Bresler Bresler
Imagery and Pain Control

by

David Bresler, Ph.D.





Goals of Treatment

You've obviously come a long way since your initial experiments with pain control. How do you look at pain now?

In the field of pain management we distinguish two goals of treatment. One is being able to reduce or block the pain sensation and if we do that, we call it anesthesia. Often we lose other sensations as well. The second strategy is to enhance tolerance to pain. For example, let's talk about severe degenerative joint disease. There's no cartilage left and it's just bone on bone and that hurts terribly. There may not be much we can do to reduce that noxious sensation but there is always something we can do to enhance tolerance to pain.

Let me put it more simply. If you imagine sucking on a juicy sour yellow lemon, that produces a physiologic response called salivation. It's a very real secretion of a bodily fluid. Why can't thinking of pain relief cause release of endorphins in much the same way? Is that a leap?

No. It makes sense to me. But please say more about how you think that works.

What Marty Rossman and I say is that imagery is the language of the autonomic nervous system. Thinking of something frightening causes release of adreno-corticosteroids and increased heart rate. Thinking of the lemon makes you salivate. I think imagery is the way the autonomic nervous system communicates with itself.

Do you believe imagery works primarily through the autonomic nervous system? Pain

No. Just the other way around. I think the autonomic nervous system is particularly responsive to imagery. For example, I can think of dancing the jitterbug but it doesn't automatically make my feet do it. But if I think of something terrifying and I really get involved in it, my blood pressure is going to go up and I don't have much voluntary control over that.

How did you get involved with the UCLA pain clinic? Did you found that?

After I completed my post-doc in psychiatry, I decided to stay at UCLA and continue my work there. I joined the Department of Anesthesia and we started the Acupuncture Research Project. That ultimately became the Pain Control Unit. After I had been working with acupuncture for awhile, we had a better sense of what it could do and what it couldn't. It became puzzling to me why two patients with exactly the same degree of pathology, let's say the same degree of osteoarthritis of the knee, could have such different responses to acupuncture. One responded beautifully to acupuncture and the other didn't respond at all. Why not?

What was your conclusion?

It made us look at the psychosocial aspects of pain and take a much broader view of what was going on. It wasn't that we lost interest in acupuncture. My interest began to shift and return to my original interest in affect...looking at "Why is this patient not responding to acupuncture?" I began to look at secondary gains and what their pain experience was. And then the imagery work became much more prevalent.

At about that time when I'd talk to medical students and ask them what they were trained to do in caring for patients in pain, they would say, "Well if it hurts a little, we give them OTC's (Salicylates); if it hurts more, we give them codeine; if hurts more than that, give them percodan or demoral...and if it hurts more than that, we refer them to a psychiatrist." And that's about how sophistocated their knowledge and training was in the management of pain. It's astounding when you realize that 90% of patients who go to see a physician do so for pain-related reasons.

By 1973, we named ourselves the Pain Control Unit. We were doing much more than acupuncture. We were using bio-feedback, massage, manipulation, movement, kinesiology, nutritional work...and of course a good deal of imagery work.

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