Pain in the Brain: It's Not What You Imagine by Jenny Gimpel - Article Example

1. Critical Analysis of the Article Pain in the Brain: Its Not What You Imagine by Jenny Gimpel, College London, 8 August 2004 Before analyzing the article, which cites two separate research studies, a summary of these will be presented. This is intended to clarify the article contents, in order that relevant criticisms are supported and to help to place the research studies within the correct context. Anomalous Control: When free-will is not conscious. Haggard, P., Cartledge, P., Dafydd, M. and Oakley, D. - Institute of Cognitive Neuroscience, University College, London. Published in Consciousness and Cognition, Vol 13, Iss. 3, Sept. 2004. The purpose of this research was to examine how actions are experienced as involuntary, with a view to understanding certain psychopathological conditions in which the concept of alien control is present. The researchers contended that if it were the case, that actions carried out by a person, yet experienced as if something made me do it, the legal implications, as well as the medical, were of great importance. To test this hypothesis, hypnosis was used, with 12 normal, right handed participants who scored 9 out of 12 on the Harvard Group Scale of Hypnotic Susceptibility (HGSHS). Thus suggestion, via hypnoses, took the place of pathological disturbance. They used Voluntary, Passive and Involuntary finger movements. Participants watched a clock on a computer screen, recording verbally, timings for when movement took place. Trials were in blocks of 40, recordings made for voluntary and passive movement, then all three movements were carried out and recorded under hypnosis. The results showed that all participants underestimated the duration of time under hypnosis by 50%. There was little difference in the experience of voluntary action between hypnotized and non-hypnotized states, nor indeed of passively produced movement experiences. The involuntary condition, the one in which researchers were most interested, showed that although the person acts themselves, the suggestion that the movement was involuntary moved the time of awareness closer to that of passive movement experience. In other words, although the person carried out the action 2. themselves, they felt as though someone else had made it happen, nor were they able to accurately pin-point the time of the event. Results suggested that a person can will an action to take place, using the volitional areas of the brain, but if under hypnosis they are told that the movement is involuntary, they do not consciously experience the fact that they themselves acted. This has serious implications, (as Dr. Oakley states in the article), not just for treatment of psychopathological disorders such a schizophrenia, (alien control) but for the criminal justice system. Cerebral Activation during hypnotically induced and imagined pain. Derbyshire, S. W. G., Stenger, A., University of Pittsburgh Medical Center. Whalley, M. G., and Oakley, D. A., University College, London. Published November 2004 in NeuroImage, Issue 23. Because many people suffer functional pain, such as lower back, fibromyalgia, etc., with no apparent medical or physiological condition to account for this, researchers and doctors have been frustrated by the inability to determine why this should be. This study sought to find evidence and identify the areas of the brain which might be associated with the sensory and emotional experience of pain. There was a belief that unusual cerebral activity was linked to such painful disorders, but nothing concrete was available to prove that the brain itself might be generating the pain. With five female and three male subjects (aged 21 - 50 years), with scores of 8 or more on the HGSHS, hypnosis, fMRI scanning, and a heat probe to the palm of the hand were used. They tested pain ratings under hypnotically induced pain (no heat applied), physically induced pain (48.5 C.) and imagined pain, triggering responses by taps to the foot of the participants. A verbal rating scale was used to obtain subjective, perceived intensity of the pain, making comparisons between highest and lowest, as well as the three conditions outlined above. The results showed that the physically induced and hypnotically induced pain caused activation in the brain areas of the thalamus, anterior cingulate cortex, cerebellum, insula, inferior parietal cortex and prefrontal cortex. In contrast, imagined paid showed little activation in these areas. This suggested to the researchers that regions 3. of the brain are specifically and actively involved in generating pain, when there is no actual cause for this (no heat applied), and goes beyond previously-made more general suggestions regarding a neural network of pain. The experiment goes some way to providing a basis for the belief in direct cortical involvement in patients with chronic functional pain. The researchers concluded that further studies were necessary with such patients, given that they used healthy, normal participants. There may well be a way to control such activity and thus alleviate this type of pain experience. Critical Analysis of Article: The title itself is somewhat misleading, suggesting that pain is situated in the head. The brain, as a physical component of the body, is disassociated in a physiological sense by the wording, which confuses rather than informs. There is also a suggestion that chronic pain sufferers may have little hope of assistance, because doctors are "baffled", and the use of the word "imagine" is also confusing. This is an unscientific and sensationalist approach, because the pain study itself refers to earlier findings regarding neural pain networks. Literature provided for patients by health practitioners shows that for many years, doctors have sought and found ways to assist chronic pain sufferers, including considering their state of mind: "The risk of chronic pain....what may surprise you is that most of the warning signs are about what people feel and do, rather than medical findings." (The Back Book, 1994) In the article, the references to the studies should include the details of who, when and why, as well as proposed dates of publication. The most glaring omission is the failure to mention the University of Pittsburgh Medical Center researchers, of which Dr. Derbyshire was the leader. This study appears more scientifically, physiologically and medically- balanced of the two, yet this is not made clear. All those involved in both studies sought information which would help sufferers and alleviate conditions both physical and psychological, yet the article seems unfairly slanted towards the work of the British researchers. This is completely wrong, the U.S.A. researchers should have been given the credit due to them. I can see little justification for such a slant, or omission, as the article is widely available, worldwide, in fact. There is little mention of the far- 4. reaching implications of the studies, other than those comments scattered throughout, from Dr. Oakley. By continually referring to what he said, the inference is that he was the lead researcher in both studies, and that what he says carries great weight and should be accepted as being of great importance. In fairness to the writer, the simplified descriptions of both studies were helpful, but as stated earlier, the reasons and future applications of the findings needed to be included. In keeping with the simplicity of explanation, it was not necessary to refer to the HGSHS selection process model, all that was required would have been along the lines of: "volunteers who were found to be highly susceptible to hypnosis were used in both studies." It has to be either simple or more scientific. Given that both studies involved hypnosis, references to hypnotherapy and its uses were totally absent, other than to suggest, with a rather out of context remark (Dr. Oakleys) that it is only really recognizable as a research tool. This is neither plausible nor truthful, appearing to deny what was, by 2004, a therapy commonly understood to be a beneficial treatment in many conditions. Incidentally, the remark regarding how "you cant easily fool a brain scanner" comes across as both dismissive and facetious, belittling the importance of brain imaging, which was most likely not the intention of Dr. Oakley. As for hypnotism and pain control, much had been written by the date of the article, in support of its efficacy. Hilgard and Hilgard (1975, 1994) included its uses in treatments for cancer, obstetrics, surgery and dentistry. Cognitive behavioral therapists have long used it with positive results, teaching relaxation techniques within such therapy sessions, in order to help alleviate stress, phobias, pain, etc. In effect, by learning and using relaxation processes which amount to self-hypnosis, some people are helped to control the effects of pain, or to boost confidence and self-esteem and overcome anxiety. "In 1984, an Australian study found that anxiety levels could be controlled with hypnosis, while research in the U.S. revealed that it enabled patients to relax during dental surgery." 5. (Peters and Woodham, p. 166, 1997) Consider also, the Relaxation Response, developed for patients with heart disease and hypertension, by Dr. Herbert Benson. By use of a focus, a mantra and controlled breathing awareness, he was able to note that heart rate, oxygen consumption and blood pressure all lessened considerably, thereby negating the danger from the fight or flight mechanism caused by pain, fear and stressful situations. Once learned, this could be elicited at any time by the patient. (Benson, Chapter 7, 1975 The Relaxation Response) In a book published in 2002, Leon Chaitow explores ways to apply various natural means to control and alleviate chronic pain. Amongst these, he cites hypnotherapy and self hypnosis: "If it is possible for the mind to delete pain, or to modify it, it should also be possible to find ways of learning how to apply such techniques consciously, and so to exercise the benefits of mind control in the management of pain." (Chaitow, 2002, p.42-43) Taken from a different viewpoint, Dr. Raj Persaud, in a review of a book on the history of hypnosis, in the British Medical Journal, again in 2002, contends that, "...it is possible to achieve most of way can be done through hypnosis by direct appeal to the conscious mind, rather than an indirect wooing of the unconscious." (Persaud, 2002) The two studies presented in the article would seek to overturn that argument, while supporting the more alternative approach Chaitow takes. Further interesting points are made, regarding hypnotism, altered consciousness and free-will, by Stephan Kockelkoran in his doctoral thesis. "Hypnotic motor suggestions become executed by directly activating the motor system without being further scrutinized by frontal motor activations...in accordance with peoples subjective descriptions of the hypnotic experience, stating that a given behavioral act, appeared to happen by itself." (Kockelkoran, p. 47, 2006) He suggests then that motor goals are not active but others might function normally, resulting in "divided streams of consciousness." 6. This is research, two years later than those studies cited in the article and supported by much intervening and previous work, and would seem to link in well with what has been examined regarding the work of Derbyshire et al and Haggard and Oakley. Overall, this article fails to take into account the history, application and importance of the role of hypnotism. Nor does it clearly identify the benefits or implications of the research, nor make any connections to contemporary methods in the wider sense, of other branches of medicine. It does, however, serve to highlight the importance of study and research into brain function, without clarifying how such knowledge could be applied. Unfortunately, the tone is sensational, slightly flippant, rather than informatively unbiased, and reads as though the writer was given some factual information, in simple terms, which they then reproduced without full scientific understanding. It sounds very much like an advertisement extolling the virtues of one medical research establishment and its chief player, while clearly ignoring the equal importance of another. As such, it loses the impact of a good piece of scientific material. There are good items of information in there, they just have to be sifted out. In order to fully appreciate what had taken place, the reader must carry out further research. This may well have been the writers intention, and if this is the case, then the piece can be judged to be successful. Certainly, the process of critically analyzing the article,has provided the impetus to examine many aspects of hypnotism in relation to chronic pain, and brain function. So while it may not be a great piece of scientific writing, it works as a good staring point to provoke interest and to cause any student to want to learn more. The choice to explore hypnotism in chronic pain relief, is based on the knowledge that health professionals are increasingly accepting that this is a powerful weapon in the field of both physiological and psychological medicine. Many courses offer training in hypnotherapy as part of their syllabus, it is no longer considered alternative, New Age or mumbo jumbo - it certainly has, to quote Dr.Oakley "moved out of the Dark Ages.." Reference List Benson, H., (1975) The Relaxation Response, Chap. 7: How to Bring Forth the Relaxation Response. Published, 1975 Avon Books, New York. Burton, K. Prof., Main, C. Prof., Moffett, J. K., Prof., Roland, M., Prof. and Waddell, G., Prof. The Back Book, The New Approach to Back Pain - A Patients Guide. Published by TSO, U.K. 1996, 2002 and 2004. Chaiton, L. (2002) Conquer Pain the Natural Way. Published by Duncan Baird, London 2002. Derbyshire, S. W. G., Oakley, D. A., Stenger, V. A. and Whalley, M. G. Cerebral activations during hypnotically induced and imagined pain. Published in NeuroImage 23 pp. 392-401 (2004). Haggard, P., Cartledge, P., Dafydd, M. and Oaklely, D. A. Anamoulous control: When free-will is not conscious. Published in Consciousness and Cognition, Vol 13, Iss. 3, pp. 646-654 (September 2004) Hilgard, E. R. and Hilgard, J. R. (1994) Hypnosis in the Relief of Pain. Published by Brunner/Mazel Inc.1994, U.S.A. Kockelkoren, S. G. J. (March 2006) A multilevel control framework elucidating consciousness - Chap. 4:4 - Hypnosis. Doctoral Thesis, Department of Psychology, University of Amsterdam. Retrieved 10 June 2006 from http://home.student.uva.nl/stephan. kockelkoren/kockelkoren%202006%20%.pdf. Persaud, R. (July 2002) Reviews: Book: Hidden Depths: The Story of Hypnosis by Robin Waterfield. Published in the BMJ, Issue 325:50, 2002. Peters, Dr. D. and Woodham, A. (1997) Encyclopedia of Complimentary Medicine pp.166-167. Published by Dorling Kindersley, London, 1997. Read More