A meta-analysis was conducted on 109 published studies which assessed the outcome of various non-medical treatments for chronic pain. Of these studies, 48 provided sufficient information to calculate effect sizes. The remainder were examined according to proportion of patients rated as improved. Studies were compared as a function of type of treatment, type of pain, and type of outcome variable. In general, effect sizes were positive and of modest magnitude indicating the short-term efficacy of most treatments for most types of pain. This finding suggests that the effectiveness of treatments may be attributable not to the differences between treatments, but to the features they have in common. Mood and number of subjective symptoms consistently showed greater responses to treatment than did pain intensity, pain duration, or frequency of pain, indicating the importance of using a multidimensional framework for pain assessment. This finding also suggests that the benefit of psychological approaches to pain management may lie in reducing the fear and depression associated with pain, rather than relieving the pain itself. The present study also highlights the advantages of meta-analytic reviews.

Objective:The objective of this study was to test effectiveness and feasibility of equine-facilitated cognitive processing therapy (EF-CPT), a manualized adaptation of the cognitive processing therapy model for veterans with posttraumatic stress disorder (PTSD) championed by the Department of Veterans Affairs, in which equine-facilitated activities are integrated into face-to-face sessions. Method: Twentyseven veterans with a diagnosis of PTSD participated (M age ϭ 51; 78% male) in a pretest-posttest design. Veterans were seen by a single psychologist for 12 sessions of individual EF-CPT. Instruments included: PTSD Checklist (PCL), Trauma Related Guilt Inventory (TRGI), Working Alliance Inventory (WAI), and the Human Animal Bond Scale (HABS). We hypothesized improvement on all measures, low attrition, and good model fidelity. Paired sample t tests were conducted using SPSS. Results: PCL scores improved significantly (M1 ϭ 68.25, M2 ϭ 35.96, p Յ .001), as did TRGI scores (p Յ .001 on all scales). HABS and WAI indicated good working relationship. Two individuals attended one session and did not return (both under the age of 50); there was no other attrition (7% rate). Audio of sessions was reviewed for fidelity; there were variations in temporal order of session plans, which is within the acceptable flexibility of the manual. Conclusions and Implications for Practice: This manualized intervention has promise as an effective and well-tolerated treatment for veterans with PTSD. Impact and ImplicationsThis pilot of an adapted, manualized equine-facilitated cognitive processing therapy model for veterans with posttraumatic stress disorder demonstrated efficacy and low attrition, suggesting a viable alternative treatment option for veterans who have been reluctant to engage with services. This pilot is unique in the use of a novel standardized manual and attention to fidelity to the model.

Within the framework of multidimensional pain assessment, this study extended an earlier finding that hypnotic analgesia and relaxation suggestions have differential effects on pain reduction by evaluating these strategies in subjects undergoing a cold pressor protocol. Thirty-two highly susceptible subjects were randomly assigned to an analgesia or a relaxation suggestion treatment group. Six pain reports were taken at 10-sec intervals for each experimental condition. The baseline measures served as covariates. A 2 x 2 x 2 x 6 repeated-measures analysis of covariance (ANCOVA) revealed a significant group (analgesia, relaxation) by pain dimension (intensity, unpleasantness), by condition (suggestion alone, hypnotic induction plus suggestion) interaction. Analysis of the simple-simple main effects, holding both group and condition constant, revealed that application of hypnotic analgesia reduced report of pain intensity significantly more than report of pain unpleasantness. Conversely, hypnotic relaxation reduced pain unpleasantness more than intensity. The clinical implications of the study are discussed.

Forty-five highly susceptible volunteers rated a series of shocks using 32 pain descriptors. Descriptors were given numerical values using magnitude estimation procedures. We assigned the subjects to one of three conditions, analgesia suggestion, relaxation suggestion, or no suggestion. All subjects were administered the shocks and the suggestion appropriate to the group, in both the waking and hypnotic state. The results support the existence of two dimensions of pain which are differentially responsive to suggestion. Hypnotic-analgesia suggestion altered subjects' perceptions of the intensity without changing their perceptions of the unpleasantness of the shocks. Hypnotic-relaxation suggestion reduced the unpleasantness but not the perceived intensity of the stimuli. These findings imply that research into hypnotic pain relief is more easily interpreted if pain is viewed as multidimensional in nature.