@ ed !ct* ro it R6e$ inro Hadacnc it ofgr€linto.lse if is io ta plid n.dicd ...
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@ ed !ct* ro it R6e$ inro Hadacnc it ofgr€linto.lse if is io ta plid n.dicd ...

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CENEA,AI INTRODUCTION<br />

Pain h d€ ofthc gs14l hme €xpdien 6 ,H6d&he reF6@1s o.e ofth.<br />

nosl t guat hlM di!ff<strong>if</strong>ofti, ils signjfd@ <strong>is</strong> ono alstru. for <strong>it</strong> tuv sietd<br />

sd<strong>io</strong>B di!€$ d rlr6dr only t6id d f!tigu.. FdtDrt ly <strong>it</strong> tusr i61at6 <strong>it</strong><br />

rcn€dr th€ llter <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> o.ly Gxeptimally do* <strong>it</strong> wm of { intd ffial ab.@.liiy but <strong>it</strong><br />

<strong>is</strong> thi! dud si8lin@cq th. boigD dd lhc poldtially fl.li€tot that shornd k€? the<br />

Dhy3iciD rnd the ibdal<strong>is</strong>t on th. alst'{H!ns., 2005)<br />

Had.che drerdd r. ubiqu<strong>it</strong>ou &d ddryndq $ct r<strong>ta</strong>.l@€<br />

<strong>is</strong> oborc 9@Z<br />

into populal<strong>io</strong>N which have bd sMi<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>, sfsing dnd d<strong>is</strong>abil<strong>it</strong>y whicb <strong>is</strong> .es€d bv<br />

hsdlchc s, iDpos EBI buda wHo bilrt<strong>it</strong>e b I f <strong>it</strong> th. qls ofyd of l<strong>if</strong>.,<br />

lirtd wirh drsabiliy, rhfr e hug€ 6mci.l @rtq in lbe U S- nft n sl ofce b ovf<br />

4500 p€r p.liqt pd ycs, R.@chd havc *ully b@ done in thc d*1op<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> wqld i3<br />

bDt hadehe d<strong>is</strong>d6 still @{in u@nqud.d,<br />

A @f@e <strong>it</strong> 1988 @nclud<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lbd niSniE b udddi!8!o*4 tbda rrst€d<br />

wdldwidc aDd in son @utrrd l<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ach€ dierdd m tul do t@iz<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> 4 a d<strong>is</strong>@<br />

bu only s selflim<strong>it</strong>irg dd dintondl slbptodq thqe <strong>is</strong> I ldg. g!9 b.tw6 ...d fs<br />

@ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> !<st<strong>ro</strong>ng>ct*</st<strong>ro</strong>ng> <strong>ro</strong> <strong>it</strong> <strong>R6e$</strong> in<strong>ro</strong> <strong>Hadacnc</strong> <strong>it</strong> <strong>ofgr€linto</strong>.<strong>lse</strong> <strong>if</strong> <strong>is</strong> <strong>io</strong> <strong>ta</strong><br />

ud.rnood <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> etr€div. rr€fidts rDd. avil.bl. hoead 1he adve6 t!rd. oq l.sr<br />

l5 ys which de so .xcili4 in ih. dd€loPcd votld do tu1 <strong>io</strong>lch on lh. liv6 ofur.<br />

.H<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>elE b t ni@r Foblo vha @np<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> !o di<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>d likc 6 hdn di54.'<br />

6cd, schizophmi. bll <strong>is</strong> . Dajor prcbld Pho oBidet d F@ d Aiden<strong>io</strong>logic<br />

poilt of vjq. h oft <strong>lse</strong>c swEy il vs foud to be oE of thc top 14 lmhlds ir tms<br />

oft.qu@ct, for *hich <strong>it</strong>dividEls 3..& oulPctiat m.di@l w. (D.LoziF ud G.ltorl<br />

l9?5). tn s sui!€y of@mplainrs, or . F. <strong>plid</strong> n.<strong>dicd</strong> dd<br />

<strong>it</strong> wq tn. third nct tcqml<br />

@nplain! (lpviloq I98?), ln a swey of |he gdefl poPulat<strong>io</strong>n 6tiDala tu f<strong>ro</strong>h 14%

ofmale md 28% of fddcs qiih A.qud $d d<strong>is</strong>t6sing beadachB <strong>io</strong> 310/0 ofnal4 &<br />

.14!d offan le wirh sv@ h.rd..h6, A.d.$*, HoltDy( & Ab.ll,099) fo$d ovd<br />

orc b.lf(52%) of a ltts. @1169. studat Dotdlt<strong>io</strong>. adoinql !o bwin8 ban'.!€s, d<br />

16r on@ n twie ! w*k<br />

1.r, E<strong>it</strong>torial Rqi.|9<br />

'fn. h<strong>is</strong>bry ofhad*hc dlrd t{.t <strong>ro</strong> 1a dFus.ld y@ d Dqe, hrd<br />

di.Lne of hdd.dc h fou.d <strong>it</strong>r ih€ drii6t mcdidd l@rds of ndv @lh6 . & iD<br />

Brbybnu Arcth6 rcfcg@ lo ne.d..h. k found in Alhd.v.d4 wi$o i! 8l A.D<br />

@nDriliDg ofmgj.d fonuls vbicb *@ 8i.!ha€d b€tw@ 150C1800 Bc-<br />

It. lan H.rM<strong>it</strong> ws @i!.d by Atsdlx r pntti.<strong>io</strong> in El a-D. in<br />

capp.docia dd <strong>is</strong> ond d.diLd I tb. "dh@vm ofmigarc tri88d b@* ofh<strong>is</strong><br />

cl$icd de<strong>io</strong>t<strong>io</strong>i ofthc @ndijob. .rd hc d66ib.d th€ 16 qu&3 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> h<strong>is</strong>gd of<br />

n<strong>is</strong>Fin , C.l'iu (215-3oo) stldly d6dib.d v!.r re|w |@slnz.d 6 9Di6l<br />

m<strong>is</strong>Ein. eiSep6 &int<strong>it</strong>rg winc or dud<strong>it</strong>y (dy5p.9€<strong>io</strong>, or old) d han offE d rh. M"-<br />

Th€ tm wd c,hsg.d to Hdidei. by cald (200 A,D)i Hmi@ia t th€<br />

d<strong>is</strong>i! ofold Enel<strong>is</strong>bsqd'M.srin"'!dth. FMc!vord Mi8tu. "Th. idathrl<br />

h€d.ci6 Fnr noh btb o6sN ra5<strong>io</strong>! dd h@anl .g@t3 ws Pur foddd bv l!.<br />

cc.k phy.icid", Pdl of^.gi.a (600 a.D). DDng hdo E <strong>ro</strong>rv <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> n<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>i.rr<br />

dooipt<strong>io</strong>r ofbadach.!, h.v. fotu<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> on ii. D.lc sufr@, da thoueh wom wilh<br />

oigd!. out IMtq, A fcw deiptid of lh. d<strong>is</strong>ddd <strong>it</strong> slrm ih@e! @ of tlc<br />

D6l inrdErins <strong>is</strong> foui in d!€ wndnSs ofdc l2t @luv Attb6., &d nvslic, Uil&rtd<br />

of Bing4 (109811?9) pMably dsiung ! DiSEinc M4 I r.w ! 8t@l s<strong>ta</strong>r' Dos:t<br />

splddid eil beut<strong>it</strong>ul, ttd p<strong>it</strong>h jl and qcadilrly Dult<strong>it</strong>lldc off.ll<strong>it</strong>s spels, w<strong>io</strong>l<br />

whicL tbe nr follovld drb*ld dd suddaly tbcy e@ sll @ihjl.Ld hciry lut d<br />

into bllck oals, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> .!!i into lh. 6yss, s th.t I odd s ind no hre"

T16 @ woal cltEl tEeoll for ha

Pain vai.s in intd<strong>it</strong>y dd level, sudda ir&rlc pain <strong>is</strong> call<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> &ut pd! <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> p6<strong>is</strong>l6l<br />

paii <strong>is</strong> cdl€d chrcnic pain.<br />

Phloepb6l<strong>it</strong> Ar<strong>is</strong>lod. sla6icd rh !.i! dould be aiw.d 6 d doti@<br />

.n

Tdr ard no. ( t 984) h.v. prcpc.d . b<strong>io</strong> Fych@i.l Dodel of chuic Fi4<br />

which $et h.E l.bel.d a dialh6<strong>is</strong> -s!€s nDd.l. Tfc Mpt<strong>io</strong>n of rh<strong>is</strong> mod.l <strong>is</strong> thlr<br />

''cJmnic pain 6ulls ton dE intd(*<strong>io</strong>n of avireMdtd .6<strong>is</strong> eilh t pttd<strong>is</strong>posi4<br />

dgeic d Fychological @nd<strong>it</strong><strong>io</strong>r o. diath6h. It. dg&ic or psy.hologicd fa€!6<br />

oDpr<strong>is</strong>ing $e diall)s<strong>is</strong> may vsry fom indivjdlsl to ind<strong>it</strong>dud, €.9. lil€ phtsical build<br />

bal$ pos<strong>it</strong>jon .nd lsycholoacal cond<strong>it</strong><strong>io</strong>niig. Tl'c spa<strong>if</strong>ic phyd@l €Bt like <strong>it</strong>jury<br />

int@cts w<strong>it</strong>h a pt.d'sposilg di.lb6i! l.adiry to a @nplaint of Pain.<br />

Enot<strong>io</strong>nal dd<br />

physi@l facld wnn which th. indiudlal cmot @!. l@& <strong>io</strong> s in@ in nusld<br />

rtuj@ Tnn iMe ir neuld ttubn lad! to <strong>is</strong>cndi4 euine a .eflex span <strong>it</strong> the<br />

@m€d aR4 long hslirg ilchdia r.las of bnd<strong>it</strong>ind sbs&te P lhal will cse<br />

lh. pain €xFi6e <strong>if</strong> the @@tral<strong>io</strong>r <strong>is</strong> luffciddy hi8h".<br />

Tbe 6<strong>io</strong>p6ycLMi.l nodel <strong>is</strong>l6 into .@ur lhc hddd<strong>it</strong>!.t<strong>ro</strong>n l r.lftimshiFt<br />

bdw6 tlFolog<strong>io</strong>l, bdEv<strong>io</strong>nl, rnd av<strong>it</strong>umo.d hcr6 <strong>it</strong> thc qpleari@ of<br />

d<strong>is</strong>ds. \vhe@ a bim.di.tl hodcl of d<strong>is</strong>.e fo.|g on b'ologi.d pl\)6s ad<br />

laE Fychologic.l pic6$ lo th. th6!F ofd. nin

Sdall studi6 have irdicstcd d Elal<strong>io</strong>nship ofp3<strong>it</strong> &d d?ssi@. 'D.pr€s<strong>io</strong>'<br />

s be seqlel& . tusativc f.c<strong>io</strong>r or a nodiryins f.dor in pain. Clmnic p.in tu me of<br />

O€ mst Fwd6t .rd d<strong>if</strong><strong>io</strong>rlt Fobld lhFicia tEr T1. bjeD o(::llt!!E ofFin<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> depBs<strong>io</strong>n hs l@d to a @!t!vary Egdd<strong>it</strong>e tbe rcl.donsbip betw€4 th.!e tso<br />

6n*udr- Scv<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> sndi6 h.v. indrqt d r rtds Miat<strong>io</strong>n hwd lb. *E<strong>it</strong>y of<br />

p6i, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> th. ws<strong>it</strong>y of d.pBive s}[pbmtobsr'(Bhdl.y! l963a Fn6, Spilz &<br />

CtE& MyDs; KEyUll& Don ld (|990) ds $ppql th. vi4 rbtr'l'.id.clc <strong>is</strong><br />

6 M<strong>ta</strong> of d.prBs<strong>io</strong>r and $gs61€d lhat ih@ <strong>is</strong> s n<strong>is</strong>! prvaloe of d@G.<strong>io</strong>n (63'l")<br />

ii hadich6, wiih dalirticd sigr<strong>if</strong>@ b.t*@ sFplms of d€prs<strong>io</strong>n, !|d<br />

fEqMcy ofh<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ach6".<br />

How.vd, oda stud<strong>is</strong> sngadt d a w.rl reldt<strong>io</strong>Bhip !€twa paiD and<br />

dcFr*<strong>io</strong>r! (Ch.@d4 Solc e|d Bdic!, |979i C@t <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Mol b.od, 1986r Ktunlirsq,<br />

swden and M@l!, 1983), L<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ds, (1990) egg6l3 th{ 'h.!deh€ p.lidrg ofto<br />

exF<strong>io</strong>e olmjlant d.p6si@ ald ih.t prt<strong>io</strong>l wirb p@eat badach* s€<br />

d.pls<strong>io</strong>tr .flid.d w<strong>it</strong>h wob@ b@ ih& Da, .!d old6 p.ti6l<strong>is</strong> ']@ Oe yoDea<br />

S.Dc n!di6 fnd th!r"d.!B€d pain p.tidt r€pon Dorc s@ p.in" (K6f.,<br />

WilkiB, C@t, Cr<strong>is</strong>s & Muhl-B&n, 1986). nr* ses <strong>ro</strong> b. a din-l r.h<strong>io</strong>nsbip<br />

betw€a th€ ddclopnar ot p.in dd d@rBs<strong>io</strong>n, (I<strong>is</strong>chbain od David, 1996).<br />

Whdly, Mllbw, Ostlsy & David (2003) e8acs.d thd 'mplq go.{ic<br />

wlnabililiB uderlie th€ dc?Bire dilthetu <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> sE6s .r?er b be e d@diut<strong>io</strong>n<br />

for g6e dpca<strong>io</strong>4 tbal sa! of€p<strong>is</strong>d. ofd.prs<strong>io</strong>tr in p6o$ wirh thd.

Howwq otha studi€! hav€ slgg€sLd <strong>ta</strong>} relst<strong>io</strong>nship belwd depGs<strong>io</strong>t and<br />

paii. (Chlpbar Sol. & Bonic!, l9?9t w<strong>it</strong>i6, Cdl & Mol baot4 ! 986; KE lingd,<br />

ssdson & M@t!, 1933).<br />

12,2. ,1snar 48lPa4 SDii\ M!,rs,v/onF.h& An iw (l9l) <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

Bldchdd Appl.br@ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> R*dniE (1990) rcFn a ri8! oryruoe ofh<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>acbc,<br />

Shrdi6 dmsf.tc ths'r didy <strong>is</strong> .l6.ly linLd lo p!i!. 'who pon p€ln fd<br />

we.t5 or n@ins th. pa<strong>it</strong>@ of r6poBe to plin cbds6, 3trd d@rcsjon doge a 0t<br />

afi..tiv. si.r. @.t s!@gly .ssi.t d wilb ch<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>c p.ir' (Stdnhc\ 197q, Adidilg<br />

chrcnic pain uually allevialer d.pBs<strong>io</strong>r". (Stmbach & Timdds, 1976).<br />

'T.ali!g lhc d€pr6<strong>io</strong>! of<strong>ta</strong> Ed6 p6in d odc p.jr ooF bahblC<br />

(Bn ll.y, 1963; <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> W&d, 1979). Bond (1978) r€port tht ih. "oEi<strong>it</strong>ut<strong>io</strong>nally d.pca€d<br />

p€tui ldds lo fel pair mE s€c:lr, tha d p@! of ! moE cldirl dirposil<strong>io</strong>r\ bll<br />

qFi6e of pain ovd m €x<strong>ta</strong>d.d pd<strong>io</strong>d of iin6 al$ bnng on d@B,on1<br />

CeL, Nm.y, E\@!, Rtun & Fur,Ldr€in ( 1989) sSgsr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dr,t "srB<br />

depr*8<strong>io</strong>r rnd pqM3l<strong>it</strong>y t a<strong>it</strong>s lan€d to h!rc . rtDrg Mi,r<strong>io</strong>. w<strong>it</strong>h Fpon of<br />

Using EMG sdes, Ptus & wils, (t 92) .@ofl Od'nad&nc $ftc6 hd<br />

highd rclrc tha non h€ldachc @n<strong>ro</strong>l! o! bsFlin€ .l61<strong>ro</strong>-nyosms (EMG) l.v.ls<br />

.nd or h€asuB of^nidy & TyF A." Th<strong>is</strong> Fovid6 supFn to rbc eodd om.dim<br />

b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> msle tm<strong>io</strong>n md h.!dach. of e<strong>it</strong>hd rh€ lru<strong>io</strong>n m nrgBu..<br />

Rdacb hs $gg6t€d rhlr li@ ma, b. nmtu €6t. thal nay @ur for<br />

a mn uMt rclat<strong>io</strong>n bctrva plin <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> de?cs<strong>io</strong>n b<strong>io</strong>logi.d" W.rd, Blom, Fawc.<strong>it</strong> &<br />

F.icdcl0983)'b.b!v<strong>io</strong>.al"Fordy@0976)"oor<strong>io</strong>nrl"Enete&Madirb(1986)od<br />

"@gn<strong>it</strong>ive" LfoG ( l98l ).

s|mb&h ( l9?0) rgoncd dEt "lvlMPI p<strong>ro</strong>filB ofttolc paiD parials, indiding<br />

eralq F dDlog,c.l d<strong>is</strong>h$re Ih& ths. of lh. fstl. pstials wilh signjf<strong>io</strong>t t6t<br />

d<strong>if</strong>doc on &pre<strong>io</strong>n psyc.h!$laia (!t) dd psycbop.lhic ddirt€ (!0 scal6". Usins<br />

th? ad.ptd v6<strong>io</strong>n ofCrcM sd Cn p Erpd<strong>io</strong>tial indq TePir, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> N!ju, (2006)<br />

rcFn d sig<strong>if</strong>cs eldado6 oo.ll d! slb sdcE l[al <strong>is</strong> !E noldra Adicy.<br />

Dc!ru<strong>io</strong>4 Hlstdiq Somtic sd Obw<strong>io</strong>. sd6 md tor€ s on thc lrc! flqling<br />

djdy .nd shatiq Apphdir ,{.<br />

Kow.i ad Prirhqrd (1990) ee86:r thlt sbj@ts w<strong>it</strong>h bsd!c!6 show.d<br />

signin@dy highd shynd, lds<strong>it</strong>iv<strong>it</strong>y, psychomalic p<strong>ro</strong>bld3, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> b€hav<strong>io</strong>nl<br />

d<strong>is</strong>lurb@e &d sign<strong>if</strong> @0y lowa p6d|il qpelalim lhb 6llols".<br />

S$di6 @ 'AtiCnie @ mlbidny @nfm.d <strong>it</strong>s eiatjon wilh div@<br />

Fychiatrid psycnoptnob8i.rl @!dlt<strong>io</strong>!s, I}rb N@ilt<strong>io</strong>r .pp.4 to be stonsBt for<br />

Dajor d@cs<strong>io</strong>tr <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> di.{y di$dq, Fni@lldy pdi. nd p}obia bu in6€d @<br />

morbidny ba ba repon<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> wilh Nb$de alw ud 6iain dierd6. Lndturc als<br />

ind<strong>io</strong>ld a gut r norlidiry in Mignin€ Ntrffi wirh u4 thd w<strong>it</strong>louf'. (R.dad &<br />

Mi86ii. d$ eferl th. rin pe@fl<strong>io</strong>r! tholgh t'. influo€ ofMignin€ on<br />

tine pgccptid h6 no1 bm syshaijcally inveire .d. Sildy @nducr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by<br />

Afrgmsod & Mirsilo$al (2005) shdv.d ! drn d s!..ding up ofdcn ir<strong>ro</strong>.l rim<br />

ke@ing nehbjm, pointira lo deF6s<strong>io</strong>n, 6 e inponei vuiable i! tinc p€o€pti@, '<br />

Studi6 suggct ri8!i6qt rcld<strong>io</strong>nship b..oa el4or<strong>io</strong>a d MMPI 3cm<br />

measine, hrpoclbndric s.d hysleri., Petrhi.iric pdnobg], <strong>is</strong> ale s6 in cl<strong>ro</strong>nic<br />

daily h€adach., Studj6 show $al childrd llffding nm Migrain€ wirhoui sM h6v€ a<br />

hjebo @gr<strong>it</strong>ivc prGing tiD., 8d lowd hal<strong>it</strong>un<strong>io</strong>n of @nic.i r6poM.

12.3. Poin 6,1 Mehory. fte qmht<strong>io</strong> b€t!@ heldacb. md ndory <strong>is</strong><br />

ssdy docm6re4 .ldbusD o \Djo.bod.l of psyclologi€l p!!€s of Dcin pl'6<br />

6ral intortde on the nnory of ps1d.nts 0sotbal & Ev€rhdt,l9?9).<br />

M.jodty of@lrld e 6tm.d wiih 6t lllning ih. .m.y <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

dilbn<strong>it</strong>y ofpai4 ndory. in clinicd B<strong>ro</strong>uF," (E6ru., Man€y & Pwce 1990), th€<br />

.Fil.blc @id€r@ i!dic.t6 ihlt "rndory for p.sl daB inras<strong>it</strong>y, <strong>is</strong> ! fiDd<strong>io</strong>n ofth.<br />

plin ar rh. 1im€ of rdll du p.r<strong>io</strong>rs wi$ hi8\ Iow la.ls of ffir pain @dl lhen<br />

plsr potu ab.vinsno'.0N)i 6&rhe i erually oa'(Gntr-Radfoid, Elic}, &<br />

Ac@dins to willid (2000), 'mdori6 ofrai, .le @n. blck 10 hun'.<br />

Rlcbbd & Lopatb (199{) jnv6i<strong>is</strong>rl€d th. "cf61 ot p.i! on thc E I of<br />

autob<strong>io</strong>er.phjcal Ddci* in E ponF <strong>ro</strong> nosil tu words rh€y pndid€d".<br />

''In sine uplcasl ctlid suld pmt. O. r.rteval of @rl.!s( t@ml<br />

ndon6 dd imp€d. thc reEieval of pl..sr n.lM6 , Tht ws $ppon d by w.ight<br />

& Morlcy ( 195).<br />

11,/, Ptbt t OrherDlsoflLe Sildi.s or htlanaaboli. d<strong>is</strong>ordh,<br />

prMlilg a hada.l'c *<strong>it</strong>h ui.iy ad d.prs<strong>io</strong>n by (M.lzcl A Dtu<strong>is</strong>, | 9l)<br />

3!9961 thst h}?ft m.r.bolic dilordd should be @nsida.d in thc d<strong>it</strong>rff<strong>it</strong>ial diagnosh<br />

of cbr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>c c.lhaldgi. e<strong>it</strong>h dicry .fl| d.pBi@"-<br />

1J.5. P.ln .rd trhd<strong>it</strong>.lce. Reschs sbow ihat MigBin€ tnds !o m in<br />

fhili.s, but the prdi* n-l'-iq of id6il&e <strong>is</strong> tul tM Comn@ njgnirer i...<br />

niBhine wi$ (MA) or *<strong>it</strong>houl au'a (Mo), h a .ewlogical di$.d6 touching ibo* I o./.<br />

of llc C-'"'.im popul.r<strong>io</strong>n. In MA, nienin. hadlch. n pr€c.d.d by t$.1, turic<br />

ad/or dyspbaic au symptme whch @ rcvcible Twin fmily stu(lj€s h!v.<br />

$9g61€d r'tnulri f.dorid mod€ of i.td<strong>it</strong>'M for q)mor higBin , ad ! sr.rgs

sacric @m!o.@t fd MA rbd fd Mo. Si@ thft <strong>is</strong> m b<strong>io</strong>log<strong>io</strong>l d godic Dct61o<br />

id@iiry c{)lmon nig6in.. .u. synptms prcvid. a d<strong>is</strong>lincliv. ch@der to idddry<br />

thoe suFcr€d of sufrdirs tom njsni!€''. Paivi (2009)-<br />

RdaEh6 ilDw tbal cluJlq hddch. tuv t€ . tffiin<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> djeqla, sndv<br />

orcvid.d 4id6e suegesting a go€tic bsi! for .lu.td hQd.ch. Equallv onp.lling<br />

wft fiDdinls sleCplbna a g6.ric iirr b.t*d nignine dd clstd h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.chc! Th.<br />

adho6 h.E sp@iar€d lhrl" bign<strong>if</strong>t dd cluna h@d.ch. @y b€ rh€ sde di$ila,<br />

tyric.ily, bll dprsi@ ot th. latra may inrclrc ! mE mPl.x PIoc4 Ilquinng a<br />

y.r lrtnoM, qr<strong>is</strong>ic or inrici. in0u64' "Le & D6vid ( 1994).<br />

sfudy by Rlsll, tslius, Oeas,lrd & ol6a (! 997) idic2rs tbll chDric<br />

t@<strong>io</strong>!-t'rE hadache ha dulr<strong>if</strong>lc<strong>ro</strong>nd i s<strong>it</strong>'G. "n!@ 5ms to b. r clrel.tid<br />

betw6 nore ev@ symptm ofh<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ach. sd fnilid lgercgat<strong>io</strong>n," (E <strong>it</strong>e,<br />

rhu|M, Ardqsl, Nein & O!6e!. 2004). Sndi6 v@ qi.d lo d.sdib.<br />

cn@tdtrie of padolr pirh 3Gt@ fmili.l, <strong>ro</strong>FHdipl.gic nignine (NHMA) ud <strong>ro</strong><br />

@mpe thffi dar! <strong>ro</strong> thc popuht<strong>io</strong>r bdcd Dd<strong>is</strong>h sludi$, Ii wa rcport<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ihai 'tdere<br />

clhicd chndd<strong>is</strong>tie offlsili.l NSMA d8d6@0y d<strong>if</strong><strong>is</strong>d tm nignin 66dy'ih.<br />

age of on 3.t e6 lo<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>, $c .9. !t wt<strong>io</strong>r wa h<strong>is</strong>ld. dd Nn slrDrds wd hoE<br />

s6." <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>it</strong> {s s6 ihat ilE offie of nigraine w<strong>it</strong>hout am w6 higb6 ii<br />

fanil<strong>is</strong>l NHi\rA. Th<strong>is</strong> study hs *iadnc and clinidl i6plic€1<strong>io</strong>s.<br />

D<strong>is</strong>vdy of. loc wlncl <strong>is</strong> lirl.d to migniE hdld<strong>it</strong>y @y otr . . 3Eid€<br />

tovatd morc €fr@tile batrndt. In 2003, lcidlill3 d<strong>is</strong>ovd.d a gde, ATll A2, <strong>it</strong><br />

hdd chmosde I dlr wa 'ssial<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>io</strong> e@ mignind ii sl'iy of six gd@tims<br />

in a ni<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>incpde f.nily. Th. sciadns bcli.r€d a mur.t<strong>io</strong>r ofd. a@ c.ls 'a<br />

b@ldoM oflh€ pMp th.r shiiix sdim od pot8siu tuou$ the ell'. ThG pr6d€<br />

of lh. eulst gne wa liDlcd wirh nignine plia th€ tudoD of tinsliq brn, &d Oe

F@pt<strong>io</strong>. of flshirs liSlts (lcicbopsia) socialcd w<strong>it</strong>h d<strong>is</strong>din. au!' <strong>if</strong> th<strong>is</strong> sde 6<br />

b€ dcfn<strong>it</strong> ly li.kcd 10 ti. $le ofhigdin , <strong>it</strong> q ldd !o tnr dd.loPmol ofmoE<br />

dird <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> efEsc<strong>io</strong>u Ecanndt<br />

L2n. Ea!treh. .ml Phts<strong>io</strong>logt H.!d&he hs phvs<strong>io</strong>lo8ical @la1€s<br />

"Osmophott! dd la.G abn@alili4 N@ dqno<strong>ro</strong>tra&d <strong>ro</strong> b. vdv lpe<strong>if</strong>ic in<br />

dil8n6irg nigrairc bul v.ry iM<strong>it</strong>i€'(Kdna! 2004)<br />

R*dc! $8sl lh.t pdntul sliDuh<strong>io</strong>n ofth. rmplc in Oplokinaic n<strong>io</strong>Dlai<strong>io</strong>t<br />

Ei8g6 nieFin lik€ .<strong>it</strong>ac,h, Studld indidi. thtt" dotid sjc&n s 6td h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> pain<br />

in.lle sN.€Ptibili1y to migmsu .t!tu*s i! m<strong>is</strong>nie suffdd dd suggBt lblt<br />

strp<strong>ro</strong>m ofn<strong>is</strong>rtinc build uFn ech olhd ii . vicic circlc" U.rfoE n <strong>is</strong> inpotui <strong>ro</strong><br />

teg€t nullipl€ sFplotu thd t(e€ individud lyhflo$ for pddting dla.k oI<br />

n<strong>is</strong>nine, studjd !y Drum<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> & Gn$<strong>io</strong>n (2005). GM<strong>io</strong>. $ppon $. tbov€<br />

'ss6ptim tley r!$ sugg6t tbd" s.lptibil<strong>it</strong>y <strong>io</strong>Dug ..d st4s ind@€d qr6<br />

.6<strong>is</strong>l v.seld ht?d e.1iv<strong>it</strong>y, e Miat d v<strong>it</strong>h nigniE F.d<strong>is</strong>pc<strong>it</strong>id, and $!1<br />

had pain nid inrasiry gdm int€srin.l dhturbd6 duing anacks ofmigEin.."<br />

Ulg.te infoms $ that.\ihft <strong>is</strong> aidaa fd a d<strong>is</strong>tulu mtul<strong>io</strong>r of<br />

ilfomd<strong>io</strong>a pltGsing in digti*te.w of @L.d & ddl rclllcd 3tudi6 in<br />

childhood. ,n adDll nilrscm d<strong>if</strong>feml nsb<strong>it</strong>ut<strong>io</strong>n <strong>it</strong> prcp..€d 4 3 Ptincipel ini6ic$l<br />

abnomal<strong>it</strong>y & w6 foud intd alia for v<strong>is</strong>ud ook.d poldtials (VEPS)" Roe[(d.<br />

P.@1, Rdcil & w.<strong>is</strong>w, (2005).<br />

Itdodialys<strong>is</strong> nat indue hadsch6 s ! twlt of €x6ivc momt of wra od<br />

cl6ltol}ns sbjfts, Tt. rclat<strong>io</strong>ndnip h.tw@ bdltologi@l pam.td & n ,&che <strong>is</strong><br />

scldoD mot€d upon wil\ regard to eleval<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> h@oSlobin ld.ls.<br />

'llaieh6 hdvc b€ relon€d in @ndn<strong>io</strong>B such s Polyctil@i. & ch<strong>ro</strong>nic<br />

driMc si.rl'*". Ar <strong>ro</strong> 0F rclrtimsbip b.iwm h€d&be & ircn, 5iudi6 r+on.d a

jgb prevalde ofhadache in wom6 w<strong>it</strong>h ha.dilary htdochDma<strong>io</strong>sl hd.ad<br />

ld.ls of<strong>io</strong>i in the Fi.qu€duct<br />

l gry banq i. 0E hdin sld hlE bo found i.<br />

patiars wirh tuignine & chrcni. dljly badache, ln noulah licln€s heldlche <strong>is</strong><br />

th@sbt to bc quscd by byporn &clod€d hdoglobh vdE. Eadeb6 hlvc al$<br />

bm obwld in @6ia ard ud fail@ 'nr. '!s. hay b€ doE inces<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> blood<br />

v<strong>is</strong>os<strong>it</strong>y or incsscd blood pq@" (A@o

n€huin, Slutu.|! <strong>is</strong> inpli€l<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in @rric{l sPqrdirg de?r6s<strong>io</strong>4 TrigBmircve.uld<br />

acdllt<strong>io</strong>i and {mlnl ss<strong>it</strong>iur<strong>io</strong>i hB b@ impliqLd in chMj. 6ignire<br />

padopbys<strong>io</strong>loF/- It <strong>is</strong> ale irwlv€d i! 6bMyalSi!, (PaE, Zud.@.A Sl)G, al(W,<br />

Solos & F!ul!a!d, 2004),<br />

L<strong>it</strong>an@ inf(mrs us Osl .ldiridi@ of pdjpn€n j & @tnt tr<strong>is</strong>dovs.dd<br />

r.eB .xpldn ilf! cfuid hyp@siriviry enich i. obglcd ir nighjnd wirh lh.<br />

wo'hhg p.14 dung 6u8li!g boding ovd dd tb. th<strong>ro</strong>bbirg <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> !tuftn t<strong>io</strong>o of<br />

6t l dd nol p€riphBal riSmird ncetu <strong>is</strong> Glorribl. for th€ dti! @id<br />

hyDqsl<strong>it</strong><strong>it</strong>ty. It ha b€t hypotbqiz€d rllr 6q6l slbpdhdieAdmo Mcdunay<br />

&livat<strong>io</strong>n ould bc . tujor d<strong>io</strong>logi.rl c@poMi i, ih. dd.loFn@r of cbmic<br />

h.!d&hc in ttF A, individuals (Knnil dd Mduclq 1984/.<br />

Ilc !!mlf hyporhd<strong>is</strong> of nighin ha @e ba by?atre.d mtnarbdy $.r<br />

iDvolvs vaclnu &d tr@nal @npon@r Ii <strong>is</strong> sugadrcd ilut ihe n<strong>is</strong>ual M vhich <strong>is</strong><br />

.xpai6c.d by nigi<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>B r<strong>is</strong>6 ton @ni@l lprading d€pr€s<strong>io</strong>!, dd ih<strong>is</strong> rclral<br />

.hl nay ds rnagd w4ld rd. .trdaq <strong>ta</strong>din8 <strong>io</strong> v.!.dil,r<strong>io</strong>q !d n@<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>c<br />

<strong>it</strong> l@t<strong>io</strong>n in th. D6ir8.d blood v6s.ts, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lettir8 rhDbbins p.iD, Tbe<br />

'lvolvdbt ofilc pm symparhelic srslo llppling r,he nnilgi6 al$ qusca<br />

i.da.d ve dihd@ ard prin" (Silbasr.i!, 2OO4).<br />

Shdi6 h.vc .r@in d rhc ..silr<strong>io</strong>tr ofal8 csNP o<strong>ro</strong>pRML to qpdihoot<br />

prin s<strong>it</strong>jv<strong>it</strong>y, ibc lwlts indiqr. rhal a @ .lelc t ssc'|t.d wjil hieho pr.su.<br />

pain lbr6lblds and th.t oPRML Dly b. a p.in Ei.nd saq Had!.h. p.lidrs 3how<br />

narlcd inlas<strong>it</strong>y d.l<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>de of@nicd rldi<strong>io</strong>ry tut.d poradals duing dd orcidc rh.<br />

bouf (Jafr6l, En&y. Bozik & Jelmicri4 l99O) ..noi€pdv€ l€v.ls {e r.duc.d in<br />

Eignin€ si|ltout !w" (Bos<strong>it</strong>q 2005).

&teyl, Han<strong>io</strong>s, Boaikl & Td6 (2005) dlmd<strong>ta</strong>t.d iltrl a lorcl o<strong>io</strong>d<br />

ncmFptjdc along w<strong>it</strong>h <strong>it</strong>s catob e prddt in <strong>it</strong>igoiral ovsule r@<strong>ro</strong>r& Tl'.e<br />

@lts $eg6r rbt miepdon 6.y b. ilwlv.d in nc@va.da h€dad6 sch 6<br />

Studi6 ilEw rhat !oD6 cnd n@ dlnb<strong>it</strong> a rligbtly dfrsdr v<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>d @ctiv<strong>it</strong>y<br />

b pdntul stimul,, ! d<strong>if</strong>fff<strong>it</strong> psin Fc€pt<strong>io</strong>n hight a@ul for ecndq d<strong>it</strong>fdc in<br />

vGculd scdvi9' Rolnilq schncida, S<strong>is</strong>gu Ko\ sabin.l. S.ilmirs & No6€r! 2001).<br />

stldi6 $geest rbri l<strong>it</strong>6ryl. hlb<strong>it</strong>3 phy a .ie!i66r oL c Etnirc Feip<strong>it</strong> 4<br />

oth6 Nsgd a sbt<strong>is</strong>tic{Dy rigrin@l relrt<strong>io</strong>tuhip bei*d ddad@s on MM?l sqft<br />

nffiin8 ht?..hon&id sd hys6ia and $. Epon of ahbnic pdin.<br />

r3.a, Poi, adt Fod<strong>it</strong>,6. "A Lning ep of @d. of rMgi ..d a n .d fo.<br />

vdg@@ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> relruing lsciaicd n.gaiivc fe.li.8! ruch 6 binmds md l!@lrnaf'<br />

(Di Bl6<strong>io</strong>, 192)<br />

'Folaiv.,6 <strong>is</strong> th€ ovd.ming ofth. n.g.tire €ffet <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> judgbdl <strong>ro</strong>waidr th.<br />

ofod6. Nol by doyirg ouslv6 th.nght<strong>io</strong> su.h.0.c1 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> jldgEqt b by<br />

.!dawin! lo vi* tb. offaldd wirb baddoa lhar h. d sh. bs !b@d. llle nghr<br />

to $d". subkovialq Ediehr a al. 0992).<br />

Csd€ (1990) viws for8iv66r a rhdrp€ulic raor in psyclDthdtt <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

6sidm lh. @gdtivc dim<strong>io</strong>. of forgi6*. ne ud6rr!& forgi@6 in $c<br />

onldl of @gnilile rcsiructuring tEl mpldals the notiv. sp€ct of d..l<strong>io</strong>g w<strong>it</strong>h<br />

walt B (I984) se "fdgivoss a a volurr.y pr6s thar lelly r.quie<br />

@uaae od Dultiple acL of the wil to onplerC'. In Wlhd'r vid *1h. p6on rho h6<br />

b6 bEl 16 t$! olt6mtiv6 <strong>ro</strong> bc d6<strong>ro</strong>y.d bt r6etn6t'rbicb ldrls to dath rd t<br />

volulary acl sd 3 d*<strong>is</strong><strong>io</strong>n <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> clDie abour how on. &rt w<strong>it</strong>h dre psr. Hot€ (198r).

Clinjcrl srudiB suggesl th.t h.{dsch€ patials havc d<strong>if</strong>fcdty ftrgiviDg pglonq<br />

tbey p.@iv. $ bving offad€d lnd ir $n. My, studiB $gg

which lhc indilidlll cdot cope adequ.at€ly h ihouslti <strong>io</strong> l..i 10 d incfu in tusld<br />

ids<strong>io</strong>n. The inclle in nuculr tosjon cd l4d to <strong>is</strong>chn<strong>it</strong>5 which Euss a r.fl€x<br />

spM in rh. involv<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ft!. lory ldsting ilchdh l@ds lo s rcl6e ofpa<strong>it</strong> elic<strong>it</strong>ing<br />

bnd<strong>it</strong>jr@ sbs<strong>ro</strong>c P ftlr *iU 6e tb. ptir qpdiae <strong>if</strong> the @.6t<strong>it</strong><strong>io</strong>n <strong>is</strong><br />

12.9. P.ia @.1 S@i&l C6t s Chndc p&n padar! bd'avid ml 6ly <strong>is</strong><br />

Eirftd.d &d sha!€d by othqs, tDt rl$ int66 .ttd sh,.pd rh. be.hn<strong>io</strong>r ofdh6,<br />

't<br />

t@hing th. spow lo l<strong>ro</strong>npt &d rci or.d.ptiv!'\l.ll &tuv<strong>io</strong>l'while bidhizing<br />

stral<strong>io</strong>r 10 pain, Social @ntexi tlays s si9<strong>if</strong>i6l bl. in th€ 4Paime of pain tle<br />

c!)mr study alm smin€d rhe €frdts of eci.l @.ldl o. t in and s<strong>ta</strong>t<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lhat<br />

"@ dtual and dvi<strong>ro</strong>mdid facloa e imponet in lh. psc€pt<strong>io</strong>r of elt€ Pain".<br />

willi@ & David (2m3).<br />

l.2.l0. Poin a.l S.f Efr@.t, " Sclf .6.*f d p.otlet judsml of th.n<br />

qp.lil<strong>it</strong>i6 <strong>ro</strong> ddte! eim ld.lt of Flonde<br />

(B.rdu,!, lary, Tayld, G llid & CGsrd, | 98?).<br />

ard to dd<strong>is</strong> @nsol ovq dot3',<br />

"lrdividuals s@ring hieh on s.lf .ffi@y m.asl<strong>ro</strong> Ld . hieh toloae fm pdn<br />

od also show<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> didace ofin@a*d ddogmous op<strong>io</strong>id adival<strong>io</strong>n wna onAo cd<br />

wiln pai.tul slimuli. On. mod.l lnat li.I! dp€r.rcy w<strong>it</strong>h tu ct<strong>io</strong>n c@6 fon @lf<br />

.frqcy lnory", B&d@ !r al. (1987).<br />

'Ap<strong>plid</strong>t<strong>io</strong>s ofself.trc!.y th6ry to D.i! pDbld h.ve fo@s€d .lte.l<br />

.xclsivcly on tdialt jdsnan aboul lbcir abil<strong>it</strong>y <strong>ro</strong> @F w<strong>it</strong>h d -"""4c p!in".<br />

(Coucil, l98q Doke Cr@k6, Mol.nciG & Dolcy!. 1986).<br />

Ths. beli.fs m idqt<strong>if</strong>cd 6 plin *lf.fi@cf dp@<strong>ta</strong>t<strong>io</strong>m. studja slDw ihai<br />

't.h ell emcicy judenar. 6n ltt* posilivcly wilh borh pain tol€@e tnd pain<br />

@nt ol", (Dole a al. 1986; Mm<strong>io</strong>S & wDght, 1983).

Racto& & Bich{d 09E8), found thd "diery ald pdr Ftiars rad lo ova<br />

pr.djcr th. inlds<strong>it</strong>y of fi€ hm", Thft <strong>is</strong> dothd dpleal<strong>io</strong>n wnich cm4 nom tne<br />

*id lmilg thory- B<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>un (1978) lain l<strong>it</strong>. o&a.vdiw sl!r6lilc didy.nd<br />

td nie)lt hav. slr6g irfoftn<strong>io</strong>ml rdE rcSardi4 oB Gffica.y judsndt orqdurirg<br />

physi.d laslq which in nm innudG bodvat<strong>io</strong>n to perfom <strong>ta</strong>sk".<br />

'Sclf €tr@.y dpcdDci6 af€d Fdl)|]rDe di6{y !d ird<strong>it</strong>cdy $tuuC} iG<br />

.fr4r @ p6odl goak. P@tral gorls <strong>io</strong> tM ind€podotly dermin€ p.rfmde dd<br />

influ@ s.lf.trec, qD..teci6 bele of go.1sigDa iDpucidy !6ms<br />

@n6dace", (Lelc & ktha l90i & saleiclq l9?7),<br />

"Lo{d *lf appF<strong>is</strong><st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> pmbld slviig @np€!@ ir r.lahd 10 in@.d !air,<br />

d.pBiu. Pain r.<strong>lse</strong>l siri $ppon *!s dir.dly rd.lcd to plr .!d d<strong>is</strong>bil<strong>it</strong>y hut<br />

irdiBdy rcldt€d to derress<strong>io</strong>q hiSI ldels ofpain rldsi $cial $ppot we fomd 10<br />

buffa (be Glat<strong>io</strong>n b€iwa Foc $lf rppn!.d pDbld &lvi4 mp

A cld Flsl<strong>io</strong>n$ip b.rw€ rriD rcbl.d bchav<strong>io</strong>. & bcli.fs [a td shoM."<br />

Th. b€li.f! of clmnjc pdn padats alour th. ndre o{pain .nd abod lheir on<br />

@pabil<strong>it</strong>i6 e pEdiciive of@9ing efons dd thcir .m@y", (Hdlrlpa, ,6on,<br />

l.2.lr. P.i, and Coping SOIe Stldid hve als €xdincd lh. asocial<strong>io</strong>t of<br />

vei.lili9 of@ping siyl. and L€tnat @nplilre in pain and hadache PaliaE.<br />

R6ulrs <strong>it</strong>rdi€r.d rhd rbe "$qor*<strong>io</strong>n of *gEtir dmtbN ws assi.l.d wiih<br />

gst€. tralrs @npli&4, dd !€l<strong>ta</strong> trelDal outd., whq4 ib9lict<strong>io</strong>r of<br />

negativc dotjoE w3 foad 10 b. 6siat d w<strong>it</strong>h p

.2.r5. P.h qd EthrL Din mee<br />

Tt@ & aduic d<strong>if</strong>rtue in cpoi.. to p.in, Dfcdt @hG Bpond <strong>ro</strong><br />

pair d<strong>it</strong>rqudy- siE Zbdo*ski's p<strong>io</strong>@ins wo* or ah!i. ad einlii d<strong>it</strong>raEq i!<br />

t\e dps<strong>io</strong>e ofp.iq nudu cliai@l studiB irv6ligaring s wjd. vdi.ty ofpdnftl<br />

od<strong>it</strong><strong>io</strong>ns hav. .orcd annic d<strong>it</strong>rffi@ in the pFvdoe dd *vd<strong>it</strong>y of pain.<br />

Spci6.dly, invdrigrloB lav. lgrty indiqr.d 0l.r Afri6 Anqids r@n<br />

g@td ldeb oflFi. th& whil6 tu 3k! @ndn<strong>io</strong>s a elal@n., AjDS, migain.<br />

bsda.fE, ja pei4 DonoFlrjve !d4 D)Dfeiat tliq &giE pe!o.i, johi p!i.,<br />

noi.9eci6c dlily pain! ud arthr<strong>it</strong><strong>is</strong>.<br />

UndcB<strong>ta</strong>ndi<strong>is</strong> of tuch fndings r@iins d<strong>it</strong><strong>ro</strong>t! sa@t stud<strong>is</strong> hav€ sue€.sr€d<br />

thfi lhysida <strong>ta</strong>d to Fw<strong>it</strong>e t6s .n te6ic d.

thdpy apprcacrl A weu iucto.ing faEily 6 h a tlelally sbon tib. beme<br />

dysfindjon lvhd mof <strong>it</strong>' bdbqs tcec $e ol. of . prin P.tiat Th*<strong>is</strong><br />

.vido€ to sDgg4t th.t "spow ofcnrcli. pair sffq6 d€v.lopd . vaidy ofPsttl'o<br />

phr<strong>io</strong>loeical <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> pychiatric di&rd@ s th.y @ rcquircd to @P€ w<strong>it</strong>ii che86 in<br />

intdpcMn l ..lafodhip &d .ddil<strong>io</strong>al bud6. Ra56 for ilslvinS lb. funy <strong>it</strong>r<br />

Eatndt of chrcnic p.in ddiv€d fon c6ida&L crin<strong>io</strong>l '<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.ll lld hrc<br />

ddor$rar.d ln€ rcl€ play.d by l[€ f.mily ndb6 in tn€ Fp.tult<strong>io</strong>n dd t<strong>ro</strong>longal<strong>io</strong>.<br />

of clmic p!in", (Block, 1981),<br />

'Ctlpnic pri! b tb. spow Dy Eli.w 6. pdtia of tu<strong>it</strong> l Gto6:bil<strong>it</strong>y i!.<br />

pltiaas pos<strong>it</strong><strong>io</strong>n of d.Fnd{hcy my b. c@m€pd by Ib. <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>l 3Dou!., lhu Einforcing<br />

th€ pair behlv<strong>io</strong>r 10 hB or ha oM ad. Il b.y giv€ ri$ lo udeinbl€ nlllual<strong>it</strong>y by<br />

moving lone sirld<strong>io</strong>g @nnids, . alliDg a n4 loDosl!3<strong>is</strong> Thc noti@ &d 3<br />

rFF6 or 4 ill,B o trevid€ !@@l&<strong>is</strong> ir ! fobiiy sy5l@ <strong>is</strong> w.ll .dlbl<strong>is</strong>hcd"<br />

(Ron 1984).<br />

Feily nmbd $me tim$ rcinforc. illn.$ b€lw<strong>io</strong>! tld ttsl th. pal<strong>io</strong>l a<br />

iholgh he s@ i!v.l'd sd sDe tin6 t!.y <strong>it</strong>lc lh. opPosib vi4 th.t th€ pauat in lh.<br />

sbee of oryuic prdDlos| dc rDl hlw pobla.<br />

Study by Flor, Tuk & Rudy, (1989) sgg6& 6x "ELr<strong>io</strong>nship olhft e<strong>it</strong>fNin8<br />

bchsvid rnd pali€nl psi. i! @mpld, they foud a najor st<strong>ro</strong>n<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> @rcltl<strong>io</strong>n belwm<br />

cirforcing Bpote &d ..laLd d)56bct<strong>io</strong>n",<br />

s.m s1udi6 by d<strong>is</strong> & vin5 ( 1990) nw. fould tbat "p.jn potiats who<br />

rcponiie high l4.h ofs@al slpFn adlpl lo Plin m@ efdtivcly e a.1iE wnn bwd

<strong>it</strong> k sugg6t d dat th@ <strong>is</strong> al$ alotbd diFd<strong>io</strong>nto pu thc €fetiv'<br />

6po.sivd€$," *hiclh @ns<strong>is</strong>ts of, a ) w€lfe Emodonswnich @ 'xmpl<strong>if</strong>i<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> love'<br />

lapp<strong>it</strong>B .nd joy, b.) Endracy dotim !ik. .nsd dd fd<br />

Afrdrrre GpoNvds 4 d€f<strong>it</strong>.d 4 th. alil<strong>it</strong>v to r6pond alprcFi<strong>ro</strong>v'<br />

silae snd quel ltGtil<strong>it</strong>v @ shom to b€ . colM@ Panm of irn@odd mons ftnilv<br />

1.2.18. P.i^ @.t Moni.S' Sddll inv€stigdos have studi€4 how d<strong>if</strong>rdml<br />

typ6 of sPoud Fpons to plin b.lnvid nv rcbtc lo Pttialt<br />

ptin lnd d<strong>is</strong>lbil<strong>it</strong>v<br />

(Flor, Kd & TuL, 198'?) potidr't sno* tpo@ igmEd o Fslond€d 'eFr erv <strong>ro</strong><br />

pai4 had high acliv<strong>it</strong>y lry€l, ladott who rpouss w@ ovdlv 3ol'c<strong>it</strong>oB bad hr3l6<br />

l*k of plh tnd lowd ld'13 of atuviq '<br />

Sbdv bt Flor, TuL & Rrdv (1989) $8sel rhd t'ladoBbip' oth4 eiDlorcing<br />

b€havid &tt ptr<strong>io</strong>l Pain <strong>is</strong> @pLx, th€v foud ' bajd s:<strong>ro</strong>oga @ddti@ b'twd<br />

rcinforcirg 6!oDs dd Elalcd dtds'r<strong>io</strong>n- The p'h sv6 dte fsd<strong>io</strong>N olsldng<br />

dd @.iving a c.fiain @out of sEcor' nel.pl$fic u' of Pain to @nv€v a Nsc of<br />

mot<strong>io</strong>r b r.ll 6<strong>ta</strong>bl<strong>is</strong>i<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>, sddin' ih' pain fot6 tn' spo@ to cde in<strong>ro</strong> th€ir orb<strong>is</strong>'<br />

&olh6 6<strong>it</strong>ic.l tunct<strong>io</strong>n of<strong>ta</strong>in in bdiag€ i5 ils N 6 a scrp'goa!<br />

pain ce b€ invok<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

to jld<strong>it</strong> ! wnol. h6t of!'h6tc <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> 6 prcvide ! povgtul ddonal' for rhc<br />

n.i ada olpa$ologcd s<strong>ro</strong>Fos"'<br />

EPsr€i!et 'l (19s2) bnve idoti6'd six tin& of involv@ors s hclt or<br />

involvd@rb inwlvndt dcvod of fetins c Nd<strong>is</strong>l<strong>is</strong>ric inwlvdot &d d'<br />

Enparhic involvdat .nd ' ovd inslvdot & I Sttnh<strong>io</strong>tic involYd€'t<br />

The following laclos also ne€d onsi'lmr<strong>io</strong>6 a lh' l<strong>if</strong>' sras€ of t fdilv b' $e<br />

tutur<strong>io</strong>tr of pu i! olii naEsge od c ihc quBt<strong>io</strong>n ofh'n@tksjs- lt <strong>is</strong> 6equ6{v<br />

not<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> th$ "sFplotr Plav a trjo' ptn in ndid rhr<strong>io</strong>lship lhe cpose Mth t!'

lFptons hN bd dsjbcd $ thc p6on widr th€ powd o .[dativ.lv' lh€ !'Mn<br />

I!.ting in powa ,hq thdforc, uing lh. tvnplom to bring .bo!t ! bal&@ in<br />

h<strong>io</strong>ircnid in@lstu<strong>it</strong>y" (M'!.!.n6, l98l)<br />

"Th. sF <strong>io</strong>m of Psin bav. b.a assiltcd w<strong>it</strong>l tttt'lsal s€elinA beilv<strong>io</strong>i<br />

(Kotb, l98O) dd idot<strong>if</strong>i<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> d a'tigrr ofllcl ofintinlcv in ih' ndilcl rl't<strong>io</strong>nship"'<br />

It js sulgel.d th rhe Psin sfl6 the Fle of $eting od <strong>ta</strong>ivinS a cdi'ir<br />

dout of si!i&c€, <strong>it</strong> b wel er.b)<strong>is</strong>h'{t snc ti@ fie psb &ttG <strong>ta</strong> spow lo c@e<br />

into lhcir orbil!, soihd inport!fi nbcdon ofp'in in ndiagc <strong>is</strong> to @ n 6 ! sp' Soar'<br />

Pain @ bc us. to !.lonaliz b.hNid 'rd previdc djen d are for thc n'<strong>it</strong><strong>ta</strong>d@ of<br />

l.z.l9. Pdrr dStd stts <strong>is</strong> t'qu@llv inplictl<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dd <strong>is</strong> ! 6nLib'ni!8 fi'lor<br />

in th€ Ei<strong>io</strong>loCy ofhadache! st 6s <strong>is</strong> d<strong>if</strong>ficoh <strong>ro</strong> qw<strong>it</strong> dd tm*hsr ncbulos ir<br />

defin<strong>it</strong><strong>io</strong>n. R@ & Gd.l (2OO?) Pl @in'dy whd trv sid "s1t65 t a d@dd<br />

upoo o68y" i <strong>is</strong> no Fe<strong>if</strong>ic rdporsc of the b'dv to dv d.tEd uton<br />

't Shatrd (200)<br />

sid'd du.l of nind 6d hodv in 6?08 !o d@d<strong>is</strong> nade upon ir"<br />

Pactdd (1998) has point'd out dst !P @m@ lnMd in $' veous<br />

defnil<strong>io</strong>s of$r6<strong>is</strong> lhesont d.rud" he @mndlsl<strong>it</strong>d dl pdpl€ e $bjeltd lo<br />

ddmd bci.g plac.d uPon sdgv' bo

Packlrd (1992) hs s<strong>ta</strong>tcd $d "stres @ o.triblte <strong>ro</strong> bad.chc ddclopDdl <strong>it</strong><br />

i|lre qays, A.) by inpoling long lm ws dd td o. ibe bdv <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nind t ducing<br />

6<strong>is</strong>rde. B,) by dir.dty FEipiLlirg tutb.d nus.uts dEtci<strong>io</strong>|\ or ch&8ing<br />

!.$le Bdiv<strong>it</strong>y in Mig{e C ) d by aggnvlti!8 dd alrqtv didila he&cne"<br />

Tne <strong>is</strong> l<strong>it</strong>tle cvid€Dd {o sur<strong>ro</strong>ri the nl. o{n.jd l<strong>if</strong>. .E13 in tbe<br />

be6d.ch., AndtsL, 1982! Blsch&d, Radn<strong>it</strong>z, Evds & schwdE 0986)<br />

't<strong>io</strong>lo$/ of<br />

Th@ <strong>is</strong> $nc oide@ to sgg6t ih.t ls e@doF nEquad 3tr6tul do<strong>is</strong><br />

6ay @ftibur.10 hod&h6 !t!.ls" Holnr ( 1986).<br />

l22O.Pti,6d Eratlons It ls ba su884Ld tbti "@i<strong>io</strong>s v6€ <strong>it</strong>ponol<br />

in ln€ .xFidc. ofp.<strong>io</strong>", (Mdskev, l98O) Phvsicids bdv' qplain'd pain a m' ofin'<br />

srbploEs s hFl<strong>dicd</strong>, (cdvsr I94),<br />

''Th* e s<strong>it</strong> MF of lltrtrMti!8 61 tb' nlqua+ of Frn' Plinn'ves s r<br />

hrluci ri@ <strong>it</strong> @ h.Pp@ in scliaPhM<strong>it</strong> dd dghl h'Ppd al$ in d€pl€s<strong>io</strong>r"<br />

Mdlcy & walM, (l9EIi s@ lv pain hrv di* 3 'nv$6cal @tYd'on sFpt@<br />

'[!<strong>is</strong> vE . via giq bv lud {td $pPon'{ bv of hvnaicr! pdi6l5 fould in<br />

Dair clini6. Amlha d..<strong>is</strong>js in elicl p6in <strong>is</strong> bd dtribultd to Eaial prrt* <strong>is</strong> lhtt<br />

of nucl. re$i@ l4rb to pairr <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> thi! nu$lc ts<strong>io</strong> on' ton dcsivc nsculd<br />

onmct<strong>io</strong>n, b.caue ofwhich ft.<strong>ta</strong>bol<strong>it</strong>e aE not pep'nv rdov€d <strong>io</strong>n nd' odingi<br />

which & thd ldrting b pain Fodd +prclch tia13 Pain a d<strong>is</strong>ile noD oFul<br />

@ndjdding. Pai! my tE r.rdcd sl$ to @ot<strong>io</strong>D, P'iDfl nh* win Prcdue<br />

psycholo8rcal cbAee <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dol<strong>io</strong>nal s* 'ko ogdd@ Pain dd ! phvsiql cse t'6<br />

a€dtu 6 ri? dot<strong>io</strong>n.l !lal. n.h.8 <strong>it</strong> wo6' And il <strong>is</strong> s6 qla dotonal mrs 's<br />

r@l.d th. Pa<strong>it</strong> d1a!6.

Thorie apl.idng hadac,i. vrt tu8ing trDn divirc (@ginrl sin) @lv.d<br />

psychosial dd spidtual i$ud b lh. hi@s@pic n<strong>it</strong>tic di& moldle<br />

As 6liq dbtustd, Pain $ff6!8 s ! nod. of €ipBi@ of p6vcholosi.il<br />

u€ehsb€lu8 z<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> sine lh. publidt<strong>io</strong>n of(B@ & FEi 1895) ce st'rdi6<br />

ofplt<strong>io</strong>ts*il! ylldi& Enrl. <strong>ta</strong>ortd 6 . gop of'lain PDt€" P.tidts<br />

to ,4k onr p.ir 6 6 fom of s.lf putulndt. Engl€ (1959).<br />

who apps<br />

Pat<strong>io</strong>B chiklh@d rchdo$lip bs ba cnd.rdiz.d bv v<strong>io</strong>l6e' aggB<strong>io</strong>tr rtd<br />

$frding, { @e c.s ei0t h6! cJEsr<strong>is</strong>al and ebe tiD6 wiih'ovd mp@sijr8<br />

d<strong>is</strong>pl.rs of cffEt<strong>io</strong>n" in Md (js pMts h.d bd @ld md rej@t<strong>it</strong>& <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> oft6 a<br />

pMt lEd sufra€d pair d sd<strong>io</strong>sl illn*,<br />

Enslc b.lidcd clmric Fin Dtulid.d s ae.?l!bl. wly fd individub to 6F<br />

wilh tun ou lgrrBs<strong>io</strong>r A NDlq of adtEs lsv. i,DPli@t d c,hildhood dvd<strong>it</strong>y i!<br />

$. .r<strong>io</strong>to$, ofp.in in odulls, (Swdson €t .1. l9?8; Cftss, Roy, v<strong>io</strong>lin & W.lka el al.<br />

r980).<br />

thc o<strong>it</strong>iv. bchw<strong>io</strong>r dplaDtid th.t !oi! &d d<strong>is</strong>.til<strong>it</strong>y Fs<strong>is</strong>i a . cul of<br />

reirfoI!@di @nti!g@t o! 6void&e b.hevim dd dplaint b.h.v<strong>io</strong>l'(Fotdyc€,<br />

r9?6;a Flor d .1. 198?). A cld rhdonship b.tv6 pah rclat d b.hav<strong>io</strong>r dd b.liefs<br />

Ia b@ shoM; "tI. beliet ofcbrenic Fir<br />

prlidrs .boul tb. rt@ ofpain $d alout<br />

rbcn oh spalil<strong>it</strong>id re prEdicrive of copirg .forls &d th.ir €fEcasy" (Hdlclaa ci al,<br />

l99r i J6sn er al. l99l; willi@ & Kefe, l99l).<br />

Th. p€sndiry fidry ofh4

Migrs<strong>if</strong>t <strong>is</strong> m exF.ss<strong>io</strong>! of un@Nc<strong>io</strong>s hostilily a€l<strong>it</strong>ut @!$<strong>io</strong>uly belov<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

!€Mn\ milrain., pa$ab rm ln€ir hodiliy 0m oltlq pq$tu aeaiBt thds.lv6 Th.<br />

Ftu! btrcjc.r5 l[. b.lov€d sld rh. hn d F$o e i!.r <strong>it</strong>rjuinS ib@lv6 ocd al<br />

th. se liD? buning the iltoj€1cd p@! sd vi@ v4& Migues bq desib<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> a<br />

psf.ct<strong>io</strong>ni$. ngid, ordqly @DpuhiE ob,3sive dot<strong>io</strong>nd, P@upicd v<strong>it</strong>h $(.4<br />

ttgtil] urstjv. ficy htE & iMbil<strong>it</strong>y <strong>io</strong> qFd i.8!tiv. f€lin8s |9pmPrilt ly.<br />

ChrDic rd<strong>io</strong>! h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>&b. sufl.@ e usDatly wonimq d€p6sd hbt idic, &d<br />

psychoslrlly cdf lict<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.<br />

8@6 & lGrd in ce b<strong>is</strong><strong>ro</strong>ti6 cig<strong>it</strong>r.lly publ<strong>is</strong>h.d i! tbci. sludi* d hrslah in<br />

I 895, sus86t d lbd pd 6uld be a lcqud& of a plltholoeicd prcbldr! thd the<br />

@nEibut<strong>io</strong>n ofpsy.hologicrl facton lo prin wft 'wnriddtd nte gsl intluoa of<br />

FFud sb.!.d Ib. bclidir D6y.ti.t!ic circle $rt Fs<strong>it</strong>at<br />

nldings i! du. lo pltrli8rlic ailn@l!.<br />

p!i! ir ttc l<strong>ta</strong>og ofo4[tic<br />

wolf (19?2) op@lirs wiihin ! th6r.li.al psycho+oDatc pdp€dive, po't!y.d<br />

rb. tuieEirc patjo|l a) @b<strong>it</strong><strong>io</strong>u {d @r6.d wirh a.!iw@.rr .rd slllra. b) g6r<br />

dell ofz6t<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>a66| . c) Sairly i&lrr.d, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> bive lov€ ofoda <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> E<strong>is</strong>ree <strong>io</strong><br />

cheec, inflexibil<strong>it</strong>y inelaticirt. sh6lloMes, @l rnd .loot<br />

Study @ rsy.holog<strong>io</strong>l tun riding in hadehc sdfffi showcd 'gMtd<br />

Fy.Iolog<strong>is</strong>l d<strong>is</strong>rub.M i! badaclE patidrs". F Ar

T6<strong>io</strong>n <strong>is</strong> fie dd.rlying @us€ of maiy back preblm8, H. sble6 '<strong>ta</strong>'n wc 10<br />

mo$d th. aot<strong>io</strong>ns s th.y dotr'l bs& rt<strong>ro</strong>ud lo rh. @m<strong>io</strong>u min

E prsi@ of ihe p6in cxpa<strong>io</strong>e <strong>is</strong> c@pcllilg & lhe individuds ono pt thcir<br />

pain into erdg' an muic & po.try lhs individuak ond dw.U on (phy now) $cy<br />

dddibe pai, d . tumjrg poini in iheir liv6 o @tilue <strong>ro</strong> opt@ <strong>is</strong>igh<strong>is</strong> ton th€n<br />

Th@ h th. walcla or th. wl<strong>it</strong> r tb. plin dpdiq.. for me individuals h s<br />

vigil, *l<strong>it</strong>ing for plin whjcr! lltcy bcli@ n.y iNade lhd ,lr d, t<strong>it</strong>nc lh@fo.e c<br />

p.in 6 .@i!g sd they out b. or dDry to int @pl <strong>it</strong>, r.bn8 hy'rctts d ftrquilim<br />

nay bclp riE pain but jl My clolrd lhen viail@ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> pui iho !t a dbldvullg€ w<strong>it</strong>b<br />

$eline s<strong>ta</strong>lthy p.ir. Fc lhcr p.ir <strong>is</strong> hidda. fael* shy <strong>it</strong> <strong>is</strong> dcSdiDS <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> D.y<br />

invadc ih@ dy rinc, d4fo.." rhay nEi DoDi<strong>io</strong>r wl<strong>it</strong> *.tch dd b. qdn ih.<strong>it</strong> @pin8<br />

@sins of pain eticip6t<strong>io</strong>.s. ltd tbcy wi foi plin !o @8., go &d @. .gail rhd<br />

thse <strong>is</strong> th€ 6 una tu th€ plin p.tiab, fd lh6e irdividu.k pain <strong>is</strong> dda'din8, md<br />

thcy DEr pur l[dFlv6 i! e aviltJ|ll@r in *hich ptin rdicf sqvie pDvid.d by lIrfr<br />

n ap.nofthcirb.li.fsFlan, b. s€pab s i ..se, bul c h<strong>it</strong>u.lf a 6onabl.<br />

FsA @po<strong>ro</strong>r. @llatobto.. @mui6<strong>io</strong>r &d @. .U. lo mI€ @nEjhal w<strong>it</strong>h<br />

th. 3ufr fc plin Mt<strong>ro</strong>l-"<br />

LeFatN infods u ort h the lnin sycr.D. wh@ pain <strong>is</strong> rcghtdd ae a pain<br />

r.li.f ryrt@. E!&rphiN $.1 trhb pair dd olstrrcl str.DI<strong>io</strong>4 fi<strong>is</strong> ha swiwt vdu.<br />

for hmm's fa€iD8 d.r8ocy, bul th<strong>is</strong> ha l<strong>it</strong>d. lory Im tdc for n.ding,<br />

''D6jal <strong>is</strong> th. Fychologiel r!alg6i. ofd. adoryhi& r@.t<strong>io</strong>q ald <strong>is</strong> potot<br />

wapon .g.ii$ ov@hdnilg thFd, D€nhl { sln. psi4 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dlbl. r !as.<br />

<strong>ro</strong> d.5l<br />

s<strong>it</strong>h ugal ne€4 ddial prcvidc ! hecbd<strong>is</strong> for uliim.rcly pMoling halln'- (Dmi.l,<br />

l98s).

Tll@ b a wide lray of priD in th<strong>is</strong> wodd. nr* @ ale oomoN NDba of<br />

F4etiv6 dd t!:'rndl modaljd6 for p3in d.pdding on the .dolo$/ a.d in<strong>ro</strong>s<strong>it</strong>y of<br />

pain bui al$ Ih. p&r<strong>io</strong>l{ ori@1al<strong>io</strong>n oft[. pa<strong>it</strong>r sDeid<strong>is</strong>l-<br />

Head&h. h one ofih€ 6lmon physic.l abpl.ints <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> usurlly d<br />

.Mp6yin8 3ympt@ <strong>io</strong> nost of rh. d<strong>is</strong>.c l<strong>it</strong>e blood pr6uE, Lidncy fril@,<br />

Moing<strong>it</strong><strong>is</strong>. Ix.y 6 b€ nild and 6 be waq tujdi9 ofbeld&hd e. boign bui<br />

lhey d b. s<strong>io</strong>s and o hw€ frtd @$.qu6c, m. Day !!3Fnd rctonds to nild<br />

oalgdicx liL apiin ard N$id olhe @y .qEE l[@Iie<br />

'"Ihe im hadachc h6 beh defn.d s in o@u@@ of pain d dbmfon ovd<br />

lhe DpF part of rh. bad tur rh. orbirs 10 th. srbacipird d". T!€ &6dr<strong>io</strong>n i!<br />

bowcE loo rstrict€d sine the sle of tb. p.jr my oriSind. ir the fac., t*th !c.k<br />

md ePtqd into thc d€ dcf<strong>if</strong>td above.<br />

La. ctrslfi.d,t<strong>io</strong>n oI E odtch.<br />

Lil€i,lr inlom B lnar b ne@logi.rl rfrdie : lyp6 of h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>l.lt. e<br />

@@only s6, Mig6,n., Tm<strong>io</strong>4 Combin.d dd Clustd H.rda..h.. Piin in thc Had<br />

<strong>is</strong> indlccd ii a lmbd ofvlys:<br />

l. Dilal<strong>io</strong> of intra cfuid & dft cBni.l blood v65.ls.<br />

2. l.ilmal<strong>io</strong>n of Oc blood v*.ls & anai€s.<br />

3. Susraincd @rtnd<strong>io</strong>n of6c oucl6 in dE sl! &d nel,<br />

4. Tnci<strong>io</strong>h on the circlc ofwill<strong>is</strong> <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ils btuchB-<br />

5. Ches6 in <strong>if</strong><strong>ta</strong> drial pE$c <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> inra @v<strong>it</strong>y pG$c,<br />

6. Infllm'lrid of inrr. .fuial & dFd tuid sti&rlB including L€ptdirg6.<br />

?. DiEl pr6uB or nfts @nrainine pain 6bas.

.Had&he <strong>is</strong> @moly @us€d by Mi.ty dd d€pr6s<strong>io</strong>. ne ow of th.<br />

psychoSdic heldaehe k lo b€ s<strong>ta</strong>in<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nEold @nbad<strong>io</strong>.! of th. nwi€s of lhc<br />

H<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> & lal. Irad.Cl. hs v&<strong>io</strong>s @us, i! $De d<strong>is</strong>dd herhche <strong>is</strong> Mial.d<br />

w<strong>io</strong>r fo.tl r@losrcd si93, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> @ hN to d<strong>is</strong>ii!8ush betwo F<strong>it</strong>urv h€dach6 . 9.<br />

Migrain dd Synptmaic nsda€he, s@sdary lo d Ddclying infecton'<br />

inflffillorr, !eul{, nophstic or .!il./ic dietdd. Ary clinicd pr6ar.rjon ih<br />

ddilld .M sliduy trDh clsidl faiG of pri@y <strong>ta</strong>d!.16 s.tfuts a rbooud<br />

eo*ut'(Schmd & S.Ddot, 2004).<br />

Tl& followins <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>dd nl6 of lh. thMb e wtul wha @Dtml<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> wirb a<br />

had&h. i, $. cliddl l<strong>it</strong>u !@. t 18l.$ing h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>r.n6 (c.& ovav..lG d non$t<br />

ssidr.d *iih n@lo8rc.l .btudalind e .aus.d !y sirucnlti Bnin l6<strong>io</strong>s, <strong>if</strong><br />

hadrch.s e .l<strong>is</strong>odic in nan[€, nmloS<strong>io</strong>d silns q slnptmr Eav pl*de o.<br />

Mp.ny dd oudsn thc hadste Th€ die.dd ir likelv <strong>io</strong> b€ b6jln (i,e @t<br />

s@id!ry) <strong>if</strong> thc s''nP|m3 ocq t€foE th. h.!d&lF, dd <strong>it</strong> b lik.lv to be @uscd bv<br />

strucnnl les<strong>io</strong>s <strong>if</strong> sFplons app@ duj!8 od ltd lh€ hcct!.ch. or <strong>if</strong>tbev oullst ii<br />

Tb. re ac.9t<strong>io</strong>r to thc lanq <strong>is</strong> haiplcgic miSnin€", (s.r|@d A $rdo4 2004)<br />

Althougl s l@y s | 5 spdtlc tF of hal&b6 bav. ha idal<strong>if</strong>cd (Ad h@<br />

Connilte on lhe ClG<strong>if</strong>ical<strong>io</strong>n oI He!d.ch6, 1962) lhe ovdh€ln<strong>it</strong>e najor<strong>it</strong>v @ b€<br />

diaFosld s e<strong>it</strong>ha \4igeinc d Tff<strong>io</strong>! 94','l of lhc patials @iEd oE of tb6e two<br />

dilgDoG, Th. pl€a( srudy b li@l.d to Tdi@ .td Mi!r!<strong>it</strong>. Had.c!6 in whjcb<br />

Fychological factob Dlsy<br />

a d<strong>it</strong>ic.l mle.<br />

A@rdjrs <strong>ro</strong> th€ Ad hoc coIm<strong>it</strong>le on th€ Cl6s<strong>if</strong>i@t<strong>io</strong>n ofH€ldlalcs (1962)<br />

Migoin <strong>is</strong> deib<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> s "Rcffiar afl.clc of had!.!e wid.lv vcrving <strong>it</strong> i.tdiiv<br />

fregMcy dd duoljon, thc altlcl. e uilltdil iD msd @ uu.llv 3scial<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> wilh<br />

A<strong>ro</strong>dia &d Melin6 w<strong>it</strong>h naua and von<strong>it</strong>ing <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Mc rc pr.c.d<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> bv or

sssilt€d w<strong>it</strong>lr @trspicloN s<strong>ro</strong>ry <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nood d<strong>is</strong>ldtee ad d on , ftDjlial.<br />

Migni.e d vs@ld hcadrche, h6 a Nddd oDel n6t ono afr€ds on. tid. ofrhc<br />

Ha4 blilds quidly lo e ints!., tb<strong>io</strong>bb<strong>it</strong>g Furding d pdsaling tuti6 rl i<strong>is</strong> p€l<br />

sd lsls rpFoxinal.ly .ighl hoh althoueh il @ tugc for a fw lom to s?vqd<br />

@ijnuou drys, tqmi .@nDsiMts @ eoEn.. nalg and flt<strong>is</strong>re faiu6 ls<br />

fr€qdt d! bm<strong>it</strong>ing, pslltr diath.c dizind, paMthdb, hyFB4nivilv to eund &<br />

liSht and @ld i! th€ qEhili4 '<br />

1,1.1, LIigr.in "lrigdin€ <strong>is</strong> a nulti flcelcd d<strong>is</strong>rda of *hicn hdd p.h <strong>is</strong><br />

only oe mlonot II tu . p<strong>it</strong>uy CNS derdd bui i! m. iDs<strong>ta</strong>B il Mv ocd for<br />

rlE f<strong>is</strong>t 1in. i. close tdponl rclados lo a lendary b.rd!.!e" MigBin€ <strong>is</strong> .<br />

p@rysE.l d<strong>is</strong>ddd ch{scrqiz.d by a1r!d3 which N 3.9d.Ld bv rvnp<strong>ro</strong>n fE<br />

intdrb siDild <strong>io</strong> cpil.psy, Mghine <strong>is</strong> cb{.daiz.d by r.Pdino of.<strong>it</strong>!.Ll nlha t'd<br />

. sirel. $bc& wbicl nat nt@ in msy individu.ls unda ca<strong>ta</strong>in c't@n4c (c,g<br />

stct", (schodo & srrdo, 2004).<br />

A !n.I Fdi.ee<br />

of dgtlM lpFotsalcty l0 % dpdide n@logicd<br />

s'mptmr host (Fmor y v<strong>is</strong>ud in Mturc dwinc the p<strong>ro</strong>

qpa<strong>is</strong>c€ t€3ch6 th€ patient ot ob8daDt fanily ihai lh. nignin. 8fi.ck hG b.8u The<br />

s@nd phe of ni8ranc <strong>is</strong> ln. sn4 cm<strong>is</strong>tiig of ciihq v<strong>is</strong>ud or ssrt Phfth@<br />

(the rwo nost @md ru symp<strong>io</strong>m) d motor wEh6s i! @ordi$l<strong>io</strong>. or dtlphsic<br />

srhptotu, such 6 word tuding d<strong>if</strong>fculty, lh. 3u! slmpims ga.nlly uurlly ple.d€<br />

the h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>a.h. ph& oflh. Dignire an&L, but @<strong>io</strong>r,lly ()ffi sinil|n@slt,<br />

sometmd rso aM rFp<strong>ro</strong>ns o@ i th. !h@k, lMlly vieal dd s6Mry rynPtons<br />

thlt my o.q sinultlnoEly or 6Mriv.ly. Tbc aW syDplos at @ gr.duly<br />

oE 5 to 20 Din ud lsudly $t6id. befoE Ih. badaclc b.8iB. The am synpt@<br />

lpp€e grrdurlly ova 5<strong>io</strong> 20 minut€s <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> usu.lly Nbside jut b.f@ lh. b.dlcha b€giN.<br />

wlh ddining . p.tidt who h3 @tly .xpqiac€d oly orc or two such an ck fd<br />

rne 6rsr dhq lhc clinici& bln d€l@i& wh.ihd lhe fo..l n@logjc aF/om<br />

r@rsol milrd@us aura or nd<strong>if</strong>B<strong>ta</strong>t<strong>io</strong>r of<strong>it</strong>dsimi tuch4ic att&k (TIA), Passe of<br />

tiDc r@6i.d .n!.lr .nd diaFosric rating nly b€ Fqu<strong>it</strong>cd lo obrlin 6r.iDty, bur<br />

€tdn f@tu6 @ ndc tDic.l of MrgBinG !w. FiBtly, v<strong>is</strong>l 5d sflsry sFplms<br />

of TL{ .nd !.iz!B wlly da€lop nore dpidly $d th€ gndEl ptuCr6s<strong>io</strong>n of e au.<br />

ova 5-20 hin!l6. S@ndly, mjglb. rM <strong>is</strong> chmd.riz.d by ! @hiut<strong>io</strong>D of n gatiw<br />

and posiiiw syDplo$. I1E nigrlinm eipdid6 a v<strong>is</strong>ul s@tom o. hol. in lhe<br />

v<strong>is</strong><strong>io</strong> (negdtivc synltons) <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> d@li.C; glinmairy $<strong>it</strong>tillding light! (los<strong>it</strong>ive)<br />

pbe@@ TlA, $cb 6 Ah.Ns<strong>is</strong> Flgq d Hsnimpic stmt, uu.lly rs<strong>if</strong>6ls a<br />

black or blanl negarive !i$al loss. Th€ @s.ry aB ofnigEin€ Nally @N<strong>is</strong>t of<br />

Ddbns o{.eltive smory sFptmx <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Fos<strong>it</strong>irc sFptons of tineling o.<br />

p.tdn6n). Agoin $e sdsrt synp<strong>ro</strong>ns Blrlly preeres oB 5_2o bi.urB &d re<br />

follow<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by ihe headacn. phs., which <strong>is</strong> lh. lhird ph4. oflh. mi8raine tnad., dd<br />

usully rh. host d!:mtic. It i! rhe h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>&h. for whi.h bqr nig<strong>ta</strong>ne p.tia<strong>is</strong> @Ndt th€

"M<strong>is</strong>nin <strong>is</strong> atb ulod <strong>io</strong> two pbe veulu prc6 inE ad 4t? @j.l<br />

va!@.stridiE F<strong>io</strong>r to h€ldlclE (whjdr in <strong>it</strong>t sdft fom Pbdu6<br />

tb. n@logi.d<br />

pmdmD*) follw<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by a r.actire vdodilai<strong>io</strong>n whi.h podud thc t<strong>ro</strong>bbing badlch€<br />

p.jn a rub6 of b<strong>io</strong>cldidl cMts a..dpsy lh* cl@96 iD pqiphdzl \6sle<br />

lon€ ard ir i3 @cl{ wbdhd th* b<strong>io</strong> ah<strong>dicd</strong> cheg6 @ . prinay or s4tdlty lo<br />

ilE d<strong>is</strong>rdq", (Kudrcw, 1983),<br />

r.12. f.6i6 E..iz.tz h @ntrs1 to Mignirc T63<strong>io</strong>n d Melc<br />

C,trtracl<strong>io</strong>q PltdDgaic d D.!6sjve t d.fncd s ey "AclE or *tsal<strong>io</strong>. ofd8htl*<br />

pBse or ostrict<strong>io</strong>r *id.ly vei<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in int#ig, 6€guo.y and dMl<strong>io</strong>r bd $D.lims<br />

l@g laninS !d 6ll@nly $b @iilal". Hadlcbe hd . @E iNid<strong>io</strong>u dla &d<br />

rslur<strong>io</strong>n, rnd h dp@oc€d s a {hll, slAdy bil.t Bl, d b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lik. pain d &h. th. pu<br />

<strong>is</strong> l* id.ns th& 081 ofm<strong>is</strong>rlile bur Dd) individud dpqi4e U<strong>is</strong> tlc of hcldlch€<br />

m a &ily b.ds t in pcM.bly <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ts tr@ suIlin<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> @ni'ld<strong>io</strong>n of sl.lc<strong>ta</strong>l n@lq<br />

ocMing s a 6pds to l<strong>if</strong>. slr6s (Ad Hoc Com<strong>if</strong>i€ @ lh. ClNi6cil<strong>io</strong>r of<br />

Had&hq I 962) od <strong>is</strong> "a1!ibuLd to stimulai<strong>io</strong>t of lain rcc?td in fie o.o_&t d<br />

nel6 rnd i$ndia Foduc.d by dprss<strong>io</strong>n of i!tra-Du$Ia d<strong>ta</strong><strong>io</strong>le', (H.F6,<br />

1930).<br />

"Onc f<strong>if</strong>ft 10 d. third ofol h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ehc sufl.@ My cxDaide hoth qP of<br />

hadehc lhe mixcd or CoDbin€d h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>dh. D?6 @ $bM.d to BUr trln bolh<br />

vos€uld and msno{[.l.td sb..rat<strong>io</strong>N lhc abov. 'Ms1s e not uiv.Bally r@F€d<br />

rnd d€ thc $re of two @n<strong>ro</strong>vd<strong>is</strong> rt plBdl Ibe 6Ft i. @nm<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> wjt\ vhclhd<br />

nigninc k norc 6re{y v<strong>io</strong>cd N . 6trrl nlhd tb& a pciphod dierdd ,<br />

(Hsm, Hariks & Ldd, 1982).<br />

R6d.rH s!€ul.l. lhat nicninc ard 16<strong>io</strong> bead.ch. n.y tpring nom the<br />

3@ D

srEibute d<strong>if</strong>rddg to ea<strong>it</strong>y of invotvdal. Mosr tlgclas didingu<strong>is</strong>h bet*.at<br />

rh* t"o herdeh. D!€.<br />

Ttu<strong>io</strong>D n .d.ch€ hs two @l.8oti6l .9r$dic md dMic. fte .P<strong>is</strong>dic <strong>is</strong><br />

rds<strong>io</strong>n lr?. h.!dach. (ETTII) <strong>is</strong> d€fincd by IHS (lnt dlt<strong>io</strong>nal Had&he Soc<strong>it</strong>v) a<br />

hqdache fr.qDd.y ofgr€tq tbd l0 l<strong>if</strong>. finG anact6, but fwd lbdl5 *t&ks pd<br />

nonlh; wi$ s avdsc atlact dmt<strong>io</strong>r of 30 hinutd <strong>ro</strong> 7 davs <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> al I4t r*o fetu.6<br />

tnat n.y includ. bild 10 Doddlre p.<strong>it</strong> inltu<strong>it</strong>y, p[6<strong>it</strong>c; ti€ltdinc a bald lil.<br />

sa&ri6 bibldltly M pdstile qudily, ald m dfti* i.dD<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> d&db.t<strong>io</strong><br />

!,1,3. M<strong>it</strong> d E.an6h. Srtulnt. Th.mix.dbadaclEsynd<strong>ro</strong>tud5oL<strong>ro</strong>M<br />

s T@s<strong>io</strong>n, Vscde hdd.ch. d CoDb<strong>it</strong>ut<strong>io</strong>n hqdachc <strong>is</strong> nod Aequdtlv 3m bv th.<br />

h€ldlchc apFid<strong>is</strong>l. The nix<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lFdlchc pllidts sfl4 lirb both nigain &d t65<strong>io</strong>n<br />

typc haddclE. SoD. c.drhd belid. ih.t in sclud<strong>it</strong>y th. Paridts vilh Dix.d<br />

hsdahG d vicim of Digllnc tnd d@B<strong>io</strong> in (MbiBtid", (Dle@d &<br />

D.l*<strong>io</strong>,2OO2).Th.d.pBid!@86'rDskcd'<strong>it</strong>torchtunicdailvtdiidtt?c<br />

h€ldlchc @nplicat.d by pd<strong>io</strong>dic nilra@us h.ldach*<br />

Ibe nixcd h.adach. srd<strong>ro</strong>ne <strong>is</strong> 6npos.d of th. fouowing svmPlonotologv!<br />

L Daily chnic ld<strong>io</strong>tr headacha<br />

2. Ha.d d tict mjs&ou nad.clE-<br />

3. I'663!d su$.dibil<strong>it</strong>y of hal<strong>it</strong>ulri@ to ovd 0E od<strong>ta</strong>, or pr*ibd <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>g!3i6<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> or Ersor mire Tart Et€, (Mrlh4. l98r ).<br />

MiSFinc h@dache oc.m Aom on lo €,ehl tind Pd modn, sn. otrd<br />

pari.nr! r?on a hbtory ofdaily h€d.chc lh.l ddonslrat€ boih ni8Eine dd tds<strong>io</strong>n<br />

tn nircd hddebe st!&ob., @ cl8,cd niSnine (tugE<strong>if</strong>t widDlt .m) <strong>is</strong><br />

F!$t howdd ctNiql niSEin. dd othd 163 h<strong>is</strong>nirc widts Nv ()6 for Mc<br />

tl

nn d hadlclc p6riats, Tt@ <strong>is</strong> ! ihstbilg uildhil ud .lsi.Ld syDD{o! ruch $<br />

eogi., du.r vm<strong>it</strong>ing, poDr<strong>io</strong>, PhonoPhobi. ald blutEd v<strong>is</strong><strong>io</strong>n.<br />

r.L1, W.m<strong>it</strong>sS<strong>is</strong>"t Horh.h. h6 divdc @u!.s, <strong>it</strong> som. didofltd<br />

he6d!ch. <strong>is</strong> slocial.d w<strong>it</strong>b n.Wloacrl ligff d syurp<strong>io</strong>4 orc hG to dhiidgukh<br />

b€tw6 ! prindl hadache qmpl€ mignin <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> a srEplomtic h€ldeh€ whicb i3<br />

mdiry <strong>ro</strong> u|dcdyilg <strong>io</strong>f.{ri@, iDo.m|<strong>ro</strong>ry, lcalr, Do pldic, c .tik?tic<br />

di$d6, Thu di.grbsir bay b. d<strong>if</strong>f<strong>io</strong>ll Udf@ il <strong>is</strong> imFrrt'r 6d 6c [6Iin8<br />

plycj& hat h.vc ! tldugi Lnoql.dg. ofha

do nol alt€d d@6s.d ihcy do mt poss ih. sjD.qmton of d.p6<strong>io</strong>l I'!t <strong>is</strong> sad and<br />

dysphonc mood; lbcir d@B<strong>io</strong>n h m.ilcd by lb.i tujor snalic @npllint, . hadrch€<br />

6tbe thd a d@r*cd mood".<br />

H<strong>is</strong>lory of mcdicine <strong>is</strong> dbowding w<strong>it</strong>h dBopl<strong>io</strong>s of d<strong>it</strong>f66i tutnol<br />

sodaljliqbetiw<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>tot .tr div.fqtslingpaindsh.rda.b.whichenowbel<strong>if</strong> b<br />

bav€ .o md<strong>it</strong> & nay be hmtul. Hsg$rd ( 1929) dMib.d lh. tollowins rrstltot<br />

giva to King Chdl6 Il (l6lG85) by lh. b6l physici4 ofthc day.<br />

''A pirr ofblood ws .rhcr.d frcD hjs n!l)t m ad hAlf a pint noi lr<strong>is</strong> bn<br />

snolldd, lnt ws follov.d by e octic s@ing Fwda, bl.cding s0nng potjm, a<br />

Dlas16 of <strong>it</strong>cb <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> piaon d6g w@ hd.d otr hi! fcd. Potim @bi.ing l@<br />

d<strong>if</strong>fmr $blre6 cli.0y nan! s *.ll s ,o drcF of qr.ds of nme 3tdl s@<br />

sllow€d. F<strong>io</strong>llt lppl<strong>io</strong>t<strong>io</strong>o ofthc b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> s<strong>ro</strong>r., g.ll ndc t@ 8ht€p or Sods w@<br />

ptg4_b€d follNina fi. dt6iE sam6t od $. hn8 di.d".<br />

Tbc $<strong>io</strong>dfc btt<strong>it</strong> for <strong>ta</strong>nia8 hadldd bcgD by Pictqiig (1933) vho stodjcd<br />

th€ rcle othindjnB ir prcducins bdd&hd.<br />

Th@ e 2 dim@<strong>io</strong>D !o tstirS priD th. pdiPh@lin &d thc otdjsi nodel<br />

rhe pqiptFnl<strong>is</strong>i th'nLs tnat <strong>if</strong> udal}lng Ddhe<strong>is</strong>s St rddong pain e mov.d the<br />

laliars suEding will bc cdlc€d, '"To !@mpl<strong>is</strong>h Ob po6s ih. pajphdal<strong>is</strong>r udiz<br />

$ch om?ts & nodll<strong>it</strong>i€s of tslnoi lik. ndc bl6k5, a@p!rchft, ss6y<br />

injmlabl€s & olhd pardt n dicrt<strong>io</strong>ns d6ign.d <strong>io</strong> chdge ih. nNchm<strong>is</strong>t y of the<br />

paiiqt 6 w€ll 6 ihe sfiuclual chmgq wjth surgicil intd@t<strong>io</strong>m tuh t€chniqEs a<br />

r ipulai<strong>io</strong>n of the spin€ hol pa€ks <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> t!e3cutd6!! nde slimulat<strong>io</strong>n folloq.d<br />

e@€€l Fincipl6 ofpdiphsd<strong>is</strong>t viq in ltEi. altdPl lo r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>u* Nic.Ptiv€ slinulat<strong>io</strong>n"

'ly bslcd @ntrlsr lh. mrDl<strong>is</strong> vi4 of cbtunic pdn trl6 irto @i.ldat<strong>io</strong>n<br />

nyriad of fa.to6 nnginS nbn dE <strong>ro</strong>r<strong>io</strong>rs v.ib.lizlt<strong>io</strong>n ofd<strong>if</strong>f<strong>if</strong>dt soc<strong>io</strong> asmic<br />

vdi.blc, fdjly pobld v@l<strong>io</strong>nal & . v@i<strong>io</strong>nal asp*r. mot<strong>io</strong>nd Md irt€llelu,l<br />

fa.loE, a wel s @nr.xr w<strong>io</strong>& which th@ vs&lB oru. Fd ih. Fin rt€ial<strong>is</strong>l<br />

foUowilg th<strong>is</strong> nodcl pain b'@E lho th. 3@ of<strong>it</strong>s parb" srd d tucl brcldd viry of<br />

rh. p6liats d<strong>if</strong>Solti6 m$i b. 6tqr.in.d". (Coq 19?9). IE 6E lin ptopo* a nccd<br />

for d interdi$iplinary .ppoch.<br />

B€hav<strong>io</strong>nl jntdan<strong>io</strong>n in tratinS cl<strong>ro</strong>oi. hc.da.h. wa stinulai.d norc l}d !<br />

d@dc rgo, lMirirg BulB w@ $gasr.d *<strong>it</strong>h b<strong>io</strong> t .db.cl Edning fidd b<strong>io</strong><br />

fc.db&lq reldlr<strong>io</strong>r tlinin& Th* <strong>is</strong>trDol! pr.d!@ si8Dfdt du.do in nad..D.<br />

adivily', (Blsch&d & Atd6ik. 1982i Hdrcyd, 1986; P@id, Hdby4 Husb &<br />

Holin. 1985). Sone widdc sulg*<strong>is</strong> thlt "@bin.lid ofil* rwo tratbdls nav b€<br />

ffi.ff..tiE $e.i.hd lrelnd<strong>ta</strong>lorc', (Bltlddd & At&!er' 1982).<br />

1.5.1. ky.<strong>io</strong> Th.dP@<strong>it</strong> bftreldotr..<br />

'D<strong>if</strong>rsdt @e'<strong>it</strong>iv. stzt€gi* hav. b€d @ploy€d for d.l<strong>io</strong>r.t<strong>io</strong>n ofrcut€<br />

p.j!", Gunq Meichobdr & CaB! 1983). It <strong>is</strong> suSgsl<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> thd th@ <strong>it</strong> a omet<strong>io</strong>r<br />

qbB b€rwa ou bclicft .!d lboushts erd th. tuld<strong>io</strong>dry ofor bodi6, tbev cfe1 ou<br />

.!to-innD. systd which nodnde ou .bili9 lo sard ofiln6, and Prebole<br />

Pair non illn.s and matic mPltilt! 6 b€ in@.d by ou<br />

s.lGlrt6ac. Spdle@s dtueferjtg 0Dugh!3 howds 6tond 10 ou Milv<br />

d<strong>is</strong>d.rs, in t.ms of orc h.li.fs dd in d di.lop., my sff4t lh. bal0\ thll6.<br />

thin$ w€ tell owlvd hlve e impact oD our physical &d dot<strong>io</strong>nal well-b€ing<br />

*I! ouleb. of @g<strong>it</strong>iv. lhdpy, rclu.t<strong>io</strong>n <strong>ta</strong>ili,lg, aid @SD<strong>it</strong>iv€ th@pv in<br />

@hbiD.tid ei$ clud<strong>io</strong> Esining on cho.ic loe ba.l lajt snd @i!r.d phFicd

ard psydo$oal dhalil<strong>it</strong>y w@ dalut d |nd @DPucd, aU I <strong>ta</strong>EHt 3FW6<br />

rdain.d siEri66tlt impDwd fton prer<strong>ro</strong>bn@f', J A T\n6, ( 1998)<br />

''CBT inprcvB @pirg wirb ptin .nd to r.de. d@63€d Dood &d hal0tce<br />

sa!i!8 H.vid d Fib@t|l8ia . Ktrhrin A Nidl.f. VoLdt .6[rB wBh.d H<br />

(20r0)<br />

Applyjlg ofFyctologiqt @BEEt <strong>io</strong> had.h. di$dd e sidpl. !d sf.igltt<br />

for*rd, inc N nor @8niz.d ttqtDots for P.i! d<strong>is</strong>d6 Bpeialv hetLc[6.<br />

Fi!di!8! showth.t @gn<strong>it</strong>iw pDto@k @ Gff!.tirc i! rcliwi4 d<strong>is</strong>tts' studi6<br />

l@m6d tbrt "tutw shrdig should m.loh intd@t<strong>io</strong>n lo spe<strong>if</strong>c ch@l6<strong>is</strong>lie for<br />

whm tbey @ int6de4 s v€[ u lddidonal 3tudie that @nbin€d phm@loacd<br />

lpp<strong>ro</strong>rcbq ktgtthd w<strong>it</strong>h @iii* i4hiqc", (KuPD.dEind, w@d, BmM a<br />

Roold,20n4).<br />

Psltloltraay f(rc ot tb. cmt<strong>io</strong>td pt!€! ossrd<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> bv d<strong>if</strong>icult .rd<br />

ch.lldSi.s qFno6. siil6 4 .1. (190) Polot d e "aiDild<strong>io</strong>n nodcl a a aosic<br />

.@ut of sch Fr]66".<br />

Snrdie nril6portly liSl o ltt<strong>is</strong> n@hrnw dd $8gel rhal'n€gatvc<br />

@Sn<strong>it</strong><strong>io</strong>ns nay inde.d rfr.d tratnot oltcone" (Bm!, Kubilu. Bn hl' Ilado &<br />

d Psy.holh@patic inr€t€t<strong>io</strong>s, StudiB rcpons rbrl @et<strong>it</strong>ive stri€gje mv<br />

b. cfrctivc in ahwlring clinidl pra Ryh6tcin 0979) fould lnnt rnicninm ian<br />

wirg Ei aDdrrivc ad adat<strong>io</strong>r di!6i@ 3!rlcgj6 sho*cd erar- atraut<strong>io</strong>tr of p!n'<br />

thd @n[ol su!jdl". BrcM& c1Ev6 (1984) hEdth rniSEil]da<strong>ta</strong>uehlo@<br />

iru8iEl oping st?t gie Epon.d dd6.

. In nodels of shes & @pins'!ain <strong>is</strong> d66ib€d !!<br />

're<br />

of srB wh€@<br />

coping <strong>is</strong> d.6ftd 4 prpo*tu| .f<strong>ro</strong>rts <strong>ro</strong> ndlgc <strong>it</strong> , Laal! Folhra Sd*rlr (1966).<br />

'AppE<strong>is</strong>lr .d beli€G abo p.in @b€lid.d to play a 6tr.l ble in thc coPin! p<strong>ro</strong>

EMD& Elr no@d ddqts<strong>it</strong>ial<strong>io</strong>! .Dd ..pM<strong>it</strong>rg <strong>is</strong> d lhdpcutic<br />

modstily which ddclops coping srd Edlc p.in. 'fh<strong>is</strong> ndLod wa us.d s . !4!<strong>ta</strong>r<br />

for trlM. (Shrpno, 1989'195) and hs b@ .clmwl<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>g.d'a effiqdos<br />

'n<br />

trqtbot ofp6t <strong>it</strong>ouailc st 4s d<strong>is</strong>ord.r'', (Chdbl.s, GBc.ly A EHm, 1998j<br />

chdtob, Tolir, v&dd & Pirne, 2000).<br />

Th. didc.ccd blss€d <strong>ta</strong>lrnor for h.ldehd wd !€grn in 1930h by Pi.*ding<br />

*to "qeir.d thc olc of hilrmiB ir FDdaing hadtule" duinalb<strong>is</strong> liiC', wolf<br />

(l9E5) w<strong>ro</strong>i. thc "clsic <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> otb* had p!ir"-<br />

In 1960\ n€diel p<strong>ro</strong>c.d6 w@ ll oily r@eniz.d fms of tr $Dd<br />

alailabl., in Mdi.gd clinj. n M found th.i trulcd inc6. in h&d Lsp.nnne<br />

oltrmpej€d @sailon of @cniE h.{dachc'pruct<strong>io</strong>@ al lh<strong>is</strong> clinic <strong>it</strong>i.d to fild ways<br />

to iltd<strong>it</strong> hod t Dpallft d a ndlod of dalilg wilh m<strong>is</strong>dire. *llEy ttld.d cat in<br />

fanr.ofut g6ieiboap/'6{n & hdr, 1969) en 6x<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lhjs blod "tuloadic<br />

fe.dbet", (sl4sr! Ga & w.ltd, 1973).<br />

It <strong>is</strong> ill.ruliry lhar b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> vming l.!ds 10 inprcvdat in h€d.ch. ldiviiv<br />

Blood flow ltuouS! tbe paiphdal v6olatuF oflhc hodr <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> th€ 6ngd h dt h5,<br />

hy whjch thcs. snuctrcs rc wd<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>, Bl@d i! incrcls.d &td the sufde of thc sk<strong>it</strong><br />

baomd wmdby h.fl bslinS fest r d thc.nd<strong>io</strong>l6 & dpilldiGb<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>iig dih.4<br />

<strong>ro</strong>tstiE @id@e $ss6r rbar tlc hnd my b. rh. ct'idoa!6id of!.r<strong>io</strong>|r (Sov4<br />

Kunzd, slmbad & Dal6<strong>io</strong>, l98l), NorcN rysid @lt<strong>ro</strong>lslhe costtidi@ of th.<br />

Fipbdlt blood vselq od . rEduodon in syn adaic tom <strong>it</strong> ne*!ry for Fiphdsl<br />

diladon <strong>ro</strong> @cu, thu <strong>it</strong> <strong>is</strong> sp@laLd thbi thmd b<strong>io</strong> f€.dback may b€ d ind<strong>io</strong>t wav lo<br />

r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>u@ lrrnp.th.tic oltilow which mly b. uctul for lboni@ or Dg.ine, nndins<br />

$gad drt 0rmal b<strong>io</strong> f€.dba.L bay b. s.ftl ir dierdd inoss€d @$d of thc<br />

synplthaic nms rynft.<br />

O.

In 60\ ald ?0t Eud4rdki, Soyv. & CoU@s!6 (19?q .ni.ul.t d thl<br />

sunlin.d @nf!.t<strong>io</strong>N ofst.l€r.l mql. l<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> b had.dE e n m inpor<strong>ro</strong>l !o [a.h lh.<br />

individlri strlfrgid lo rcdu@ th* @ntid<strong>io</strong> whcl world lad to dl*ildon ofpiir<br />

and had.ch.. ft. p!6.de they d4dop.d jlvolv<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nd<strong>it</strong>ori!8 ld<strong>io</strong>r ld.l! in<br />

for€head nuel. .nd prcvidins f<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>bsck 1o dbl. psti@tt lo lowd lhc<strong>it</strong> tds<strong>io</strong>n l.vcl via<br />

lone rhat dc.@6 i! nt€ or pirch s nNcl. rld, hs bffie a trat<strong>ro</strong>t of choie fd<br />

t6<strong>io</strong>n h6dsdC', Sloyva & Budzrrrrj (1970) "sD€d.le lbnt AdiarfoElad EMG b<strong>io</strong><br />

f..dbtct r'lduc u ovqlll sIde ofrclt$d@ *hic! lbey t66.d (olliv.Ld eu!d)"<br />

1.5.2, EMDR (Ey€ Movemot D66dtlrtti@ !d R.P|gbg). Th.Ey.<br />

novddt D<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>l<strong>it</strong>izrt<strong>io</strong>s ard RepMring (EMDR) wa int<strong>ro</strong>duc€d a 3 dannal tor<br />

t"ma, Shlp<strong>io</strong> (1989-1995) "ard hs bca rc@gniz.d i! rh. irehldt of Pdt traM.tic<br />

srrs di$rdq", (cthblB €r d. 2001; cndtob, Toli4 v&ds & Pi!n[' 2000),<br />

EMDR b. nql'rat for cl'mjcDoi! fo. | luDbdoflt.$G (d EMDR ba<br />

b6 fo6d <strong>io</strong> bc .tr djvc in F.ua whjcn <strong>is</strong> l@8!iz.d s being d. of th. prilury tul(<br />

fac<strong>io</strong>r for chmnic pd.". (sa!deG,200i). O) Chrcdic Pain<br />

<strong>is</strong> a kind of Mall't" tr.ma<br />

Ey€ Movdol D*ds<strong>it</strong>iat<strong>io</strong>tr dd Rep<strong>ro</strong>csiDg (EMDR) <strong>is</strong> e inlegnlivc<br />

psychorhdpt .ppFacll They os<strong>is</strong>l of psychody@ic, osD<strong>it</strong>ive b.<strong>ta</strong>v<strong>io</strong>El,<br />

int D.tui.l, dp.nal<strong>is</strong>l, ald bodyst r.d lbdpi6. DMDR pslthoth.t py h $ cidt<br />

pdrg.d .ppl!&h to dbat a side Edee ofplychoPltbologid rr f{s lo dE P6$<br />

qpqi@6 which @ GDo&ibale h!v. 3.t tlF gtuudso* for p.tbolo&/, lhc pt66i<br />

siiut<strong>io</strong>n! rhat activates dy*grrlat<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> mot<strong>io</strong>n! '"rh. pdDary 1a4d tur EMDR<br />

pG*.i.g <strong>is</strong> $. oripnrl incidat, in which $. injuy o@Ee4 or th€ fiBt tin. th. p.in<br />

Th. bsic EMDR lra@ preto@l i5 re.d in th<strong>is</strong> tpplic<strong>it</strong><strong>io</strong>" (Sh!p,rc. 2001)<br />

_EMDR q de b€ N.d b trsd thc e4do ofp.i! .!d dsts .bool syDp<strong>io</strong>N ..d

clat<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dielil<strong>it</strong>i6", {Gtu! 1999)- Stl'di6 show thd "EMDR bay b€ eftoc<strong>io</strong>u in th€<br />

<strong>ta</strong>llot ofcnrc.ic !ain, 0bugh ndhd Garch in thb sa t watul€d", (lvil.y,<br />

2@2).<br />

l5J. B<strong>io</strong> F<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ha|. B<strong>io</strong> f<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>b!.! tu d opdet laming p<strong>ro</strong>es in ehicb rbc<br />

individud <strong>is</strong> Fovid€d Esulsly f..dh* @ r sFci6.d Dbts<strong>io</strong>lo$/ r6!oe (<strong>ro</strong>lysE h),<br />

f..db..k <strong>is</strong> lovid<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> to help Ih. irdividu.l <strong>io</strong> l.ding 10 $lfrg]rlalc ad rcldi'rily<br />

@nbol a phts<strong>io</strong>logical rs?osc.<br />

Tb@ @ lb@ b<strong>io</strong> f.<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>b.cl tEtmdt |pprc.clB lo niSran€ h€adacb*<br />

!lr@8@o! t@porrl attdy tud thm.l .l@i<strong>ro</strong>mtlgnphy b<strong>io</strong> fe.dbad.<br />

Tehpotul Ad.2 B<strong>io</strong> F.el B@b Th. go.l ofcmponl ersy b<strong>io</strong> f€e(6!.1( t 10<br />

la.h ltr€ pllidts to Edue pd* dpl<strong>it</strong>utlc TlE patidls & ldght 10 @jn ir llr€ v&<br />

@atlu.tiv€ si?!t &il to rd@.rcid ve diht<strong>io</strong>n i! thc t@F .l4tc.y e th.t rn. p.i!<br />

Mll b. r.duc€d. Ar d. last lL. <strong>if</strong>ids<strong>it</strong>y .d dMti@ of ltqd !.ir m b. si!ni6@0y<br />

rheml Bi. FeenbnchBady <strong>ta</strong> pat\E non r fngd. h.s b6 !.d a e<br />

<strong>it</strong>rdil4-l E€a$e of Fiphoal bl@d volm. hid'd t@p6&t6 indidte in6€d blood<br />

volMe thmal. b<strong>io</strong> firdba.k n€€ds .dcciilg s lbm<strong>is</strong>tor 10 r fingd dd tdining ih.<br />

patidi <strong>io</strong> incMe 1he irgd idpdtuF.<br />

ELM M<strong>ro</strong>Crd?hi. B<strong>io</strong> F..db^.! thb wa B€d lo tr@l Ituid h€drh.h€. Ii<br />

ha al$ b€ ucd to bat nie6in€, rb. It@. i! <strong>ro</strong> d!@ eldiimtoenphic l<strong>io</strong><br />

fc.dbrd <strong>is</strong> <strong>ro</strong> !rd!@ el€\.r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> l@h of n@lc t@i@ .rd rhd by irdin dy to Fd@<br />

slmldrhctic Nusal. It r.t6 f4 <strong>ro</strong> ont<strong>ro</strong>l nBl. 3ir6 $4 tdp@l anqy blood<br />

rclhe pul* d l<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tdFrrc Th. .mo.y @ al$ b. ircEs€d by porr.bl. uils<br />

for boE. pEctie <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tEiDiDg Elmt<strong>io</strong>! rE!i.gj6,

Sndi6 hwc sboM "Modinc.don ofm<strong>is</strong>rdn Hadlclt6 by c4[.tic Blood<br />

volm. pul*, drd EMG B<strong>io</strong>fe<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>bet , (B.ld, Haq & Ad.ns, l9?9).<br />

"B<strong>io</strong>f..dbact qth or wilhoul ombircd autog.d. hining <strong>is</strong> l<strong>ro</strong>M to bc<br />

.tr@rive for l!€ trE tndl ofnienire. nrc b<strong>io</strong>f..dback-as<strong>is</strong>t d autogqic trainjng i3<br />

etr div. for 1h€ rarlndt ofmigr&r. .|d <strong>it</strong>s 0ldpdtic .fr41 t clo*ly r€ht d to thc<br />

inp<strong>ro</strong>@6t of rh. uicty ldel"- E@-Ho K., J@Eon P., chiGSmS c., ( 2008)<br />

Ma&&rlys<strong>is</strong> of stdi6 irv6iFdnS th. cffdrs ofb<strong>io</strong>ft.dbtrt m tdi6<br />

had&h6 ws q@i$d ard B<strong>io</strong>f€€dblct *s fould lo be Dorc cff.div. lhe n<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>tch.<br />

nonilo ing, pl.ctbo, snd rcldet<strong>io</strong>n thalpy, Th. inprcvoals Eult€d lor tcqMqv of<br />

h.!da€h€. "Funld si8rt<strong>it</strong>di .trels s@ ohdcd fm nMl€ tds<strong>io</strong>n, self{ffrcacy,<br />

symp<strong>ro</strong>Ds of dictyi depBs<strong>io</strong>t\ md arlgdic n diqt<strong>io</strong>A b<strong>io</strong>fe<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>brck @Bt<strong>it</strong>uG3 6<br />

.fleriv., did.n6brs.d ilalrnal oF<strong>io</strong>r fc td<strong>io</strong>!-typ. h€id..ne" N6totilc Y, Ri.f<br />

w' M.ni. A. Vd!-.r'dys<strong>is</strong> (2008).<br />

B<strong>io</strong>fccdlek ha lotr8 bd u!.d fd r.dEirg rhc syttlt@r of lff<strong>it</strong> hadacb!;<br />

wo* ws don ir the 1960s &d s rcpon.d iD lhe l9?0s l,? ft@ <strong>is</strong> a sa.ng spFn<br />

for th.md <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> EMc b<strong>io</strong>t@dbact fq m<strong>is</strong>rde, ind lus sPpdt <strong>is</strong> c@<strong>is</strong>&nl wilh<br />

filding! Adn ney n€t'-malyr6 errdr.$ing ooi only nigrdne bul als lmon'llF<br />

had&h. . AldEil( F,. (2009),<br />

lj.a. R.lst<strong>io</strong>r Tninin& Soss t rd . toll o! ou stst€o" *bd n <strong>is</strong><br />

qFi@c.d 0E My im.di.Lly ..3Ft|d5 wirlr physiel cb4ge whicd lad to inqle<br />

iD blmd pBE ! E6t rat., bsrhjra nL, hc<strong>ta</strong>holi@ .nd Uood flow <strong>io</strong> f,el6 Thc<br />

body gds .quipp.d to d€il wnn ey dagdcyl prclona<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> sb* 6 lwll in h.d!chc.<br />

"Rcld<strong>it</strong><strong>io</strong>n work s o etidot€ lo s<strong>it</strong> s3", lne sJmpad€tic .ems svstm slow!<br />

doM, blood F*ure, sli! renqcd, h.d t t dd bqthins nle d. i€dn .d Bl@d<br />

Iows to iltc bai! ture

Tlc c{t dol@irc's (iltc bnin cl<strong>dicd</strong>) lhd stiDuhr€ bddld. <strong>is</strong> Edua.d.<br />

B6in w.!6 b6me mft sFchonjz.d dd pbnotirg cdn 63 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> reldot<strong>io</strong>n, dd<br />

nBcle ids<strong>io</strong>! de1)@6 h.lpins th€ bod, <strong>io</strong> h.61. A fd c{)Mor y pEctic.d l4hniqc<br />

Deep B@thi.s: Rr.&<strong>it</strong>gde.,y thrcqgn you noe athdc oxycpn flow to<br />

you bnii vhich sulting ir gqlq rcldal<strong>io</strong>n.<br />

Ar'ogdi.Ttui"inat 1!i! l€doiqE !5d sr|ggc.iid to olee blo.d flow &d<br />

rcduc.d hMlc tds<strong>io</strong>tr e <strong>it</strong> 6 b. N.d wh6 lhm <strong>is</strong> l6d&h., Aulosaic Flining ha I<br />

s€q@@ of body. Empl., I m calh <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> r.ld.d,<br />

1J.5. M.d<strong>it</strong>rrlor: Itjs inrclB rcPar<strong>it</strong>g. wod or. _Mlr?'vtil. you'c<br />

El[€d pos<strong>it</strong>id w<strong>it</strong>i .loscd cyd .nd trsrb<strong>it</strong>S slowly Th<strong>is</strong> *@3 olbs lLoughrl awav<br />

Am the nind <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> h.lF schnv€ the @nd<strong>it</strong><strong>io</strong>n l€eMt for abslute rela:il<strong>io</strong>n Th.<br />

insru.<strong>ro</strong>r waut 8iv6 ! tuh. whid @dd b. ArLAg o OM<br />

Rcldai<strong>io</strong>n (pmgBile rclaxali@) <strong>is</strong> widcly uscd <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> i! ! vdv Fwdftl<br />

rdhniqu€ <strong>ro</strong> p<strong>io</strong>dn€ s r.lu.r<strong>io</strong>n 6po$q rcldt<strong>io</strong>n tba.Py prcdu@s .frels in which<br />

@brq phls<strong>io</strong>losical Nw.l '. Ble.bEd, And8iL, N€fr & At@ (1982) "in I<br />

n.<strong>ta</strong>Dlys<strong>is</strong> ofavail.ble studi6 dployiry r.lu.t<strong>io</strong>n b<strong>io</strong> fc.db!.r FvclDloeiel &<br />

phm!@logi€sl pl@bos foud, Ior t6<strong>io</strong>n hodscbe b<strong>io</strong> f<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>back relaai<strong>io</strong>n dd<br />

mbimt<strong>io</strong>n of bolh yi.ld.d 3igti6ml impre@t Fd bieni!. h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>!c!. dlogaic<br />

fe€dblck sd rdual<strong>io</strong> <strong>ta</strong><strong>it</strong>!@t p'Ddue sPdid oul@ff "<br />

Th. dcalalins €fr*t ofoulogaic tms pati@ldlv ue full B<strong>io</strong> fe€dback<br />

rerrndr p@.d6 6ll.d vemotor b<strong>io</strong> f..db.cl e sl$ s.d Th€ slbj<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>! e ak€d<br />

b panicipots @ laneht lo ddEicl blood flov to .bdt mighi*, il il al d qF<strong>it</strong>mlrl

'admdon trinins <strong>is</strong> dilizld fd il5 d<strong>it</strong>d bus4l& eff@ls" (€.8 K..fe, Block<br />

Willims dd Suwil, l9E I ). rd irs Educdon of g@ddiz€d mual (. g Lin<strong>io</strong>d &<br />

Mcli4 I983), fd <strong>it</strong>! @griiiv. efre.t (i.e., 3 a d<strong>is</strong>t<strong>ta</strong>ct<strong>io</strong>n or ailot<strong>io</strong>n div*<strong>io</strong>n straleey<br />

dforiBirilidPl&.lbvtloe). Reh{t<strong>io</strong>!pm.dlc@1bc$q.s<strong>it</strong>lvutiliz<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

v<strong>it</strong>hout a fru d @8njtiv€ prcc.dlE. Thd tu rb. ida"divc atrd EiPrcc.l rcle of<br />

o!'r<strong>it</strong>ids, hdEvid <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> doti@s. nF thalp<strong>it</strong>l h!.i idatiry the @!,t<strong>it</strong>ivc @FMl<br />

oflh€ ste..doi stimllu s well d the rdPoN. bd$ <strong>if</strong>th€ oSt<strong>it</strong><strong>io</strong>$ e Maltq€d<br />

r<strong>is</strong>y vill @rtinE !o Finfor ln€ p6'chophysicll EpoN,"<br />

Rd@$6 h.!G cpott d th. .f<strong>io</strong>.y of.Dpli.d td<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>lid L.i.<strong>io</strong>g b patiats<br />

e<strong>it</strong>h goad<strong>is</strong>.d dicty .rd panic !rl!ck. sn)di6 .ls ea! th.l th. hoh+bls.d<br />

rcla:*<strong>io</strong>n r€.fi.nt nay @nnihn€ a vilbl€, low-@n .ltmlriv. to t'. not€ 9pical, bui<br />

dp@ivq cliricbs.d p@€dlB in thc trstrndt of rdj@lt !d&h." Stda J.<br />

T.dqs!, Edei.d 8.,. AndEiI !., Su$ E, Jui!b., D

dpdt t<strong>io</strong>n. If. plliat <strong>is</strong> told fmly th t *illhav. @ p3in.nd the @<strong>plid</strong>rid of<br />

R.dads blE light ad <strong>if</strong>lh€ D6ri6rs rdly bclid. rh<strong>is</strong>, tr rry b. uwillirgly ESdd d<br />

plh ey so!.1<strong>io</strong>n h. aFi.tE .id il! +?Uer<strong>io</strong>4 !i.ld! & Prie (1981) $eg€ds lbat<br />

"dpet t<strong>io</strong>r ofimu<strong>it</strong>y E@ p.i! ..1iv.r. thc ddoiphin mcdi.r€d systm b rbe<br />

widoe fo th<strong>is</strong> ha @t b6 @nfm.d".<br />

The ondir<strong>io</strong>@d <strong>ro</strong>poGc nod.l cm6 f<strong>ro</strong>n th€ wo* of Pav<strong>io</strong>v (i 97,<br />

Ee rcti<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tEr "dE dos! b.se <strong>ro</strong> !.livat bcforc th.y @uld !c d m.U tb.ir foo4 lF<br />

re.lizld Ibat r stinulus cmplcl|ly ral'd in i$.lf w6 r.pst€dly pff<strong>it</strong>cd b.fm€ one<br />

(food)Ihemmalphys<strong>io</strong>logicdqctjonof ssliv.t<strong>io</strong>nwouldlle. @wbaw€apply<br />

d<strong>is</strong> nodel to th. plac€lo phmn64 n k +psdt tn.t ltt n@rid 3tinuls sucb s<br />

{nmy <strong>ta</strong>u€t lmldrg li|. .5pi!i! o giv. r.l rdid nlD p.h berw lhe !.1i6t ba<br />

!@ @odiloDcd oq th. y6 to dFi66 &.lg6i. followirg lh. r"rloqing of<br />

Plac€to should b..Lfn<strong>it</strong> ad ltong, P.h i!. lubj.diwplmaa in whicn<br />

lhc indjvidual aniMe &d ndd sr!1. ir i<strong>ro</strong>lgly b6lv.d, piin will o.iy bc El<strong>is</strong>.d <strong>if</strong><br />

lhe pd<strong>io</strong>l ha a pos<strong>it</strong>iE !din|d. to lh! th@py sd 0E qp.d6cy tbrl plin will te<br />

T!€ plcbo €fret ha !o b€ vEry dctully d.6ncd saF M.ybsg & Stodsl<br />

(1997) ll tu e spetlt<strong>io</strong>D rhar whlt yor @ b.ing offq.d will h.lp yo\ <strong>it</strong> <strong>is</strong> mt rhe<br />

loeq ofpd<strong>it</strong>ive thinline, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>it</strong> <strong>is</strong> not norhing". Ifyo! b.li.v€ a lr€atrnat wiil h€lp you<br />

dd <strong>if</strong>you systm h$ the c8p&<strong>it</strong>y to g.r w.ll you nry lciully have eoht<strong>io</strong>n of you<br />

''Plac€ho effer! d<strong>io</strong>ic th. .f@ls ofddgs, ir th. Cuie ofshich, ihey e<br />

p@t<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> e.g, pl.c.bo <strong>ta</strong>quilib, 6 lowd h.In nr. <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> blood FM, sh@

pl@bo ltjbuldts @ incjte h..'t dc and blod pBse", (Fruld, Jarpe, Wd &<br />

w6& 1963; Kieh & weix.! 1988).<br />

L.rEtue infom u lhal popl. Bpond to plGbo! bs& of th€ n@ing<br />

@m61cd wirh $?ets ofrhc n dicil qpaiac., ri€ vh<strong>it</strong>c @r1! ofthc dodor.<br />

slelhcop. lhe fid.d d.3r, th. rh@Fllic ..nin& all s.r lh. slagc for posilive<br />

chsgd bru€ of thci. nairSs qp41lt<strong>io</strong>B of hov w.ll a drug d lurgdy worlq ily<br />

acrivatc dE s. n !6i pathw.]s s F*ipt<strong>io</strong>n b.dicic<br />

M.yb€s A $o*l 0 99?) teXde lhal "qp@trti@ ofhow wcll o drus or<br />

sug6y ril vqt my .cnr.lly &riEt llc 6c nar.l p.lhwry 4 F6q'priv.<br />

m<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>icina. Plac€bo etuly cnegc il,e vay that pain sigr.ld a€ p<strong>ro</strong>c6$d in the bnin".<br />

A.ddinS b Waga (2004) phab$ d@ rh. ba<strong>is</strong> Gpo@ b p.iD ia a6 ih.t<br />

sems to od€ for hagn<strong>it</strong>ud€ ofpah erp6i6e'"Tn<strong>is</strong> $g86ts ihat thc qpsi6@ ofplin<br />

elly <strong>is</strong> .lrard".<br />

Wass <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> h<strong>is</strong> @ll€asu6 u.d frbcrid.l MRI to 3how tnal p.i. irdlcing clelric<br />

sno4 lc1ivaI.d r '!6ir Datrn" O. rhaldu, $na<strong>ro</strong>, sosry @ qr, in$la @d eIa<strong>io</strong>r<br />

on x in dE hdin ofpdticipei!, the G6r.h @npa.d .ctivily in th6. Eg<strong>io</strong>n h .<br />

pl@bo grcups w<strong>it</strong>b lhat in a @DtDl g<strong>ro</strong>ut th.y obw.d a r€duct<strong>io</strong>n in rcpdt<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> pain in<br />

the pl.c.6o amu!, vhicb vs .ssill€d wirh d6as.d &liv<strong>it</strong>y in th. p!i. natrn-<br />

Wasd tho n6u€d boin dctivat<strong>io</strong>4 in Gpou. to eticipat<strong>io</strong>n of pain reli.t<br />

Th€ .ff.d of pl...to otr p.jn wd Miar.d eiib .ctivrr<strong>io</strong> in llc d(fuhrqd<br />

prefonlal <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> orbibto d @ncx s6 ofurc brajn r.ld.d 10 ortrbl oflnado. ard<br />

fl.rd nahd<strong>is</strong>. In the ffind rtudy h. inv6r<strong>is</strong>r,&d that l<strong>if</strong>e ole of dE plac.bo<br />

etr cr they foud thai pla€bo b.diar.d r.duci<strong>io</strong>r in b6<strong>io</strong> activadon of0F pain o.tix<br />

()ffi.d late ir rh. plin r6!oi*. IE othor hr?oi!6i26 th.i tne lcl. d.@ nay<br />

Gflel @g'iliv. @ppniek oIp.iq or olod n .!dim u<strong>is</strong>eptd by prcl@8<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> p.in,

Th<strong>is</strong> 3tudy @!6m.d'1h€ inpor<strong>ta</strong>re oflbe dos.l.ldl Prcndd .rd r.61rdl dldid a<br />

well s mid bnin dring the dticipat<strong>io</strong>n oflhmal pu in <strong>it</strong>s rdiel adivltid in th.<br />

othd r.g<strong>io</strong>ls of lh. bdin 081 midt be mE d<strong>it</strong>6{y Eld€d b th. tsm<strong>is</strong><strong>io</strong>n tnd or<br />

ps€epi<strong>io</strong>n ofpain ws nodulal<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> latd in thc qu* ofnoxjo$ stjnuht<strong>io</strong>N<br />

" Wagq<br />

(2002) $8g613 thli in pairl s in ParkiMs dir.e d<strong>if</strong>rdt bnin re8tom tuv be<br />

i.rclwd in th. dticipal<strong>io</strong> s oppos.d lo th. Fc.lt<strong>io</strong>n<br />

of bo3ft Mial.d s<strong>it</strong>h<br />

''Exp.

ddnostltrqs ine dinic8l eficacyof rn<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>i&t<strong>io</strong>r in a widc ese ofD.dical @ndiridrx<br />

hsiruct<strong>io</strong>N: SininS n dilar<strong>io</strong>D<br />

1 Do et !e dknd€d fd tL. Ert 20 nirur€s, d@ ln. dod.<br />

S<strong>it</strong> slr.ighl in th. .hair, I€r you slouldffi d<strong>ro</strong>p, Cloe you €y.! & <strong>it</strong> fcls<br />

2. L.t tbe nucl6 in you body r.ld, f(}se 6 you bEth€, sindy obw€ $e<br />

no!6drs of tou bdrhc i! lrd o[r of you @strils.<br />

3- Do nor ler you ariat<strong>io</strong>n w&dd jun fou @,oubElhing. Do mt b. up6a<br />

<strong>if</strong>yo! g€t d<strong>is</strong>t!.Ld. T*G a rcrG of}!u rholgh r,n dm b tow bFin,<br />

4- and 15 ninuld gRdully opo tou .ye. You m mw ||ar and Fldy <strong>ro</strong><br />

fttu rrFDa.h of Alddhilr qiein ba ben N.d by Krht-Zim (l95) <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> |@,<br />

clinicies <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>chas wirh gqt cljnj..l cff6tiv6qs. 'Tn. 6dts suggBr rhal<br />

n dilrid dtu\ c.b68. rh€Ew s@.y qpqiae of plia bul61hq EdlA l[€<br />

dor<strong>io</strong>nal 3F.€ rhat ocm wh6 pai! <strong>is</strong> sticiprr€d, Tht i! ir€lf opp@ <strong>ro</strong> b.<br />

mlet to !.d@ ibe bdagb* of ln. qFiac.d p.i!, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tbougb rb. sasdy<br />

expdiace ie uncnmg.d. M<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ilal<strong>io</strong>n irains th. brain to bc DoE pBol-focucd <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

th@f@ lo spod ls timc dli.ipdidg tuu n€rliE datsr<br />

'M.d<strong>it</strong>at@ t4ps the bind AoD &ticip.ting pain ald so dulh a p6ont<br />

cxFiae ofpoin" ch5l6 {2010).<br />

1,5.8, Di.f.cdol Dstlct<strong>io</strong>r <strong>is</strong>.ftetivc rE6t€gi6 to coping w<strong>it</strong>h pain.<br />

R6@h6 turad thlr m etrc<strong>is</strong>r ey <strong>ro</strong> dql eirh plin or dy &b€dbL sin[t<strong>io</strong>r <strong>is</strong><br />

<strong>io</strong> d<strong>is</strong>tncl d*lf non the wl<strong>io</strong>n d upr.dirs flot<strong>io</strong>.al rdcl<strong>io</strong>n wlicn .d6 non<br />

rh. .gonizirg nihuhl<strong>io</strong>n, DbE .r<strong>io</strong>n <strong>is</strong> nLd ht6ly a r psin @ping slrarcEy.

1,5.9. P.in $d M<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ory. R€@lhdlhft irfm.d rb. as@iat<strong>io</strong>b€twa<br />

pdn {d nmo.y @ l.lding to n* Mys- Nd6 @y pai. sie.ak <strong>ro</strong> rhc bhin wh@<br />

thcy n<strong>it</strong>ular. els whicb e inpliqt.d e<strong>it</strong>h nati!8 |]@di6 of Fir Th<strong>is</strong> qcil*<strong>io</strong>!<br />

<strong>is</strong> a GDoNblc fq @ntriburina to post i{ury poia lt mte . hci!)r<strong>ta</strong><st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> s<strong>it</strong>iv<strong>it</strong>, tbrl<br />

ru l4l fd vek9 1hd€ <strong>is</strong> ! r€hr<strong>io</strong>Dship b.iw@ psiD <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> mmory. R€scb6 hav€<br />

foud nol@|.! c.ll€d ERKS-Ei!6 c.[dq sigral Eld€d ld.M ud rcmtly found a<br />

gdc .dl€d Mala whid plovide r lirt bcrwd ndory <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> p:in. th<strong>is</strong> b lading <strong>ro</strong><br />

n w dvD6 <strong>ro</strong> ontDl pain, "Io giE p6i! Liu6 b.forc Fli6l fel Fi! nor !nd'<br />

'pleiptiv€ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>g6ia', "Pain alt6 $. rdos systqtr j! a way rhlr molq D6rb of <strong>it</strong><br />

smiliv. 10 loir fd hoN to nonrhs, Mmory they @nclud.d <strong>is</strong> rclF6iu. fd rhG prin<br />

tbat <strong>is</strong> dFidc.d ana Mgcry, a !e$ @o!d or &y mqd rh.l ma}6 e @ src <strong>ro</strong><br />

l}. toucb fo. qE timc," (w@l[ 1983)_<br />

15.10. E}?!6ir. As delbcd by U. Andi@ rsycrDbgi.d A$ocjrt<strong>io</strong>n<br />

Dv<strong>is</strong>,on of P3yclDlo8ical Ht?nos<strong>is</strong> <strong>is</strong> ,,a lbc.dft d$ng which a he,lth pref*<strong>io</strong>r{l d<br />

'whd $e8ds rn l a cl<strong>io</strong>q paddq d qpajDdrd p.tricilet dpdide ch.ns6<br />

D sqt@, F!c!ti@s, tboualrs, d b.nlv<strong>io</strong>,.Hypffi<strong>is</strong> n rhc h.iELra.d srlc of<br />

sussqtibiliry, sEh rht th€ suaget<strong>io</strong>ns gi@ e sept€d B being Eue Ed cff€d |he<br />

b€liefs hab<strong>it</strong> pccept<strong>io</strong>ns <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> b.hav<strong>io</strong>r ofd iDdjvidual in v.,yinS d€sr6 a@ding to<br />

m. d.pih ofh}!n6h. D-pd ld€l ofhr?nos<strong>is</strong> oabt6 ih€ hyp@tizcd jndjvidud lo<br />

.xFime spla lj/pdotic phamtu-.<br />

Th@ e pai! @trd<strong>it</strong><strong>io</strong>B lb<strong>it</strong> e b6D.l rh. B._L of n <strong>dicd</strong> .nd @n€dod<br />

psy.hologr lil. Miehin€r Trjgdbst N@nlgia Hrlms<strong>is</strong> j! a popdtul .linidl lool in<br />

cmlinS mton oul of dhcdfo4 sine hlilDosk €f.crivcly in lh. nMgodt of<br />

h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.cl€ requiB norc rnm . siDptc !p,ptic!$@ of! hr?.otic indldi@ follow.d by<br />

$eg6t<strong>io</strong>r orpdr o.t<strong>ro</strong>l. .HypG<strong>is</strong> mlr b. wi&ly in@,p@r.d irb a brelds

psyc[oth@Flrc i qvqrjon' Borb6 (1982) <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Edelsrcin (1981) wha <strong>it</strong> <strong>is</strong><br />

incorFral.d il s bc uheiy powdtul p.n oftrdtnqt.<br />

'llnt<strong>ro</strong>stu tu d clte€d sbr. of 6M<strong>io</strong>N* ch&&rdi2.d by Dut€dly<br />

ind6<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> rcc?tiv<strong>it</strong>y to s!8asti@ 6d the qpety fo diret @Dt<strong>ro</strong>l of paiq cetul<br />

inv6t<strong>is</strong>alo$ hsv. st$l<strong>is</strong>h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> rbat bpnotic Oain @iEol <strong>is</strong> uiq!.ly supd<strong>io</strong>r lo rhal<br />

achid.i by oths psycboloAiBl n@s" Hilg.rd A Om. (1980) "ht!.o!<strong>is</strong> <strong>is</strong> s<br />

ddonsirabl. powatul ddgBia jr <strong>is</strong> puzling thar ii <strong>is</strong> mt $ w<strong>is</strong>.ly u.d rtlhoueh n <strong>is</strong> t<br />

a<strong>it</strong> lly iDFnmr .djbc1 in ln. trsE @t ofch<strong>ro</strong>nic pain ! hcldrchd', Tdbd (197t)<br />

@e ofrh€ l€dirg hypnor<strong>is</strong>l $id rhal <strong>if</strong>s1o NSsdlid in hytmi<strong>is</strong> tu B.d ptuFty in<br />

onjuct<strong>io</strong>n ir ncd<strong>io</strong>l hclp, ir w<strong>it</strong>l s!..d <strong>ta</strong>vay dd attdialc p.in dd djsnfon lim<br />

b6&dE. HnD6<strong>is</strong> <strong>is</strong> I psyclologic.l pb@omn which @ b. ird!.cd h most<br />

mmd p@plc by v.rbal sgg6r<strong>io</strong>4 &d <strong>is</strong> lowatutty G<strong>ta</strong>r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> 10 the i.dividut cqt<strong>ro</strong>ry<br />

fq inaginat<strong>io</strong>l HyFosi! w<strong>it</strong>h. &dsei. suggqij@ cmol Edue pdn. n&ueb<br />

sueSdt<strong>io</strong>n th€ hypnotic lubj4t 6 bc d€d &d blind bur pi$olt lpai.t suggal<strong>io</strong>n he<br />

b@ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> sa s wcll w<strong>it</strong>hin byTnosi! 6 wh€n mr ht?notiz€d":<br />

Expdibool nudi6 by cr@c & Rcyh6 0 9?2) irdicatc rhai .trlnotic<br />

suga6t<strong>io</strong>. ac13 principally by blocking 1he Dqrer<strong>io</strong>n ofpli4 nth6 rhe by ,rdu€in8<br />

Midy a . sdquilizine drug woutd do Bt?,btic i !.cd datgGia <strong>io</strong> ctinjc.l<br />

s<strong>it</strong>rDl<strong>io</strong>! <strong>is</strong> nkh noE rho a pl.c.bo, ll<strong>is</strong> <strong>is</strong> @rrDGi.t.<br />

R6arcn6 otr paii hd lot p.jd nuch an666 <strong>ro</strong> hr!@<strong>is</strong>. Mctzc_! rcFDn d<br />

thai "eli6 th6e w6 @ Eli.bl. did.ne Am @,<strong>ro</strong>lt.d ,turti6 to pretd. did6e<br />

for hD'<strong>ro</strong>s<strong>is</strong> being thoir@dcdly effariv. for oy fom of chftnic pain ., (M.<strong>ta</strong>r,<br />

1980). Howcvd M.lzac,k & p.(ry 0 975) foud th.t .Arlnodc <strong>ta</strong>inirg j<strong>ro</strong><strong>io</strong>ct<strong>io</strong>M<br />

prcduc<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> subslmtiat r€licfoftui4 sig.jfiMtly gqts lhe b<strong>io</strong> fc€dbacl, Howaq,<br />

wha the br?noric rliling insruct<strong>io</strong>tu w@ p6dLd, togellld w<strong>it</strong>h b<strong>io</strong> fe€dbacl fi.

pain Eliefws sign<strong>if</strong>cln{y g"il€r th& plduc<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by b$c linc plaNbo sess<strong>io</strong>E".<br />

(Melzact & wall, 1982).<br />

Thh $udy by M.lack &d Pqry (19t5) ws a s6 aeEt advd@, idietinS thrl<br />

the 5u@sntl bdtuor ofdrcrh <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> !al. pain n€€d.d th. @nlinine of ht?notic<br />

sngg6t<strong>io</strong>tu wirb fe.dbacl, In 1990 borc anddoi wdgivo to ht?noric augg6t<strong>io</strong>N in<br />

lh€ Iralndr ofpain w6 md<strong>if</strong>gr in publhh.d snr(li.s, 3uch s tho* refqrcd by Ciblon<br />

aBap(l9l).<br />

Ericl@n Heilay (1967) rcport€d ..a veiery of wnlodox rda*.bty su@stul<br />

hatnals for pain. Thde e tv. reclDique !s.d <strong>io</strong> @1€ brpotic d5l8!s<strong>is</strong> a.)<br />

Aneth6i|, b.) Di@( Djninut<strong>io</strong>! of p.iA c,) Sd.ory Slbst<strong>it</strong>ut<strong>io</strong>n, d.) Dtpla.ddt of<br />

Pair <strong>io</strong> eorbd, l€s wlndahle body aE od e) D'sscilr<strong>io</strong>n".<br />

A!6ibcds $8g6t<strong>io</strong>s @ idue hdllwinlijo, of e6tb6i! th,t omb! Oc de<br />

lo pai4 $ ihar thc p.tien i! 6abl. <strong>ro</strong> *peine ihc peiD but jun fel !mbn6s, ..h @<br />

be9n !o f-l nMb, wirh m sa<strong>io</strong>n at all, rIft b d<strong>if</strong>icutt to Mve<br />

Dirc.r Dln<strong>it</strong>ttih: Ih<strong>is</strong> rabiiqe j! fd ,.d!cjrg s.ery p,ia . suggcn<strong>io</strong>D <strong>is</strong><br />

sv6 b. n!d. i,You @ntiru. 6joy feting i!@irgly well, wir! @ch bElh you t le<br />

s <strong>if</strong>d<strong>is</strong>@nfod <strong>is</strong> eb.l,ow I'ad!.Iy going away, suggolinr focu on rh. dininur<strong>io</strong>, of<br />

|he inr4<strong>it</strong>y oI pain. OD. njdt ey tht \dmdof rlE p.jn d b. nn.d doh<br />

Dgdipl<strong>io</strong>B for reing dou volm€ dime bnghbB, mtine, high ldp@tuE .i..<br />

Tbe P8timt <strong>is</strong> s|.d r! l@rd th. iltw<strong>it</strong>y of rhe pain to e dy d<strong>it</strong>r.he @ b.<br />

S4ory Stba<strong>it</strong>u on: HyprFric suee6l<strong>io</strong><strong>ro</strong> e e <strong>ro</strong> @L rcinrapa&do. of<br />

sNt<strong>io</strong>& .) sfue of i,<strong>ro</strong>lftlte bhing, @ b€ uoNc<strong>io</strong>uly $pptd@r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by @rna<br />

3@$r<strong>io</strong>4 nol v6y pl@! fr qu}t. irchiDg or 6lda*, su.i atLb.rc fetins trvc<br />

ws.l advsreg6. Ilc pld6t <strong>ro</strong> kmw tbe plir i. 3til $aq h€ q6 p.ra1 for

yple <strong>is</strong> mt <strong>io</strong>ld rl[t be pill noi g€{ rhe 66 a ir slill th@ e thlt he dos nol<br />

d<strong>is</strong>&Iinu. lbF b.dic.l lralndt<br />

Sasry $!6Ijtui<strong>io</strong>n @ b. 6i.d oul wirh tbe followirg sgg6t<strong>io</strong>B,<br />

(Su@tuly lsd vilh a peq cgjc Fti@o sufraing Aom dyss0!6i! in rhc l.gs. ..ttF<br />

feling tbai tou d6db. s hoi n6dl6 nrbbirg you @ begir, or .tllty 6ough to sen,<br />

s <strong>if</strong> tbe n.€dl6 e qhi.g noc &d horc btwl od bDe4 alhosl s <strong>if</strong> ihey h!v.<br />

belme tiny, n.sgire firgd whal e id6t'ES s€@d@ yo! b.8in <strong>ro</strong> h!r€,<br />

thoNrld. of *cD 6!96 buirg. i-serC you leCll ml qtn€ty p<strong>lse</strong>l bui<br />

PqhlF . w.lM€ r.liet'<br />

Dnrp&ar.rri TMfdina ofih. pain nm orc @ ofrh. body !o eo<strong>it</strong>6 s<br />

b€ enjcd oul. (Abddb.l p.jn js Dorc {i<strong>is</strong>uing rh& ljnpild. Th<strong>is</strong> b a valuble<br />

tetDriqu. Ihar @ inci!* th. @nddae of! pat<strong>io</strong>r who <strong>is</strong> cFjc.l stour hs o, ha<br />

hypootic sbjUtica, e suge6r<strong>io</strong>n for aeridg d<strong>is</strong>pls.dor ftr eg, <strong>is</strong> giva "you Da, have<br />

alBdy Dolic.d th.l p.in Dov6, da s slighrly <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> you @ bcsin b ,oria d<strong>ta</strong>t ttr€<br />

novdot s@s <strong>io</strong> b€ ir &.t ouwddly spiatinS s€dd dn€s<strong>io</strong>.. a you € inu€ !o<br />

anmd to Oat novodq you Day not Dotj@ lrtil h1€r thlt th! p.in ha etubop nov.d<br />

out of you dbdmd <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ir !@s to b. s<strong>ta</strong>yi.g in you 1.ft b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>,,. Thc gol <strong>is</strong> <strong>io</strong> cheg€<br />

d€ locu olpain dpr<strong>io</strong>@ so thai pain <strong>is</strong> t* tltr lr@ing o hFn6t opl,er<strong>io</strong>n of<br />

such nod<strong>if</strong>et<strong>io</strong>n h lhd <strong>if</strong>pain @ choue jn losr<strong>io</strong>r il @ atlo chanee ns dintu<strong>io</strong>n &<br />

ulthat€ly ruy b€ elin<strong>it</strong>rt d otiEly.', T.bbct 0 9?7).<br />

,i$.drciar.. H}l<strong>ro</strong>ric slsasrim @ @l€ o d<strong>is</strong>ecjlr<strong>io</strong>n &ob 0D p.in, ile<br />

pari.nr i! able <strong>ro</strong> d*cib€ lh. sdll D.sj{ine pain vjrhout ey lfletiv. jnvolvocnq,.the<br />

paiD <strong>is</strong> pqeiv<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> hnt ihd€ <strong>is</strong> <strong>ro</strong> $fraing Dh$'rt<strong>io</strong>n js u.tul wn.n Ibe p.ridt <strong>is</strong><br />

imobil€ ..g. duriq su€ry or dwing sne painftl po*dw-fo, a p,ri6t wno <strong>is</strong> b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

riddd to d€te d<strong>is</strong>sociat<strong>io</strong>n nig<strong>it</strong> be .tr <strong>is</strong> umc$dy fo, you b sr.y hq. h b€d

6e<strong>io</strong>B of all ibe reutin that @us,I mndd <strong>it</strong>you fel6 <strong>if</strong> you @ djoying s<br />

lov.ly tut .nc|]rM r6dna oi ihe hach. You b.dy o @.in h@ in b.4 i, orda<br />

lbrl .ll lh. nutje thirgs @ b€ doft for yo'r bur ,ou nind q <strong>ta</strong>l. yd fs awly dd<br />

yo! @ djoy wbalcva )!u lilc p<strong>it</strong>b nothirS <strong>ro</strong> boils you". Pon byForic auggGt<strong>io</strong>n<br />

@ usd for qlantin8 fic afrd! hF<strong>ro</strong>ric alggBr<strong>io</strong>tr @ al$ sivc I oe rhrr @ begin !<br />

$886Ld dFt@ d b.hv<strong>io</strong>. ce. .\yh6da I l<strong>if</strong>t you ms yo! wdld di@vd ar<br />

that Dov@@q how rilty @mton bl. yor f.el ' th<strong>is</strong> $ggsr<strong>io</strong>n *ould @te &dgqia,<br />

whdffi th. pltidts l<strong>if</strong>t! h<strong>is</strong> m.<br />

tl€ c!. 6 cls b. hatL s tulcr<strong>io</strong>. of ontexi for €.g. on€ nighi s, ,5rhoeva<br />

you necd <strong>io</strong> IEI relia<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> f<strong>ro</strong>n ihh pa<strong>it</strong>\ tou hdve sld

'nF liil<strong>it</strong>y ofhran$<strong>is</strong> in for bum wods br6 bd st{di.d dd il !a b@r<br />

EFn.d 6 a \setul p6ychologicd inl!@t<strong>io</strong>n lhar @ iugnh! dd ir m. q6<br />

l€ple, o<strong>io</strong>d n€dic.don", (waldd & K.pld, l9?8).<br />

Hilg.d (1975) brv. dcsib<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ! M d<strong>is</strong>si.do rhsry ofFir! 'h)4Dci5 ind<br />

@ni@l l.radizr<strong>io</strong>tr in cq.bril pltrc63ins", (Csb.l, l9E8). Moa dd L&L 0 9E2) ir<br />

onftsl a nmbqof invdrigal6 hlv.qu€rjon d wh.rlE H)Dnoric phm'@ he e<br />

.ft.r bctod r,t!t ofplac.lo" V.rdyct & H@gdu<strong>it</strong>r (1990).<br />

"Chndra *bo $fra filr c.|e hrrc to b@, pdnftt Prrc.dG rhlr @<br />

.ssiaLd e<strong>it</strong>b i@C@ dcgd ofFJlto*id diriw. Hypc<strong>is</strong> bs b@ sle.'stuIy<br />

!s.d ii the dDlgd@t ofDain b aduttr bu <strong>is</strong> fuI well sn<strong>dicd</strong> in t di!&ic populor<strong>io</strong>s<br />

ftd i5 .l)mdyet oorgh@r.h did.@ <strong>ro</strong> lefuad hypooria'. Dev. J (2004).<br />

l5.ll. M6b.rtrD. MMa<strong>io</strong> digird.d i! th. l8th 6rry by F@-<br />

Mtus, hc bclie.d tb@ ws e invjlibl. quid qhjc! v$ c.tt.d siDal hagl.ri6d,<br />

whicn va supDos.d b b. Bponribt. fd .ll physi.d and psjchorlogic.t iUs, M.anq<br />

aid h<strong>is</strong> 6ll*g!6 wfr qu<strong>it</strong>€ ef.dive i! Edlcing p.in i, surgicd op6st<strong>io</strong>4 ,oD. *d€<br />

ctnicd .bout ln. claiG mmd bui achowt.dg.d h<strong>is</strong> dp6ti& in p.in @r<strong>ro</strong>l <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

p8jnl* s!4dy Fd!6 ( t 645) .tndnd<strong>is</strong> tu<strong>it</strong>rs o. of th! scidt<strong>if</strong>c cuic<strong>it</strong>iB <strong>io</strong> rhc<br />

h's<strong>io</strong>ry of eal86ia <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> antul<strong>io</strong>n of h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>acbel<br />

M@dim wd a rh€nportic do.{.i!. or sy'ld! in whjch a rlincd pn..ii<strong>io</strong>rd<br />

tu irdu@ a htlnoric st!r. in . parid by rhc q@<strong>is</strong> ofa fo@, H<strong>is</strong> rehniqB h&l<br />

gFlr !!pql <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> w@ delopd by orhd pndir<strong>io</strong>nd tyirS rh. lhe fobd.t<strong>io</strong>n of<br />

lJ,r2. IDtlcrt. V<strong>is</strong>udjzr<strong>io</strong>n <strong>is</strong>. r.cldqc 10.trer rh. phF<strong>io</strong>togy ofrhe<br />

hw& body. lt <strong>is</strong> ! virat @mpondr of imgay Fyc<strong>io</strong><strong>it</strong>c4y ! mepr thr hrs ba<br />

uod for 6nri6 w<strong>it</strong>h grat .frqcy i! !I th. cutvlr€d eB l<strong>it</strong>c El<strong>is</strong><strong>io</strong>n. Ir <strong>is</strong> $eger€d

lhat ihb techriquc which us! v<strong>is</strong>ualialim stinulatc you brain, "1o f@l th€ se<br />

ssat<strong>io</strong>nr dtd yo! fel wh6 you e cslly dpdiadng en€thiig wonddftl. Elmdc<br />

you body 0o!rirg, tbc w@il of the ff o. tou body, aiDcd d in@jrg blood to*".<br />

R6dd6 sga6t rhlt'tE@logic.l path mys e iiinuld€d by vir!.tizir8 e<br />

o.liv<strong>it</strong>y a wha onnD.r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by sinilr El sdmuti tm rhe qrdrt ydld. A lEeD wil<br />

Ep.!d w<strong>it</strong>h lmy of rhc phyriql cbea* in facing .t h@gry rigcf s <strong>ro</strong> insgirirs a<br />

niSblaine ollrw lEling hdid ndby. Mcdi..j t@g,n€ rhi! phdd@n ard<br />

$phjs:ridcd r@h w@ dd.lop.d s $@panic took by Br@r & Fnd 095?). TtE<br />

h$ic<br />

'rmie n d[t. thougt q ldd |o. pnys<strong>io</strong>tosjcrt 6pons wbich inrm l.r

Coadtrt<strong>io</strong>n q@<strong>is</strong> b.gi! p<strong>it</strong>h di@bErlnltic bdrhing. n€ q@<strong>is</strong> bcg<strong>is</strong><br />

w<strong>it</strong>n 3 sbv ud d.? diaph4rnalic brdbs. ftb lahniqe hmcs "$e powdnll<br />

'58l&cilg' .tf..i thal p<strong>ro</strong>F br.5lhing ha oD th€ phys<strong>io</strong>los/ ot th. body ard €Mtely<br />

bffi6 a @ndiIi6.d stiDulu! for clMt<strong>io</strong>n." Swad pain thar<strong>is</strong>t! hw. preposcd lbri<br />

pain <strong>is</strong> @epos<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> of boIb smry, motivlt<strong>io</strong>Ml facrc md rbal inrq8<strong>it</strong>y of thc p.in<br />

dpd'@c. b link.d wi$ ud mdiat d by dor<strong>io</strong>nsl st rd", (B@hd, 1956; Ch.pmr4<br />

196; LaDlhal & Evdn.rq 1980).<br />

M.lz!.* & Wall ( 1965) hs et.d thilp<strong>is</strong>t Elsl dtow .cg.iivc dpEs<strong>io</strong>., ."!in<br />

wlcthq @donal or p[ynd b qus.d dirly by popt6 oM 6in!e! <strong>ro</strong> ilc D.tud<br />

dF*<strong>io</strong> of rltcir amr<strong>io</strong>tu." Th@ t .vi.t o€ Il|.r .ligh lcwt, of djdy uenor<br />

Plir" &d S<strong>ta</strong>Dbrch @nclud.d (196) rh.l &t mdipDirtid thar r€du6 diay at$<br />

rcduc ln. pai4 .xFihdtii p.in &d di.t haw b@ .<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>uccd by @g'r<strong>it</strong>iv.<br />

<strong>ro</strong>ntdF€t <strong>io</strong>n rrNctudnS.<br />

Studi6 inv€6rjeai.d tn€ .ttrc!.f oftwo rrTs ofihagrD& sula$/ lqeE.k<br />

'rektiv. <strong>ro</strong> a pla€.lo mntrel goup on 6ld pFsor pain &d nignin€. 11l€ nDaginat<br />

s<strong>ta</strong>r$r gtulp {6po6e sbup) wa hlin€d <strong>io</strong> inlgi,€ pl6dl s6B *nidr m<strong>is</strong>r.{i<br />

ofth€ir om rcstorB (.,g. nuc d Eld,l<strong>io</strong>n, dc.p bqrhing). Ttr. orha imgin.l<br />

.b-al€gy 8tuup (srinulu gbrp) v6 irriucr.d <strong>ro</strong> in.gjn. 3@6 *irh ney niNbs<br />

ddails, AX lhc sbj.dr w@ idtrud.d to r rb.n ft..rcgi6 <strong>if</strong>th.y 3ae t r ln.y wft<br />

goirg lo hlE . h6deb. or w@ h.d ! had&!e, . he

healing ener8J <strong>is</strong> sloDtlr@uly dd effonkssly t oNfd.d fim on€t oM body b<br />

@thd org!.<strong>is</strong>, lhrcugh 6e lorhiiS ofhD4r Th. stra8th ofth. as8y d.lqds @<br />

lhe ne€d! of ine l@ivd. in giving R€iLi '\,. @ mor€ $d a j$t 6 c,hmel, w. b@D€<br />

Rfi". S.lfhelilg dagi6 @ .*!r6.d rhougb rb. Fes<strong>is</strong><strong>io</strong>n ofReilj. M{ry<br />

clinj€d rri.ls h.v. b@ oducrcd to lalidllc lhe he.ling .ffds ofReild t<strong>ro</strong>trnals.<br />

Th@ @ fou pos<strong>it</strong>i@ w to let h.rd6.h. in R.ikj,<br />

l) Th. hsld ova ihc.y6 w<strong>it</strong>h tben pdrs or ih. forch.ld,<br />

2) Pl&ing lll. finga on lh. tsrplB <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tbc Flo5 o th. !pp.r sid. ofthc hdd.<br />

3) Covding lhc 6 wilh pd@ ir. @pping pod<strong>it</strong><strong>io</strong>u. S.lftrstual vould d<strong>ta</strong>il<br />

@pping ih€ 4 wil} fn86 poi .d b ln. top ofrh€ hdd-<br />

4) Pl.cjre Ih. hrnds @d th. bsd rh. hald llal! bddsd. .!rl n€ct pr$bl@.<br />

Ad<strong>it</strong><strong>io</strong>mlr D@ al6 ofEih <strong>is</strong> mw h€n ir\cii8ar<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> $cb a d<strong>is</strong>ld n alirg<br />

.rd b<strong>io</strong> ecgDatic sbjeld tq@G. All th* @ in th. wts b@e clhiql rials hav.<br />

prcvm tnlt "R.iki af1:.r3 rn€ F@n\ phlsi.rl, dor<strong>io</strong>.al, mot l <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> spir<strong>io</strong>.l w.ll<br />

bcilC' Ro.lm c. R., (2010)-<br />

1,5.14, Th.np.udc Totrctr. It b apu.poely dirccd hstin8 Dodal<strong>it</strong>y<br />

thr pnd<strong>io</strong>tna pk6 h<strong>is</strong> bod on th. pariat w<strong>it</strong>h id@t to hel ad r.b.loe Oc<strong>it</strong><br />

6.r&/, md dn5/ 6.1d. Tnft ac nmbd of thap@ric <strong>io</strong>uch systds in pEctie. Th.<br />

hon polulaly ui.d <strong>is</strong> $. Kri.gd'. llErFlric Iouch (1935), Rcili .nd Ptuic beljrg,<br />

TIF 1T a$n€s thar thd€ <strong>is</strong> l<strong>if</strong>c 6asi which <strong>is</strong> the spirir, $ut <strong>it</strong>rrye& Eagnetim,<br />

.lc.tric<strong>it</strong> , q Einst in od5| bs...l miv* rhdi6. Livirs b.iras ptodlc.d ao5|<br />

which flows 6*ly in hrhe being. !o and foh lh€ qvil1mm1, Th<strong>is</strong> hondlesh @<br />

orly b. Drinrain d vlt@ m i.rlivid!.] <strong>is</strong> ar uiiy ad Fe<br />

wiIh hiE$lt Bur <strong>if</strong>he <strong>is</strong> mi<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>if</strong>n<strong>is</strong> wirh6 ee b.ing $!pBs.d Ej@r.d &p6sc4 tr <strong>if</strong>he D..iilg r6h<strong>ta</strong>@ tho<br />

rhft <strong>is</strong> no hmonn .i1h6latir8 to Duc! d vqy lftdG ddsf, rh. .ih of eo.t of TI n

to dol hmonyinte€n rgy 6eld <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> "lo @ld thc 6agid of the individual". Tlt@<br />

e m @nclsie 5:ludi6 on TT, $n. Ej4tins <strong>it</strong> dhd $prdirnS <strong>it</strong> Howdarh@ c<br />

tuy s<strong>io</strong>n6 &d ar<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ols $pponirg <strong>it</strong> hghly 6 n Fovid€s sPir<strong>it</strong>ud etrG.r, ft@ ha to<br />

be a @n$<strong>io</strong>us in<strong>ta</strong>t<strong>io</strong>n of O€ !r!.l<strong>it</strong>j6d <strong>ro</strong> rcbalde th€ oagy tow i! th. Wy of lh€<br />

pat<strong>is</strong>t lr ; si.d our by 6irs rh. h.,tls ofheld a . ft.u to frcnirr. lhc dn!.|<br />

h.ding prc6s, Tndp€ltic Touch h ldnir<strong>is</strong>r.rcd i. s r.ss<strong>io</strong>n whicn leB abour 20<br />

niN1e !.d l[. pdi€nr b. Btd to Ii. diu, eld.d i! . @ftd.U. Fsil<strong>io</strong>n<br />

and <strong>io</strong><br />

twi! qui.t IX. Fact<strong>it</strong><strong>io</strong>F tbo ple bjs d hd hdds a fa irch6 abo!. lhe bod,<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nov6 rba sloely ond rhyihhiqly.<br />

SoG Ddiar qFi@e tDy $bj61ivc sgdos ard fdlings Ift. nqr .!d<br />

noving 6dF whil€ TT b bcire don. on thd. For Do$ p.opl. TT <strong>is</strong> gd€rally<br />

rcldir& bDI oth.B m mddgo aoi<strong>io</strong>d Epo6 lddilg to eln,c,<br />

Thft ,& pq.l hyF1bd<strong>is</strong> ..d tcMIid ude{ie th. TT 4,po:b. L<strong>if</strong>c<br />

mdgy to* ii4ly t<strong>ro</strong>ugh dd our of€.h Fson's ff<strong>is</strong>| f.ld wha . F&n <strong>is</strong><br />

unlellhy .nd in dirc Oc 0oe ofodo/ i! hirdor4 foti€4 ohrnci.d <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dc D.lr.d<br />

TT rr..l<strong>it</strong><strong>io</strong>!6 innuq@ the o6F/ 0ow <strong>ro</strong> mov. towlrds whola* arld halh_ TT 6<br />

b. donc wirh no phtsiel bucb a rhe si6 b a&ninjda€d by ling doM d s<strong>it</strong>ting,<br />

tne pr!.rn<strong>io</strong>n6 @M<strong>io</strong>Bly pl.G h6 *lf in ! cdn .lat sble of bng in tE !6at<br />

mov@ol, lhd e sh. moB h6 h.nds, &on rhe body rh€ h.dd k€lp a nolc of ey<br />

d<strong>if</strong>ad@ i! l!. noe of oe$i, ard hela Eg<strong>is</strong>la &y d<strong>if</strong>fa6e jr lh! aEg/ now<br />

md sh. nov6 ha h,nds <strong>io</strong> ! sad. rhylhbic not<strong>io</strong>n wjin d€ inicndo. <strong>ro</strong> Ebrle€ lhe<br />

re'v6 od8y f€ld. Tlft <strong>is</strong> foltow.d by a 16r F<strong>io</strong>d<br />

of 20 Dirut6 whicn <strong>is</strong><br />

d@@C<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> beie b th<strong>is</strong> 161 F<strong>io</strong>d lnc n!,r!rEl lal<strong>is</strong>e DdtEiM i! dF bo

adjbcl <strong>ro</strong> otha irealndls bui <strong>it</strong> pdticul&ly givs pain Eliefin th€ plirfl nag$ of<br />

child bird, ner .nd b&r poi4 in<strong>it</strong>'ble bowl sjrdrco. dd cr'mric nigni@ ll <strong>is</strong><br />

in6.t61!uy ! $le of dot<strong>io</strong>id &d $ir<strong>it</strong>ual slr@gth that N$ ,or le ou !a.<br />

Mmy slldi6 rcFor ihe .ffo.y oflidp.rnic bu.h, Ani., ,ohn l' HakEq<br />

Elaire ard Em! Edad ( 2000) . Bt@, rana.d c., ( 1999). A lEdr stldy fourd 3<br />

"s?€<strong>if</strong>c pdtdn offi tra6)dl prldE d . !igni6@t i.o@. ir lml<strong>if</strong>€r.l<strong>io</strong>n of<br />

fb.oblsrq Od.oSldt! &d L.oc't6 i! cdne. TT nry .fr.6 mmd eI! by<br />

sribuloringellFolfa i@", clowir.(200E).<br />

I.5.I5.GrclpTn npy. Grc(9 Th@py ir thdp.Dtic nod.lily b tlatjr8 Fjr<br />

dd olhd F dFlogictl d<strong>is</strong>ordd. Hada.n. plriar f.e cfud preblds (dmpl.<br />

atldi(rid to p.i! Lilli!8 ddgs, tEufut dclre<strong>io</strong>a <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> q6ivc d.?@da.y. GrcuF<br />

e heling lh€y nect w.*ry b8k ard @ irrad.d to hclp Ftidi! rcntild. th.ir<br />

tueE i<strong>io</strong>l trad &rl tl<strong>is</strong>rs velally lhcn lbbld,<br />

poiru, olnidf, intdFon l .rd<br />

inra Flrhic, tusrat<strong>io</strong>r &d ..b.! wirh orh6 grcl4' Dmb6, Pltidts aftiM. i. vqy<br />

imponarl whjcl th. gDup letld nu't rafc @gninrF oE<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>is</strong> r.h€d <strong>ro</strong><br />

'l|c6s d<br />

flilw ovd whicn $. hada oueht !o qen $m. in0Me. Hadach. md Chrcnj. pa<strong>it</strong><br />

p.d@ls u$dly 6td th. grerp Gl.r<strong>io</strong>nship wirh ! pNiv. .ft<strong>it</strong>ud. od @hpl.r.ly<br />

dddd o.. f<strong>ro</strong>n ortside aeals sd not willins to b€6h€ dynmic .8ol! ofchdg..<br />

Ir€ rc of 6a?py r<strong>it</strong>h thd ie to h.lp ih@ elinglk! lDd tuUre rhi! lowdt*<br />

Liratw inform N rbrt tbft m sa cl<strong>it</strong>riqly Fo@ |q!c ftr ocidai!8<br />

pain gDup8 6 a reli.bl. trafnat inl€Nor<strong>io</strong>Dr<br />

lain et0146 lovide r Eo.r dmnic w of rbapolic le!rc., alowilg lt<br />

hclla lo rdt a nMbd ofpadots !t @ tin..

Prin srD|9s helps to rlduc. saE of i<strong>io</strong>bri@ dd diad<strong>io</strong>! tld .botdotnar<br />

whch h fobd in 3ll h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>!.h. dd psn p.1idt, ihey ihinl <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> beliwe "l m d<strong>if</strong>rdd'r<br />

6d orh6 b@@ ofDy Fin" $dnb!.h 09?4) mtcd lhd 6<strong>is</strong> w ofi aFsEI<br />

slidsti@" includ.d felira ofb.iDg h.bl4, lrd oDt of@nbol ofbcirg dery and<br />

suspic<strong>io</strong>N toweft olh6 @d bloils o$@ for (M d<strong>if</strong>fi.tnti6 tld t!tt@i!B.<br />

Plin r<strong>ro</strong>ups previde thc pai<strong>io</strong>rs <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> srclp Ddba! vilh d.dibl. fe€dback<br />

(mtlntnid) d lan in lhen .j€ *ii.n @ @r foud ildid.hal <strong>ta</strong>ha|s i! @. 10<br />

one b6i3, Pltidts nay Bid f.cdbet f<strong>ro</strong>n ihdp<strong>is</strong>r or lh. Fmi3. lnrt the thflp<strong>is</strong>i <strong>is</strong> .<br />

wdl pas who sinply .afut rtDrirr. lhc d<strong>ta</strong>t of rh.<strong>it</strong> 3utuir8,.<br />

P.in C<strong>ro</strong>ups p@idc th. thdp<strong>is</strong>r p<strong>it</strong>h ! d<strong>if</strong>ffi1 di$mslic vi.*Toinl !d@ he<br />

8ds & o<strong>ta</strong>rMiry to c lh. b.Srv<strong>io</strong>r ofrh. hadd.h rrd p.in prli.nl iD thc sid<br />

nilo intdacting wiih otb6 in thc lNial @nrdt <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> th@ he @ ot6q* hs sttong<br />

.6 h3 &fciq ldlplive ad hd ld,ptiE @pirs sLiI. &d hn i .r&r<strong>io</strong>n !bilti6.<br />

Plin Crcl+€ p<strong>ro</strong>vid. a of'p!tutujty ph@ patidtd @ o$.nia rld ftiE<br />

iaigbt! inlo then tbo!8hrx .d bd8id dd .le prDvidd sugcelli@ to olha.<br />

Pnr erculs d$ e oppodu<strong>it</strong>y to !:mb6 <strong>io</strong> 6rd ooa EfaqE goup3 or[(<br />

Th. aout .l$ li@ot6 rh€ mc.pt of uivddiry n nrl6 rh. paljdt q gorg<br />

lMh< wbo <strong>is</strong> ot ofr lonelr. d.pl*.d .!d wjlh&.M ircid€l p i@t awd thai ihcy<br />

G @t d@. E.id.d in th€n n<strong>is</strong>.., .!d th.y htE alevo thrt |[?y o <strong>ta</strong>lt abou rhn<br />

wont fs ald thoughb nely b@w thcy N <strong>ro</strong>t b.ing jdgpd.<br />

Gdp thdpy <strong>is</strong> . pl@ fo gjvbg infodd<strong>io</strong> di3dfming hyths, foltld<br />

chag6 <strong>it</strong>r @ot<strong>io</strong>rd inlolcl<strong>io</strong>n duing @.vasati@ &d r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>u.t<strong>io</strong>n in th. uoul of nD..<br />

Cmup tt6.py <strong>is</strong> ako do@ eh..! p.ti@l! @ toudt <strong>ro</strong> intoidi@d slills. Ald

SyDploN @ringot i 6.d<strong>io</strong>r <strong>is</strong> offa rtbcl.d <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>ro</strong>ughr dd *rts of<br />

@muic,ring wilh othm.<br />

M<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ic.lT6hot<br />

1J.16, Rrd<strong>io</strong> Fr.q&!ct. R d<strong>io</strong> ilqhcy <strong>is</strong> r tm thd ref@ to .l<strong>ta</strong>ftting<br />

cl)m1 (AC), tlErc <strong>is</strong> a filq!tuA of el€drmlrrclic ndi.lr@ in ln. trg! I which nrl<strong>io</strong><br />

signals d€ c@nine4 *lich tug€ ton 3 kilohdt2 to 300 gig.hqtz It <strong>is</strong> 3d rhat<br />

slm<strong>io</strong>l bodi6 lilc Dul.@, qu.l4, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> p6s:bly @il r.d<strong>io</strong> &Equ@cy ndi.ti@ I!<br />

h.ad.ache &d f@ p!i! rhal do nol Bpo.d <strong>ro</strong> hd<strong>it</strong><strong>io</strong>n l hotneir, S@c TMG <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

hir'!in. sFidin u. a!rccde c.ll<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Fd<strong>io</strong> frlqDacy, Fr4hct ThmoMlos<strong>is</strong><br />

b rmi!,I. th. mod p6intu oDd<strong>it</strong><strong>io</strong> ofnigr.ir. DodoB eho @ ihtu lehnolos ha<br />

say Save rbd b6ck rheir liv.r "iD s sirSlc v<strong>is</strong>ir,<br />

Prd<strong>io</strong> A.qMcy ddcdn<strong>io</strong>r of Cr€6 i B<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> i! cdi@e6ic hadlan6 rhe<br />

p@c€dw k p<strong>ro</strong>bably not bd.ficial in @i.o8hic [<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>!ch.!, (Slohdi, Koh<strong>ta</strong>d &<br />

Hcld€I, 2001), Howdd olh6 snldi6 show ".6cacy ofRrd<strong>io</strong>li.quacy C@iel<br />

ZyS.Fphysl Nmtony i! P.ti6ls *il! Cl!@ic Cd<strong>io</strong>8aic llad&h.". Jb& Jug<br />

, Juo. Do.8. Sue, dd Htus, (2007).<br />

lJ.l?. R.d<strong>io</strong> Ft qu.lcy N&o<strong>ro</strong>ny. <strong>is</strong>d<strong>io</strong> Fi.qEcy N@tony <strong>is</strong>a<br />

p<strong>ro</strong>.€dw vqy higl y spll<strong>is</strong>t<strong>io</strong>r.d ald advec.d whid @Bi5l ofrb. alttli..r<strong>io</strong>n of<br />

aein.dly hrg.t d el..lricd neld b Fodu@ chdes u thc nde nrd<strong>io</strong>!. ln th<strong>is</strong><br />

po..dw . pr!b. tu posili@cd tl!o!C! thc atjr ad Dwla lo tb. r'relr.d ffi6 rql<br />

lo th. rpine in dt frc.tjoinls, and th. 6d<strong>io</strong> frcquocy wv.. injw lhe Ainal nd. m1<br />

Third @ipirrl-n@.otmy <strong>ta</strong>rs.ts th. pdiph6.l a@s oflh. rd6, 6 thc c€ll<br />

body dain inl6d lhe.wc rcgamrc aie 3on tirc, but th. reliel<strong>is</strong> pr.vid.d

n.velb€ld ihe pd<strong>io</strong>d! ofEli.fobh<strong>if</strong>td 6 qtqtsirc <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> siSErfdq €licf@ b.<br />

$ught dgrin by lhc rcpa<strong>it</strong><strong>io</strong>n ofih. t<strong>ro</strong>c.duc.<br />

Th<strong>is</strong> pmc€d@ do6 ml .dd6 lh. eN.<br />

of pah - n <strong>is</strong> only . pdliltiv€ pb€dm ! b.<strong>it</strong>d lrEillff w<strong>it</strong>l long lasting elief<strong>is</strong><br />

r.quir€d howqa al F6al lh@ <strong>is</strong> m otba fom of Ee.e6l fd th<strong>is</strong> fom ofhadacr'..<br />

E:pqimdral liudiB h.!. ird<strong>io</strong>tcd $.1 rcfdtEd plb frm ihc c2-c3 zygrFplysi@l<br />

joi <strong>is</strong> Feiv.d<br />

in lh. h.!d, Cl<strong>it</strong>r<strong>io</strong>l srudid h.rc 3hom lh.l lhir fon ofn<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.cle 6<br />

b. relid<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by ucslh.tizing th€ 3rd Mipid ndc, Studid show ln.t "RF wicd<br />

zyg.pophtsal joint n.@luny h4 shoM 10 prcvide subsla i.l P8h Eli.f il pd<strong>io</strong>ls<br />

wiln c!'jonic cdi@gaic hdd..$. wt6 @tuUy *l€d<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Kol@", , (2007)-<br />

r.5.18. Nd W.rNdm TdlloLar. Moddd *idli<strong>it</strong> hlE fo'€.a<br />

c<strong>it</strong>rerdinary n.dic.l .pplicat<strong>io</strong>.r, tiny'heo docloi'org4i@ lrt t tiiv.l thrcuel the<br />

body d hbe c@putcr intof|A (w.[ a?) to dla@ b4lnbd<strong>io</strong>ni.S'NBC<br />

@v6g@e .M r.chmloF/, ndd€d w<strong>it</strong>h b<strong>io</strong> tchmloSy infornd<strong>io</strong>n r.dftloey tnd<br />

@gr<strong>it</strong>iv€ *i6a ptuiiG <strong>io</strong> dclivd D.jd d.v.lolhats in n.Wlogicd tcdDologre.<br />

Mmy 6uii6 hav. inv*t d in in<strong>it</strong>iativ6 to ddclop mt€rials od dei6 tl tub<br />

holald $d€! (Mn<strong>is</strong>, 2004).<br />

15.19. TElgiIoU EleFicll Nm6 Sdmd.r<strong>io</strong>! Ttreue@u<br />

Glc.i.icd .dB srihul.tid h6 h6 uscd for rclj.f ftr pdn, si.a 19?0 $<strong>is</strong> i5 a<br />

nonjnvsiv. l€.hdiq@ whi€h allo* the $frc ot rh. Pdi6l to .cdu* h<strong>is</strong> 6 <strong>ta</strong> pain<br />

. thjs @i.Cly . $f. pD€dE wiihoul et side etr cl.<br />

T.E,N.S. <strong>is</strong> !r!d ir .ll Linds ofprin lrd .clE <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> <strong>is</strong> a relDiqu. whi6 <strong>is</strong><br />

drrm.ly relilblc. pncti..i od .felivc ir th. Eo<strong>it</strong>nor of cdi@l had&l'6<br />

slid<strong>ro</strong>n€. Trsc eeu! .l61rical nfl. slinuht<strong>io</strong>n CrENS) cEolly <strong>is</strong> on€ ofth€<br />

bosr cfuody u.d foms of €l€do&als6ir Sdqal re?ons of ii5 .fracy 4<strong>is</strong>t

L<strong>it</strong>rahp<strong>ro</strong>pos rh.6{ln<strong>is</strong> by whi.h IINS ptldwc$ @rmodtiLt<strong>io</strong>n n rb.<br />

Pr6]Taltic inbaidoi in thc ddsd hon oI $. lpin l @rd<br />

Endos@u pair @!tt!l (vi! ddorphiN, a*!ph.lia, .id dyndphia) 5<br />

Drel innibirid of e abrcmally qc<strong>it</strong> d nd.<br />

R6r@t<strong>io</strong>n of afldt inpur, Sihkii, Bolding (201Cr.<br />

o@jiial Nd6 stinulat<strong>io</strong>n. (oNs) For h..d.chc ft cni€d out w<strong>it</strong>h a s€nel<strong>io</strong>r<br />

which b $b.!t{ously inpl6t64 ehich €oBilt of a bdlry th8l <strong>is</strong> Fsir<strong>io</strong>rcd<br />

ch61 d aHon6 dd <strong>is</strong> @tu*rcd <strong>io</strong> th. drds<strong>io</strong>n larh whjch N linl€d lojoin<br />

€letrdB plo.€d .ft$ 6 borh @ipird nd6- ftj3 ichniqE ne b6 u.d w<strong>it</strong>h<br />

@Bid6.bL ba.f<strong>it</strong> h H@i@i! CodiM (HC). (BM!, w.tliN, 2008).<br />

in lh.<br />

1510. Vrgud.Stird.r<strong>io</strong>u, V.gEa*nidd.ti@r.dEtet.<strong>ro</strong>ry<br />

nicEine <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ci6t6 Lad!'hc, vigs tF6 stimllri@ hB a idtdl!tr1 olc ir<br />

tr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ng eft rcFa(rdy hanlach6 fd inn r.blc d@tric hiSniE od cluss<br />

h&d&hrs, (Moukopl, 2005).<br />

ErFinmi Eilg <strong>ta</strong>l tiDc btiin in.gi!& ddorur.t€d Ort "individuds l@tr€d<br />

lo rcdue the tut<strong>io</strong>n of p6in !y oeolliry th. lctiv<strong>it</strong>y of lh. urrl sLr<strong>it</strong>r cingdal<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

ond, which <strong>is</strong> od€ci<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> to th. !@ involv.d i. pain p@ssin& In th6ry t!@foE'\l<br />

<strong>is</strong> pcsihle tur p6ple lo dldiatc pain ortudr n e f..dbrck, wilhout Drues",<br />

(Rodaick, ciltey & Kil<strong>ta</strong> 200?).<br />

sub Occip<strong>it</strong>d Ndm Slinul.t<strong>io</strong>N Signiner <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> @siddible adve@s have<br />

b€ r€toncd in rem $inuhrid tehliqu* fd ncdic.lly inhciabl. chftnic nad,che<br />

dierd6. "Tso pmc.dG hiv. prcgB.d in cl<strong>it</strong>ricil sttin$ sub@ipii.l stinulal<strong>io</strong>o<br />

oftbe sdl6 @oprlrl nd. ald h)4Fihaldic d..? b6ir gtjEul.t<strong>io</strong>tr in dds 6<strong>is</strong>rd<br />

c!rcnicr.d+}!. sy !obc" (Bu4 2@E)

1.511. Spb.l Cord StlDlLdd, A! impbnul|. stimuht<strong>io</strong>r eyst@ imludilg<br />

.?idursl lad for 3pin l .dd 3tihul.t<strong>io</strong>i d$ ldDM s do6.l cord 3timuld<strong>io</strong>n.<br />

a@rdirg <strong>ro</strong> lcD9-CM, Spirsl @ttl $inul.t<strong>io</strong>n (SCS), .ls LmM s &a.l @lu@<br />

sribuhr<strong>io</strong>D, b . prcccd@ fd r.liai!8 .bqic, !.l@ p.in tftush clc.lidl<br />

stibulti@ of tbc Aind @il. lt tu @mpl<strong>is</strong>h.d by ibplel<strong>it</strong>g & .l4totric lribul.lot<br />

ne dE 3pin. <strong>ro</strong> inrdul p.jr 3i8r.l5 to rhc bnin. r'dtuc i. th! d6dopD@$ oftb.<br />

ad6lelir8 of noslb<strong>io</strong>log/ of Fi! b3. in0@cd 3iru.ru.{Fi6c Eehda dld<br />

Itrplmt d donq for 3t<strong>it</strong>ul.t<strong>io</strong>r Tii! <strong>it</strong>ulda two d.vi€; Spind qd sinult!@ ..d<br />

dep t6ir ltiDuhnor Slibuln<strong>io</strong>n of o. lpie w3 p.i! wi! Finily G.L @tt!l<br />

Mar&<strong>is</strong> rhtl @dd bc ..iiv.Ld tt rtiDd.tlD of r hg. nmb6 of .t<strong>ro</strong>at tba ir<br />

rb. ddd @lEM of tb. !Di!.| dtl Dd llc qla n .b&<strong>io</strong> of Fi! td<strong>if</strong> &d <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>sdir <strong>is</strong><br />

tut dtirdy udoc@d. Etc.tic .iiDuLli@ of 6. 3Pi!d ottl @y Fvidd.lict<br />

. 1512. Trl!8.FFbt bj..do!t. O?I) Tri88a Fint iljld<strong>io</strong>n E bi8hly<br />

duetd dlvdoFar <strong>ro</strong> lsl Finirl |B of m!*lc Nmd nu!.lc @|t.rct! .nd<br />

El.G wba n tu a.ti€ 'A Ei8gr. poilt <strong>is</strong> r hol or dgb! rcPy b.!d ofou&|. tlx<br />

fm! wl<strong>ta</strong> Du&j. ftib <strong>ro</strong> !.1q. Thc lDr ona o bc f.ll 6dd llc 5Li! ud uy<br />

twirc! insl@t rily wha toEh.d (.dld. jDP 3i9)."<br />

Th. LigSpr poirr m .88nvlr. th. s!ftuding 'w6 dd lad to t f6.d Dd!<br />

wbichirp.in f.ltinelbaponof6.body. Ov6r<strong>io</strong>. dy lad to Sq t<strong>is</strong>c,l@ or<br />

mg. of nor<strong>io</strong>A ud *.d6a my indag,<br />

rh dton ial irigga Firt inj.d<strong>io</strong>n <strong>it</strong> . w.ll !@g!iz.d ffi61 lelniq!. lh.i<br />

<strong>is</strong> *i&ly cFld sd ulcd in Mu!.I. Ta.<strong>io</strong>n Had!.b. fol bolins thc sycl. ofwhicn<br />

rr&<strong>is</strong> *nb rig€lr poirt !.liEt<strong>io</strong>tr r!*, sd 3t<strong>if</strong>f<strong>it</strong>g ofolha trggd Po<strong>it</strong>l! 'A<br />

myofd.id Ei!g6 poiri <strong>is</strong> ! ht?qirir.bl. los wilh<strong>it</strong> . tlut b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> oflt l.id hscl. lhli

h<strong>is</strong>tologically @nt<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lege qMt<strong>it</strong>i6 ofpl.l.lc& rrd EAt cd\ 6n d@6il5 abn@.I<br />

!!slar@ lnd nilo.hoid.ia, s@E qudlt ds .ld mu@Flysa4ldidc d.?o6<strong>it</strong>3."<br />

'tng8d poin<strong>is</strong> e l@i of ov@diw nalc lrd impo<strong>it</strong> d cir.ul.t<strong>io</strong>i lh.y e<br />

tmds poini3 wiihi! palp$l. tigl! repy or Dodula b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>s ofnus.l€ ir sPm" Fd <strong>it</strong>!<br />

hqhboi s 24 E !rl!g€ .e<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>l€ <strong>is</strong> <strong>it</strong>udt.d dirccdy into lhe spot <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> o d$. of I nl or<br />

0.5% blpiv@ilc b irj.d€d into th€ hucle '"Ih. pariFl will @cl w<strong>it</strong>h 3n involu<strong>ta</strong>.y<br />

juporgruDt wbd th.irigSdpoi tu inplt d", b<strong>it</strong>i.Iylh. <strong>ta</strong>dds.td U. D.i!<br />

wil incg*b n will follow wilh Crat rdicfin Dlin &d hadacba T[b .licfh.s ba<br />

lusdz.d by obj€li!. .le<strong>io</strong>pnys<strong>io</strong>logici 1ddng. T!€ injetim b.y bc FD.5t!d lnd<br />

. fd dlrs howdd <strong>if</strong> r€l<strong>if</strong> i! not achid.d .nd b tElnals they b.y b. s. oiho<br />

p<strong>ro</strong>bld whi.h mds <strong>ro</strong> b. iiLni<strong>if</strong>.d.<br />

I d6tjon.l pr@€de such 3 n@B blEL tnd tiges toid <strong>it</strong>j6rj@! h.w<br />

lmg bna u$d ir |}e tstddt of had&bc d<strong>is</strong>n6. t.!|* n howdq lild. dr| for<br />

O.ir etfiqcy in tslnar of had..b6. Molwa $d! <strong>is</strong> e widcly .ceplcd<br />

{g:a6r do.g hada.he sp@.l<strong>is</strong>l 3 to th. oPtinal tenniqrE of i4cd<strong>io</strong>A 0?. od<br />

th€ dorcs ofii. local &.stberic us<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>". Ilsb.ptt (2010).<br />

1.5,23. Cryo.€u<strong>ro</strong>lys<strong>is</strong>: o@ipil.l dyoncuolF<strong>is</strong> <strong>is</strong> d intefl@t<strong>io</strong>nal p<strong>ro</strong>c€dw<br />

u€d <strong>ro</strong> tdt rd. tu whicb <strong>is</strong> gadLd by Fiphanl nffi G*dhid c l6!t d<br />

oursid. llc slin l @l!m .nd stul) dE to lh. @t|d<strong>it</strong><strong>io</strong>n of@ipirll fturdgi& A pob.<br />

whicb <strong>is</strong> satl (rc lusd rbm ! mll trcdlc) t mcriq<strong>io</strong>usly md @etuliy pl.c.d Dqt <strong>ro</strong><br />

il. spe<strong>if</strong>c ndo Tl€ spe<strong>if</strong>c @ i6 idoti6.d .td thc ih. pob. <strong>is</strong> u<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> to $indaic ih.<br />

nnq On@ ih. pbb. <strong>is</strong> posil<strong>io</strong>n€d of prepd pl.@a! th€ tip of th€ pmb <strong>is</strong> aol.d wilh<br />

n<strong>it</strong>mu oxid. <strong>ro</strong> ! tdp@tu6 bctwd -50 od -?0 'C C58 ald -94 'F) to $. ndc in o<br />

ie bdt. Th. n.rc i3 tunct<strong>io</strong>N ard sc b4t lowotds <strong>ro</strong> ufma Nm.L 'l<br />

onpddjvlt ! sfc precld@ rX@ & hadly dy si& .ffets &d ullc€$r od<strong>io</strong>N<br />

<strong>is</strong>

ft ru!. Sonc tin6 socn6s in ihe rw. nly conti@e for ! @ql. ofdrys d ftilw<br />

of nd. turcr<strong>io</strong>r 6Dpli@1<strong>io</strong>n.<br />

" O@ipiral dtq.elys<strong>is</strong> <strong>is</strong> a prcc.duc which <strong>is</strong> u.d to tF.t .d. p.in<br />

.es.d b, Fiph@l |rct gdd.ny du! b tb. @rdili@ @ipiLl <strong>ro</strong>idri.". (WiUi@<br />

2010),<br />

1.5.2a. Phy.lo0.npy. PhF<strong>io</strong>thdlpy Dd ths.pdtic dm<strong>is</strong> dn<br />

mipdalv. thanpy brv. ! rcle i! b<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>&b. rldud<strong>io</strong>n", (r!I & St e4 20Ol; ToEli<br />

JeIM & OIel. 20ol), Moy tee'ots whidt e spporr.d by didene, clircpnctic<br />

d. si&abl. dida@ s 10 il! .6cacy in rh. trsfidt of Ttu<strong>io</strong>n iype md cdi@g6ic<br />

hadlchc, ln th<strong>is</strong> nod.l<strong>it</strong>y low for tQbriqc 6 mid thd.py, M6.ge ircluding<br />

Tngg6 point El.aser d€.p h6r th6.py Dobili2lt<strong>io</strong>D, sEclliDg ultnsu4 Fld<strong>io</strong>tr a€<br />

us€d. Ms$8e pdt in nilmlou! ways. .) Bbcrs the tlmi3s<strong>io</strong>n orpain. b) tclu6<br />

r€enurcle .nd trcbrbl, h$ . FFlologiql f..br. Mas$g. ha g@t dErFrlic<br />

v.lE ard vcry mrhi.s sd Eluins. Evs Enc<strong>ro</strong>vd (200t6), Kl.ppa 099), frcud &<br />

s.hwanz (2000),<br />

lJls. EyF.bld. O!tg@ Thd.pt, ll)Fndic orygd thraly <strong>io</strong>pli6r6<br />

brqthirg pe oxyg6 b a pcsEz.d mD, Oxyg6 th@ty k N.d <strong>ro</strong> lrei<br />

dMp€s<strong>io</strong>r sicli6s, infet<strong>io</strong>ls, osls lnlirtb dd blbbl6 of ai. in the blood, atd<br />

woutdr whicb dorl nal b@e ofcqtlir d6i6 l<strong>it</strong>. dirha6 d rrdiadd injlry.<br />

ln . ht?sndic ory86 thaipy r(m, lh. tir lrEm<br />

tu ino6d to dre iiG<br />

hi8!d rhm nomol pEsN, Urd6 in@.d pr@ue lhc ls$ @ draw togclhd tbrc.<br />

tin6 mrc oxygo thd <strong>is</strong> Fsibl. !r mm.l sir !6sft.<br />

'lxygo-rich blood st<strong>io</strong>ullre th. body which rel.e $bs<strong>ta</strong>re call.d gml1h<br />

laclon <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> s<strong>ta</strong> ells that dd hcrline". El*via (2004)- HlTdbdic orygBn ll4py <strong>is</strong><br />

@ciddrd lot cff<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ivc in he

(Lyd@, Held€, whil6, Brub.kll & slona, 2004). The 6dts do not pd ey<br />

d<strong>it</strong>rdc in thc hyp.ttdi. oxyepn ard @n!!l arcups <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tbe p<strong>ro</strong>l@l do6 et show a<br />

sign<strong>if</strong>@r pr!9hyl.dic cr..t i! DicniE &d dc ful inO@6 thc lqcl of ddoth.li@<br />

1,5.26. lcDprivc A!.lcsir 'Tt!|mtu<strong>io</strong>n of <strong>ta</strong>ir si9.l3 .vok.d by<br />

t<strong>is</strong>s &nagc l<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>s to sos<strong>it</strong>iz{ri@of thc Fnphdl <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> 6ttd p6in palllw.y!, Pc<br />

@ptiEoda6i!k.rr..h@rlbd<strong>is</strong>iiili .db.fwth.$r8i6lpd.d@inoddlo<br />

..dw lhtu @<strong>it</strong>izrtD Owin8b lni! Fd.

welfsd RcRols, (2009). Fy b show ho{ ERK'S pbvid. a linl brtq@ pa<strong>it</strong><br />

dd nmory, <strong>if</strong>you h.v. .bdoninal surS!ry you do noi lcl pain b@!u. yo! @ undq<br />

a!6th6i.. howa.r, th. <strong>if</strong>t<strong>is</strong><strong>io</strong>n ofski! snd su$lc rtodw6<br />

hu8. d<strong>is</strong>tB sirlrls, rbnt<br />

t nv.l via F€. <strong>ro</strong> ERK'S in r. ell3 of dE 3Di!d od- nF ER('s lad 1o shon .!d<br />

long im cnegd !o t*. elts in ih. spin l @d, and in lh€ bEin wl@ sos<strong>it</strong><strong>io</strong>r of<br />

pain <strong>is</strong> f.ll. wlrd you 8ct up aw.k. and th. ddth6!, thde .ihsge c.lls rdain lbe<strong>it</strong><br />

hsinral<strong>io</strong> p<strong>ro</strong>longins tltc pa<strong>it</strong> <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> $nds. Pon opaltive pain <strong>is</strong> 3 nd<strong>if</strong>*ti<strong>io</strong>t of<br />

$<strong>it</strong>ahag on lh. ndoty of pr! th nG su.d duina lh€ sEg!ry thlt oDclu<strong>io</strong>D<br />

opa tbe w,3 for Nv.l w.ys <strong>ro</strong> ler Fin, To Sivc !di. lill6 b.for t ti6l f..l Fin<br />

nor.ft6'prmPtiv. urlg6ia'- Al& Got$h.!r (1998) telort d rhd prmplive<br />

maleBia silt<strong>if</strong>i@{y drcs post opdaiiv. Plin duing hosp<strong>it</strong>diat<strong>io</strong>. ald lolg ona<br />

di$hdgp. Morphin. n mp bonc Ds.d lhk *!y adoidst€riry ii b.for. ndE ih& &n6<br />

lardor TIF 6.!rch6 DlN. 6c tsic qu.st<strong>io</strong>tu lDv ERK s ptodud Prin'\re<br />

believe wc lN. foutd ihc @?tm d tpind @.d cclk thd ih@ pmaire !.i upon qll<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

NMDA & <strong>it</strong>s k.y to @nt olling th. scil.bilig ofrR€ e[t', (Wolf, 1985) The<br />

r€sdchd do not wer to tum ofr, lhe Id of pdr, $ai wm yoD lo.n4d @clhins<br />

rhal b 10 hot ot cidicrlly nox<strong>io</strong>u. Popl. vho c!@1 fel lh<strong>is</strong> tind of Pain fd €xdple<br />

ir dlsralon@i. sufla e@ nutlar<strong>io</strong>D od r.due l<strong>if</strong>e s!6i lh! 8od<br />

in66e qc<strong>it</strong>lbiut, rhd Fldn6<br />

wound .d han d<strong>is</strong>d*<br />

<strong>is</strong> !o .wid<br />

RMlly Bc!rchd nave foud e dztDc in the lnjn thtl hdc pa<strong>it</strong> lat 6ns<br />

rw€ injuiy od th<strong>is</strong> Srves d <strong>is</strong>ieht dd uddrltdj!8 oI lhc br.!n maleim for<br />

.l@nic p!in. ZhlP s.d @ll@g* (2010) fourd d<strong>is</strong>.d lry.l oflhe 6zlm. rml.in Ki'e<br />

M z<strong>ta</strong> ir ! rcgjon ofln. bnin dl.d lb. urdid cilrdat.d dIs oflh. injurd mie<br />

1J.27, O<strong>ro</strong>r. Tl.npy- Odn. (O3) b d alot<strong>ro</strong>Pic dd ooriz.d fom of<br />

oxysa wilb c<strong>it</strong>rs .l4trbtu, ut€ word O<strong>ro</strong>n€ cohcs fton ! CEt wotd nding to "1o

smdl n <strong>is</strong> hrrlly b€neficiil in mmy n<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>icd d<strong>is</strong>odd lik h.rd.chs mdj, bu1 Dor.<br />

e in cpin<strong>io</strong>.y di$d6 lrc breochid snnd dd COPD (Crd<strong>io</strong> Pdnonay<br />

D<strong>is</strong>dd). Dr. ono wlilltr in l93l 90 lh. NobL Ptiz€ i! M.djcilc tu. previns<br />

sc&dtully thal ozotr. <strong>is</strong> lr<strong>is</strong>Hy bo€fcirl i! 6s.<br />

Thft e fow w.y3 to ',r-i;ds 0r mcdical O-trq !) Auto hdolneltv<br />

iNmald dicli 6t!il ff<strong>io</strong>vjlg ndf pint of blood t@ th. P.ti6l .!d .dding om.<br />

dd orygo ss <strong>ro</strong> lh. bl@d $d l!@ injeiing lb. bl@d b!.1 to lb. pltidt b) Rd_t l<br />

insmst<strong>io</strong>s ozone and oxygd <strong>is</strong> adnin<strong>is</strong>la.d .! i Mial ooa c) Ob.. baecine<br />

which bvolvs having e ertigblbag mod lh. d ble t<strong>ta</strong>t d A mixnftof od.<br />

sd ortga <strong>is</strong> pmp.d lo lb. blg .td lbetb.d $rcuri tb€ *in. d) O@. <strong>is</strong> sl$ u!.d<br />

dt6ndly in th€ fm of Oeiar€d oliv. or ruflowd oil<br />

' B<strong>io</strong>{ndadre thd.pi6 bav. incdiblc rugc ofappli.rt<strong>io</strong>t tm hdt &d bl@d<br />

v*l d<strong>is</strong>.e pIhutry dilag inf..t<strong>io</strong>u djsa$ di.btl6 6@ ollLe Uood en<br />

lFph <strong>ro</strong>d6 ad<strong>it</strong>s <strong>ro</strong> Di8Eire h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>&h6. Allhough O&rc ad hvd<strong>io</strong>Sa pdxid. e<br />

hiSlly toxi.. n!€y hav€ ba foud to bc both sf. ad .tretilc phm dilut€d to<br />

ihdFutic ltrl' Obn <strong>it</strong> .Ppli€d o.e or tvi€ i!.ilv d FhlP€ o! .lrdare davs ir<br />

@n@tl!m tur<strong>it</strong>rs Aon | 080 mi@ gds F obic bni frq ir a gal qwdrv a<br />

@ b. nfely @d cmfonlbly st eib€d bt ih. b.dy- iht <strong>is</strong> @linu.d till fi. prebld<br />

gG .w.y. "Thft e nsy rePorb abod sl@siil <strong>ta</strong>tnot of c4.q sbowirS lnrt<br />

oar ir sfe and M loriC'. Midd, S., K<strong>io</strong>g M., dd Bu$rdt. B ' 095?) & M64l<br />

D,.098a)- Ode ltdpy ns h@ tqffiad.d to tqt IMv @td<strong>it</strong><strong>io</strong>6 l<strong>it</strong>.<br />

hcdla.ho &d p!in", (Fon<strong>ta</strong>in , 1879).<br />

Autol@othdPy <strong>is</strong> . t chniqE in which btood <strong>is</strong> tlkd o tftueh a ve<strong>it</strong>' En.d<br />

wi$ obrc gls ard ln@ ini*Ld ha.L Wl|r dich€d widr oaE n 5 b€n u.€d in m.<br />

E4un@i of osldtlr<strong>it</strong><strong>is</strong> ald tnm.toid lntuils

ft@ E oths lhddiv. lheapi6 whrch nc€d to b. incorpoELil sm. tho!6<br />

lmFF thll appli€i<strong>io</strong>n ofw@rh 10 thc aldtr @lM vasodii{4<strong>io</strong>n (dpdns<strong>io</strong>t ofblood<br />

vsselt whi.h brings blood <strong>io</strong> ih. body's $!fd, emth s cAe nucle r.la&t<strong>io</strong>q<br />

.nd cold rdDFrru6 haw th. ot'p6ile .fcd.<br />

1.5.28. Botulnrb To!i.. Typ.A hlveb@ lpplovcd by FDA forlowbsc*<br />

pain Mi8r!i.. and Tos<strong>io</strong>n <strong>it</strong>?c hclda.lE. Botuliru bnn i. a Do1€nt n€Wloii<strong>ro</strong> which<br />

<strong>is</strong> FodDcld by tt<strong>is</strong> bsder<strong>is</strong> .d whicl <strong>ro</strong>tts Clos<strong>it</strong>i(hm Bor'rlinr@, ln.n .tr d tu .r lh.<br />

rMu*uld ju.;tid wh@ lhcy o!*ud th. rd€e & dzym. !.dvlcholin. *bi.I<br />

Fddts Dwle dElct<strong>io</strong>n sd quilg Aaeid P.nlts<strong>is</strong>,<br />

O<strong>is</strong> €ulG l€dile to teeat<br />

choodq@d<strong>io</strong> ord r.d!6<strong>io</strong>r in .div<strong>it</strong>y in trxc nuslq san glads, o sph<strong>it</strong>ds vill<br />

dirinM !id. .frer. Botllinu rdin ns bd us.dfo. tBdng dl hlds of d<strong>it</strong>r@t<br />

q,!€ ofn rdtche. including .pi<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ic digninc. toEo._iype h.!tLc.h€, a{i .hmic ddlv<br />

h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>*lrc, Thc |<strong>it</strong>drw b rqlcr. e ! r@ru oiefi:..y, but als t pt€le w<strong>it</strong>h rcpdt! or<br />

lek of pmf of b6etu. At pffiL 'l <strong>is</strong> ! dEo6id <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> uprevd lbmPv. v.t thR<br />

rc 'lotidts who do spond lo ttea<strong>it</strong>bdl, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lon€ rdy vo..l ldrcates" Wclch . .t al<br />

42001).<br />

1.5.t9. Ro6trg, RotfrS6rl dsd-pl<strong>is</strong>sEb6$gq whic!rEl43rt63dd<br />

inprcving hobil<strong>it</strong>y, postuq b.locei <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> iuclc inct<strong>io</strong>n d€v.lop€d by Rolf ( I9? I )<br />

Pr..i<strong>it</strong>imd !!ply sl@ pr65@ wirh 6.<strong>it</strong> knu.U6, lhmbs, fo8d, elbo* & lne <strong>io</strong><br />

tbe $n i<strong>is</strong>a Rol6ns @n@tr ld o. oppGine nucl. greuPd, 3ud a th. hiccP6 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

Fic@s in ih. uppa am. ftc p.irciPlo md t@hniqu.s @ ba.d on O€ wo* of Rou<strong>is</strong><br />

h€ b.liv.d thlt i[. t<strong>is</strong>6 smurding thc nsl6 b@nc !ti6 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lhictd.d wiln !9.'<br />

vbj.b la

qort lh.i Rolfna helps wiih fldibiliy sd inFo6 lb.t F61ft.<br />

ad di€ty". R@h€rd (20r 0).<br />

11 myrdi* sftss<br />

1J30. BvtbDb' studid E?on lblr ! @nbiut<strong>io</strong>! of th.vii.m<strong>it</strong>r 82 tud<br />

B12 ha 'n.lgFic Fm!6ti6 ir ddilid! of ncurcp.lhy, It b la in &iml I<br />

dpd<strong>io</strong>@ts lnal v<strong>it</strong>sins B tldue <strong>ro</strong>icc./iv. cpode i! spir.l 8rd lbalmic<br />

a@s; sd pot€nrial.s <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> h.iShrn rh. Dti mi*lDtiv. .f<strong>ta</strong>l of dals6i6.<br />

Sinihrly, B vndn<strong>it</strong>u .ts po<strong>ta</strong>r<strong>io</strong>r. thc .tfet ofdiclofoac <strong>it</strong> pati@ts Oon<br />

eule lo* bdcl pair, Iindings suggdt thal "Bvilei P<strong>ro</strong>i61 ih. t@. @Is aeaiBl<br />

s@ndel dmase due to ApoptGiJ', J6., RGdr M€ra & Ja*a ( | 92}<br />

.Supplddt tj@ w<strong>it</strong>h tue ndtft of th. v<strong>it</strong>min B @Dpld-rmcly,6jmin ,<br />

viirmb [8.$b-6], sDdor v<strong>it</strong>anin [B.stb.l2]-my Edw plia ..P@iaUy @palbjc<br />

ad nueloctclclrl p.in sy!d@6', wqnr.lt (2006).<br />

- r.sjr. om.!r 3. R6at[ rbo$ rh.r lurplmt|rid pi$ @.er 3<br />

polylnsltnt d f.tty eids blt bc cffc.riE i! lh. hdrgddt of'Ell@l oienjF i.<br />

.dolMrE th.rc Dly std to bc . r.du.t<strong>io</strong>D in badlclE ttq@cy, thntie and<br />

wd<strong>it</strong>y of bsdehe drirg hol'nat w<strong>it</strong>h ftb oil !'d olivc oil," Har.l, (Gagn, Riggs,<br />

vaz, BrcM & Eail, (2002).<br />

1532. Wd€r Crre "Debyddt<strong>io</strong>n <strong>is</strong> th. pDDiry omon f6ctor md pain<br />

prcducing p<strong>ro</strong>bld of the hud body' <strong>it</strong> <strong>is</strong> diabl<strong>is</strong>h.d whd lh@ <strong>is</strong> t sw@ce of<br />

rcg<strong>io</strong>ml walqshonige in ihe hujm body sd thd <strong>is</strong> oot @ug! Aqh v.t€r'to go<br />

e@d dd wdl oui lhe toricins in th. body. ft. nd. @ding b th6e M sme lhe<br />

in

"b lr..tdml ofcht@ic Po<strong>it</strong> of thc body, sinple vala lG n€dicinal .tr d fr<br />

supd<strong>io</strong>r lo dy pain n€di@nof,. Pain n<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><strong>io</strong>t<strong>io</strong>n shDt doM th€ d<strong>is</strong>a qll of $c bodv fo!<br />

wald bui do nol o161 th€ 'fr.sh w.td shotug. in ih. <strong>it</strong><strong>ta</strong><strong>io</strong>r ofthe hodv fd watd<br />

whruth€ w.tdilt.k cd€cl lh. bsi. pain Prcdeirg deuehr ud sE thc bodv am<br />

fidrhc dsad, D@pl. .El si.I thcy dG D.hytltd.d' (B!tno8!eldji. 1987).<br />

''Mignirc @ltiry fon the dEttydr.tid <strong>is</strong> oDnon but d t@eniz.d bv n.diql<br />

pof6<strong>io</strong>nok", (BlN, 2005).<br />

H€ siat d 'Do\ ue D.dieb@ to cM tbiBl Bv dt<strong>it</strong>ling ile tielt mb<strong>it</strong>ul<strong>io</strong>n<br />

ofwald w<strong>it</strong>h soD€ add<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Celtic o HiMlltd s.! sdt add.d, lhousands hlve b'd cu'{t<br />

of.vdtding fton 66 , deinq h.an di$s., ariltr<strong>it</strong><strong>is</strong>, RSD, Bek paia aub innuc<br />

diMd@.d nuch nda Prcv<strong>io</strong>s studi6 e sppon d bv oihdr*scfiet'.<br />

1J.33. aoFncn|fr. ardcidt lom lfch<strong>it</strong>Fm.dicinefrs|Mt<strong>io</strong>.d in<br />

lh. lirddw in 581 B.c. a sdll pacdc.d in C1i6 lodav Acltude hs b@<br />

t@8Dz.d s a trahdt forladrch6, docMds $egdl lh.llh. ptE d@ e* old<br />

40000 y@ !8o, Ii <strong>is</strong> hDm that <strong>it</strong> <strong>is</strong> Bldtiallv.ldlsique fd ge<strong>it</strong>iry a siidl$,<br />

pr.fdsbly a clnMl jntolhcc€ rsl Ndou systd Th.bel points to N' @ lh$'<br />

nd. fibd @ nost 4ily apch.bl€. ExePl. moto. points, orsss, or notd Poinl!<br />

.dj@t lo nd€ @ls &d 6b6 R.!@chd h.w foud thd .<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>le 4e 'tr'ds on pin<br />

.!d rh. lddilaof elefi. ol@t 'l6$t 6 0r cfrd of barD€d @fm.d O<br />

r{apucllE n<strong>is</strong> tL. pain thr6botd Th. Ecllein <strong>is</strong> uca<strong>ta</strong>i4 borh lh' Pd and<br />

homonll s)51@ hq€ bd $846Ld a likcly h.di.<strong>io</strong>6<br />

Ch68 & Pobe RM ( l9??) $sg61!'d thd A@pudw d'lg6ia odd<br />

b€ s.dht.d by al leasl two pah relieving m4hd<strong>is</strong>, orc !e<strong>it</strong>8 lhe ddotph<strong>is</strong> svstd,<br />

which <strong>is</strong> kv6cd by naloxon€ & lh. othd b.<strong>it</strong>g thc no! adolpbjn sFrm' Prebablv

involving smlo n rnd mela*.pbdil Acupu.nE etnul.tc B Endo+hi! @<strong>ta</strong><strong>it</strong>ing<br />

n.ut6 ofih. pdiacqu€dElal gtt hstt r & $ stinulate atdogaou pain @nt<strong>ro</strong>l palh<br />

w.ys, h a ttlmd simik b rtEdtr<strong>ro</strong>u .L

stiDdatid h@ vould afrd lhe Colgi ladon dgs, !l the iEat<strong>io</strong>n ofthc supqiq<br />

trap@iw 8d rh. rihNl€ido Dadoid mwl6.<br />

't<strong>it</strong>ldiDul<strong>it</strong>ettcmlorpoiltsofth..torsdi c,rE$.tdaddrdqnu&16of<br />

t!. rhmb. Thi! h th€ ho6t wid.1y N.d of .ll @pmclw poinh ldli@laly fd<br />

aflict<strong>io</strong>ns ofih. uppq part ofthe tody, <strong>it</strong> hs s sign<strong>if</strong>i@dy latg. repres|.t<strong>io</strong>n on o€<br />

srfae of $. mbnl anq. N.€dle el€clodB 6 b. Nefi<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> bjlalBlly inlo th6.<br />

poirr!-<strong>if</strong> lb! !.d16 N lla stiDtnrtcd w<strong>it</strong>b r cumi ih.l altdndG baw@ 2 <strong>ro</strong> 8 Hz<br />

and 80 <strong>ro</strong> IOO Hz B.t! otdorphi4 ndalehlilr !d dy!.tpbj! tldPtN d b.<br />

dinul.t d *iO th. a.rrEt<strong>io</strong>r of do* '|c@ltom(E Mtial fd noduht<strong>io</strong>n of tL.<br />

G.B 20 od Lj 4 e N<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>, (r@<strong>io</strong>ndly a D..dl€ in lbe de of th€ dPhint a for<br />

tupl. GV-20 |r rh. bp of lhe sdlp fd had!ch., la$.d al rhc vsla\, d ST 8 fd<br />

tdponl had!.lE ll <strong>is</strong> sspet d dar loclt<strong>io</strong>! !t th. so oft!. patidts 6npl.i of<br />

pain h6 nft of. pl&6o valu. by wty ofnal<strong>it</strong>S th. plridt "wbqE n hdr3" nc.dl6<br />

may clso b. plac.d in d€ oncha of a.b y@' n cdld $ ph.€d and .lehi..lly<br />

stinulai.d hav. . ddonsrrable va$l c661 Fod!.ine a lowding ofblood prcBs€,<br />

slowing of pule ud . garal c.lm<strong>it</strong>e cff4t Flidirg tbe auietv <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> !!€3, th.t @ s<br />

omody ct<strong>io</strong>lo8ol fadoE ii hadach.,<br />

For th. rrato.lt ofpain b lh. fa.id r.g<strong>io</strong>t\ tEtr 3 tie@i.il Fr.l8i4<br />

aiypicd f&i!t p.in, TM, s,nnnD€, .d 00!6 th. se p.ncipld e follow.d<br />

Li 4 i! u.d bilateralM s thr! <strong>is</strong> th€ most powdftl poi<strong>it</strong> fd P.j! jn lh€ t€8<strong>io</strong>n of<br />

th. lsd. N.€dld e plac<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in 6. Conch! of ach d. Orhd ft<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>lB 4c pla.ld 3bour<br />

the lbe in a@.d wi0r rhe .E ofptin oi p.Oolory.<br />

For tstMt of poin i! ln. f.cirl Egjoi $cll a Tdgai..l loElgi{ . tyPicil<br />

f&irl pain TMJ srndMe, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dh@ ih. .d. Fincipld m follow.d. Wc w Li 4,

ihr-.lly w. s ft.d16 in ih6 @od! of€c, othd !€.d16 pla.ld in thc @ ofpar<br />

d palhology olhd poin! u..d e ST ?, Sl I9, Li 20, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ST 6<br />

sT ? <strong>is</strong> udd thc euSDatic eh i, Ao oftht @ldovl€ ofthc D<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>jbl€' in rhe<br />

hollos 6rt fils upo! opqi!8 ofdc jN; 3t<strong>is</strong>uld. hi&cle oflhc <strong>ta</strong>tpor.l .!d iDland<br />

ST8 In lhc d.pts<strong>io</strong>n b€rwd th.lF88 !d lh. tudibdu joinl w<strong>if</strong>i the<br />

mouln sligbtly op6, stinulaL h(&ch6 of th. hcid <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> tdpo<strong>ta</strong>t nFd<br />

Gv-20 Bi!.di6 oftbe eg<strong>it</strong>td li!. Yhich sthll.t i!. Stdld @ip<strong>it</strong>al lde<br />

sT- 19lr tud of th. t rrE!,.l lh. dqr*<strong>io</strong> btd., wh@ lL.muth <strong>is</strong> sliehdv<br />

op6, ninul.t. th. uicdo tenpod btw! of V and f&ial |@.<br />

ST6 Ju.t<strong>io</strong>n ofuppd 2r3 and lowd l/3 ofth€ D4dd 6scl.' at ft notor<br />

Firt stib .lc lhc gsls uiculd, f@ial, 8d t<strong>ta</strong>e<strong>ta</strong>ic rd6<br />

LI-20 N@ltbid fold v<strong>it</strong>h<strong>it</strong> rb. fold of.!.dq .1 tb. ld.l of <strong>it</strong>fqi@ .dg. ofd.<br />

nsi; stimulat6 infr. ot<strong>it</strong>d bruEh of V sti buasl bEEn ofvll.<br />

Th* points e ona u<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> bilaidauy or th€ sid€ ofthc plin or <strong>if</strong> lhtu <strong>is</strong><br />

r@ sd<strong>it</strong>iv€. Good r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>|s @ ale b. obbin d by BirSrbe optosjt f!@ d hqd 1be<br />

sriDul&ng wiE 6 b. .n&h.d b dy ond<strong>io</strong>t llr.l@<br />

'It. followi.g poinb re 6.d fd bad4h. ndaaadt D! 20 Du | 4 u 4 Li I I<br />

Sr s St ,14 GB 20 !..dld re inst d in ih. h.rdlche poi s thcv s ds b€ ustd<br />

Acupoice $dl cW for t nianjtC'tbe drnv tuil (251h Novdbd<br />

2oo2) r+on d th.t Act'pErdw <strong>is</strong> n@.ff-riw thd &uas h rcliaing dEBjsqv of<br />

PrnciplB for Trat ndl oflt<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>..hd<br />

l. scld Go@ins ?oini. Du20dEx6

Sd.dDblPtu E{&$44<br />

sd.d L.c.l P.h Accordbabtncot L.dd'<br />

s&.Ani!.fd {bihtnflEr<br />

Fardl l}.nd.<br />

Du2lYBl 6<br />

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Do ZYB 6<br />

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&SrS-ii.Srd.r.d.l<strong>it</strong>l|firFoirti!H-lrLd'A'<br />

b.dll<strong>it</strong>S<strong>it</strong>t@l<br />

h20<br />

u,1<br />

rlg? tlrB 6(|dili tuldltt

lail Poim GB 20<br />

vFdcal H€d.che<br />

Du 20<br />

Li4<br />

Ub60LiE2Du2<br />

L..d Point Du 20<br />

Uvr3& Li ll <strong>is</strong> ut d fohlFrd.id for @diprdd Sdj<strong>io</strong> 6 for<br />

iMia Ei 6 .nd nssg. <strong>is</strong> us.d for sfi<strong>it</strong>d of r€ct mNL tddos of ftligu€ cmpg<br />

Gb 34 fd d.pB<strong>io</strong>tr 4d uidy 3.d.tiw Fina Hdr ? & Ub 62 e Dsd.<br />

Sd',tun n Electical Sltulat<strong>io</strong> : StipEde Elctricd dijouLd<strong>io</strong>nofdagv<br />

poi.!. sripdctle <strong>is</strong> e ttrd€l whiclt ws ilvml.d in Fm@ *<strong>it</strong>h lbj5 insmd! w.<br />

@ !l}.1.@ thc 0ow of cEg i! ou b.dy, <strong>if</strong> ! pldat bs a Fobl@<br />

<strong>it</strong> @uld be iL<br />

reNlr ofblo*.d @agy ii die r.g<strong>io</strong>n whae $c paiq <strong>if</strong> thc ci@l.lid ofddg/ <strong>is</strong><br />

i@ff.ial *intldid b r.qdE4 <strong>if</strong>aa6/ <strong>is</strong> blod.d, d<strong>it</strong>pas<strong>io</strong>n E ds <strong>io</strong> b. &o.' th.<br />

iGtuDdtdct.silt pBi!.l@l<strong>io</strong>n of $. poi.t to be slimDhl€d. Elch point <strong>is</strong><br />

.l@ricdly n.d fo. l5-20 sdnd! to. If odSy <strong>is</strong> blet d tb. d<strong>is</strong>tdsi@ <strong>is</strong> donc<br />

Le .q4ucn!e Ld6t d4elolods @ d<strong>io</strong>d. dwi6 wiih a 780 n m<br />

v.e.ldglh &t G30 nw dd <strong>it</strong> tlsls th<strong>ro</strong>usD tlE sli! <strong>io</strong> siinul.l. lh. A@pwrd<br />

loids wnidr s s<strong>it</strong>ttcd !p <strong>io</strong> a d.?i! of! 6dndd udd th. sk<strong>is</strong> s&.q 6ch loint<br />

<strong>is</strong> tho stimuldt d foi 30{0 wav6 of ?50,000 to 1.000,<br />

Sotuperdc Soud qc rt<strong>dicd</strong> to lclplncnm ndidid sy$co G foud<br />

to bc saf€, .ffetirc md e lotdly paiDl* and have patiml acc4lbil<strong>it</strong>y,n cqui6 30'<br />

60 s ofsrimllor<strong>io</strong>n ald hs @ .ffcdjv. d.pd ofpa.nldd of68 @.

Moxilusnon: Monbs&n <strong>is</strong> lh.ldintcd dsjvat<strong>io</strong>o of the Jspd* *o.d in<br />

Mo.ge Mor4 in th<strong>is</strong> the lav6 oflh. n€dic<strong>it</strong>d nqb And<strong>it</strong>ia wlg,r<strong>it</strong> e u.d in<br />

d<strong>if</strong>fff<strong>it</strong> f

€xesiv€ qudt<strong>it</strong>i4 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> @uld allo hav€ !dv@ j<strong>it</strong>dc$@s w<strong>it</strong>h n dicir6' Hdbal<br />

M€dici6 e tl$ !rcninddy ur.d in lh. fi.ld of Fin n@8@at nm e nmba<br />

ofhatuwhi.be!5.d1068hlh.st&ie l)f.v.rfd<strong>is</strong>vayPopuldmign<strong>it</strong> hdb.l<br />

m.dy, 2)Fppdjnt ha !@ us.d d a bctd..,lE tm€dn 3) Pasim tlowa i. a<br />

cdniie l<strong>ta</strong>b ll<strong>ta</strong> 6 t6 bcf@ H .!d P|lmls sl@.!d <strong>is</strong> ds!€lia.d to h.ve dri<br />

inflaMabry and t in tilting prcpcni6.4) Ginko Bilob4 th.laf of ginlo ha k m<br />

dtrd.ly popnd hdb fd bqd!.h6 bll lhc m.di6l did@e <strong>is</strong> still d<strong>is</strong>put d Ci.lo <strong>is</strong><br />

sid !o ibpov. tlc flN ofblood ttrd glr n@ oxvsa <strong>io</strong> lb. br.<strong>it</strong>, hae mt onlv<br />

moving h€adsch€ blt imprevirg nmdt <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> d€rrnes s w.ll G<strong>it</strong>to d c$e side<br />

.f.ff a.! (Pasi6 httrid @r) s ! bjcnilc tsl'Mt Tn. do$s. lumad€d<br />

Ms6 fbm 50 na to 150 ng i. a 8@<br />

3tudy t€rdolq wd u$d tbicb b I blna bu<br />

cxt rd. Othd dogs us€d e Bay lt@I, @trcq @!yd.l<strong>is</strong>' JMai@ dog' for niSraine<br />

ard ndilsi., Klu Kav. for rs<strong>io</strong>n hada.rE d!s@ l6f for tFou h€d.cltlq<br />

val@in for h€da.he ndc <strong>ro</strong>Dc $d wdd bct.nv<br />

Rcql r.seoh6 show rhal sffein. hs dalgBic PtoP.ni4<br />

in th. neagdot<br />

of badach6. cltrci* b D &lg6ic !dj!vs! *La @bin.d wn sdhinoPho 'nd<br />

AsDirin t!d@s hadach. pain'Ttuid sd Mjst.ine Dimoid ( 1999) stldv wd<br />

@rduckd to lss lh. ue of lbupref@ plu 4ffeine in hadach4 Conlirt<strong>io</strong>n wilh<br />

eftiE ptovid $pdid u.lg6i4 Diamnd, .rd Fr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ai.L (2001)<br />

Al&n iv€ lbenDld<br />

1J35. Mutic Tbd.py. Muic hG p.in rEducing .trc.b dpincd irv6lttt<strong>io</strong>s<br />

of the D<strong>io</strong>lrric dd prin Edsins Fopdtia<br />

r.due dicty sd p.in. {S@tle4<br />

of f,cic e.tl thd nuic si8n<strong>if</strong>i6dv<br />

2OO3). Msic lhdpv k th. olinj.sl <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> .vidoe<br />

bos.d r ofnwc inlervat<strong>io</strong>B Hahbv individuols @ w baic fd tlr* ttdud<strong>io</strong>n<br />

vi! activ. nsic msljng such s dming s w.ll 6 9Niv. l,stmi4 for rclddi@'

Maic <strong>is</strong> ond widcly slpFn for pbys<strong>io</strong>l d@i*. Muic <strong>is</strong> us.d ir gdcd lpspiLb to<br />

eld&€ mood <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> d.prql<strong>io</strong>n, Rceatch ha shown th.t nwic ha fobd €fi81 on thc<br />

bodt od th. ptcl!., lh@ <strong>is</strong> . greeilg 6.ld ofhaltb .c t oM a 6uic ibalpy,<br />

whjcl, lB nusic to hal, lt ha b@ lorbd uctul ir c.'E p!ti6! child<strong>ro</strong> e<strong>it</strong>l ADD<br />

sd oIhd, il h d$ u<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in pah lmagddt 10 Mrd of dcprs<strong>io</strong> &d <strong>io</strong> pbnote<br />

mvdat ard Muic lf4rs |h. mir|d .r'd tody in Fsatul w.rs.<br />

'gEt<br />

R*arch ha shou th6t nuic w<strong>it</strong>h a st ng beat d stinolai. b6in wav6 to<br />

b syr wilh lb. let wirb rh. faid bet brilg i! 3b!rF d6lll<strong>io</strong>n rrd @G<br />

.ldt thinking, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> slowa rdpo p.miring qld, n d<strong>it</strong>ativ. n ra R€s.Nh h$ ds<br />

fo!fl| lhat th€ chaa. jn bni! w.v. ..tiv<strong>it</strong>y ldch th.t mBic @ bring a!bl6 ihe b6in<br />

to 3hin s!6d .m dily o i<strong>is</strong> oh a .c.d.d- Wlic! na<strong>ro</strong> tnlr ruic 6 brinS LeijrS<br />

bo.i<strong>is</strong> to you st t€ olnind d6 aftd yo! b!v. stopp.d l<strong>is</strong>rail8; thft e olso<br />

ch&g6 in bd$jng <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> bdr nlc, wirh altq.ri@ in br.in vrE od6 ch&a6 jr oIha<br />

body turd<strong>io</strong>n, tlrce go@.d by Ntolmic rdoE syslm, och a bqthing <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> hqll<br />

nL @ al$ b. .lt r.d by the chds6 lbar huic brinrs, th<strong>is</strong> @ m@ slowd b@llin8<br />

do*d len d. <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in rdivat<strong>io</strong>n ofrh€ Ela.t<strong>io</strong>d 6!d$, Mcic @d mBic rhalty<br />

6 euld th€ dhogiry efldts of cholic sr68. Gsdy pmoting r.ldarid md<br />

hahlr Muic s b. u$d b b,ing . mE Dos<strong>it</strong>iE slal. of mirA lo l..p d.pr*<strong>io</strong>n al|d<br />

di..iy !r bay. Mutic ha b@ found to lopd bl@d p@@ ud <strong>it</strong> <strong>is</strong> .ls @mid6.d -<br />

& idponol <strong>io</strong>ol <strong>io</strong> @ain hcdthy,<br />

Ite b.low ug @b.*{ on tdrl<strong>it</strong><strong>io</strong>n l.rd $iati6c lhdi.s,lhly h.E @l b@<br />

All fom of Dsic havc thdaFutic cfrd<strong>is</strong>, a.ddinS <strong>io</strong> chil*'s Dcdical<br />

tbory de 6v. iltmal oreu ard nBidiu ,tstds de b.lid<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> to hav. ffilordirg<br />

Duj.rl ton6, vhich @ u!.d !o doEaac hdlins.

T<strong>ta</strong>€s of mujc d<strong>if</strong>ra ir lh. iype of ndmlogiql slib .tid th€y qot ; cl.sdl<br />

huic ns b@ foud lo eEc @nfo<strong>it</strong> dd rcletj@. Muic nly acltw. ils lh@p€utic<br />

.ffcds iI prn by ddalils lh. pliD thr6tDl4 MBic bat b. u8.d wilh glid.d iDagdv to<br />

Drcdu@ alrd<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> stlt of @nrc<strong>io</strong>usd lhlt hclp uwdltiddo @ot<strong>io</strong>nl epou6 dd<br />

st<strong>it</strong>ul.td @tiv. iBighlE il ill .ts u<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in tb€ cls trd in tbe dw.lopDai of<br />

Rrdins erd ldgrl.g. shlt. Th@ tu widd.. thlr muic h., inctt@ 6Fntiv.'B lo<br />

sli depBdls, M6ic hs b6 u.d a a l@l of hdlrg s're &c<strong>io</strong>t tib6. ApF€ring<br />

ir thc miing of@ phil@plE hlhgoEn Atidod. !d Pldo, Ntt<strong>is</strong> Amat@<br />

dd olhs ildigoous epup6 hav. s<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nBic to @ho@ tnd<strong>it</strong><strong>io</strong>n.l t€.lbg y!.1i6 fd<br />

6hri6 Chi!*D.didr6 (TCM) @ nuic fo hdl<strong>it</strong>g, ft.d<strong>it</strong><strong>io</strong>nal R ga &d<br />

mlodie u.cd in .lsi6l nsic <strong>it</strong>r hdia .,i Plti5im hlvc bet us.d <strong>ro</strong> @r. d<strong>if</strong>fGr<br />

3<strong>ta</strong>l6 ofosd fq heling.<br />

lJJ6. Di.Dlngdltc BM(Itng, A l!fua of d..! latuil bd'.hin8 ir<br />

hUM, in *hich the lm$ qpsnd dE to th. lowairg of thc di.ph?gm Rthd lhm lhe<br />

dpm<strong>io</strong>r of d. ch6! Daplng<strong>ro</strong>aticb<strong>ro</strong>thins, abdomi$l b@&ine, bclly blaihins.<br />

dc.p br€tbirg d orral bElllina <strong>is</strong> d. a.l ofborbing d.., into dcs l@gs by odin8<br />

orCs diaphragn Elh6 tlb brathjna sbdlowly by fleuS ot!'s nb c!ge. Dilphragnatic<br />

br.dlfng <strong>is</strong> iriadcd b n.b you s rhe di|'hEsn @<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>y, dd6e ih. wt of<br />

bralninA by sloeirg youbElning Et ,.l..|te lhe 6tyaq dd,trd ud w ls efon<br />

&d mqgy !o b@lh. B@thjng patttu both sigld md triggd spe<strong>if</strong>c ANS dd CNS<br />

cpons tele bMrhirg .ha4ps @ ijllw.t d by bod rh. ANs .!d cNs c<strong>ro</strong>ns,<br />

Th. pmF u. of d<strong>io</strong>phragn ic bRthiry 6 h€lp @6. dt!tunct<strong>io</strong>ml @ae6cy<br />

6cs rsporu6. I1E da8oc, or'6eh or nid " r6!oM <strong>is</strong> ! valualI. @npotrst of<br />

th. wivsl of $e final rld il allows fd lh. in |'n<strong>ta</strong>@u h.iBhIai4 of tu !d<br />

srdgb nn swival udd l<strong>if</strong>. thr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.ni4 ond<strong>it</strong><strong>io</strong>Ds.

Ealy recosnil<strong>io</strong>n oflh<strong>is</strong> phoonma od the u. of@r.cl dialbra€rndi.<br />

bFtling tehniqM @ @M<strong>it</strong>arrly . Fw.rtul<br />

r@l in B6ing ney dtsfibcr<strong>io</strong>n l<br />

d<strong>ro</strong>n tic cpo's which Eia86 ad qr@!!r. nadad* Mo6r had!.he Ftiarr<br />

ould bocdl nof, l.ain8 ih6e 1e.lniqB. DilphEgtuii. bEihirg <strong>is</strong> simply uiry th.<br />

diapkaen fd bsthjng, Pali6|l rc iunw&d to w abddinil nscl* to db6e thc<br />

no\ebt ofth€ di.phr.8n. Ahdmir.l DNl. qps,rds on i.nddid <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> m<strong>ta</strong>d d<br />

€xndar<strong>io</strong>A Mdy, !q!i@b e idvtu d lo rct mE lbcc ".@sry bel6"<br />

which e sociai.d w<strong>it</strong>h ddgdcy b@lhii& includine th. uppq cb6t, ft.k dd<br />

Di+hgmllic Bathirg telDiqu<br />

Li.onyoub.ck@aflal$rfdwilhtn6bad&dyoqhsdsryon dyo!<br />

@ ue llE lnow uda yow kn6 to suppon you lecs.<br />

Plc oE lD

individuls l@<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> to niiiSde the sa6t<strong>io</strong>! of p6in by cGc<strong>io</strong>uly ol<strong>ro</strong>lli4 th.<br />

obsruc activ<strong>it</strong>y of tlE RosF.lelqid Ci!gul.t.4 d @ of thc bnin iNolv.d in pain<br />

p'lGsine- ln d@ry, n <strong>is</strong> posible for p..!1. 1o dlaide priD tlru8b tr6Df€.db&L,<br />

Dialnrrnatic bothinr <strong>is</strong> d€ of 1he di61 skills you 6 D$t6 for @tural<br />

nignirc cli.t You will likclt fel lh. !fr.(rl qlicuy sF<strong>io</strong>cirS . sming in thc<br />

btr& Dd f.d, nusl. Elur<strong>io</strong>A rln . sa. of lrsla €lD. Or. of dE nosl valubl.<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> natlEl Digmi& Elicfskills that rydy niSllin sufr@ should m$s <strong>is</strong><br />

dil'hl8Earjc h€rhing, Diu (2009).<br />

15Jz Almt Tndpy. ali@ tid.py tu l!. @ of 6stid oils dFd.r.d<br />

ton pldts w,ih th. ain of pdrning balth rld.t<strong>io</strong>n <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> feli!8 ofwdl n€ing.<br />

EMtirl oil @1aiB lh. cloe of ih. ple !t'd ha t@ u.d for c6turi6 for<br />

thdDcnic Flpos. OiL hwov&rirs p<strong>ro</strong>Fti.l rn 1e6i.. &t<strong>is</strong>epdc {d dti<br />

inodmalory wnicn {c @nndqEd lo .dd halirg od Eldatim. Althougn th@ k gpl<br />

dql of e..doral didocq O@ d<strong>is</strong>t vdt fqw o.tol studi6, Am6 Therey ce<br />

pr.vot th. o$d ofhadrd. I q 2 dFF of bv6da oil Mlh 6v. d<strong>ro</strong>F of olive oil <strong>is</strong><br />

@g.d in r circl. d Doti@ .m lh. ldpl6, h.Siid tbe @ 8nd on lbe bod( of tlc<br />

,ek. SMi€s .le i.diqtc thc .bjl<strong>it</strong>y of Ldon d@tilh <strong>io</strong> nodul.t. rh€ behav<strong>io</strong>El<br />

!.@n.l repolg <strong>ro</strong> <strong>ro</strong>jefl<strong>io</strong>! ad !.in,<br />

(Alo<strong>is</strong>j & c@eu,, 2002).<br />

Applicd<strong>io</strong>s ofhot lrd @ld fondtrli@ 10 !4. ofEe]r -<br />

2 niruld !ot, I<br />

nirut old cmprs. Hdd q?n€4 d6dd oil G bldrd to rclicF hailachc .nd<br />

1.5J8. F.lO E..lir& r.ib heling <strong>is</strong> lbe b€li.fLhrl ..lig<strong>io</strong>u ftih 6 kirS<br />

lbout haliry €id!6lhsugD Flys or ntu.13 th.t.c€rdina lo dn.mls mok a divir.<br />

pr.se srd pows towlr& @netins &<strong>is</strong>i6 .rd d<strong>is</strong>lbil<strong>it</strong>y, qcali.S ha ba Noci.Ld

MlL etgjoi, Fl<strong>it</strong>h haling n 6icd out h rligjou satiles n Nudly bl6 pl&! in r<br />

ch!rcn, Dosq@s, or in pFys goup meeting ul<strong>it</strong>. otns f(ms of bolins, tub 4<br />

thoaFrtic louct <strong>it</strong> <strong>is</strong> off6 eEcd ou1 a1 . d<strong>is</strong>r&a .!d n<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> mt iDvolle, tou.,h d cl@<br />

1.5J9. Pny.i Pra<strong>ta</strong> dy be defi!.d $ o a.-1 cslirg fd $delhing while<br />

ainins <strong>ro</strong> @D.d *ilh God tr sollld objer ofwdship. Pnine for th€ sick d ding<br />

ha ba . o@n plrdte lhmughout b<strong>is</strong>to.y- P6plc nay p6y fd lh@dv6 or for<br />

olb6 "lntd*sery F!ye" rd6 lo p6y6 $id or b€t!.lfofpopl. pho @ ill or ir<br />

n..4 inrEM b.y hsE sFcinc obj€ciiv6 d tuy e<strong>is</strong>h fo.86otl w.I bcirg, d<br />

inprev<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> hallh. lnidq$ry p6yd my bc pdf@€d tn . d<strong>is</strong>te@. Cld5,, spir<strong>it</strong>url<br />

hsl6 d $dn<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> by th.n Eletiw il.rnut<strong>io</strong>c to {t&* lh. slinod .rd dodoDal<br />

nc€ds ofFhysic.l <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> m€nid p3tiats ihen fdil<strong>is</strong> a lov.d 06.<br />

II t63 bq su88at.d, tbar D.tia|3 who pEy.d lbr ilEelves d @<br />

aw thd olhm e pnyirg for thd, nay da.lop sfdSd 6ping skills dd d..E<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

didy, which my iDprcw hald! me p@pl. bel<strong>is</strong>. rh.l prayd ha b@.6ci.l .feI<br />

on ilt imue 6t!il ndous syrtd or q.d<strong>io</strong>vrsns or hmotr.t stsld. Rqarch<br />

s8s6ll th3l in pmr int€t1:€$ry pnt6 tuy r.due pdtr frtS!., tod6Fs! swcUi4<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> wek'd!. fi'ft s€ spei.l Ayols dd osuy fd plin (App..dix B). 0r padots @<br />

6k€d to dilc tullowinS alal I I Iin6 for had!cl'. (Speidly Mj€r.in.).<br />

?>tbL/LtI<br />

-.h L, *L :r "A i ah Di i i 1, J't ir -c/ L,1 L d./t 4<br />

'avF-"L'1<br />

!4r drn,1l jj,,il t.{tJ.j Jjp<br />

Th. s<strong>io</strong>lic .pptu .h *hich allows ! d<strong>if</strong>tml onc?nl.liat<strong>io</strong>n of 0e srurw<br />

ari naing of lair in th€ pali€nfs lila For 0'€ palidl .ppr.r m@irgle6s<br />

@st<strong>it</strong>ut6 on€ of lbc tighIairg npets of syEfloo, (Cruldm, l9E6)- lrri@G n6d to

find lon€ n@ing for tbe stbplon, A thalpddc .n<strong>it</strong>ud. tbal BbB hope by<br />

i.6asin8 a palials f€eling ofb€iig h6d dd sddtood cm thls be imtdl.d. Finally<br />

lh. job ofthe thdpin h b (let ihe houbl€d 3ool uburd@ dl rh. grip4).<br />

Ir tbe noasdat ofchMic hctdlchc & .ppmach that lddrsd th.<br />

ni@@ti!.' s e.I 6 moi<strong>io</strong>r.l .od F rhologicd @nporals ofihe clsnic plin<br />

dFi6e <strong>is</strong>6 of g.rd.ry eli$ 6neci.l copoeI<strong>io</strong>$ tire out tob *o* &d<br />

othd oFst rcinfoc d v.ll s <strong>ro</strong>.tun, Hy Ddr'ei.s, nu$le straelb@ilg ad<br />

othd n@ phy$oloSrc Be.h&iM ofpdr. Hary dPba<strong>is</strong> upon E€duet<strong>io</strong> of<br />

pri6t's c<strong>ro</strong>nsibil<strong>it</strong>y <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> actvc physicd r.llontlo a td's ofr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>uorg p|lr6l3 irpul<br />

q v.ll a rh.ir Fycholosi@l srng<strong>io</strong>hs. Patid<strong>is</strong> e raughl th. mphrs<strong>io</strong>logy <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

.tu6.<strong>ro</strong>by of pain in sinpl€ ffi. Al .ll tim6 Dcw<strong>io</strong>4 sppon @ntonlat<strong>io</strong>o<br />

drugr <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> 6cn cfr€

It. mour ad trTe of pdn D.diqr<strong>io</strong>r Nsc <strong>is</strong> mth6 b.v<strong>io</strong>nl !!Ee of<br />

pai. tnd <strong>is</strong> n q6tly r€porre4 t dds slould include thc m<strong>if</strong>lig@ Ng. F dry, od<br />

th€ spe<strong>if</strong>ic AF ofpdliativ€ {kug pEqibcd d l.i.d S.be ofth. Eosl wtul<br />

ilfomai<strong>io</strong>n r.s$dine p.in b.bavi@ @ b. @ll@r.d by dirEt obw.ti@ by oth6.<br />

R.ting shcl! @ bc us€d: th€ *lfftrdr ofpain b.$.vim @ d$ b€ ollaLd.<br />

ftc 6ml cFG. stst n <strong>is</strong> phys<strong>io</strong>lori..l mG.sW of hdt nlc mugl&<br />

8tiviry, 'r.rinr<strong>io</strong>tr !d oths 6DoIB brw ba $.d b 6r<strong>io</strong>ar. ldomic mLql<br />

.nd D.ir le<strong>it</strong>y na5@ h.v. rdi.d uD@ p.!@f. ddqipl<strong>io</strong>n oflh. saldy<br />

phys<strong>io</strong>logiql sp.qs ofth€n p!i! int@<strong>it</strong>y, ey rloqhts b€liefs d ibag6 pat<strong>io</strong>!, h|v.<br />

th.t tri8gn or .ggrsEl€ tb. pain, (Mel4k, 1983), Inttu<strong>it</strong>y ncase tu Nu.lly 3iDpl.<br />

nudicndng*al6of sub.j<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>iv.Dibi .tu<strong>it</strong>y,Th.t npoEldpelloft!€!.li4t'3<br />

Dair slbuld b. r,ss€d for ftqudcy !d dE don. lo.rli@ peud6 of lh. pl<strong>it</strong>r N<br />

al56 @[et3 by h.virg lh. Fliaf sh!d.lh! loc{do ofrbc plin @ th! tul ald 0E b&t<br />

of h!fu nsB. d by sinply ty d.sdibing sh@ rh. afr€Ld @ <strong>is</strong> l@tc4 fimlly<br />

th. m.a!@ ofp.i, qual<strong>it</strong>y <strong>is</strong> ohlain d by Bting prli.r s to d€.dib. lh.<strong>it</strong> p.i! siiS<br />

words such $ bhi!9, sLbbiry ald c@ping,<br />

Onc ofthe nost inponot agels of th. nod<strong>io</strong>dl &alys<strong>is</strong> defining u.<br />

Elat<strong>io</strong>nsl p bw6 th. dac.iba<strong>io</strong>r ofp.in od vsou osn<strong>it</strong>ive, b.hav<strong>io</strong>El<br />

lhjs<strong>io</strong>logicd omdon l dd dtl!|@o1'l n<strong>io</strong>uli. coirire siiDuli @ ilchdc &y<br />

$ouer$ bdic8 or imes prti@t! my h.!. th.i t iSgq d lgsnv.rc dEir Fin n!r.. Ihc<br />

clinicid lhould .xplore Dot€nti.l @gn<strong>it</strong>iv. dtc.dals, Th. n xt .sret ofth.<br />

4slsal strrt sy rnodd be a f(fu on ficr6 that b.lp rcduce lh. palial\ rda<strong>it</strong>y-lh.<br />

clinicim !h@ld dmjre oertrt<strong>io</strong>! od dk<strong>io</strong>n<strong>io</strong>D. Coping t!.t ile !.en may cngigc <strong>io</strong><br />

l6s th. pai.. lh6e include *lf stltdDoq iSrdirg th. paia Einldprding O. paiA

Alti d9r€o. odidi@ e tlqEdy 'rlizcd $ e .id !o ni* piirdfs<br />

rubjcrriv! drr.l<strong>io</strong>ld <strong>ro</strong> F<strong>io</strong>. R..<strong>ro</strong>r. dc.r vd.c tull6 cycl6 <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> D&€ Fli6l, ffi<br />

e@blc <strong>ro</strong> olld Uaqoric iD<strong>ta</strong>v.di@n .rrDiidd .rd rlr(lolo8icd i3og ...d lo<br />

Mrii.l @uE lirg ir t qEdy wy i! nc <strong>it</strong> lilg ocw ilts!(i<strong>io</strong>od<br />

Ftlaa b.rqq lpo|c !n toDily t!6ba TlF tDonr.'. iMlvqEt <strong>it</strong> @[ilald<br />

<strong>io</strong>Flrrd in ldptug to .lls nrl d,griE i.tsrrid p.naD bva 4oos .!d bily<br />

!@Dq! r<strong>ro</strong>sEic Erilils i! dlo h.lDfd.<br />

nF 4p!cd<strong>io</strong>! of pry.loloriel @dud. to cb!6i. txi! dildtlq i! lilpL .d<br />

&.idft.w..d. M{y l.(rDhE od tlaryy h.w D.(n u.nd in rL <strong>ta</strong>M of<br />

It-d!.ld dd Fi!, ltd E nypc4 S<strong>ro</strong>rp i[E py n40ontvlqFaiE lhd.py.ouic<br />

tb-.py &d .dft lp Ddairb, 0...4 T|!g Ct4or & B!da, 200(,) & (w.n &<br />

M.la.lq 199). Mrly of ttc coiliwD.5.v<strong>io</strong>.Oapy c.B.r t.rbhB 0!. e u.d<br />

h d.fls<strong>io</strong> Dr!. .rd Di..y !! u..d in Fin .d h6dt rlE. Tt@ G bdidly fou<br />

n r. iD rh. tt@gdan olhrjc Fi! dilodar &d <strong>ta</strong>d.da S&? I .dldi<strong>io</strong>n<br />

@!tE!i.srlb.jd.lr6ic Fin <strong>dicd</strong>.d b.fd!&y clilidotc8id !t .tiig d<br />

larilg dMic FiD d<strong>io</strong>daa !. ltFuld tE .cquini.d e<strong>it</strong>l . Llic 'dadatiDe of<br />

3ltlt ryidMo All hadrrF F <strong>io</strong>& El by . pydDlogii nuli b. nldiqtly cla&d<br />

.!d @uutdi6 wilh.FiDry E didl prlvidtlbrelglou Uc cout*ofoatbdr <strong>if</strong><br />

ne.3rdt &d dw.y! etul. SLp I $. c.li!i6l i.<strong>ta</strong>vile. Good .lini6l ac@.d i!<br />

tG Lcy nloc ofSpod <strong>ta</strong>nbal <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> qi., th. butLlid oft!. D.t lologiql seoot<br />

i! 6. clin<strong>io</strong>l intdvia. TIF cliDicilD @id&l!d r p.in inldid slnld nor diE6.d<br />

ey Frllirtic d Fydologiql fi.td ulil h. L! fln oh.ir.d .I d.L rlSadirg tt<br />

Fin Fobl€n, bo ona p.in Ft'Etr bdi4 tLl trt Fy.lolo8in vi4! ilcnp.i! B'dl<br />

in rh.bad".rd brallyi atdcd i! Fy.lologic|l Fobld!, @t dd! Fia 5& will

da bair pnd<strong>it</strong><strong>io</strong>nd i! s .tt6lpr <strong>ro</strong> 8d thd <strong>io</strong> p|qurwly fdu on psyclotogel<br />

fa.tors, ir a wly <strong>ro</strong> rcinfoE rh<strong>is</strong> ftt* pq..pri@ of dErpy ld.dlG 4d !'!63ine.<br />

If pB€d by a p.iiai lo d<strong>is</strong>.s p3ychologicll <strong>is</strong>su.s, pm.tucly 'l rally do vmi <strong>ro</strong><br />

d<strong>is</strong>N th,l, dd I p'mi* yd ibt wc will gcl <strong>io</strong> ilt<strong>is</strong> i$e hrd on in ih. jl<strong>ta</strong>via. Bln<br />

6r* I rc€d to nddrdd yow pain 6 b.si s I posibly @, Tb. qucst<strong>io</strong>s t pr.cl<strong>it</strong><strong>io</strong>ra<br />

shod.t ask ab.ut had p.in & fos on d.enpt<strong>io</strong> loet<strong>io</strong>t\ <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> 6rn omtme of th€<br />

pain, Any phtscal or psycholog<strong>io</strong>l 4dt! ocMing aoud pain otrti<br />

frequdcy/irtos<strong>it</strong>y dtlali@j wbat h.k6 O. p.in b.iid/woe; uecialql sydptms<br />

Fd<strong>io</strong>B<br />

pain rrdtr<strong>io</strong>ll, (Bldcr8d &,A. ailq 1985). o!'. ofoE ltin$ a.linicid<br />

should srrivc for in dy int rvid b lhc gol&n Fd whd p.li6<strong>is</strong> @ cn@t€.irng<br />

ll€n pain on€ stould tB l@hDg fot thoe wbo odidly .td &ur<strong>io</strong>lly dffiibe lben<br />

pl<strong>it</strong>r (in ! cl6ic.l hrsldic cpolE) s wll d individu.k *Do rry <strong>ro</strong> "bn6h oF plin or<br />

<strong>ta</strong>l( lbou <strong>it</strong> d<strong>is</strong>pss<strong>io</strong>dely, B <strong>if</strong> 0Ey w@ d<strong>is</strong>ing th. walbd 0j b.llc iDd<strong>if</strong>@)<br />

individuk *no mllra offidly .t!r." ir'. t b.d p.ir" d qtF tlo.idly sttt 'ils 1ft.<br />

Ajd6 w.b ofpaia a Ftr de. I f.cl lil. my bFi! ir h big for Dy shll or ir <strong>is</strong><br />

i*<strong>is</strong>dng ny tnin lnsug! ny .y. hdl. Or lilcly <strong>io</strong> b. poor Eqtnol Bpond6 wh@<br />

dtins .bour f.mily ndb6 BpoD. wha prtidls e i! pai! w€ hust find iho*<br />

indivjduals in li. eysh who doL scesiv.ly on thc p.tidt! 6 well a individuls vho<br />

@i!.lly iry to pu<strong>is</strong>h lh. palial3 for th.ir p.in, G@d lr<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ndi outcon. e<strong>is</strong>, wh@<br />

fuili€s pr6di thdlelve v<strong>it</strong>h r@nsbl. mouni of @rcd rcgdding i!. palimls<br />

well being <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> dlow the pat<strong>io</strong>tr lo Frtor a tuy of rulin€ l<strong>if</strong>e t sk 6 possible lt <strong>is</strong><br />

al$ inporidt 10 tollow up oD r.npoEl rclat<strong>io</strong>Nhip b.tw@ . pltidt's pain dd tr.ma<br />

It <strong>is</strong> <strong>io</strong>Fnd b inquiF lbout egd d.trd<strong>io</strong>n <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> di.ty llt* e tbe mot<strong>io</strong>s<br />

ih n{E ba inplicir€d in 6sin8 &d b.i .idts p.i! lEly all pain <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> hadac!6<br />

psrids ft€d to !e trai.d fm @. d DN of th6c @!d<strong>it</strong>iG. Th€ !$r najdily of

h.!dach. p.li@ts h.v. a m.jm dcpGs<strong>io</strong>n or dysthnia diae<strong>ro</strong>s<strong>is</strong>; ney patidt! h!rc<br />

addil<strong>io</strong>nsl p6ychiatric diag<strong>ro</strong>s<strong>is</strong> Ncb $ agonphobi4 peiic d<strong>is</strong>o.do, PTSD ard sbstr.a<br />

abus. Dilen6ine a headlch€ <strong>is</strong> likc pl.yinS twmty q!€!t<strong>io</strong>s. Eipdts aec thst .<br />

d.iliLd qu6tim dd mw s<strong>io</strong>n e<strong>it</strong>h . pali@t 6 ona p<strong>ro</strong>dre @oud infml<strong>io</strong>!<br />

ftr di.gD6<strong>is</strong> tuy 9T6 of badndB h!v. cld ot s)@pims wnich fal in lo oily<br />

|€sdzrbl. p.tt@ .plliars Day t 4t.d; Hoe ond

atndt b.gi6 wii! €d@ting rh. cli6i about th. mture of MgEin€ &d swing thm<br />

thd il<strong>is</strong> <strong>is</strong> a b<strong>io</strong>logi.al dtord€r €au!.d by alt ..d bE. chd<strong>is</strong>ry *ilh Mondlry<br />

$<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>d ch&96, <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> usually a h.r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>il.ty !tr dkr@<strong>it</strong><strong>io</strong>E S.Daina n b h.lpirl to hrv.<br />

th. spoe F@l and qplain lo lb. oupl. thlt H<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>rcne a.d Mignin ir pali@la,<br />

@ ono povotcd by botutrsl cle86, cqlrin fo.ds rigeEs5 d<strong>is</strong>ing lEli iEgula<br />

sl..p prrrcnll' T6vel d sre<strong>if</strong>c lirl<strong>is</strong> ,ac€ov. Do<strong>is</strong>c cielr.rle tuking, @tl<strong>it</strong>r<br />

FtuEd o. @.[s, or olh6 stimli bly .d a ni!96 ,SoE. D.di€l<strong>io</strong>s. Both ov6 ti.<br />

@uia ald pBdipt<strong>io</strong>r ilruss tu prdipi|r. h€dacha<br />

A bnef b6td slatN dDiBt<strong>io</strong>n mli b. t.k6 wdy clilicie hu ston6 of<br />

individu<strong>is</strong> who sffi <strong>ro</strong> h€ fibcl<strong>io</strong>ning w<strong>it</strong>hin mDol lini<strong>is</strong>, dtil th€ v6y ad ofth.<br />

int@i*, wh6 '€sFdira lo r qudl<strong>io</strong>n $.:h $ ".lo tou hlE ey q€ial pow.r?<br />

'R.portcd lbar thcy'oe tIE M to r<strong>is</strong> ddy hding nld *t d.ry @ing" nndly<br />

oic penla pl.!m@ dEt ()m wilh Fin p{ri6t! rnd scd to b. a .lini6l pr.dicrd<br />

of D@r GF.e b r.erndl <strong>is</strong> lhc Dlsjc of a "Mytning wo d b. pqfcr in ny<br />

l<strong>if</strong>. <strong>if</strong> I did <strong>ro</strong>t have th<strong>is</strong> &ft p!in" an<strong>it</strong>u& duing ih. iltdvid- suc! individuals doy<br />

sy patr prcblms aoin8 or th.n f<strong>if</strong>.; r.pon no nsilg€ or ohil&m prcblm. If the<br />

paf<strong>io</strong>ls have had pM Ior or s s'r honth!, such do.l 6 @vhne !p sou<br />

psychopalhology. St€p 3 th@ m lMy inrtrum€nld th8t the nd<strong>ta</strong>l h€alth p<strong>ro</strong>f*<strong>io</strong>nal<br />

d e to Gd b<strong>is</strong> or ho p6in paiia<strong>is</strong> p@ml<strong>it</strong>y ql@t€rttig dd 6g!<strong>it</strong>jv. flcloB,<br />

suh s pljn b€li.fr ond 6ping 3tyl6, MMPI 2 b ona u!€d. St@ 4 bls€d or oDtrDl<br />

GeFh t!@ relhe baicptcrDlogtcil i d@l<strong>io</strong>$ for clbric pain Dd h@d!c!.<br />

{lnin<strong>is</strong><strong>ta</strong>ld ir dlpll<strong>io</strong>i ba<strong>is</strong>; @8!<strong>it</strong>iE b.bv<strong>io</strong>r tlkdlx rcla:.li@ thfrpy or b<strong>io</strong><br />

fcd bact oi a @bbi@r<strong>io</strong>n of tbmal b<strong>io</strong> f.cdba* .rd clM<strong>io</strong>r. Irsqy <strong>is</strong> .e.d.d fo.<br />

Cohbir<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> MiSnire, Tm<strong>io</strong> hadrch. od thr p.l'ot! who @ sig.<strong>if</strong>i@dy deprEs.d,<br />

do p@.ly wilh h<strong>io</strong> fegl h.cl m rclaat<strong>io</strong>o alonc, Son. Iom of C.B,T ain€d al

d@ing tbc !.qEle of tL Filn prB<strong>io</strong>a suiay ltd .4rt llr Eey p.i! Fl<strong>io</strong>l<br />

dFiqFpdor to or coelffir b<strong>io</strong> f..d Dod d rdel<strong>io</strong>d i!la6ti6. I a!6dm<br />

*!qld b.not ha.ficid to 0@ p.ti.di' eho c !ii6d{y dqra..d B<strong>io</strong> ft.dh.d<br />

tu ! vry ur.tul djuadiw 0t6.py-lhc Doi rx.incl .L{!ilid ofb<strong>io</strong> f..dbrd i!<br />

Fovidcd by Ol<strong>io</strong>n & N@b€g ( l9E0), oy !*lniqE thid iFa!.. rh. dil<strong>it</strong>y of !<br />

Fsn <strong>io</strong> @ntd slut tily Dbr<strong>io</strong>losicd ..dviri.t by Fovidins hfomdi@ $ou tld.<br />

!.tiviri6. I inslvB lh. E of r D..!ie wbich doe! . 6atpid lo Dd<strong>it</strong>d lb. p|ti@!<br />

todily EqolE 8sF.lly<br />

EMG (rrna rel.lo!i@) d stftp. 3tin t@F.te<br />

h&drt<strong>io</strong> o|t@!i!g tb. p.liat! thyl<strong>io</strong>loSicd E pds whtd at lb6 Erryd b.d<br />

to {E Fti6! lsEdly .<strong>it</strong>ha tlnougb .l .d<strong>io</strong>rr Ddd<strong>it</strong>r (r <strong>ta</strong>* elti.h 8oG hiShd d<br />

low d.radi.8 06 {y no!.L !a.id SoinS hiSld q loE .!d d . v<strong>is</strong>ud Dodd<strong>it</strong>v<br />

mw uu.lty | @!pn-loa fd qdpl. &d@ *i! t@Frr@ i! Fphd d.<br />

!@id !y 3@!d bai! duils a[ FiD!lG). 'Dmus! th! ibyl<strong>io</strong>losicd f..db..r. i!<br />

l'.'p.d ttd ! Fliar<br />

will b. $lc <strong>io</strong> lqn lFw 10 conlol hj! d ha bodily r..Eon €.<br />

tDugh IEul t!€a B<strong>io</strong> fc.dbr.L Ga.cidly lppaB b hold F@i& s . cliniqlly<br />

ulcftl tclliqE i! th. <strong>ta</strong>t<strong>ro</strong>t ofiEdxr!. .!d Fi!,<br />

ODaiDd clidol inl<strong>ro</strong>vqFl i.<br />

obnilcd wha . b<strong>io</strong> f..dhcl <strong>is</strong> $d *nhin O. @ld of . mFd@ivq DuIi<br />

dieipliidy p.in ne!€dort Fognm. TlE onuhliE wigl|t of !t!. cvid.t . 5!88rsc<br />

rh.t EMC b,o f..db.d. t liLly to b. h.bnd 3 . i<strong>io</strong>dc 6dpt i! ih. tEhatl of<br />

nu.otd 3tcldri 1ry6 h.l F<strong>it</strong>r. Ndl, mPr.lBiw D'nd di*iPlindt p.in clini6<br />

i@rFr.tc o8niriw t.l)eid tldryy wilh ciilq Flulid or b<strong>io</strong> li.d b.cl w<strong>it</strong>b<br />

hadlclE p.riar!, Cogl<strong>it</strong>ivc bdrviG rhqr9y <strong>is</strong> rqy enn *nh P.in Prlictt<br />

qmi..ti@ of Dd.d+li€ !.lf lrtrdan It <strong>is</strong> d$ u!.fu <strong>ro</strong> dmie p.lial'! bdi.n<br />

M.fring lctiv<strong>it</strong>y l4d, lt D.!ir of p.ir nd.gaFt &d la[Gtt plM<strong>it</strong>g <strong>is</strong> !<br />

tuad<strong>io</strong>Dd Drlyri Thtu inclld6 t da.ild @.lu.t<strong>io</strong> ofoE f.i! oopl.<strong>io</strong>t !d!€$

ogn<strong>it</strong>ivc, b.hrv<strong>io</strong>El .nd phyr<strong>io</strong>logiel tlspon!. dii6<strong>io</strong>4 ihe ass6sot of th.<br />

p6tial'r @gn<strong>it</strong><strong>io</strong>N irvolv.d o orlyrir of in o8liliE @B ard s.lf lrllsnh<strong>is</strong>.<br />

co<strong>it</strong>iE .t@ Ffq 1o DaladapriE !.nd of0inlira tnat e u'stirrjc <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

d<strong>is</strong>bn€d. TlEy e llsu€d to be @sdly rcl.r.d to rb. mint@d@ &d d@rb!ti@ of<br />

lbe plin conDlsirr sd cd intsfft w<strong>it</strong>h tqnDot. S.lf slardats l<strong>it</strong>! (pain h<br />

c<strong>is</strong>hrdiig or n hui! <strong>ro</strong> bad) slfsrrrqrars @ inrd l didoc!€s, thcy d<strong>it</strong>ra ton<br />

og.<strong>it</strong>ivc ffi ir lbn tbey b!E@t ba.n lyrld to r.aftst s@ Eddli!8t li.f<br />

syn@ 6 flulty losic, $cb a 0 will t|cE b. !Dl. to oloab. ln<strong>is</strong> Ftrbl@) rh.<br />

tberp<strong>is</strong>r nBi .l$ l@t fd di.holomu thinbng a |my potial3 b.lie $.1 <strong>if</strong> the at<br />

a hjd 9.in l.vcl $cy should be in bcd od mt pafomirg ey activ<strong>it</strong>i6 .nd <strong>if</strong> thfr e<br />

al low par ld.h &d ! f.€ling gm4 ln.y slbuld tunct<strong>io</strong>n 6 <strong>if</strong> tbey had b6 p.in &e,<br />

hdpin sbould @nily mine pGsiblc !4 of srr6s in a !rli@t's l<strong>if</strong>c, Rdy or the<br />

gdial's subjcriv. <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> id<strong>io</strong>slmlic dFiae tb. clinidie slodd irqliG .bout<br />

relig<strong>io</strong>u b.li.f!- Mery plin pdidttcliefn i! a pMidmol nm tu fd sn d lnar<br />

rhey hav. doN, or rh.r prarq .lonc shoutd b. $ffidot <strong>io</strong> .liDinal. lh.n pair olhd sil<br />

retod thot th.y h.v. prsy€d <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> thc loin m.iB ald Dding th€y hav. a la.l of f!iu,<br />

<strong>if</strong> scn bdi.f6 e h.ld by pat<strong>io</strong>ls 6d rh. th@<strong>is</strong>t <strong>is</strong> dd<strong>it</strong>er I.' d<strong>is</strong>r Air<strong>it</strong>ual i$ws<br />

<strong>ro</strong> &y gral .ndt h. r€qud rh.i th. Ddtiat s hk tcrn<br />

l Eli8<strong>io</strong>u halor for !<br />

slinrud Fslanivc. Tbcihslp<strong>is</strong>rbw n thc &ga,lb. d.p'w<strong>io</strong>.rd $. didy<br />

trt @4<strong>is</strong>t p<strong>it</strong>h .hrcnic pain th! p...l<strong>it</strong><strong>io</strong>M DNt .ls aat mE timc w<strong>if</strong>i ! b.havidEl<br />

c@po!@|. On. of$e tsycrDbsilt prinary job <strong>is</strong> lo notivat€ the badachc !3iidi lo<br />

r<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>!@ $.n i!ol.n6, b.ein to inIflct wiih olhh one agdi4 dd ino6. ilc momt of<br />

pl6Ea!1. d6ll in rh.ir l<strong>if</strong>e tur dbpl. v<strong>is</strong> a Aidil lb.y !rv. mt v<strong>is</strong><strong>it</strong> d 80 fo. s<br />

ie c|@ <strong>it</strong>d thcy ajoy. ftebult of thdpy l<strong>it</strong>. &y job b t d<strong>io</strong>s job (h.r inrclc jusr<br />

fllira in rh. blark, .!d dat!.Iy 3dlilg dE ns!1 hfomalol! ph@ &. ndlt uy, to

the p&tidr fte thalp<strong>is</strong>r D!.t t lch thc paiidi to bEat 1!. pdn d@Ki@ cyclo To<br />

in(fu lbc dMr of tun in h<strong>is</strong> l<strong>if</strong>. c.g. v<strong>is</strong>ii rcr<strong>ta</strong>wrnilNs th€ losibil<strong>it</strong>y<br />

of doing<br />

voluLry wort <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in tbe dd in@rpont<strong>io</strong>n ofd<strong>it</strong>rG@l tldpdtic i6luiqu6 slil<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> to<br />

the cliab nc€d. A[ trdtbdt3 h!v. to b. individually tllorld th@ @ no bl.nkel<br />

RaSr<strong>it</strong><strong>io</strong>n thal per <strong>is</strong> a cohpl€x, trMphyt<strong>io</strong>logic b.h.v<strong>io</strong>nl dd a<br />

pslrbologidl ph@omo. hB ld 1o lh. dd.loprndl of iMvativ. t@lD@l Pr&8.<br />

prcge. T1'6. ttu8rMr .hG orc omplq MPt<strong>io</strong>tr If p.<strong>it</strong> i, mpld, lha .<br />

mbirarjon of rratbdr r..hniqc b n..dcd !o s@.nnly Ear paddts, b.bvid<br />

rhalpy mdl<strong>ro</strong>dr e tujor @nponots of norl of dE hult<strong>it</strong>od.l prc8tlG.<br />

lJ1). Il.rdoti.npy. Phma@thqrpy of MiSrltc My b. dividcd <strong>it</strong><strong>io</strong><br />

rbE typ6, | ) T<strong>ta</strong>lDar w<strong>it</strong>h no 3De<strong>if</strong>ic A!d8€ic, 2) Aon. 6& <strong>ta</strong>h6t *ilh ihgs<br />

lnrr hrrc sFj6.d ttmMlogic i6n<strong>it</strong>y b biid !o ei.ir Foldin r6.tt6 8rd .l<strong>ta</strong><br />

i[€ naft ddid: inflaM.lo.y !d vtslr plr'@ of M<strong>is</strong>ninc .rd 3) ft. dlily e<br />

of pF@tiE m€diet<strong>io</strong>u.<br />

Comotr @lg6i6 sd a !spirn!. Ac.asjmpld d NSAIDS (Nllqa<br />

Sodiu) ond previdB rclicflo p.t<strong>io</strong>u p<strong>it</strong>h B'gn<strong>it</strong> h..da.l'6, dtdially <strong>if</strong>L<strong>ta</strong><br />

aly in rhc on c*. hc.drin cxtrr stragth sd3 10 be suF<strong>io</strong>r in t .lting nild lo<br />

noddte MieFir. bad&Dd, NSAIDT CoDbimt<strong>io</strong>n an lg6i6 such 6 Midrin, F<strong>io</strong>ret<br />

ard F<strong>io</strong>rinsl, als hav€ bdeficial mli. in migr.irs <strong>if</strong> tdd .dly ,Tha. @4Fuds<br />

lare the lototial <strong>ro</strong> qus. srlSdic <strong>ro</strong>boqnd <strong>if</strong>latd l@ oltd. su.b s m@ il& iiue<br />

tjn€s . day bul rh.y 6 b€ vdy holptul <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> e !6f. lo late for Milrainc atlacls lbat<br />

ocd$Gor fouiim$ ano h, Ardg6ic rcboud k morc lik€ly relat<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> b n q@t<br />

dosine oI lha. druS!, <strong>ro</strong>tha thd to th. totd nmbd ofdosB tttlt may b. trLa sally in

1.5.41. NSAIDS: Th.y e ihc fBt lin tr. Eldt choie fd 3I DiSni!.<br />

atlcls, including sd@ !tt!.ts thai }avc 6pond.d !o NSAIDS in ibe pdl done th6.<br />

most @B<strong>is</strong>tot did.G di* fd dpin!, ibuPrcfdr na}rcx@ sodim, tolf@ic eid<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ih. €bbiEtim asE scamimpha @id Dd th. cmbird<strong>io</strong>D ag@t @idilopbo<br />

plu apfi4 plN dfreine fd 0E @la ha[n@l of bjSEiE, TratJ!@t of @i.<br />

nigni* srr..]( *s l@htidizcd h 1993 w<strong>it</strong>lt $. irftd!.r<strong>io</strong>. of Smrlripl[s<br />

Zoln<strong>it</strong>riptrE, Nr.bipl4 ad Riatripl4 Ddihydf<strong>ta</strong>8oidie bd bs avril.bl.<br />

3i!e1945 a e inj4r<strong>io</strong>r .a ndd sFay ws intidu€d in l9? .oI ln* iltuS! N<br />

.fl*liv. b@e of lh.n sp6i6c Dlm.ologic atrnjty 10 bind lo cdlain m<strong>io</strong>lin (5lI<br />

@.lor and i.tmpt the M chdi.d ,innmmalory<br />

and vlsld cheg.6 $at ocs<br />

in nigd<strong>if</strong>t I!* diuC! e @i..i!di€i.d h pllidL tlkjng MAcbnibilon.<br />

Pmtiw b.diqt<strong>io</strong>B D.y bc <strong>ta</strong>l@ dlny by p.doa who $frd E qDdt stE Ls (c.8.<br />

lhie d fou) d n@ d lhd. *to bae. di$blcd fd 48<strong>io</strong> 72 [oG dd on@ d M@<br />

! m<strong>it</strong>h- o' y th. p.dot @ .LdaDnE <strong>if</strong> h. w<strong>is</strong>lE <strong>ro</strong> |,il. dailt Fqs<br />

ive b.dicar<strong>io</strong><br />

o Sfr<strong>ro</strong>rir a€ontsrs (tripld). ftd tu gmd did.@ for lne .f€dir4jB oftriprlr.,<br />

nErripres, nzEipt{L satdpte ..d @lrn<strong>it</strong>rjpt n. Irr@ d€ b@.f<strong>it</strong> of traling<br />

higlily d<strong>is</strong>bl<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> nienine patimi w<strong>it</strong>h alni fjpt tu while pain <strong>is</strong> nild, (KaPpBl, Lu@,<br />

1.5.42. Drgotrmird: Itrc <strong>is</strong> good didae fo. lh€ e66f <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> ef.ty of<br />

inF. sl dihyr!rc orddinc (DHE) a !!)@lha.py fq !c!te nienin afi*L<br />

1.5.43. Op<strong>io</strong>ds: Op<strong>io</strong>d. e Bood D.lg6i6 bm tlt@ n aidor ody fo. tt.<br />

.f<strong>is</strong>cy ofbutorph@l n.sal srny. oltd Ag@i' fd lh. $lorrnoN dd int!.a$l<br />

lmar<strong>if</strong>lm for palials ofdus and wmiliiS triples e oftlindicat€d <strong>it</strong> pti@ts<br />

wirh rtk. F&r .vidff $8ig€s<strong>is</strong> thlt alidctic mctoclopmid€; givo iltrav@oNly

@y b! s lpFlFilr€ cboi@ s momtb@py fd @le anack p3ni@laly in Plt<strong>io</strong>ts<br />

w<strong>it</strong>h Bug <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> v@iliD8.<br />

't.6. C<strong>ro</strong>@ otfr.tb.,u.<br />

Sire pltiar r8pds <strong>ro</strong> tb<strong>is</strong> rh6py e not rlwtF Fldidlbl. bdivi.ludiz.d<br />

n&agsDot ie inporrdl. Tl'. choia of rr€.tndt shodd b. b8.d on tbe A€quacy ud<br />

<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><strong>it</strong>y of.rbct, lh. prcee .nd d€e@ oflarpoE y d<strong>is</strong>.bil<strong>it</strong>y .rd $. pmffl. of<br />

Miat.d srDptonE Tb. pn<strong>io</strong>rt rdnory of cpo@ to lDd ldaie of sac<strong>if</strong>c<br />

m<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><strong>io</strong>t<strong>io</strong>n should als b. @nsid6<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> cdinirg @!(ht<strong>io</strong>s $ch a hdn d<strong>is</strong>de<br />

pEgtucy d'd u@nllllcd htFntuid tuy lim<strong>it</strong> trshdr d)oi6 E!€rt suggBls<br />

rhd etc dF{py dDuld b. limn d <strong>io</strong> @ ll@ lhu f<strong>io</strong> rin6 F wcc} 1o gltd .8.i.n<br />

o<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>idl ovd e h€dbch. (or drug iduc.d hc.d.ch.) m<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ic<strong>it</strong>id ov6 * hadach. i3<br />

thoughl to Eult Eob A€qBl u. of aolc icdiclt<strong>io</strong>n @d ba . prt n of inM<strong>it</strong>S<br />

.<strong>ta</strong>d.ch. fiql|@y, on@ Buliilg i! daily bgdadc.<br />

Thc Btidalc fd wdcnikjng OG prMGludy @ Itc thft wa pN<strong>it</strong>y or<br />

i6dch <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> h<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>d&he wE ! n€cle.t d e ia culMt clinidl <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Bdrch s.n'!8s in<br />

P&<strong>is</strong>i6. nE lstsor diagM<strong>is</strong> ard D&r8@aI of l€tb.lF D.ti6ts<br />

bad @l ba<br />

giva du. .natim ln ?rtinn ln. nad&h. tstiar gc toD dodor <strong>ro</strong> do.1or goi4<br />

thbugh dFnsive <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> invsive prcc.dw lilc C,T. sm MRI which nost olth. l<strong>io</strong>. e<br />

@@ery .nd nosr of th. P.L<strong>is</strong>lads @uld ill !ffod.<br />

r.1. Se6 i, P.l<strong>it</strong>e,i Eoq<strong>it</strong>al!'<br />

It ha gpE.lty b@ obw<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> th.r hadd.h. pafa18 e .<strong>it</strong>hd 3im<br />

pain ri 6<br />

or symprmatic traln4t which <strong>is</strong> e<strong>it</strong>h6 p.nially b.neici.l or bdpnt for a brief Pd<strong>io</strong>d,<br />

$h..q@0y lne Fti61<br />

dsrclop.d lold:@ or lh.y Ld to ESould, Bada.!€ &d linl.<br />

tu dorc !o l@k into ih. unddlying I6yctFpdoloe/, l<strong>it</strong>e Atui.ty d d.pE3<strong>io</strong>n whjch<br />

@y b. qusn& Mirtlining o docb.ti4 lhc 6ymptott.

Hadacb6 baing tbe orgeic badachB e a cry for h.l9; <strong>it</strong> <strong>is</strong> e m1c str€ss<br />

@.t<strong>io</strong>n !o .l€finable dorl. They m Dulti d.tmircd tb.y do nol ()M m o<br />

psychologiql v@u tbey b.ve . r.WFydDlogicd sid lnologic.l p€qetive. h i!<br />

ihpdrdr Io lEt rhe vbol. psriar Il i! . Dultj ld.L4 nulti llts<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Fobld ohjch<br />

,q!i6 inrdddd .ds . r@bd of p.nnaai, liL b.IDvid, <strong>io</strong>agdt. Dngs<br />

qqdsc @gnjlidl. di.l' body .ligm61 dplsing fdily dlMics\ €dw.ting sieni66t<br />

dn6 <strong>if</strong> l..tins E ir. e. <strong>ro</strong> .!ls<br />

Tl@ ws rc.d 1o utiliz. Fychologictl intdot<strong>io</strong>u, to mdast&d th.<br />

psycboprlhologiq bddlying h.rd&hc! 30 th.y @uld b. b.t<strong>ta</strong> Ma€d. H<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>rchq @<br />

on. of 6. 6'1mn6l phFical onplri s ard i.vdirbly s d o@npdyine symptm in<br />

m6r of thc d<strong>is</strong>.e, . lt js one of th. ho.r pFdordd d,snD.ridal di$rda ba th@<br />

e m P<strong>ro</strong>pd tuag@t @iqs d h6d!.,18 clid. i! P8i&<strong>ta</strong> Ths! <strong>is</strong> @. lgEh<br />

gdng d ir !I q. , Aosi.a E!eL!4 ndy, C@.!y dn Wiudia bo*ffi, 6a! @ F<br />

.fidiw cdFlhojE cli.i6 d i a€lid i. rhi.@<br />

Expci@3 of pain e d<strong>it</strong>r@t in d<strong>if</strong>rdor @lnB dEugh rh@ @ carl<strong>it</strong><br />

@mon l<strong>it</strong>i6, th6€ ws a n€.d <strong>ro</strong> deelop &d reslli. toob wnicn odd aid <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

a$s@r 3pei6e <strong>ro</strong> ou cdtw.<br />

A swet ws @nduct€d in sdie! Holpii.l ir ahjch sp@3li$ n@ d<strong>it</strong>rmi<br />

6cld. like pslrhiatry p€di3lri6 olhthalholo&/, E.N.T. Aapucture, d<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>iciE w@<br />

intdiewsd r.s&dins he5daclc sl6mal &d ic h@gsn6t Eacn sFre .@rdiae <strong>io</strong><br />

hir spocidly o.*qm w* @gqMr of ha&.lE ws tur @beivc but<br />

frlgnat d. Ey. sF<strong>is</strong>l<strong>is</strong>r $id rhrl EE d<strong>io</strong>n .rd C.T. *d ncds to be 6i.d our<br />

Pcdi.r.icid str63€d @n<strong>ro</strong>l ol fad rld p<strong>ro</strong>F f..ding ..€ds <strong>ro</strong> b€ 6i€d o!1 rh€<br />

n.dical sFci,lin @pnav<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> blood, ald uinc €xMiul<strong>io</strong>r E-N.T. sEs<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> that thnal<br />

dd sinus rc€d lo b€ t t6 @ ot Plychiarn$ f.[ lhst miety &d depress<strong>io</strong>n necd lo

. &tjr6sl Tbc cliniql psrdolog<strong>is</strong>l fccl dut @ntrids n€.ds !o b. telvcd Thc poin<br />

@Nllart eid lhar iij.ct<strong>io</strong>ns 6d nde bl@k! lhodd b! eiva- Tltt Aopu.tE<strong>is</strong>i felr<br />

Aclpuetu. po<strong>it</strong>u for lad.cbe should b. 3linul6t€d ald <strong>io</strong> csllllt chi (which i.<br />

lh3l<strong>if</strong>e fod ir OG Maidiu Cbqel) <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> Ac!F.3sw of0E srlp.<br />

All fcll [dd..!! ws a n.Sl.d.d @4 6cl| sFt @ding lo bt oh speidty<br />

@@|!6H wd thlt sss6t ms.g@6t of iadacnd wd not @h6iv. lut<br />

Aagoar.d. Blt .ll f.li ihat hadachc ws a n.gl.ci.d ea wilhoui p<strong>ro</strong>p.r s.ssot <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng><br />

Tbe ovdidilg tuiivsrid fd uddrlE g 6e l6dd ws tnn ttc |grcLa<br />

olld e@uncrcd lhk prcblo in lhc dld@/cl<strong>it</strong>ic.t s€dine ltd f.ll lh. nc.d <strong>io</strong> dNlop<br />

s udGl<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ing .!d dpql<strong>is</strong>e in th<strong>is</strong> @, Th<strong>is</strong> would a$de ln. €@hd's<br />

c.pabil<strong>it</strong>y fd h.tpirg th. hadad. pari6ts. Il <strong>is</strong> inpotul lo h!rc <strong>it</strong>lqni.d .pPNch<br />

dd .hG! d<strong>if</strong>dl .Ppd.lE <strong>io</strong>to @ @nprhadE sysld. Thc nudv wdd belP in<br />

fosine in th<strong>is</strong> d rnd nsy hclp in th. 6tlbulhmal oflb. sllrc of 0E .n @rd for<br />

hsda€hB d Ihe 61lblktlDal of! p.in cliric, A 3t p ir lh<strong>is</strong> dir€.r<strong>io</strong> tu O.<br />

dt blidDdt ofih. h..daclE clinic in lh. dcr{rtndt ofpsyd,irEy, Sdi6 Hospiid,<br />

rjhoe ad ihe prcjccl hB bd apFDvcd by th. Pujdb Crvc@ot<br />

The ftdina oflhc @.rh sodd h.E pos<strong>it</strong>ilc clini..l ihPl<strong>is</strong>li$ ttd mv<br />

h.lp doc<strong>ro</strong>rs, psychothdlp<strong>is</strong>ts "nd .mlogi3t! i! in mor€ effetiv. m48ddt of<br />

hodach6. FrcD ! I di4 of reldet studid, e. ddive <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> lnddl<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ing of d<strong>it</strong>r@t<br />

rh@Fdic nod.l<strong>it</strong>i6, .f<strong>ta</strong>riv. tu pah Educt<strong>io</strong>n on€ r.y bc .blc <strong>io</strong> d.v.lop t<br />

6mF€[6ivc p&k.8. whi.n i|Mlv. d<strong>if</strong>f.dr rhopy l<strong>it</strong>c .olpun rlrq Eih,<br />

psfchoth6.p, d<strong>io</strong>ptrctic, @ial tb6!py, phyt<strong>io</strong>th@ly hnsI'ma .letricil<br />

slinulst<strong>io</strong>A !'pnosh, sonopu€rw, vi$tl im84y tld obove dl pnyd ir fie<br />

6elgd6t of hadsch.. R4al admq in thb diiddd Fovide hop. &d

oflimi$!.Sd.nl typ6 ofothel int@ot<strong>io</strong> w.ll int gBld <st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> delverd udd onc<br />

Thc ovdiding notiv.t<strong>io</strong>n for udcn.king thc carch ea thli tb. llschd<br />

oi6 dcoutd.d tb. p<strong>ro</strong>bld ir lhc irdo@ Dd ouido6 .!d felt ln€ rc€d to decloP<br />

ad uid1lrding dd exDdri$ ir Oi c O<strong>is</strong> muu dn[@ 6e lMdd aFbil<strong>it</strong>t<br />

for h.tping lhe hdd!.i. pati6rs. To dcv.lop eEdng i$sma<strong>is</strong> enicn @ @1<br />

ihblgh lhc grs sort .nd r.[ ln. doctdr *h@ th. Fir l)ltrs how d.6ilii,t<strong>it</strong>8 il n<br />

vhai olh6 facid $ch s strs b.y b. contributi4 !o i $ rbll do

lwil.ble {hd th€ sbdy w.s iD<strong>it</strong>iaLd, a prin plotool (inst@dt) Mc Cill P.ir<br />

Qu6t<strong>io</strong>mirc<br />

(MPQ) wa t6slai.d rnd validatcd for ue in clinic,l eninss.<br />

4. To 6r.bl<strong>is</strong>h lhe reliabiliiy ofiln p6ycbon.ric prcpdri6 ofihe ad.pr€d v6<strong>io</strong>n of rh.<br />

Mc Gill Pain Q'6t<strong>io</strong>@ir (!fQ).<br />

5, To fomdt prcrlnlt r6rs <strong>ro</strong><br />

'!s<br />

h6d&t. wilh r fooe on rh. .liri.id D..d <strong>io</strong><br />

lal th.6t<strong>it</strong>y ofd.pB<strong>io</strong>4 di.ty (wt|rl.E Flholoe, n tuy t t6*d m p|ri6!3<br />

!@61.- rtrld rh& fGing ojun th. lrttrplod of h€d&h.).Ih€. mDld b.<br />

uriliz.d ir clidcal sttirg @ p.ii6b for il3 cf6ti6s<br />

6, Dd.loPllol of . @mprchdsive p<strong>ro</strong>lo@l d@npasins nultinod.l i d@t<strong>io</strong>! to<br />

b. uscd in ihe .linic.l srudy .nd sdtings<br />

?. To pmvid. a $!rd b6<strong>is</strong> for IreE!@! wid@ bd.d sulll wft.€quiFd 6. ih.<br />

cdpa<strong>is</strong> of spe<strong>if</strong>ic pb,']'relogj@l (dorF) ald M phm@logiel rrEtlat3<br />

' sud s Fyclolhr4, da.doo, pl@)o, &d FrprnciG<br />

8. A mjd obj<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>ir .Dd puF{. olthc crdy wG th. d€Eloptjmt ofoinrall, b.*d<br />

rhdlFlric in'datjd i! t. EMgdGn of h6di.I6.<br />

9. Codud U. 6t!t .q Btuch in thi! &.r, r. th. fndings ofll€ se{rch woutd b.<br />

us.tul for clinical sttings to Fbvida did@a ba.d nnoale for moF .tr ctiv.<br />

hMgddt ofn.ad&he by eocral pd.tidhaq clirical pstcholoA<strong>is</strong>t,<br />

psyclDlhftl<strong>is</strong>t &d llmlog<strong>is</strong>ts.<br />

r.E" obj..n$ ofdt Pr&ntsttdr<br />

FollNins obj6tiv6 w@ fomular.d for dc srdri<br />

l- ldot<strong>it</strong> th. Elddlyirg p6ycl'oFthologi6 i. MigniB $d TG<strong>io</strong>. hadlcl* plri6ts.<br />

2. D.v.lopnai of a onnnly relddl &d rdi.hl. plir NNal lml.<br />

3, Id6li6elim ofl€adadB and thcn pah inttuiri€s usirs the p<strong>ro</strong>l@ls dd.loD.d for

4. Thdp.ulic outiMe uing DruSA Dtu€F +Thdpv o Th.t4v' *Licb b$ Nsr<br />

5. To previ&didaet !.d Dl<strong>io</strong>ML for.fcdirc ri6t6ot<br />

In i!i! study, h.rdlclF qu6t<strong>io</strong>@<strong>it</strong> w3 d@.loP.d,<br />

Halltct Ot a<strong>io</strong>Ne<strong>it</strong>ut lr i.,20 <strong>it</strong>ar qlca<strong>io</strong>tridhi.! wa od8indlv<br />

dwelop.d in M<strong>is</strong>ssiplr by Ab.l od Lm (19?0) <strong>it</strong> th. 6ly r9?0s dd n M<br />

p<strong>is</strong><st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> b A.lboy $ii s t<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng>.t d ir Urd! by Eutll<strong>ro</strong>r . ?rcfsr of Fotru<br />

Chr<strong>is</strong>ti$ Coll.g€.nd. Cliuiql Psychologj$ <strong>it</strong> Urdu d@llegulgcin |95 th.<br />

qu6lid.irc wN d€v.lop.d ir & *lia Pilot snrdy .ih. qudt<strong>io</strong>m.irc @vs.d<br />

Fsdl,<br />

f&nily, @<strong>it</strong>il, d!€donrl, @lpximd .id do $i.l tinory .nd<br />

p@<strong>io</strong>u n€dicsj ad pry.hi.Eic hidoty,<br />

lI0. Srudt t: Pryc<strong>ro</strong>D.6o!.eiq i! Mtdi!. !.1T6.im Ead!.[6.<br />

lll, sftdy 2r Dd.loDmlr of ah. T@l ud R.llrbltry .hdy<br />

Prd. i: !) Developnat ofa !d! qu*t<strong>io</strong>Mire.<br />

b) DqEIoPttraI of irdie@u iDsuals {d t@ls <strong>io</strong> b.<br />

u<st<strong>ro</strong>ng>ed</st<strong>ro</strong>ng> in lhc nain 3tudy.<br />

Pra, 2.Dcr@in d6 of Eli.biliry of lhc &v.lop.d <strong>it</strong>uEd6t!.<br />

1.12, studt3: D.EloDdor oft!. frc<strong>ro</strong>eh for !D ln clb<strong>io</strong>l s.iingt<br />

Pt6? ,: !ffidt 6d mcasllm@t of bad&hc udnS prct@ls<br />

otr l&9. orle<br />

Prd.rj A$6motof cmp@iivc.ffclcy of vd<strong>io</strong>us<br />

thorratjc <strong>it</strong>rtd@r<strong>io</strong>B s m6u.d by Fe dd pon llffidl<br />

pret@ls ovd a six wet irLn iw ts66t F<strong>io</strong>d.

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