multiple bio-psycho-social factors were identified; tender points in 21 patients (by physiotherapist), stressful life events around the onset of pain in 26, serious daily conflicts at present in 30, catastrophizing thinking in 21, repressive thinking in 12, avoidance in 2 and perseverative coping in 6. Many of them did not or partly perceive their somatic tension / discomfort. Multiple factors were considered to inhibit the effect of treatment in those patients. In individual hypnosis, therapeutic conversation, permissive induction and indirect suggestions were employed. Direct suggestions for analgesia were not applied. Among 33 patients, 25 patients experienced hypnotic analgesia during sessions, 14 of whom finished their sessions with the decreased daily pain level or the enhanced effect of medication until the end of the 3rd year. Among them, 5 patients evidently improved (one phantom limb pain and 4 other chronic pain). Hypnosis successfully helped 42% of the patients who had failed to respond to multi disciplinary treatment. The psychosomatic resources in patients need to be more attended and utilized in chronic pain treatment.