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General Observations and Results

The following observations are drawn from the client case notes on a population of Worker’s Compensation patients who were injured during the course of their employment. All patients were referred by members of a multidisciplinary team composed of two orthopedic surgeons, a physiatrist, a pain anesthesiologist, and a psychologist.

  • Approximately 90% of patients have experienced complete or near-complete blocking of pain in the first one-hour session. Of those who have been successful in blocking pain during the first visit, 90% have been able to repeat the initial results using the audio recording of instructions at home without telephone backup.
  • Everyone who has mastered the first level of the training has been able to achieve the cueing or prompting level in the office.
  • A number of patients have spontaneously discovered the next level of training without therapist instruction, an indication of the natural and progressive formation of neuronal networks.
  • Some 80% of patients have reported feeling rapidly developing warming sensations in the painful areas of their bodies when pain relief begins. This apparent vasodilation hasn’t been the result of a conscious instruction or suggestion.
  • A number of patients have spontaneously and creatively adapted the approach by adding other forms of imagined symptom representation. Infrequently, patients have reported spontaneous mental imagery and changes in mental images of changing symptoms.
  • A number of patients have been successful in reducing their pain almost entirely but then have developed resistances. Brief therapy has been successful in exposing unconscious motives for this blockage. For example, some patients believe that to reduce pain fully would be equivalent to forgiving the person who struck them in the car accident (approximately 10% of the patients had been injured in car accidents). Some previously very active patients have wanted to have pain serve as a reminder to go slowly, serving as an internal governor to keep them from overdoing and possibly reinjuring themselves. The program uses strategies for helping individuals overcome resistances.
  • Rarely have secondary gain features surfaced. The chief resistance noted in patients has been avoidance of confronting a core fear or failure in personal achievement. Once brought into awareness, these resistances have almost always been easily resolved. Seldom have we found psychological problems expressed symbolically through physical symptoms. However, it’s easily demonstrated and well known in the literature that anger, anxiety, and depression directly amplify the subjective experience of pain.

    More about common resistances to pain reduction encountered in NeuroBehavioral work…
  • A negative attitude about whether the process will actually work for the patient hasn’t appeared to be a variable in initial treatment results. Skeptics have had as positive a pain reduction outcome in the first office visit as other patients. There has appeared to be no difference in results based on age and gender in this largely working-class population.
  • The duration of pain relief has varied greatly, from 30 minutes to 4, 6, 8, or 24 hours, or even 2 or 3 days. Migraine sufferers have claimed the longest relief periods.
  • A review of the daily pain reduction logs suggests that patients often don’t use their pain reduction techniques as frequently as one would think they would, given their stated level of relief. It appears that the ability to reduce pain may change the meaning or significance of the pain and consequently the urgency to change the pain response. Generally, patients have agreed that having the ability to reduce or eliminate pain has caused them to feel less powerless in the face of pain and its commanding grip. Under these new conditions, pain becomes more of an inconvenience that patients will get around to reducing later.
  • Approximately 10% of patients have been unsuccessful in getting pain relief using this model. For a certain percentage of this population, this result may be related to low general intelligence, as found in biofeedback research.

Future research will include pre- and post-ratings employing the widely used SF-8 to obtain assessments of quantitative and qualitative changes in daily functioning both emotionally and physically in addition to changes in pain levels. While we’ve invited patients to maintain contact with us for backup and support, we don’t yet have any data on patterns of long-term use of the NeuroBehavioral Pain Management Program approach.

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