Donald S. Scott

The effects of psychological factors and physical trauma on recovery from oral surgery

This study evaluated the effects of several psychological factors on postsurgical recovery while controlling for and also evaluating the effects of the physical trauma induced by the surgery. Subjects were 38 patients (18 males and 20 females) who were scheduled to have four third molars surgically removed. The psychological factors measured included anxiety and expectations about recovery, trait anxiety, coping behaviors, and health locus of control. Surgical trauma was rated after surgery, and the following aspects of recovery were monitored: postoperative pain, interference with normal function, swelling, and healing. Poorer postoperative recovery was significantly predicted by each of the psychological variables and by higher levels of surgical trauma. In addition, the effects of the psychological variables on recovery were shown to be largely independent of the trauma effects. The data suggest that (a) future studies which give patients more positive expectations and reduce their anxiety about recovery may improve their recovery and (b) the types of patients most in need of preoperative psychological support would be those who have higher trait anxiety, vigilant coping behaviors, or an internal locus of control.

Myofascial pain involving the masticatory muscles: An experimental model

&NA; Thirty healthy volunteers were assigned to one of the following two conditions: (1) hyperactivate the lateral pterygoid muscles by vigorously thrusting their mandible forward for 5 min, or (2) a non‐exercise control condition. Subjects who protruded their mandible reported significantly more pain than control subjects. This pain was located in the immediate preauricular area. This pain was similar in quality and location to many patients diagnosed as having the myofascial pain‐dysfunction syndrome. Other signs or symptoms associated with the syndrome (e.g., tenderness upon palpation, limitation of jaw function) were not produced. This constitutes the first direct, experimental test indicating that the pain of the myofascial paindysfunction syndrome may be caused by hyperactivity of the lateral pterygoid muscles.

Cognitive Control of Pain: Effects of Multiple Cognitive Strategies

A total of 80 subjects were exposed to cold pain or pressure pain under one of four experimental treatments: (a) instructions to use five cognitive strategies to reduce pain, e.g., to dissociate oneself from the pain and to imagine that the stimulated area is numb; (b) the same instructions to use five strategies, but given in a brief form (45 sec.); (c) instructions to use one specific cognitive strategy (to think of pleasant events); or (d) control. Both the long and the brief instructions to use five strategies raised average pain tolerance about 100% above the control level but did not change the ratings of pain intensity or distress. It is concluded that it is much easier to change tolerance of pain than to change perception of pain or the distress produced by pain.

Modification of Pain Threshold by the Covert Reinforcement Procedure and a Cognitive Strategy

The threshold for cold pain was obtained for male and female subjects, while one hand was immersed in icewater, before and after one of four experimental treatments. The four treatments were: (a) the covert positive reinforcement procedure—i.e., reinterpreting the sensations in a manner incompatible with the experience of pain and then imagining a pleasant, reinforcing image; (b) a reinterpretation strategy only; (c) a group that was lead to expect pain reduction on the posttest; and (d) a control group. Subjects trained in the covert reinforcement procedure raised their thresholds above the thresholds of the reinterpretation strategy as well as of the expectation and control groups. The reinterpretation strategy and the expectation groups raised their thresholds above the control group, and did not differ from each other. Males and females did not differ on either the pretest threshold or their ability to use the covert reinforcement or the reinterpretation procedures.

High versus low intensity acupuncture analgesia for treatment of chronic pain: Effects on platelet serotonin

&NA; The 26 chronic pain patients were tested in a baseline plus cross‐over design. Half of the subjects were first treated with high intensity acupuncture; then they were treated with low intensity acupuncture. For the other 13 subjects the treatment order was reversed. In the first treatment sequence subjects reported lower pain estimates and engaging in more activities of daily living during treatment with high intensity acupuncture — but not with low intensity acupuncture. In addition, under high intensity acupuncture (i.e. with low pain levels), subjects had higher levels of platelet serotonin; this last finding is consistent with recent research which implicates central serotonin in pain control. The results of the second treatment sequence were ambiguous.

Myofascial pain of the temporomandibular joint: A review of the behavioral-relaxation therapies

&NA; This paper reviews the behavioral‐relaxation treatments of myofascial pain‐dysfunction syndrome. The evidence indicates that this pain (located around the oral cavity) is due to muscle hyperactivity, most commonly of the lateral pterygoids. Research concerning relaxation techniques (i.e. progressive muscle relaxation and electromyographic feedback) has indicated the following: (a) in analogue research, normal healthy controls can learn to relax their muscles of mastication profoundly even during stress, and (b) in case reports, relaxation treatments are helpful clinical interventions, especially for pain patients who are not depressed, and who have not had the pain for more than a few years. Well controlled research is the next, essential step.

Serotonergic Activity in Man as a Function of Pain, Pain Mechanisms, and Depression

Lumbar cerebrospinal fluid levels of 5-hydroxyindoleacetic acid, which are used as indicators of central nervous system serotonergic neuronal activity, were significantly higher in 67 patients with chronic pain and in 32 patients with acute pain (23.6 ± 3.3 and 23.1 ± 3.8, respectively) than in 30 patients (8.8 ± 1.7) who had no pain. However, there was no correlation between levels of 5-hydroxyindoleacetic acid in patients with chronic or acute pain, nor between groups of patients with chronic pain whose pain mechanisms were of psychogenic, sympathetic, somatic, or central origin, based on their responses to differential spinal block; there was also no correlation between levels of depression, as evaluated by the Zung scale, in patients with different types of chronic pain, even though ail of these patients were depressed. The elevated levels of 5-hydroxyindoleacetic acid in the depressed patients with chronic pain are not consistent with previous studies on the etiology and types of chronic pain. As recent research indicates that the perception of pain may be modulated by endogenous analgesic systems involving enkephalin and serotonin (5-HT), this study was undertaken to clarify the association between 5-HT activity and nociception. Our findings did show a link between acute noxious stimulation and central increases in serotonergic activity. However, we could not differentiate between pain mechanisms and degree of depression. Our studies did indicate that, because of both the persistence of pain complaints and the increased levels of brain 5-HT activity, the endogenous analgesic systems are not totally effective as natural inhibitors of pain. Furthermore, the increased depression and continued pain in the presence of elevated 5-HT activity in patients with chronic pain may represent a tolerance or decreased responsiveness to 5-HT.

Cognitive Control of Pain: Four Serendipitous Results

The experiment was designed to determine whether specific cognitive strategies are effective in reducing pain. Subjects were tested either on cold pain or pressure pain. Although the cognitive strategies did not significantly alter pain tolerance or pain intensity, the following four findings emerged: (a) males and females responded in a similar manner to the painful stimuli, (b) both the experimental subjects and the controls had surprisingly high tolerance of pain, (c) subjects typically generated their own thoughts and images to control pain, and (d) subjects responded to cold pain and to pressure pain in a similar manner.

Four considerations in using imagery techniques with children

Abstract Behavior therapists have generaly used overt techniques when treating children. However, imagery offers a promising set of techniques which have generally been overlooked. Based on the available information, therapists should, when using imagery techniques with children: (1) tailor imagery scenes to fit the age of the child, (2) incorporate existing fantasies and cognitions into treatment, (3) use non-verbal cues to supply important information about the treatment process, and (4) utilize verbal reports of images in treatment.

Effects of a traditional trance induction on response to “hypnotist-centered” versus “subject-centered” test suggestions

Abstract 82 randomized Ss were exposed either to a traditional trance induction procedure emphasizing relaxation and passivity or to a no-induction (control) treatment. Next, half of the trance induction Ss and half of the control Ss were tested on a “hypnotist-centered” scale (the Barber Suggestibility Scale, Barber, 1969, Appendix A) in which the hypnotist declares that the suggested effects are occurring (e.g., “[Your arm is] weightless and rising in the air [Barber, 1969, p. 244].”). The other half of the trance induction and control Ss were tested on a “subject-centered” scale of suggestibility (the Creative Imagination Scale, Wilson & Barber, 1978) in which the test suggestions ask Ss to use their own thinking and imagining to create the suggested effects (e.g., “Think of a strong stream of water pushing your hand up [Wilson & Barber, 1978, p. 244.”]). The results showed that a traditional trance induction is useful with a “hypnotist-centered” scale but not with a “subject-centered” scale: When the ...