McGlashinEvansOrneHypnoticAnalgesia1969

McGlashinEvansOrneHypnoticAnalgesia1969 - The Nature of...

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The Nature of Hypnotic Analgesia and Placebo Response to Experimental Pain THOMAS H. McGLASHAN, MD,* FREDERICK J. EVANS, PhD, and MARTIN T. ORNE, MD, PhD The effects of hypnotically induced analgesia and placebo response to "a powerful analgesic drug" were investigated. Highly motivated Ss, who were either very responsive or essentially insusceptible to hypnosis, performed a task which induced ischemic muscle pain. Special procedures and a modified double-blind condition were adopted to establish plausible expectations in both groups that the two treatments effectively reduce pain intensity. Changes in pain threshold and tolerance following hypnotic and placebo analgesia (compared to an initial base-level performance), were evaluated and were related to changes in the Ss' subjective ratings of pain intensity. The results support the hypothesis that there are two components involved in hypnotic analgesia: One component can be accounted for by the nonspecific or placebo effects of using hypnosis as a method of treatment; the other may be conceptualized as a distortion of perception specifically induced during deep hypnosis. ALTHOUGH dramatic demonstrations of the use of hypnotically induced anesthesia during major surgery have been reported, 9, 23, 24 controlled experimental studies have not objectively substantiated its effectiveness.1, 2, 14, 30, 31, 34 A similar paradox exists concerning the pharmacological effects of analgesic agents. Although opiates, known since antiquity, are potent analgesic drugs, their effects on pain thresholds have been difficult to demonstrate experimentally.4,5 Review Pain as a Complex Experience Pain usually depends upon the stimulation of specific end-organ receptors. Subjectively, however, pain intensity does not necessarily reflect the level of stimulation, the extent of tissue damage, or the danger to the organism. Psychological factors, such as the meaning From the Unit for Experimental Psychiatry Institute of the Pennsylvania Hospital, and the Department of Psychiatry, University of Pennsylvania, Philadelphia. Supported in part by Contract Nonr 4731(00) from the Office of Naval Research. We wish to thank J. M. Dittborn, C. F Holland, K. Hurson, J. J. Lynch, E. P. Nace, U. Neisser, D. N. O'Connell, Emily C. Orne, D. A. Paskewitz, C. W. Perry, and P. W. Sheehan for their helpful comments during the preparation of this report, and Mrs. Mary Louise Burke and Mrs. JoAnne Withington for their considerable editorial assistance. Received for publication Dec 16, 1968; revision received March 19, 1969.
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*Present address: Massachusetts Mental Health Center, Boston, Mass. 227 228 Hypnotic Analgesia ascribed to the sensation, past experience, and anxiety contribute to the individual's response to pain. Beecher 4 introduced a useful conceptual distinction between the primary and secondary components of the pain experience. The primary component is the pain sensation itself, which includes the perception, discrimination, and recognition of the noxious stimulus.
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