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As psychologists and psychiatrists probed further into the emotional components of pain, they realized that if anxiety is dominant for some patients, depression is for others. So doctors have now begun prescribing such mood-elevating drugs as imipramine (Tofranil), amitryptiline (Elavil) and a related compound, Triavil. Patients being treated with these drugs are able to function normally in everyday activities, and are allowed to drive cars. As with the tranquilizers, it is mainly the perception of pain that is altered, although some grateful patients report that their pain has actually been eliminated. Standard psychotherapy, both on a one-to-one doctor-patient basis and in groups, has also proved highly effective in relieving patients' perception of pain and their reactions to it. Presumably it does so by allaying their anxiety or lifting them out of depression.
Filter the Hurt. The newest and most striking psychiatric approach to the relief of pain is through hypnosis. In recent years, medical hypnotism has gained acceptance, and a leading exponent is Manhattan's Dr. Herbert Spiegel. What he teaches his patients, says Spiegel, is the art of handling pain so that it cannot tyrannize over them: "The patient learns to superimpose a feeling of numbness over the pain area, and to filter the hurt out of it. He does this through a focused awareness, like being absorbed in a task." In the days before medical hypnotism, a man might have focused his awareness away from his broken leg by biting his finger or his lip. Now, says Spiegel, about 80% of people can be hypnotized; only 20% may go into a deep trance, but for the others the lighter trance state is sufficient to reduce the perception of pain.
With hypnosis, many victims of incurable cancer can have their morphine dosage reduced by two-thirds, if not eliminated. Clearly, in these cases and in other disabling, recurrent pains such as migraine, the signals received and transmitted by the nerve fibers are not altered. What is changed is the mental perception and processing of pain.
It is upon these mental aspects of pain that medical researchers must concentrate, since there is no prospect that its sensory bases can be modified. Along with the pioneering in psychotherapy there goes an intensified search for more potent and safer analgesic drugs. For it is now clear that even such renowned pain killers as morphine exert their beneficent effects largely by allaying anxiety and thus altering the overall reaction to pain.
* With the exception of herion, which no U.S. physician may legally posses or prescribe, although it is still used in Britain and some other countries.