His interest came from his own experiences during the Second World War when the Pacific conflict regularly filled the 7700 beds at the military hospital at Fort Lewis, Tacoma, Washington. Out of Dr Bonica’s search for ways to relieve his patient’s pain came the genesis of the idea that the treatment of pain must come from a teamwork of a number of medical specialities.

There are two types of pain clinics — comprehensive pain clinics and single-treatment methods which doctors call ‘single modality’.

In single-method clinics, one type of treatment such as acupuncture, biofeedback, hypnosis, nerve block or TENS is used. This may not adequately rehabilitate a patient with chronic pain. Pain altering methods frequently do not prevent chronicity.

If all single methods were incorporated into one clinic, the basis for a multi-disciplinary and comprehensive clinic would be obtained. There are few such clinics in Australia. Pain clinics are either single modality, or modality-oriented.

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Jack’s facial pain

Jack, a 58-year-old retired textile mechanic had been referred by his treating physician because of constant and severe facial pain. This had been present for six years prior to him coming to the pain clinic and he had been diagnosed as having trigeminal neuralgia or tic douloureux. He described the pain as being always on the left side of his face. There was never any reference to the right.

‘The pain always hits around my left eye. My eyeball swells up. I have pain from the back of my throat to my temple. It comes with a bounding pulse. I have pain in the left side of the neck and above my left eye and it extends into the left side of my head.

‘When it’s extreme I sweat over the local area of my left forehead. The pain mainly occurs when I’m asleep at night. It wakes me up. The pain builds up to a pitch where I can’t stand it. It then gradually fades away. It’s been happening every night for the last week.

‘I’ve been going to the local hospital casualty department and I’ve been seen a few times by my local doctor. He’s given me an injection. The pain is excruciating. It gets me to the screaming stage.

Six years before, he had had an alcohol injection into the trigeminal nerve. The pain returned after two months despite him being left with numbness of the entire left side of his face. Two months prior to being seen his pain had recurred. Nothing in particular had triggered it. He had first sought help from his local doctor.

One of Jack’s complications in his recent past was that he had two heart attacks within three months. He was on a lot of medication including cortisone, medication for asthma, antidepressant medication and fluid tablets for heart failure. When he came to the acupuncture clinic of a public hospital, an examination showed nothing obviously wrong. But he was a man who had obviously suffered over a long period, judging by his medical history and his heavily lined face. He looked as though he was perpetually frowning.

A diagnosis of cluster headaches (severe headaches which come in bouts, or clusters, probably caused by an allergy and usually occurring in the early hours of the morning) rather than trigeminal neuralgia was made.

Cluster headaches, unlike migraine, can be treated very effectively by the use of antidepressants, antihistamines like Dilosyn and by acupuncture. This treatment was prescribed for Jack and he commenced acupuncture treatment. The acupuncture treatment consisted mainly of needles in the left side of his face, the left hand and arm, and left leg.

Jack came back three days later. ‘It’s fantastic! I can’t believe it! I’ve had no pain since Friday!’ The acupuncture treatment was repeated. Again, he returned a week later. He had experienced a severe bout of pain the day before which lasted about half an hour. Prior to the first acupuncture treatment he was getting pain for at least four nights a week.

Within the first four weeks, he reported: ‘Look, I’ve only had a few mild attacks. None have gone to my neck as they did previously. I’ve had no sweating. But the headaches I’ve had seem to have hit me when I was under tension. The last headache occurred when my daughter had her twenty-first birthday.’

Two months after the first treatment, he came back delighted, saying: ‘I really haven’t had much in the way of headaches at all. But I’ve stopped the tablets because they made me feel nauseated.’

Jack wanted further treatment to keep up the good work. He continued treatment on a fortnightly basis for the next three months. With virtually no severe headaches at all, he was now off all medication and then stopped having acupuncture.

(A word of caution here. There is no guarantee that the headaches will not return. But if an accurate diagnosis is made, and the treatment is correct, there should be no reason at all why Jack should not be helped again with simple measures like taking tablets or having acupuncture.)

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Creative imagination scale (CIS)

The creative imagination scale is a less formal method of assessing whether someone has a good, fair, medium or poor talent for hypnosis.

It was introduced in 1977 by American psychology researchers Dr T. X. Barber and Dr S.F. Wilson and consists of 10 exercises in which you would be asked to use your imagination to experience what is being described to you by the therapist. If you wish to measure your ability to use the imagery-based pain management approaches described in this book you can measure your score on the CIS.

Record the following 10 exercises on a cassette tape and replay them to yourself or have a friend read them, slowly and rhythmically. It is simply enough to close your eyes as you try to experience what is being described. To score yourself give yourself a score from 0 to 5 for each item. Score zero if you experience nothing at all, 1 if your experience is a little the same and 2 if your experience is about 50% as real as if it were actually happening. You would score

3 if the experience were much the same as described and 4 if your experience were almost the same as described. The maximum score is therefore 40 and if you score anything above 10 you probably have a capacity to use imagery-based approaches to stress and pain. Above 30 you have a very definite talent for imagery and you are potentially a very good hypnosis subject. Properly carried out, the exercise should take ajjout 25 minutes in all. 1. Arm heaviness

By letting your thoughts go along with these instructions, you can make your hand and arm feel heavy. Please close your eyes and put your left armAstraight out in front of you at shoulder height with the palm facing up. Now imagine that a very heavy dictionary is being placed on the palm of your left hand. Let yourself feel the heaviness. Your thoughts make it feel as if there’s a heavy dictionary on your hand. You create the feeling of heaviness on your hand by thinking of a very heavy dictionary. Now think of a second large heavy dictionary being placed on top of the first heavy dictionary. Notice how very heavy your arm is starting to feel as you push up on the dictionaries. Push up on the heavy dictionaries as you imagine their weight. Notice how your arm feels heavier and heavier as you push up against them. Now tell yourself that a third big, heavy dictionary is being piled on top of the other two heavy dictionaries on your hand. Your arm now feels very, very heavy. Let yourself feel as if there are three heavy dictionaries on the palm of your hand and your arm is getting heavier and heavier. Feel your arm getting heavier and heavier. Very heavy. (It is now approximately one minute and twenty seconds since the start of the image. )

Now, tell yourself that your hand and arm feel perfectly normal again and just let your arm come back down and relax.

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However, acupuncture had been used in the Western world some 400 years earlier when it was first brought back by missionaries returning to Holland from Japan.

Acupuncture usually consists of the placement of fine stainless steel needles into specific locations on the body’s surface. These locations were developed by the Chinese over thousands of years and have been simplified and their scientific basis established over the past twenty or so years.

Acupuncture may involve the placement of needles into body points and limb points, or ears and other parts of the body.

Laser acupuncture Laser acupuncture has been developed over the last 20 years and involves specifically created light shone directly onto acupuncture points on the skin’s surface.

It is totally painless as there is no sensation from the low-powered light source used in this treatment.

The most common conditions treated effectively with laser acupuncture are soft tissue injuries leading to myofascial pain syndromes such as whiplash, chronic low back pain after lifting injuries or falls and migraine headaches. Other conditions said to respond to laser are trigeminal neuralgia (facial pain) and post herpetic neuralgia (shingles pain).

Acupuncture with needles Acupuncture with needles cannot be said to be totally painless. A certain degree of discomfort is almost inevitable for acupuncture to be beneficial if, as is now commonly believed, acupuncture requires the closing of the ‘gate’ within our nervous system.

Acupuncture, with needles, is also sometimes associated with hand manipulation or electrical stimulation of the needles.

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