[Double-balloon enteroscopy for the diagnosis and treatment of patients with unexplained gastrointestinal blood loss]

In 3 patients, 2 women aged 56 and 57 and a 65-year-old man, who presented with overt and occult gastrointestinal bleeding, no focus of the bleeding could be found during gastroscopy and colonoscopy. The patients were then examined and treated by double-balloon enteroscopy (DBE). DBE is a relatively new endoscopic technique that allows high-resolution visualisation of the entire small intestine with full endoscopic instrumentation. The 56-year-old woman had coeliac disease and an enteropathy-associated T-cell lymphoma with stenoses over approximately 150 cm of bowel length. She was given chemotherapy and responded well. The 57-year-old woman suffered from Rendu-Osler-Weber syndrome with multiple angiodysplasias in the small intestine. She was treated 5 times with argon plasma coagulation during DBE, for more than 40 angiodysplasias, and thereafter no longer needed blood transfusions. The 65-year-old man had a history of recurrent melanoma. During DBE, multiple metastases of a melanoma in the small intestine were found and tattooed. The tumours were later surgically excised, with no further metastases in the following 2 years. DBE has proven to be a good diagnostic and therapeutic tool in the management of small intestinal diseases.

The effects of alcohol celiac plexus block, pain, and mood on longevity in patients with unresectable pancreatic cancer: a double-blind, randomized, placebo-controlled study

OBJECTIVE

This additional analysis of data from a previously reported prospective trial comparing the effect of intraoperative alcohol or saline placebo neurolytic block in patients with pancreatic cancer was conducted in response to the development of a new theory, which explores the relationship of negative mood states to pain, pain-related behavior, and ultimately, longevity.

METHODS

The original study used a double-blind procedure to randomly assign 139 patients with histologically proven, unresectable pancreatic cancer to receive either an alcohol or a saline block. Data on visual analog pain, mood, and interference with activity were collected preoperatively and every 2 months postoperatively until death. The current analysis was conducted on the complete data sets received from 130 patients. Demographic data were submitted to chi-square analysis and to univariate and multivariate analysis of variance. Univariate and multivariate analyses of variance also compared 1) the effect of alcohol versus saline on pain, mood, interference of pain with activities, and longevity and 2) the impact of mood on pain with longevity as the dependent variable. Correlation and regression analyses examined the impact of mood on life expectancy.

RESULTS

The alcohol intervention had a significant positive effect on life duration and mood scores. High negative mood states correlated significantly with an increase in visual analog pain, the rating of pain intensity at its worse, and pain interference with patients' activities.

CONCLUSION

In these subjects, the neurolytic block, as compared with medical management alone, improved pain, elevated mood, reduced pain interference with activity, and was associated with an increase in life expectancy.

The Additive Impact of Anxiety and a Placebo on Pain

OBJECTIVE

We investigated the effects of pain anxiety and a placebo/nocebo/neutral intervention on ice water-induced pain.

DESIGN

We divided 72 volunteers into high- and low-anxiety groups before randomly assigning them to experimental and control subgroups.

METHOD

Participants completed preimmersion tests of pain anxiety, pain worry, and mood. We scored first immersion pain behavior, experience, and intensity. Each subgroup then received an instruction designed to elicit a positive (placebo), negative (nocebo), or neutral response. After repeating the pain worry test, we gathered second immersion pain scores, and participants repeated the mood test, completed the treatment credibility measure, and were debriefed.

OUTCOME MEASURES

We used the Pain Anxiety Symptom Scale; self-rating Likert-type scales for pain worry, pain intensity, and pain-coping; the Multiple Affect Adjective Checklist (mood); timed measurements for pain threshold and pain tolerance; and a treatment credibility scale.

RESULTS

Pain anxiety and the placebo interventions significantly altered participants' pain scores, with best-to-worse scores reported by the low pain-anxiety/placebo, high anxiety/placebo, low anxiety/neutral, low anxiety/nocebo, high anxiety neutral, and high anxiety/nocebo groups. The high pain-anxiety group demonstrated the greatest response to the placebo/nocebo intervention in the expected directions in pain, worry, and anxious mood scores and in decreased self-confidence in managing pain (this was also negatively affected by the nocebo in each pain-anxiety group).

CONCLUSION

This study demonstrates that the interaction of the personality variable of pain anxiety with the placebo/nocebo response has an impact on pain, worry, and mood.

Perceived control over anxiety-related events as a predictor of pain behaviors in a cold pressor task

The extent to which perceived control over anxiety-related events contributes to the experience of pain was investigated. It was hypothesized that perceived control over anxiety-related events would predict pain behaviors induced via a cold pressor task because perceived control may alter the meaning of a pain-inducing stimulus. Eighty undergraduate students completed the Anxiety Control Questionnaire. Pain Anxiety Symptoms Scale. State-Trait Anxiety Inventory, and Penn State Worry Questionnaire. Heart rate was assessed prior to hand immersion. Participants then immersed their dominant hand in ice water and rated pain intensity at their pain threshold and tolerance times. Results indicate that perceived control over anixiety-related events predicts pain tolerance and endurance (i.e., overt pain response) but not pain intensity. threshold, or heart rate. It appears that the psychological process variable of perceived control over anxiety-related events uniquely influences participants' ability to cope with the experience of pain by altering the perceived threat of the acute pain induced via a cold pressor task.

Suggestion/placebo effects on pain: negative as well as positive

This study explores the effect of positive and negative placebo suggestions on pain induced by hand exposures to ice water. Thirty-six participants were randomly assigned to one of the following interventions: (a) positive placebo suggestion, (b) negative placebo suggestion, and (c) control. The positive placebo-suggestion participants were given favorable messages about the beneficial effects of ice-water hand immersion. The negative placebo-suggestion group was given messages depicting the negative effects of exposure to ice water. The control groups were given neutral messages about exposure to ice water. Participants rehearsed the messages and focused on them during their second hand exposures. Results indicate that both the positive and negative placebo-suggestion interventions significantly altered participants' pain threshold, pain tolerance, and pain endurance. Participants exposed to a positive placebo condition tolerated pain better than a neutral condition. Participants exposed to a negative placebo did not tolerate pain as well as participants with a neutral condition.

Pain ameliorating effect of eye movement desensitization

This study explores the efficacy of eye movement desensitization and reprocessing (EMD/R) in the management of acute pain induced by hand exposures to ice water. Thirty participants were randomly assigned to one of the following interventions: (a) eye movement desensitization and reprocessing, (b) eye movement desensitization with music (EMD/M), and (c) control. The EMD/R participants focused on negative experiences associated with exposure to ice water, generated positive self-talk, and diverted their attention away from pain by focusing on a rapidly moving light on a monitor. The EMD with music group received eye movement desensitization coupled with preferred music. Repeated measures univariate and multivariate analysis of covariance was used to analyze the data. Results indicated that both procedures alleviated participants' pain to a similar degree and significantly more than the control, P < 0.05.

Promoting healthy nutritional habits by paradigmatic behavior therapy

Paradigmatic behavior therapy was applied to alter the maladaptive nutritional habits of a 41-year-old depressed female. The client's activities, affect, and cognitions were self-monitored, along with daily intake of processed sugar and fruits and vegetables. The intervention program included contingency contracting and the production of pleasant affective states. The program promoted a favorable attitude toward fruits and vegetables and led to a significant increase in their consumption with significant decrements in sugar intake. The client became less tense and depressed. The favorable effects were maintained at a 5-month follow-up.

Semantic desensitization: a paradigmatic intervention approach to anxiety disorders

Studied the effectiveness of semantic desensitization in alleviating public speaking anxiety. Thirty speech-anxious clients, matched on the severity of their problem, were assigned randomly to one of the following treatment conditions: (a) semantic desensitization; (b) attention placebo; and (c) waiting list control. The semantic desensitization group received a self-instructional, anticipatory-anxiety hierarchy paired with visually induced, relaxing, pleasant scenes. Semantic desensitization therapy resulted in significant reductions of both the affective and behavioral components of anxiety as compared to the two controls. The placebo control also showed improvement in several indices of subjective anxiety as compared to the no-treatment waiting list control. The beneficial effects of semantic desensitization therapy were maintained on follow-up.

Some personality correlates of contemplated suicide

Using subjects' own reports of serious suicidal thought, a group of American university students were divided into two groups in terms of contemplated suicide. The group admitting serious suicidal thoughts ( N = 111) differed significantly from the nonsuicidal group ( N = 356) on 7 of the 9 personality dimensions covered by Lanyon's Psychological Screening Inventory and Eysenck's PEN Questionnaire. The suicidal group on the whole presents a much more disturbed and pathological profile than the nonsuicidal group.

Transfer of verbal conditioning to non-verbal behavior

In this study neutral syllables pre-rated on Osgood's semantic differential scale were presented as names of blocks. After negative meaning was associated with the syllable XEH Ss re-rated the syllables on three descriptive scales. This conditioning of meaning was established by using unpleasant, weak, and mixed weak-unpleasant evaluative words. These affects were shown to be conditionable to the syllable XEH, to be transferable to a wooden block named XEH, and to be able to modify S's non-verbal behavior toward the labeled object, block XEH. The application of such words as negative reinforcers in psychotherapy was endorsed.