The Diagnosis and Psychophysiological Management of Chronic Pain and Anxiety

  • Ian E. Wickramasekera


There is a growing awareness that the parameters of acute and chronic pain vary widely. Acute pain is easy to localize and recognize, and may, in fact, be mediated through different pathways from chronic pain (Sweet, 1981). These pathways include the (a) dorsal-column post synaptic system (DCPS), (b) spinocervical tract (SCT) and (c) neospinothalamic tract (NSTT), which are all rapidly conducting systems suited to convey phasic information (Melzack & Dennis, 1978). Acute pain is marked by an increase in mytonia, heart rate, blood pressure, skin conductance, and peripheral vasoconstriction together with other indicators of sympathetic activation. From a psychological or behavioral viewpoint we are seeing the same signs that indicate fear or anxiety. Chronic pain has been defined as any pain that has persisted for over 6 months and has not responded to standard medical management, including drugs, physical therapy, and surgery (Sternbach, 1974). Bonica, a pioneer in the study and therapy of chronic pain, defines it as “pain which persists beyond the usual course of an acute disease or a reasonable time for an injury to heal, or it recurs at intervals of months or years (Bonica, 1980). Studies by Johnson (1978) and Barton, Haight, Marsland, and Temple (1976) reveal that 75% of patients who complain of recent onset back pain experience spontaneous remission within 3 months.


Chronic Pain Acute Pain Pain Behavior Chronic Pain Patient Tension Headache 
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  1. Andreychuck, T., & Skriver, C. Hypnosis and biofeedback in the treatment of migraine headache. International Journal of Experimental & Clinical Hypnosis, 1975, 23 (3), 172–183.CrossRefGoogle Scholar
  2. Aronoff, G. M. [Editorial]. Clinical Journal of Pain, 1985, 1, 1–3.CrossRefGoogle Scholar
  3. Barton, J., Haight, R., Marsland, D., & Temple, T. Low back pain in the primary care setting. Journal of Family Practice, 1976 „3, 363–366.PubMedGoogle Scholar
  4. Beecher, H. K. Measurement of subjective responses: Quantitative effects of drugs. New York: Oxford University Press, 1959.Google Scholar
  5. Blanchard, E. B., & Andrasik, F. Psychological assessment & treatment of headache: Recent developments & emerging issues. Journal of Consulting & Clinical Psychology, 1982, 50, 859–879.CrossRefGoogle Scholar
  6. Blackwell, B. Biofeedback in a comprehensive behavioral medicine program. Biofeedback & Self-Regulation, 1981, 6, 445–472.CrossRefGoogle Scholar
  7. Bond, M. R. The relation of pain to the Eysenck Personality Inventory, Cornell Medical Index & Witley Index of Hypochondriasis. British Journal of Psychiatry, 1971, 119, 671–678.PubMedCrossRefGoogle Scholar
  8. Bond, M. R. Personality studies in patients with pain secondary to organic disease. Journal of Psychosomatic Research, 1973, 17, 257–263.PubMedCrossRefGoogle Scholar
  9. Bonica, J. J. (Ed.). International symposium on pain. Advances in neurology (Vol. 4 ). New York: Raven Press, 1974.Google Scholar
  10. Bonica, J. J. Pain research & therapy: Past & current status & future needs. In L. K. Y. Ng & J. J. Bonica (Eds.), Pain, discomfort & humanitarian care. New York: Elsevier, 1980.Google Scholar
  11. Bowers, K. S., & Meichenbaum, D. Unconscious revisited. New York: Wiley Interscience, 1984.Google Scholar
  12. Brena, S. F. The mystery of pain: Is pain a sensation? Management of patients with chronic pain. Jamaica, New York: Spectrum Publications, 1983.Google Scholar
  13. Budzynski, T. H., & Stoyva, J. M. An instrument for producing deep muscle relaxation by means of analog information feedback. Journal of Applied Behavior Analysis, 1969, 2, 231–237.PubMedCrossRefGoogle Scholar
  14. Budzynski, T. H., Stoyva, J. M., & Adler, C. Feedback-induced muscle relaxation. In T. Barber, L. Di Cara, J. Kamiya, N. Miller, D. Shapiro, & J. M. Stoyva, (Eds.), Biofeedback & self-control. Chicago: Aldine-Atherton, 1970.Google Scholar
  15. Budzynski, T. H., Stoyva, J. M., Adler, C. S., Sr Mullaney, D. J. EMG biofeedback & tension headache: A controlled outcome study. Seminars in Psychiatry, 1973, 5, 397–410.PubMedGoogle Scholar
  16. Chapman, C. R., Casey, K. L., Dubner, R., Foley, K. M., Gracely, R. H., & Reading, A. E. Pain measurement: An overview. Pain, 1985, 22, 1–31.PubMedCrossRefGoogle Scholar
  17. Coger, R., & Werback, M. Attention, anxiety, & the effects of learned enhancement of EEG in chronic pain: A pilot study in biofeedback. In B. L. Crue, Jr. (Ed.), Pain: Research & treatment. New York: Academic Press, 1975.Google Scholar
  18. Costa, P. T., & McCrae, R. R. Hypochondriasis, neuroticism & aging: When are somatic complaints unfounded ? American Psychologist, 1985, 40, 19–28.PubMedCrossRefGoogle Scholar
  19. Cox, D. J., Freundlich, A., & Meyer, R. G. Differential effectiveness of electromyograph feedback, verbal relaxation instructions, & medication placebo with tension headaches. Journal of Consulting Clinical Psychologists, 1975, 43, 892–898.CrossRefGoogle Scholar
  20. Crue, B. L. Multidisciplinary pain treatment programs: Current status. Clinical Journal of Pain, 1985, 1, 31–38.CrossRefGoogle Scholar
  21. Edmonston, W. E. Hypnosis & relaxation. New York: Wiley, 1981.Google Scholar
  22. Edwards, P. W., Zeichner, A., Kuczmierzyk, A. R., & Boczkowski, J. Familial pain models: The relationship between family history of pain & current pain experience. Pain, 1985, 21, 379–384.PubMedCrossRefGoogle Scholar
  23. Engstrom, D. R., London, P., & Hart, J. I. EEG alpha feedback training & hypnotic susceptibility. A.P.A. Proceedings, 1970, 5, 837–838.Google Scholar
  24. Evans, F. J. The power of a sugar pill. Psychology Today, April 1974, pp. 55–59.Google Scholar
  25. Eysenck, H. J. Psychophysiology & personality. In A. Galse & J. A. Edward (Eds.), Physiological correlates of human behavior. London: Academic Press, 1983.Google Scholar
  26. Flor, H., & Turk, D. C. Etiological theories & treatments for chronic low back pain: I. Somatic models & interventions. Pain, 1984, 19 (2), 105–121.PubMedCrossRefGoogle Scholar
  27. Fordyce, W. E. Behavioral methods for chronic pain & illness. St. Louis: C. V. Mosby, 1976.Google Scholar
  28. Forster, P. M., & Govier, E. Discrimination without awareness? Quarterly Journal of Experimental Psychology, 1978, 30, 282–295.CrossRefGoogle Scholar
  29. Friar, L. R., Sr Beatty, J. Migraine: Management by trained control of vasoconstriction. Journal of Consulting Clinical Psychologists, 1976, 44, 46–53.CrossRefGoogle Scholar
  30. Gentry, W. P., & Bernal, G. A. Chronic pain. In R. B. Williams & W. D. Gentry (Eds.), Behavioral approaches to medical treatment. Cambridge, MA: Ballinger, 1977.Google Scholar
  31. Gottfredson, D. K. Hypnosis as an anesthetic in dentistry. Doctoral dissertation, Department of Psychology, Brigham Young University. Dissertation Abstracts International, 1973„33, 7–13: 3303.Google Scholar
  32. Hendler, N., Derogatis, L., Avella, J., & Long, D. EMG biofeedback in patient with chronic pain. Diseases of the Nervous System, 1977, 38, 505–574.PubMedGoogle Scholar
  33. Hilgard, E. R. Hypnotic susceptibility. New York: Harcourt & Brace, 1965.Google Scholar
  34. Hilgard, E. R., & Hilgard, J. R. Hypnosis in the relief of pain. Los Altos, CA: Kaufmann, 1975.Google Scholar
  35. Hult, L. Cervical, dorsal, & lumbar spinal syndromes: A field investigation of a nonselected material of 1200 workers in different occupations with special reference to disc degeneration & so-called muscular rheumatism. Acta Orthopedica Scandinavia, 1954, 17, (Suppl.) 1–102.Google Scholar
  36. Hutching, D. F., & Reinking, R. H. Tension headaches: What form of therapy is most effective. Journal of Biofeedback & Self-control, 1976, 1, 183–190.CrossRefGoogle Scholar
  37. Jaynes, J. The origin of consciousness in the breakdown of the bicameral mind. Boston: Houghton Mifflin, 1977.Google Scholar
  38. Johnson, A. D. The problem claim: An approach to early identification. Department of Labor & Industries, State of Washington (mimeo), 1978.Google Scholar
  39. Karron, J., DeGoode, D. E., & Tait, R. A comparison of low back pain patients in the United States & New Zealand: Psychosocial & economic factors affecting severity of disability. Pain, 1985, 21, 77–89.CrossRefGoogle Scholar
  40. Katz, R. L., Kao, C. Y., Spiegel, H., & Katz, G. J. Pain, acupuncture, hypnosis. In J. J. Bonica (Ed.), Advances in Neurology (Vol. 4 ). New York: Raven Press, 1974.Google Scholar
  41. Kerr, F. W. L. The structural basis of pain: Circuitry & pathways. In K. Y. L. Ng & J. J. Bonica (Eds.), Pain, discomfort, and humanitarian care. New York: Elsevier, 1980.Google Scholar
  42. Kihlstrom, J. F. Hypnosis. In M. R. Rosenzweig & L. W. Porter, (Eds.), Annual Review of Psychology, 36, 1985, 385–418.Google Scholar
  43. Kihistrom, J. F. The cognitive unconscious. Science, 1987, 237, 1445–1452.CrossRefGoogle Scholar
  44. Kimble, G. A. Hilgard & Marquis’ conditioning & learning ( 2nd ed. ). New York: AppletonCentury-Crofts, 1961.Google Scholar
  45. Levine, J. Pain & analgesia: The outlook for a more rational treatment. Annals of Internal Medicine, 1984, 100, 269–276.PubMedCrossRefGoogle Scholar
  46. Lewicki, P. Nonconscious social information processing. New York: Academic Press, 1986. Linton, S. J. Behavioral remediation of chronic pain: A status report. Pain,1986, 24, 125141.Google Scholar
  47. Loeser, J. D. Neurosurgical control of chronic pain. Archives of Surgery, 1977, 12, 880–883.CrossRefGoogle Scholar
  48. Loeser, J. D. Nonpharmacologic approaches to pain relief. In L. K. Y. Ng & J. J. Bonica (Eds.), Pain, discomfort, and humanitarian care. New York: Elsevier, 1980.Google Scholar
  49. London, P., Hart, J., & Lebovits, M. EEG alpha rhythms & hypnotic susceptibility. Nature, 1968, 219, 71–72.PubMedCrossRefGoogle Scholar
  50. Lynn, R., & Eysenck, H. J. Tolerance for pain, extraversion & neuroticism. Perceptual & Motor Skills, 1961, 12, 161–167.CrossRefGoogle Scholar
  51. Mathews, A., MacLeod, C. Discrimination of threat cues without awareness in anxiety states. Journal of Abnormal Psychology. 1986, 95 (2), 131–8.PubMedCrossRefGoogle Scholar
  52. Medina, J. L., Diamond, S., & Franklin, M. A. Biofeedback therapy for migraine. Headache, 1976, 16, 115–119.PubMedCrossRefGoogle Scholar
  53. Melzack, R. The puzzle of pain. New York: Basic Books, 1973.Google Scholar
  54. Melzack, R., & Dennis, S. G. Neurophysiological foundations of pain. ln R. A. Sternbach (Ed.), The psychology of pain. New York: Raven, 1978.Google Scholar
  55. Melzack, R., & Perry, C. Self-regulation of pain: Use of alpha feedback & hypnotic training for control of chronic pain. Experimental Neurology, 1975, 46, 452–469.PubMedCrossRefGoogle Scholar
  56. Melzack, R., & Wall, P. D. Pain mechanisms: A new theory. Science, 1965, 150, 971–979.PubMedCrossRefGoogle Scholar
  57. Newman, R. 1., Seres, J. L., Yospe, L. P., & Darlington, B. Multidisciplinary treatment of chronic pain: Long-term follow-up of low back pain patients. Pain, 1978, 4, 283–292.PubMedCrossRefGoogle Scholar
  58. Ng, L. K. Y., & Bonica, J. J. Pain, discomfort & humanitarian care. New York: Elsevier, 1980.Google Scholar
  59. Pagni, C. A., & Maspes, P. E. A critical appraisal of pain surgery & suggestions for improving treatment. Recent advances on pain pathophysiology & clinical aspects, Springfield, IL: Charles C Thomas, 1974.Google Scholar
  60. Payne, B., & Norfleet, M. A. Chronic pain & the family: A review. Pain, 1986, 26, 1–22.PubMedCrossRefGoogle Scholar
  61. Pena, F. Perceptual isolation & hypnotic susceptibility. Unpublished doctoral dissertation, Washington State University. Pullman, Washington, 1963.Google Scholar
  62. Pilowsky, I., Crettenden, I., & Townly, M. Sleep disturbance in pain clinic patients. Pain, 1985, 23, 27–33.PubMedCrossRefGoogle Scholar
  63. Qualls, P. J., and Sheehan, P. W. Electromyograph biofeedback as a relaxation technique: A critical appraisal & reassessment. Psychological Bulletin, 1981, 90, 21–42.PubMedCrossRefGoogle Scholar
  64. Robinson, D. Psychobiology & the unconscious. In K. S. Bowers & D. Meichenbaum (Eds.), Unconscious revisited. New York: Wiley-Interscience, 1984.Google Scholar
  65. Sainsbury, P., & Gibson, J. G. Symptoms of anxiety & tension & the accompanying physiological changes in the muscular system. Journal of Neurology, Neurosurgery, & Psychiatry, 1954, 17, 216–224.CrossRefGoogle Scholar
  66. Sanders, R. S., & Reyher, J. Sensory deprivation & the enhancement of hypnotic susceptibility. Journal of Abnormal Psychology, 1969, 74, 375–378.PubMedCrossRefGoogle Scholar
  67. Sargent, J. D., Green, E. E., & Walters, E. D. Autogenic feedback training in a pilot study of migraine & tension headaches. Unpublished manuscript, 1972.Google Scholar
  68. Schmort, G., & Junghanns, H. Die gesunde und kranke Wirbelseule im Roentgenbild. Leipzig: Thieme, 1932.Google Scholar
  69. Scott, D. S., & Barber, T. X. Cognitive control of pain: Effects of multiple cognitive strategies. Psychological Record, 1977, 27, 373–383.Google Scholar
  70. Seres, J. L., & Newman, R. I. Results of treatment of chronic low back pain at the Portland Pain Center. Journal of Neurosurgery, 1976, 45, 32–36.PubMedCrossRefGoogle Scholar
  71. Shevrin, H., & Dickman, S. The psychological unconscious: A necessary assumption for all psychological theory? American Psychologist, 1980, 35, 421–434.CrossRefGoogle Scholar
  72. Skinner, B. F. Science & human behavior. New York: Macmillan, 1953.Google Scholar
  73. Spanos, N. P., Radtke-Bodonik, L., Ferguson, J. D., & Jones, B. The effects of hypnotic susceptibility, suggestions for analgesia, & the utilization of cognitive strategies on the reduction of pain. Journal of Abnormal Psychology, 1979, 88, 282–292.PubMedCrossRefGoogle Scholar
  74. St. Jean, R., & McLeod, C. Hypnosis, absorption & time perception. Journal of Abnormal Psychology, 1983, 92, 81–86.CrossRefGoogle Scholar
  75. Sternbach, R. A. Pain: A psychophysiological analysis. New York: Academic Press, 1968. Sternbach, R. A. Pain patients: Traits & treatment. New York: Academic Press, 1974. Sternbach, R. A. Treatment of the chronic pain patient. Journal of Human Stress, 1978, 4, 11–15.Google Scholar
  76. Sternbach, R. A., Janowsky, D. S., I luey, L. Y., & Segal, D. S. Effects of altering brain serotonin activity on human chronic pain. In J. J. Bonica & D. Albe-Fessard (Eds.), Advances in pain research & therapy (Vol. 1 ). New York: Raven Press, 1976.Google Scholar
  77. Swanson, D. W., Swenson, W. M., Marita, T., & McPhee, M. C. Program for managing chronic pain: Program description & characteristics of patients. Mayo Clinic Proceedings, 1976, 51, 401–408.PubMedGoogle Scholar
  78. Sweet, W. H. Animal models of chronic pain. Pain, 1981, 10, 275–295.PubMedCrossRefGoogle Scholar
  79. Turk, D. C., Meichenbaum, D. H., & Berman, W. H. Applications of biofeedback for the regulation of pain: A critical review, Psychological Bulletin,1979, 86(6),1322–1338.Google Scholar
  80. Turk, D. C., Meichenbaum, D., & Genest, M. Pain & behavioral medicine—A cognitivebehavioral perspective, New York: Guilford Press, 1983.Google Scholar
  81. Turner, J. A., Calsyn, D. A., Fordyce, W. E., & Ready, L. B. Drug utilization patterns in chronic pain patients. fain, 1982, 12, 357–363.Google Scholar
  82. Watson, D., & Clark, L. A. Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 1984, 96, 465–490.PubMedCrossRefGoogle Scholar
  83. Watson, D., & Tellegen, A. Toward a consensual structure of mood. Psychological Bulletin, 1985, 98, 219–235.PubMedCrossRefGoogle Scholar
  84. Whatmore, G. B., & Kohli, D. R. The physiopathology & treatment of functional disorders. New York: Grune & Stratton, 1974.Google Scholar
  85. White, J. C., & Sweet, W. H. Pain & the neurosurgeon: A forty-year experience. Springfield: Charles C Thomas, 1969.Google Scholar
  86. Wickramasekera, I. The effects of sensory restriction on hypnotic susceptibility. International Journal of Clinical & Experimental Hypnosis, 1969, 17, 217–224.CrossRefGoogle Scholar
  87. Wickramasekera, I. The effects of sensory restriction on susceptibility to hypnosis: A hypothesis & more preliminary data. Journal of Abnormal Psychology, 1970, 76, 69–75.PubMedCrossRefGoogle Scholar
  88. Wickramasekera, I. Effects of EMG feedback training on susceptibility to hypnosis: preliminary observations. Proceedings of the 79th Annual Convention of the American Psychological Association, 1971, 6, 785–787.Google Scholar
  89. Wickramasekera, I. EMG feedback training & tension headache: Preliminary observations. American Journal of Clinical Hypnosis, 1972, 15 (2), 83–85.PubMedCrossRefGoogle Scholar
  90. Wickramasekera, I. The application of verbal instructions & EMG feedback training to the management of tension headache: Preliminary observations. Headache, 1973, 13 (2), 74–76.PubMedCrossRefGoogle Scholar
  91. Wickramasekera, I. The placebo effect & biofeedback for headache pain. Proceedings of the San Diego Biomedical Symposium. New York: Academic Press, 1977.Google Scholar
  92. Wickramasekera, I. On attempts to modify hypnotic susceptibility: Some psychophysiological procedures & promising directions. Annals of the New York Academy of Sciences,1977, 796, 143–153. (b)Google Scholar
  93. Wickramasekera, I. A model of the patient at high risk for chronic stress related disorders. Paper read at Annual Convention of the Biofeedback Society of America. San Diego, California, March, 1979.Google Scholar
  94. Wickramasekera, I. A conditioned response model of the placebo effect: Predictions from the model. Biofeedback & Self-Regulation, 1980, 5, 5–18.Google Scholar
  95. Wickramasekera, 1. Clinical research in a behavioral medicine private practice. Behavioral Assessment, 1981„3, 265–271.Google Scholar
  96. Wickramasekera, L A model of people at high risk to develop chronic stress related symptoms. In F. J. McGuigan, W. E. Sime, & J. M. Wallace (Eds.) Stress & Tension Control. New York: Plenum, 1983.Google Scholar
  97. Wickramasekera, I. A conditioned response model of the placebo effect: Predictions & postdictions from the model. In L. White, B. Tursky, & G. Schwartz, (eds.), Placebo: Clinical phenomena & new insights. New York: Guilford Press, 1985.Google Scholar
  98. Wickramasekera, I., Truong, X. T., Busch, M., & Orr, C. The management of rheumatoid arthritic pain: Preliminary observations. In I. Wickramasekera (Ed.), Biofeedback, behavior therapy & hypnosis. Chicago: Nelson-Hall, 1976.Google Scholar
  99. Wiesel, S., Feffer, 11., & Tsournas, N. The incidence of positive CAT scans in an asymptomatic group of patients. Volo Award Paper read at Annual Meeting of the International Society for the Study of Lumbar Spine, Montreal, Canada, 1984.Google Scholar
  100. Wilson, S. C., & Barber, T. X. The fantasy-prone personality: Implications for understanding imagery, hypnosis & parapsychological phenomena. In A. A. Sheikh (Ed.), Imagery: Current theory, research, & application. New York: Wiley, 1982.Google Scholar
  101. Wolff, H. F. Headache & other head pain ( 2nd ed. ). New York: Oxford University Press, 1963.Google Scholar
  102. Wolpe, J., & Lazarus, A. A. Behavior therapy techniques. New York: Pergamon Press, 1966.Google Scholar
  103. Zborowski, M. People in pain. San Francisco: Jossey-Bass, 1969.Google Scholar

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© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Ian E. Wickramasekera
    • 1
  1. 1.Behavioral Medicine Clinic and Stress Disorders Research LaboratoryEastern Virginia Medical SchoolNorfolkUSA

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