Somatosensory event-related potential and autonomic activity to varying pain reduction cognitive strategies in hypnosis.

OBJECTIVES: The issues of differential effects among cognitive strategies during hypnosis in the control of human pain are under active debate. This study, which employs measures of pain perception, electrocortical and autonomic responses, was aimed at determining these pain-related modulations. METHODS: Somatosensory event-related potentials (SERPs) to noxious stimuli under an odd-ball paradigm were recorded at the frontal, temporal and parietal regions in 10 high, 9 mid, and 10 low hypnotizable right-handed young women, at waking baseline, varying cognitive strategies (deep relaxation, dissociative imagery, focused analgesia) in hypnosis and placebo conditions. The phasic heart rate (HR) and skin conductance response were also recorded. The analysis was focused on the frequent standard trials of the odd-ball SERPs. Repeated measures analysis of variance was conducted to examine the experimental effects. RESULTS: Focused analgesia induced the largest reduction in pain rating, more in the high than low hypnotizable subjects. In high hypnotizable subjects, the N2 amplitude was greater over frontal and temporal scalp sites than over parietal and central sites, whereas in moderately and low hypnotizable subjects, N2 was greater over temporal sites than over frontal, parietal, and central sites. These subjects also displayed a larger N2 peak over temporal sites during focused analgesia than in the other conditions. The P3 amplitude was smaller under deep relaxation, dissociative imagery and focused analgesia in the high hypnotizable subjects. For these subjects, the smallest P3 peaks were obtained for dissociated imagery and focused analgesia over frontal and temporal sites. In contrast, for the P3 peak, low hypnotizable subjects failed to show significant condition effects. In all of the subjects, the skin conductance and HR were smaller during hypnotic suggestions than in the waking state. CONCLUSIONS: The effect of pain modulation is limited to high hypnotizable subjects rather than low hypnotizable ones. Higher frontal-temporal N2 and smaller posterior parietal P3 may indicate active inhibitory processes during cognitive strategies in hypnotic analgesia. These inhibitory processes also regulate the autonomic activities in pain perception.

Carbon dioxide laser surgery in colposcopy for cervicovaginal intraepithelial neoplasia treatment. 10 years experience and failure analysis.

CO2 laser vaporisation is an effective method in the treatment of cervico-vaginal pre-invasive lesions. In a case-series of 334 patients no case of invasive neoplasia development were registered at longterm follow-up. The failure rate is comparable to those described with traditional surgical methods and are due to the particular topography of the disease.