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Objective Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain, disability, and distress. These limited effects may be due to the failure of current therapies: a) to help patients learn that their pain is influenced primarily by central nervous system psychological processes; and b) to enhance awareness and expression of emotions related to psychological trauma or conflict. Methods We developed and conducted a preliminary, uncontrolled test of novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions. A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline, post-treatment, and 6-month follow-up. Results Participation and satisfaction were high and attrition was low. Intent-to-treat analyses found significant improvements in hypothesized change processes: psychological attributions for pain, emotional awareness, emotional approach coping, and alexithymia. Pain, interference, depression, and distress showed large effect size improvements at post-treatment, which were maintained or even enhanced at 6 months. Approximately two-thirds of the patients improved at least 30% in pain and other outcomes, and one-third of the patients improved 70%. Changes in attribution and emotional processes predicted outcomes. Higher baseline depressive symptoms predicted greater improvements, and outcomes were comparable for patients with widespread vs. localized pain. Conclusion This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain, but needs controlled testing.

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Emotional trauma occurs in many patients with chronic pain, particularly fibromyalgia syndrome (FMS). Current cognitive-behavioral treatments for chronic pain have limited effects, perhaps because the trauma is not addressed, whereas emotional exposure-based treatments improve posttraumatic stress, but have not been tested on chronic pain. We present a novel, brief treatment protocol for people with chronic pain and unresolved trauma (Multi-Stimulus, Multi-Technique Emotional Exposure Therapy), which involves detecting avoidance of a range of emotion-related stimuli, implementing exposure techniques tailored to the patient's avoidances, and negotiating the process and therapeutic alliance. This treatment was pilot tested on 10 women with intractable FMS and trauma histories. Three months post-treatment, the sample showed moderate to large effects on stress symptoms, FMS impact, and emotional distress; and small to moderate improvements on pain and disability. Two patients showed substantial improvement, four made moderate gains, two showed modest improvement, and two did not benefit. This pilot study suggests that emotional exposure treatment for unresolved trauma may benefit some patients with FMS. Controlled testing of the treatment for FMS and other chronic pain populations is indicated.Chronic pain is a common source of disability and distress, and fibromyalgia syndrome (FMS) is particularly problematic. This condition, which afflicts about 4% of U.S. adults, primarily women, is marked by widespread muscular pain, multiple tender points, and often by fatigue, sleep problems, disability, and mood disturbance. Controversy surrounds FMS Correspondence concerning this article should be addressed to Mark A. Lumley, Ph.D., Department of Psychology, Wayne State University, 5057 Woodward Ave., 7 th Floor, Detroit, Michigan 48202. Phone: 313-577-2838. mlumley@wayne.edu. NIH Public AccessAuthor Manuscript Psychotherapy (Chic) because of the lack of tissue pathology in the face of often incapacitating symptoms, the elevated levels of psychological distress found in many patients, and the limited effectiveness of medical and psychological interventions. Both patients and providers are often quite frustrated.Many patients with FMS have had serious psychological trauma or conflict. Childhood or adult victimization is common, even before FMS onset and even when compared to other pain conditions. Over half of FMS patients have post-traumatic stress disorder (PTSD) or subclinical PTSD (Cohen et al., 2002), and patients with FMS respond to interpersonal conflict with increased pain (Davis, Zautra, & Reich, 2001). Trauma likely creates difficulties in emotion regulation, such as emotional suppression and avoidance, as well as in relationships, such as balancing trust and autonomy. These emotional and interpersonal problems likely contribute to FMS onset or severity in many patients, and may be key reasons that treatments often fail.How should one deal with the trauma and its affective and relational consequences found ...

The ability ofhypnosis to modulate the orocaecal transit time of 10 g lactulose was tested in six healthy volunteers. Orocaecal transit time was measured by the hydrogen breath test during three periods in random order. During the control period the subjects remained throughout the test in a semirecumbent position without moving. During the hypnotic relaxation period subjects were hypnotised before lactulose ingestion and were instructed to experience relaxation till the orocaecal transit time had elapsed. During the acceleration suggestion period subjects were hypnotised before lactulose ingestion and were repeatedly instructed to imagine the acceleration of lactulose through the intestine until transit time had elapsed. The mean orocaecal transit time was significantly longer during the hypnotic relaxation period (mean (SEM) 133 (8) min) than during the control period (93 (13) min). The mean orocaecal transit time during the acceleration suggestion period was 105 (26) minutes and was not significantly different from the mean transit time during the control period. The individual values during the acceleration suggestion period were scattered. We conclude that lactulose orocaecal transit time is delayed during hypnotic relaxation.Hypnosis induces a state of relaxation. The physiological changes of the relaxation response, including a simultaneous lowering of blood pressure and heart and respiratory rates, are opposite to those induced by stress.' Psychological stress has been shown to shorten the orocaecal transit time of a standard meal in healthy volunteers.2 The first aim of our study was to test the effect of hypnotically induced relaxation on the orocaecal transit time of 10 g lactulose in healthy volunteers. Suggestibility is increased during hypnosis. The second aim ofour study was to test the effect of the suggestion during hypnosis of transit acceleration on the orocaecal transit time of 10 g lactulose.Service d'Hepatogastroenterologie,