Background & Aims

Pain is a personal experience that is impacted by biological, psychological, and social factors at various levels. This means that levels of subjective intensity, understanding, and rejection of pain highly depend on sensory, emotional, and cognitive factors, making it different from other sensations. Treatment approaches that are currently suggested for chronic pain include pain education, cognitive behavioral therapy, mindfulness, and exercise therapy. In our previous research, we devised an emotional approach that employs arousing images for patients to erase the “sites of pain.” The results evidenced that the intensity of the pain and discomfort improved in both healthy patients and patients with non-specific chronic low back pain. Therefore, this report aims to explore the application of this approach by extending it to an examination of the therapeutic response of a patient with specific low back pain.

Methods

The participant was a man in his 20s, with specific chronic low back pain. In 2017, the patient was diagnosed with lumbar disc herniation. His pain intensified the most when he woke up in the morning and was alleviated later as he moved his body. On the following morning, the pain would intensify again. This research used a single case ABAB design. During phase A, no intervention was made, and during phase B, an intervention was made by showing the patient emotionally arousing images of low back pain on a tablet device and having him erase the “sites of pain” and “sites of discomfort” by moving his finger freely to use the blur effect on the tablet. The duration of each phase was 8 days for phase A and 6 days for phase B; the two phases were alternatively repeated for two cycles. The endpoints of pain and discomfort were measured with Pain Catastrophizing Scale (PCS) and Visual Analogue Scale (VAS), and measurements were taken on the first and last days of each phase.

Results

The measurement results of each phase are shown in the following order: the last day of phase A1, immediately after the intervention on the first day of phase B1, immediately after the intervention on the last day of phase B1, the first day of phase A2, the last day of phase A2, immediately after the intervention on the first day of phase B2, and immediately after the intervention on the last day of phase B2. There was no decreasing trend in the intervention in the PCS?19?11?15?12?21?11?9??pain intensity (13?5?35?6?67?23?5) or discomfort (12?5?49?6?67?25?6). Secondly, the results immediately before and after the interventions in phase B are shown in the following order: immediately before and after the intervention on the first day of phase B1, the last day of phase B1, the first day of phase B2, and the last day of phase B2. These indicated decreases in pain intensity (from 19 to 5, 46 to 35, 32 to 23?and 8 to 5) and discomfort (from 22 to 5, 59 to 49, 35 to 25, and 11 to 6).

Conclusions

Unlike previous reports that showed a therapeutic response in healthy patients and patients with non-specific chronic low back pain, this treatment approach did not lead to a chronological decrease in the pain-related items associated with his specific chronic low back pain. Furthermore, the patient expressed his subjective viewpoint, expressing “It felt like the pain was alleviated immediately after the intervention, but once the pain developed later, it was uncontrollable.” In fact, the VAS of both pain and discomfort measured immediately before and after the intervention showed declines, but they were not sustained. These results suggest that in specific chronic low back pain, organic factors have a noticeable impact on pain, making other treatment approaches ineffective. Therefore, we conclude that this research provides useful information on the possible indications for this treatment approach. Further examination with a larger sample size is required in future studies.

References

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Presenting Author

Hiroshi Maeoka

Poster Authors

Hiroshi Maeoka

PhD

Kio University

Lead Author

Takahiko Fukumoto

Kio University

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies