LABORATORY STUDIES OF PAIN CONTROL METHODS

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The use of behavioral methods (which include biofeedback and relaxation training, reinforcement therapies, cognitive control techniques and hypnosis) in the management of clinical pain have been shown in clinical outcome studies to be effective in reducing pain due to diverse clinical conditions. While these methods are increasingly advocated as primary or adjunctive pain therapies, little is known about the mechanism(s) by which such methods serve to reduce pain. This application proposes a series of studies of laboratory pain that are designed to increase our understanding of how changes in behavior might effect pain. We accept the now widely-held position that pain is a multi-dimensional construct, composed of both sensory and reactive components, and have examined the relationship between the intensity of pain and its impact upon the patients in descriptive and clinical outcome studies. These studies have impressed us with the multiplicity of factors that could be responsible for behavioral control of pain. While recognizing that generalization from laboratory pain models to clinical pain is difficult, we will attempt to meet some of the objections raised to previous studies by (1) using two types of laboratory pain, stimulation of the tooth pulp and cold pressor stimulation, (2) measuring several response channels, including evoked cortical potentials, autonomic and electromyographic activity, and subjective measures such as tolerance and intensity ratings, (3) using experimental tasks where the activity of the subject is under maximal experimental control, with performance subject to measurement. We will examine the effects of attention/distraction, background muscle activity, and electrocortical arousal on measures of response to tooth pulp and/or cold pressor pain. We will develop a model of laboratory mood induction to examine the effects of mood state on laboratory pain. We will attempt to refine measures of facial expression as indicators of pain severity. Finally, we will test specific cognitive strategies, both with and without hypnotic induction, on the laboratory pain models we have developed.