Hermeneutics and Experiences of the Body. The Case of Low Back Pain

The purpose of this paper is to elaborate on the notion of clinical medicine as a hermeneutical enterprise and to bridge the gap between the general perspectives of hermeneutics and the particularities of medical practice. The case of a patient with low back pain is analyzed. The discussion centers around the metaphor of the patient as a text and a model of five social discourses about low back pain. The problems addressed are: (1) the nature of a moral experience, (2) the variety of available texts, (3) the difference between the doctor's and patient's narratives, and (4) the patient's and doctor's responsibility regarding the existential, biographical meaning of an illness. Although many problems are left unsolved, it is argued that from a philosophical point of view the notion of medicine as a hermeneutical enterprise opens up the possibility of gaining insight in the foundations of the clinical encounter.     

The long-lasting now: Disorganization in subjective time in long-standing pain

This paper presents a phenomenological-hermeneutical case study on long-standing pain (LP), a public health problem of great importance. Although there has been intensive research interest in this phenomenon, most studies have been based on traditional medical and cognitive-behavioral approaches. Our thesis is that new frames of reference can provide additional heuristic insights.
The phenomenon of LP shows a strong association with existential factors. Our case study focuses on the meaning-structure of lived temporality , a fundamental existential constituent in the lifeworld of the pain patient. A series of in-depth interviews with four subjects showed that lived temporality is disrupted in pain experience, causing a disorganization of the patient's being in the world. The results generate several hypotheses about implications for time estimation in pain experience.     

Personality disorders and response to outpatient treatment of chronic pain

As part of a comprehensive interdisciplinary evaluation conducted prior to participation in an outpatient chronic pain treatment program, the psychological status of 101 persons was assessed. The majority of participants was found to have a form of personality disorder, determined by conservative cutoff scores applied to their Millon Clinical Multiaxial Inventory (MCMI) profiles. DSM-III-R Cluster C disorders (i.e., Avoidant, Dependent, Obsessive-Compulsive, and Passive-Aggressive) were overrepresented in this sample. Subsequent analyses revealed that personality disorders were related to higher levels of self-reported distress and pain at both the beginning and the end of outpatient treatment. Differential responses to treatment were observed on self-report measures; however, few relations were found between personality disorder and physical therapist ratings of impairment and improvement. Implications for the assessment of personality disorders in outpatient pain treatment programs are discussed and appropriate intervention strategies are considered.     

Alexithymia and hypersensitivity to touch and palpation

Alexithymia appears to be directly related to the process of somatization of psychological distress that has not found verbal expression. The lack of a meaningful dialogue between mother and child in early infancy may predispose the development of an alexithymic strategy in expressing psychic and psychosocial stress. This can occur in the form of unpleasant bodily sensations or pain. The human skin is, in addition to the oral and gastrointestinal organs, the earliest contact sphere between the young infant and the environment. In a group of 312 randomly chosen patients at an outpatient primary health care clinic a significant relationship was found between palpational hypersensitivity to touch on the one hand and somatization proneness and the degree of alexithymia on the other hand.     

“I Have Not a Want But a Hunger to Feel No Pain” Mexican Immigrant Women with Chronic Pain: Narratives and Psychotherapeutic Implications

We present a foundation for psychotherapy for Mexican immigrant women with chronic pain. We describe research on health care and the multiple identities that influence health behavior, including identity as Mexican, as immigrant, as Mexican woman, and as Christian. The importance of situating the pain narrative within the client’s life narrative is illustrated by interviews with five Mexican immigrant women with moderate to severe chronic pain. Emergent themes revealed the profound impact of culture and gendered imperatives: matriarch, worker, sufferer, stoic. Suggestions for psychotherapy are provided, guided by awareness of core value systems, socioeconomic impact on access to care, and experiences as immigrant.     

痛苦逃避和自我参照惩罚条件下脑电特征对自杀意念的分类效能

采用支持向量机的特征递归选择算法, 创新性采用三维心理痛苦量表和自我参照情感激励延迟任务, 建构自杀意念分类模型的重要特征集, 并比较自杀意念和抑郁的分类模型重要特征集差异。结果发现, 痛苦逃避是自杀意念分类模型的首位特征; 基于痛苦加工特征的自杀意念多模态分类模型效能优良。研究首次证实了在机器学习建构复杂的自杀意念分类模型中, 痛苦逃避及其相关脑电成分的重要性。拓展了结合心理痛苦三因素模型和机器学习算法对自杀预测的临床应用可行性。     

Neural basis of affective touch and pain: A novel model suggests possible targets for pain amelioration

Pain is one of the most common health problems and has a severe impact on quality of life. Yet, a suitable and efficient treatment is still not available for all patient populations suffering from pain. Interestingly, recent research shows that low threshold mechanosensory C-tactile (CT) fibres have a modulatory influence on pain. CT-fibres are activated by slow gentle stroking of the hairy skin, providing a pleasant sensation. Consequently, slow gentle stroking is known as affective touch. Currently, a clear overview of the way affective touch modulates pain, at a neural level, is missing. This review aims to present such an overview. To explain the interaction between affective touch and pain, first the neural basis of the affective touch system and the neural processing of pain will be described. To clarify these systems, a schematic illustration will be provided in every section. Hereafter, a novel model of interactions between affective touch and pain systems will be introduced. Finally, since affective touch might be suitable as a new treatment for chronic pain, possible clinical implications will be discussed.     

A Comprehensive Examination of the Model Underlying Acceptance and Commitment Therapy for Chronic Pain

The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date.     

Degree of extraversion and physiological responses to physical pain and sadness

Extraversion is a personality frequently discussed as one of the strongest and most consistent factors that relates to individual subjective wellbeing. The goal of this study was to better understand how people with varying degrees of extraversion psychologically and physiologically respond differently to unpleasant circumstances. Emotional responses (e.g., levels of intensity, valence, and arousal) were assessed in determining the sensitivity level to negative stimuli that were specifically designed to provoke physical pain and sadness emotion. Physiological changes (e.g., heart rate (HR), blood volume pulse (BVP), and respiratory sinus arrhythmia (RSA)) were also measured during pain and sadness to observe sympathetic and parasympathetic activities. Our results showed that the degree of extraversion was associated with less unpleasant responses to sadness, less HR responses to both pain and sadness, and greater RSA responses to sadness. The findings suggest that the lower HR reactivity to painful and sad situations and greater RSA reactivity to sad situations in extraversion could be possibly due to increased parasympathetic activity. Additionally, enhanced parasympathetic activity to negative situations may explain an important mechanism underlying the positive connection between extraversion and subjective wellbeing.