Mechanism of analgesia induced by hypnosis and acupuncture: is there a difference?

Hypnosis and acupuncture can alleviate experimentally induced pain but the mechanism of analgesia remains unclear for both techniques. Experimental pain was induced by cold pressor test (CPT) in 8 male volunteers. Analgesic effect of hypnosis (HA) and acupuncture (AA) was assessed before and after double-blind administration of placebo or naloxone, in a prospective, cross-over study. We found that pain intensity was significantly lower with HA as compared with AA, both with naloxone (P less than 0.001) and placebo (P less than 0.001). Within HA or AA groups, pain scores did not differ significantly when naloxone or placebo was administered. During AA, however, pain scores were similar to control values when naloxone was given (P = 0.05) but decreased significantly with placebo (P less than 0.002). Analog scales for pain intensity and pain relief showed a good correlation (r = 0.94). Plasma levels of beta-endorphins did not change significantly in any combination. Heart rate, peripheral arterial blood pressure and skin conductance were very insensitive indices to assess pain intensity or relief, as well as intensity of acupuncture stimulation or depth of hypnotic trance. We conclude: (1) HA and AA can significantly reduce pain from CPT, and HA is more effective than AA: (2) HA and AA are not primarily mediated by the opiate endorphin system; and (3) plasmatic levels of beta-endorphins are not significantly affected by either HA or AA nor by naloxone or placebo administration.

[Psychological impact of cataract surgery in the elderly patients]. / Impact psychologique de l'opération de la cataracte chez le patient âgé.

A standardized interview was undertaken in twenty patients, mean age of 70, suffering from cataract fifteen days following extra-capsular extraction of the cataract, and implantation of a lens in the posterior chamber. The patients were selected on the basis that they had no risk factors of socio-psychological complications either during the illness or post-operatively. The study investigated retrospectively the impact of cataract on different aspects of personality and life-style in these patients. We also studied the degree of reactive depression in the postoperative period, as measured by the Hamilton depression scale. Although the precise psychological correlation between the two time periods was not possible, half of the patients suffered from a major affective disorder, as classified by DSM-III, 15 days before the operation and a quarter of these were depressed after the operation. Our results show this condition to be associated with considerable but non specific socio-affective upheaval in these patients.

[From the letters (to Freud) to the diary (of Ferenczi)]. / De la correspondance (avec Freud) au journal (de Ferenczi).

This article presents the figures of Sigmund Freud and of Sándor Ferenczi as they appear in their exchange of correspondence, in the close interweaving of their private and professional lives. The most critical aspects of the practice of psychoanalysis, which was the passion and constant preoccupation of the two correspondents, are sounded in this correspondence which also shows the relentless effort that was made by the two men to consolidate the theoretical basis of the field. The document that follows this correspondence, Ferenczi's "Clinical diary" thus appears as an act of self-assertion, being addressed to Freud in a manner no longer explicit but implicit.

[A few insights into the history of the correspondence between Freud and Ferenczi. "The intrications of the different couches"]. / Brefs aperçus sur l'histoire de la correspondance Freud-Ferenczi. "Les intrications des différents divans".

The author has given an account of the history of these documents, as from the step taken in 1948 by Ferenczi's widow Gizella who was living in Berne at that time and who contacted Anna Freud in the aim of obtaining the letters addressed by her husband to Freud. One step followed another, and after a number of circuitous moves and hesitations, and, as Michael Balint remarked upon, an intrication of "a different couches", all the protagonists encountered the obstacle of a reticence working to protect the private lives of people still living ... Today, after the formation of a committee for the publication of these 1,300 letters which constitute a veritable human and psychological treasure trove, the psychological and legal barriers surrounding their publication seem to have been done away with and, financial backing having been found, the moment when these valuable documents will be published appears to be near.

[Psychotherapy of depression]. / La psychothérapie de la dépression.

A review of the factors susceptible to explain the inner life of the depressed person and help to elaborate a psychotherapeutic approach.