Pain is the most common presenting medical complaint and a significant risk factor for morbidity and mortality in many diseases. Substantial evidence suggests that pain's maladaptive effects on neuroendocrine and immune functioning constitute a primary pathway by which pain exerts its adverse effects (e.g., increasing the risk of cancer-related mortality). However, while much recent research has focused on treating acute and chronic pain, virtually no studies have included pain's physiological consequences as a primary outcome measure. This notable limitation of the existing literature is likely due in part to the absence of a systematically-validated laboratory pain model which investigators can use to study the effects of interventions on the immune and neuroendocrine concomitants of pain. The sequential studies proposed here will identify a laboratory pain model that reliably stimulates neuroendocrine and immunological alterations, and then obtain preliminary data on the effects of hypnosis on immune and neuroendocrine responses to acute pain. There is now strong evidence for the effectiveness of hypnotic analgesia in patients experiencing acute or chronic pain, but no studies have examined its efficacy in buffering pain's physiological impact. The initial phase of this research will systematically manipulate several parameters of commonly-used laboratory pain tests to establish a laboratory pain model that is well-tolerated and that reliably stimulates neuroendocrine and immune responses. The second phase, a pilot randomized controlled trial, will constitute a feasibility study of hypnotic analgesia's capacity to alter maladaptive neuroendocrine and immune responses to pain. Pain, especially chronic pain, has reached epidemic proportions around the world. Many of pain's adverse effects, ranging from depression to premature death, are at least partially due to pain's negative effects on several of the body's key physiological systems. Although much current research is aimed at finding treatments that reduce pain, very little is known about whether these treatments protect people from pain's negative physiological effects. This study will identify a method to evaluate these measures as outcomes, and will provide vital information related to the delivery of the hypnotic analgesia intervention and the overall protocol design, as well as allow examination of estimated effect sizes and possible subgroups who are more or less responsive to the intervention. ? ? ?
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