Imagination, children and pain reduction techniques.

Children can be taught to use their imagination to tackle frequent bouts of stomach pain, research shows.

A relaxation-type CD, asking children to imagine themselves in scenarios like floating on a cloud led to dramatic improvements in abdominal pain.

The US researchers said the technique worked particularly well in children as they have such fertile imaginations.

It has been estimated that frequent stomach pain with no identifiable cause effects up to one in five children.

The research, published in Pediatrics, follows on from studies showing hypnosis is an effective treatment for a range of conditions known as functional abdominal pain, which includes things like irritable bowel syndrome.

“ There is really a dearth of information on how to manage children with abdominal pain ”
Professor David Candy
In this study, the children had 20 minute sessions of “guided imagery” – a technique which prompts the subject to imagine things which will reduce their discomfort.

One example is letting a special shiny object melt into their hand and then placing their hand on their belly, spreading warmth and light from the hand inside the tummy to make a protective barrier inside that prevents anything from irritating the belly

The researchers, from the University of North Carolina and Duke University Medical Center, said a lack of therapists led them to the idea of using a CD to deliver the sessions.

In all 30 children aged between six and 15 years took part in the study – half of whom used the CDs daily for eight weeks and the rest of whom got normal treatment.

Among those who had used the CDs, 73.3% reported that their abdominal pain was reduced by half or more by the end of the treatment course compared with 26.7% in the standard care group.

In two-thirds of children the improvements were still apparent six months later.

Anxiety
It is not clear exactly how the technique works but studies have shown it is partly about reducing anxiety but there is also a direct effect on the pain response.

Some researchers think hypnosis-like techniques reduce “hypersensitivity” in conditions such as irritable bowel syndrome.

Study leader Dr Miranda van Tilburg said it was especially exciting that the children were able to use the technique on their own.

“Such self-administered treatment is, of course, very inexpensive and can be used in addition to other treatments, which potentially opens the door for easily enhancing treatment outcomes for a lot of children suffering from frequent stomach aches.

“Children are very good at using their imagination – when you use this in adults you have to overcome a barrier first.”

Professor David Candy, a consultant paediatric gastroenterologist at Western Sussex Hospitals, said his team had tried hypnosis in a small group of children with severe abdominal pain problems and had 100% success rate.

He added they are now keen to try the guided imagery technique to see if they can replicate the US findings.

“There is really a dearth of information on how to manage children with abdominal pain and it’s a very common problem which keeps children out of school.”

Technorati Tags: Abdominal Pain, Care Group, Dearth, Dramatic Improvements, Duke University Medical, Duke University Medical Center, Fertile Imaginations, Floating On A Cloud, Frequent Bouts, Guided Imagery, Hypnosis, Irritable Bowel Syndrome, Minute Sessions, Professor David, Protective Barrier, Shiny Object, Stomach Pain, Type Cd, University Medical Center, University Of North Carolina

  
 October 10th, 2009 | Leave a Comment

What can you do to reduce your post operative pain

It’s Not All In Your Head: Descending Neural Mechanisms Of Placebo-induced Pain Control.

(Aug. 29, 2009) — A new study reveals that when it comes to pain control, the “placebo effect” involves evolutionarily old pain control pathways in the human brainstem, the part of the brain that is continuous with the spinal cord. The research, published by Cell Press in the August 27th issue of the journal Neuron, provides fascinating mechanistic insight into how and why simply expecting that a treatment will reduce pain can act as an effective analgesic.

Placebo analgesia refers to an individual’s relief from pain following administration of a chemically inert substance and is thought to be due to a person’s belief that a potent pain medication was administered. Endogenous opioids, which are naturally produced by the brain in small amounts and play a key role in the relief of pain and anxiety, have been implicated in placebo analgesia. Brain imaging studies have shown that placebo analgesia stimulates release of endogenous opioids from higher brain regions associated with pain modulation and is associated with a decrease in signals from pain-sensitive areas.

“It has been hypothesized that placebo analgesia also recruits the opioidergic descending pain control system, which inhibits pain processing in the spinal cord and, therefore, subsequently reduces pain-related responses in the brain, leading to a decreased pain experience,” explains lead study author Falk Eippert from the University Medical Center Hamburg-Eppendorf in Germany. However, thus far this has not been demonstrated experimentally.

Eippert and colleagues employed sophisticated brain imaging techniques to examine both higher cortical and lower brainstem responses in two groups of subjects: one receiving a drug called naloxone, which blocks opioid signaling, and one group with a natural opioid state. Expectations of pain relief were induced in both groups using an established placebo analgesia paradigm.

The researchers found that naloxone reduced behavioral placebo effects as well as placebo-induced decreases in pain-related brain responses. Most importantly, they also observed that, under placebo, cortical areas interacted with brainstem structures implicated in pain control and that these interactions were dependent on endogenous opioids and were related to the strength of experienced placebo effects.

“Taken together, our findings show that opioid signaling in pain-modulating areas and the projections to downstream effectors of the descending pain control system are crucially important for placebo analgesia,” concludes Eippert. “It will be interesting to see whether opioid-dependent activation of the descending pain control system is a common feature of different forms of pain modulation, such as hypnosis and attentional distraction, which share some common neuroanatomical features.”

The researchers include Falk Eippert, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Ulrike Bingel, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Eszter D. Schoell, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Juliana Yacubian, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Regine Klinger, University of Hamburg, Hamburg, Germany; Jurgen Lorenz, Hamburg University of Applied Sciences, Hamburg, Germany; and Christian Buchel, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

http://www.sciencedaily.com

Technorati Tags: Analgesia, Brain Imaging, Brain Regions, Control Pathways, Endogenous Opioids, Hamburg Eppendorf, Inert Substance, Naloxone, Neural Mechanisms, Neuron, Operative Pain, Pain Experience, Pain Medication, Pain Modulation, Placebo Effect, Sensitive Areas, Sophisticated Brain, Spinal Cord, Study Author, University Medical Center

  
 August 30th, 2009 | Leave a Comment

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