Background: Primary headaches such as migraine and tension type headaches are extremely common an... more Background: Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states. Objectives: Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decades. These treatments have been shown to be efficacious in reducing symptoms as well as in improving patient functioning and quality of life. Treatment effects have been shown to continue even after termination of therapy, as patients are given tools to regulate their sympathetic arousal and taught to adopt more constructive coping behaviors and thought processes regarding their condition. Despite the plethora of studies demonstrating the effectiveness of mind-body and cognitive-behavioral therapies and despite recommendations made by various consensus groups, these therapies remain under-used in routine medical practice. Discussion: In order to address this problem we propose a graded, integrative model currently being implemented in the "Functional Neurology Clinic" at 'Soroka' University Medical Center. This model contains a three-step treatment algorithm for quickly and effectively teaching patients self-relaxation techniques. The model is meant to be used in conjunction with pharmacological treatments for primary headaches and can be used in inpatient hospitalization, outpatient clinics or multi-disciplinary treatment centers.
Background: Behavioral Medicine is an inter-disciplinary field concerned with the integration of ... more Background: Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. The problem: Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plethora of studies demonstrating the efficacy of behavioral interventions, these tools are underused in today's medical system. The reasons for this have to do with a dichotomous view of mind and body rooted in the biomedical approach, which was the dominant paradigm in the medical world up until the latter half of the previous century. In accordance with this paradigm, diseases were "assigned" either to medicine (i.e. they are physiological) or to the mental health professions (i.e. they are psychological), but never to both fields simultaneously. As an extension of this position, behavioral medicine was not included in Israel's socialized health care plan, making the use of behavioral techniques largely impractical, so that even physicians who agree with and believe in the importance of the bio-psycho-social model are often untrained or unable to provide effective behavioral treatments which would address the psycho-social aspects of their patients' illness. Discussion: In Israel today there exist a number of facilities which provide behavioral treatments, however, there is, as yet, no public body in charge of organizing and promoting the knowledge and use of behavioral medicine in Israel. For the sake of patients, physicians and the medical system itself, it is imperative that, in the future, medical and paramedical professionals, including students and interns, are exposed to and trained in the use of behavioral techniques. In addition, thought must be given as to the integration of such techniques in routine medical care. For that purpose, we propose a number of guiding principles for effectively implementing' behavioral techniques in the day-to-day practice of modern; medicine.
Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral a... more Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plet...
BACKGROUND Primary headaches such as migraine and tension type headaches are extremely common and... more BACKGROUND Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states. OBJECTIVES Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decad...
BACKGROUND Behavioral Medicine is an inter-disciplinary field concerned with the integration of b... more BACKGROUND Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. THE PROBLEM Despite the fact that the bio-psycho-social model is the dominant model in 21st century medici...
Stress is a well-known trigger for primary headache yet its impact is difficult to demonstrate in... more Stress is a well-known trigger for primary headache yet its impact is difficult to demonstrate in large epidemiological studies. Israeli national TV news is often referred to as the “tribal fire”, as many Israelis watch national news coverage following terror attacks or military operations. We examined the association between exposure to television news and their content with headache related Emergency Department visits. This retrospective cohort study included data on daily Emergency Department visits with a chief complaint of headache in Soroka University Medical Center, during 2002–2012. Data on daily television news viewership ratings were obtained from the Israeli Audience Research Board and its content from Channel 2 headlines, the highest rated TV news program. To estimate the short-term effects of news rating during the evening news on the number of daily headache visits, we applied generalized linear mixed models. 16,693 Emergency Department visits were included in the anal...
Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and
mental heal... more Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and
mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic
disorders. This situation is particularly troublesome due to the high prevalence of
these conditions. Although progress has been made over the last few decades in
understanding mechanisms underlying the mind-body relationship, disparities remain
between research and its clinical implementation. One possible reason for this is the
lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial
framework and is rooted in an understanding of the various psychobiological pathways.
Such a model would enable better communication between physicians and MHPs,
allowing them to provide coordinated, stratified treatment. In this paper, four archetypal
case studies, together with standard care options are presented to illustrate the
current state of affairs. A four-tiered conceptual model of mind-body interrelationships
based on pathophysiological and psychopathological mechanisms is suggested to help
optimize the treatment of somatic complaints. This Four-Cluster model consists of:
(1) Organic Conditions: Structural, or degenerative processes that can affect mood
and psychological responses but are not clearly exacerbated by stress. (2) Stress
Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as
inflammatory or autoimmune diseases, whose progression is clearly exacerbated by
stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to
stimuli together with hyper-reactivity of the autonomic system form a “vicious cycle” of
mutually enhancing learning processes. These processes involve biological mechanisms,
such as central sensitization and psychological mechanisms such as catastrophization
and selective attention. (4) Conversion Disorder: Physical manifestations of psychological
distress, expressed somatically. Symptoms are solely an expression of problems in
patients’ psychic functioning and are not caused by biological pathology. Finally,
suggested management of the aforementioned case studies is presented through
the lens of the Four-Cluster model and a proposed integration of our model with
existing theories is discussed. As it is rooted in an understanding of psychobiological
pathways of illness, the proposed model enables a new way to discern which form
of mind-body interaction is manifesting in different diseases and proposes a way to
coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.
Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral a... more Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plet...
Background / Purpose: Here we report the results of treatment with a novel surface acoustic wave ... more Background / Purpose: Here we report the results of treatment with a novel surface acoustic wave ultrasound treatment device, The Nanovibronix Painshield, in 25 subjects with trigeminal neuralgia. Main conclusion: 17 out of 21 responding patients treated (81%) achieved a final Barrow Neurological Index score of IIIB or less after an average of 1.5 months of treatment (range 1-6 months), indicating that their pain was now adequately controlled by the treatment.
Primary headaches such as migraine and tension type headaches are extremely common and present a ... more Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states. Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decades. These treatments h...
The Four-Cluster Spectrum of Mind-Body Interrelationships: An Integrative Model, 2019
Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental healt... more Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental health professionals (MHPs) find it difficult to treat patients with psychosomatic disorders. This situation is particularly troublesome due to the high prevalence of these conditions. Although progress has been made over the last few decades in understanding mechanisms underlying the mind-body relationship, disparities remain between research and its clinical implementation. One possible reason for this is the lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial framework and is rooted in an understanding of the various psychobiological pathways. Such a model would enable better communication between physicians and MHPs, allowing them to provide coordinated, stratified treatment. In this paper, four archetypal case studies, together with standard care options are presented to illustrate the current state of affairs. A four-tiered conceptual model of mind-body interrelationships based on pathophysiological and psychopathological mechanisms is suggested to help optimize the treatment of somatic complaints. This Four-Cluster model consists of: (1) Organic Conditions: Structural, or degenerative processes that can affect mood and psychological responses but are not clearly exacerbated by stress. (2) Stress Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as inflammatory or autoimmune diseases, whose progression is clearly exacerbated by stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to stimuli together with hyper-reactivity of the autonomic system form a "vicious cycle" of mutually enhancing learning processes. These processes involve biological mechanisms, such as central sensitization and psychological mechanisms such as catastrophization and selective attention. (4) Conversion Disorder: Physical manifestations of psychological distress, expressed somatically. Symptoms are solely an expression of problems in patients' psychic functioning and are not caused by biological pathology. Finally, suggested management of the aforementioned case studies is presented through the lens of the Four-Cluster model and a proposed integration of our model with existing theories is discussed. As it is rooted in an understanding of psychobiological pathways of illness, the proposed model enables a new way to discern which form of mind-body interaction is manifesting in different diseases and proposes a way to coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.
Background.—Although both pharmacological and behavioral interventions may relieve tension-type h... more Background.—Although both pharmacological and behavioral interventions may relieve tension-type headache, data are lacking regarding treatment preference, long-term patient compliance, and feasibility of behavioral intervention in a standard neurological outpatient clinic setting. Objective.—To describe patient choice, long-term compliance, and clinical outcome in a neurological clinic setting where patients are given the choice of the approach they wish to pursue. Design.—Patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic tension-type headache or chronic tension-type headache) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly. Patients were given the option to cross-over to the other treatment group at each visit. HR was performed during standard length neurology clinic appointments by a neurologist trained to perform hypnosis (Y.E.). Follow-up interviews were performed between 6 and 12 months following treatment initiation to evaluate patient compliance, changes in headache frequency or severity, and quality-of-life parameters. Results.—Ninety-eight patients were enrolled, 92 agreed to receive prophylactic therapy of some kind. Fifty-three (57.6%) patients chose HR of which 36 (67.9%) actually initiated this treatment, while 39 (42.4%) chose pharmacological therapy with AMT of which 25 (64.1%) patients actually initiated therapy. Patients with greater analgesic use were more likely to opt for AMT (P = .0002). Eleven of the patients initially choosing AMT and 2 of the patients initially choosing HR crossed over to the other group. Seventy-four percent of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches (P = .16). Long-term adherence to treatment with HR exceeded that of AMT. At the end of the study period, 26 of 47 patients who tried HR compared with 10 of 27 who tried AMT continued receiving their initial treatment. Conclusions.—HR treatment was a more popular choice among patients. Patients choosing HR reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance. Patients receiving HR were less likely to change treatments. HR practiced by a neurologist is feasible in a standard neurological outpatient clinic setting; HR training should be considered for neurologists involved in headache treatment.
The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primar... more The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primary care clinics and physicians (PCPs) and to test the hypotheses that: (1) the quality of primary care provided in battalions is higher than that provided by other primary care providers and (2) the evaluation of a specific PCP within the framework of the quality assessment program results in an improved score during a second evaluation. Teams of two physicians carried out the control process. Each primary care clinic is evaluated in a standardized manner by filling a prospectively established form. Five parameters are examined: (1) direct inspection of the PCP, (2) medical record audit, (3) high-risk patients' management evaluation, (4) evaluation of secondary health care characteristics, and (5) medical staff guidance evaluation. The various clinics and physicians evaluated were classified as: battalion clinics, division and brigade clinics, training center clinics, and home-front c...
Background: Primary headaches such as migraine and tension type headaches are extremely common an... more Background: Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states. Objectives: Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decades. These treatments have been shown to be efficacious in reducing symptoms as well as in improving patient functioning and quality of life. Treatment effects have been shown to continue even after termination of therapy, as patients are given tools to regulate their sympathetic arousal and taught to adopt more constructive coping behaviors and thought processes regarding their condition. Despite the plethora of studies demonstrating the effectiveness of mind-body and cognitive-behavioral therapies and despite recommendations made by various consensus groups, these therapies remain under-used in routine medical practice. Discussion: In order to address this problem we propose a graded, integrative model currently being implemented in the "Functional Neurology Clinic" at 'Soroka' University Medical Center. This model contains a three-step treatment algorithm for quickly and effectively teaching patients self-relaxation techniques. The model is meant to be used in conjunction with pharmacological treatments for primary headaches and can be used in inpatient hospitalization, outpatient clinics or multi-disciplinary treatment centers.
Background: Behavioral Medicine is an inter-disciplinary field concerned with the integration of ... more Background: Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. The problem: Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plethora of studies demonstrating the efficacy of behavioral interventions, these tools are underused in today's medical system. The reasons for this have to do with a dichotomous view of mind and body rooted in the biomedical approach, which was the dominant paradigm in the medical world up until the latter half of the previous century. In accordance with this paradigm, diseases were "assigned" either to medicine (i.e. they are physiological) or to the mental health professions (i.e. they are psychological), but never to both fields simultaneously. As an extension of this position, behavioral medicine was not included in Israel's socialized health care plan, making the use of behavioral techniques largely impractical, so that even physicians who agree with and believe in the importance of the bio-psycho-social model are often untrained or unable to provide effective behavioral treatments which would address the psycho-social aspects of their patients' illness. Discussion: In Israel today there exist a number of facilities which provide behavioral treatments, however, there is, as yet, no public body in charge of organizing and promoting the knowledge and use of behavioral medicine in Israel. For the sake of patients, physicians and the medical system itself, it is imperative that, in the future, medical and paramedical professionals, including students and interns, are exposed to and trained in the use of behavioral techniques. In addition, thought must be given as to the integration of such techniques in routine medical care. For that purpose, we propose a number of guiding principles for effectively implementing' behavioral techniques in the day-to-day practice of modern; medicine.
Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral a... more Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plet...
BACKGROUND Primary headaches such as migraine and tension type headaches are extremely common and... more BACKGROUND Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states. OBJECTIVES Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decad...
BACKGROUND Behavioral Medicine is an inter-disciplinary field concerned with the integration of b... more BACKGROUND Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. THE PROBLEM Despite the fact that the bio-psycho-social model is the dominant model in 21st century medici...
Stress is a well-known trigger for primary headache yet its impact is difficult to demonstrate in... more Stress is a well-known trigger for primary headache yet its impact is difficult to demonstrate in large epidemiological studies. Israeli national TV news is often referred to as the “tribal fire”, as many Israelis watch national news coverage following terror attacks or military operations. We examined the association between exposure to television news and their content with headache related Emergency Department visits. This retrospective cohort study included data on daily Emergency Department visits with a chief complaint of headache in Soroka University Medical Center, during 2002–2012. Data on daily television news viewership ratings were obtained from the Israeli Audience Research Board and its content from Channel 2 headlines, the highest rated TV news program. To estimate the short-term effects of news rating during the evening news on the number of daily headache visits, we applied generalized linear mixed models. 16,693 Emergency Department visits were included in the anal...
Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and
mental heal... more Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and
mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic
disorders. This situation is particularly troublesome due to the high prevalence of
these conditions. Although progress has been made over the last few decades in
understanding mechanisms underlying the mind-body relationship, disparities remain
between research and its clinical implementation. One possible reason for this is the
lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial
framework and is rooted in an understanding of the various psychobiological pathways.
Such a model would enable better communication between physicians and MHPs,
allowing them to provide coordinated, stratified treatment. In this paper, four archetypal
case studies, together with standard care options are presented to illustrate the
current state of affairs. A four-tiered conceptual model of mind-body interrelationships
based on pathophysiological and psychopathological mechanisms is suggested to help
optimize the treatment of somatic complaints. This Four-Cluster model consists of:
(1) Organic Conditions: Structural, or degenerative processes that can affect mood
and psychological responses but are not clearly exacerbated by stress. (2) Stress
Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as
inflammatory or autoimmune diseases, whose progression is clearly exacerbated by
stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to
stimuli together with hyper-reactivity of the autonomic system form a “vicious cycle” of
mutually enhancing learning processes. These processes involve biological mechanisms,
such as central sensitization and psychological mechanisms such as catastrophization
and selective attention. (4) Conversion Disorder: Physical manifestations of psychological
distress, expressed somatically. Symptoms are solely an expression of problems in
patients’ psychic functioning and are not caused by biological pathology. Finally,
suggested management of the aforementioned case studies is presented through
the lens of the Four-Cluster model and a proposed integration of our model with
existing theories is discussed. As it is rooted in an understanding of psychobiological
pathways of illness, the proposed model enables a new way to discern which form
of mind-body interaction is manifesting in different diseases and proposes a way to
coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.
Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral a... more Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments. Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plet...
Background / Purpose: Here we report the results of treatment with a novel surface acoustic wave ... more Background / Purpose: Here we report the results of treatment with a novel surface acoustic wave ultrasound treatment device, The Nanovibronix Painshield, in 25 subjects with trigeminal neuralgia. Main conclusion: 17 out of 21 responding patients treated (81%) achieved a final Barrow Neurological Index score of IIIB or less after an average of 1.5 months of treatment (range 1-6 months), indicating that their pain was now adequately controlled by the treatment.
Primary headaches such as migraine and tension type headaches are extremely common and present a ... more Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states. Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decades. These treatments h...
The Four-Cluster Spectrum of Mind-Body Interrelationships: An Integrative Model, 2019
Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental healt... more Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental health professionals (MHPs) find it difficult to treat patients with psychosomatic disorders. This situation is particularly troublesome due to the high prevalence of these conditions. Although progress has been made over the last few decades in understanding mechanisms underlying the mind-body relationship, disparities remain between research and its clinical implementation. One possible reason for this is the lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial framework and is rooted in an understanding of the various psychobiological pathways. Such a model would enable better communication between physicians and MHPs, allowing them to provide coordinated, stratified treatment. In this paper, four archetypal case studies, together with standard care options are presented to illustrate the current state of affairs. A four-tiered conceptual model of mind-body interrelationships based on pathophysiological and psychopathological mechanisms is suggested to help optimize the treatment of somatic complaints. This Four-Cluster model consists of: (1) Organic Conditions: Structural, or degenerative processes that can affect mood and psychological responses but are not clearly exacerbated by stress. (2) Stress Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as inflammatory or autoimmune diseases, whose progression is clearly exacerbated by stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to stimuli together with hyper-reactivity of the autonomic system form a "vicious cycle" of mutually enhancing learning processes. These processes involve biological mechanisms, such as central sensitization and psychological mechanisms such as catastrophization and selective attention. (4) Conversion Disorder: Physical manifestations of psychological distress, expressed somatically. Symptoms are solely an expression of problems in patients' psychic functioning and are not caused by biological pathology. Finally, suggested management of the aforementioned case studies is presented through the lens of the Four-Cluster model and a proposed integration of our model with existing theories is discussed. As it is rooted in an understanding of psychobiological pathways of illness, the proposed model enables a new way to discern which form of mind-body interaction is manifesting in different diseases and proposes a way to coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.
Background.—Although both pharmacological and behavioral interventions may relieve tension-type h... more Background.—Although both pharmacological and behavioral interventions may relieve tension-type headache, data are lacking regarding treatment preference, long-term patient compliance, and feasibility of behavioral intervention in a standard neurological outpatient clinic setting. Objective.—To describe patient choice, long-term compliance, and clinical outcome in a neurological clinic setting where patients are given the choice of the approach they wish to pursue. Design.—Patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic tension-type headache or chronic tension-type headache) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly. Patients were given the option to cross-over to the other treatment group at each visit. HR was performed during standard length neurology clinic appointments by a neurologist trained to perform hypnosis (Y.E.). Follow-up interviews were performed between 6 and 12 months following treatment initiation to evaluate patient compliance, changes in headache frequency or severity, and quality-of-life parameters. Results.—Ninety-eight patients were enrolled, 92 agreed to receive prophylactic therapy of some kind. Fifty-three (57.6%) patients chose HR of which 36 (67.9%) actually initiated this treatment, while 39 (42.4%) chose pharmacological therapy with AMT of which 25 (64.1%) patients actually initiated therapy. Patients with greater analgesic use were more likely to opt for AMT (P = .0002). Eleven of the patients initially choosing AMT and 2 of the patients initially choosing HR crossed over to the other group. Seventy-four percent of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches (P = .16). Long-term adherence to treatment with HR exceeded that of AMT. At the end of the study period, 26 of 47 patients who tried HR compared with 10 of 27 who tried AMT continued receiving their initial treatment. Conclusions.—HR treatment was a more popular choice among patients. Patients choosing HR reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance. Patients receiving HR were less likely to change treatments. HR practiced by a neurologist is feasible in a standard neurological outpatient clinic setting; HR training should be considered for neurologists involved in headache treatment.
The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primar... more The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primary care clinics and physicians (PCPs) and to test the hypotheses that: (1) the quality of primary care provided in battalions is higher than that provided by other primary care providers and (2) the evaluation of a specific PCP within the framework of the quality assessment program results in an improved score during a second evaluation. Teams of two physicians carried out the control process. Each primary care clinic is evaluated in a standardized manner by filling a prospectively established form. Five parameters are examined: (1) direct inspection of the PCP, (2) medical record audit, (3) high-risk patients' management evaluation, (4) evaluation of secondary health care characteristics, and (5) medical staff guidance evaluation. The various clinics and physicians evaluated were classified as: battalion clinics, division and brigade clinics, training center clinics, and home-front c...
Background: Medically unexplained symptoms (MUS) refers to a laboratory, imaging orcommon group o... more Background: Medically unexplained symptoms (MUS) refers to a laboratory, imaging orcommon group of conditions in which patients express various somatic symptoms that are not explained by electrophysiological investigations. These include various painful syndromes, such as chronic tension headaches and fibromyalgia, as well as non-painful syndromes, such as dizziness, tinnitus and paresthesias. Objective: To review the difficulties of medical practitioners in communicating about and treating MUS. Methods: A systematic search of the medical literature using the keywords: medically unexplained symptoms, chronic pain, functional symptoms, and somatic symptoms. Results: The term "MUS" reflects a dichotomous view that medical conditions are either "real" biological diseases or "merely psychological" manifestations of emotional distress. This view results in dismissing any condition that cannot be described in terms of a specific pathophysiology, as "unexplained". Such labels are inaccurate and detrimental to the therapeutic process and to doctor-patient relationships, leading to feelings of mistrust, animosity and isolation. Conclusion: We suggest replacing the term Medically Unexplained Symptoms (MUS) with one that is more accurate and respectful by adopting the term "Low Threshold Syndrome" (LTS). The term LTS refers to one of the central clinical characteristics of these disorders – a lowering of the threshold of neuronal sensitization mediated by the limbic system and affecting inhibitory sensory pathways. Inasmuch as the name LTS refers to joint psychological and physiological processes and avoids vague or accusatory language, it has the potential to create better communication between patients and physicians, enabling a more efficacious therapeutic process.
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Papers by Yacov Ezra
mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic
disorders. This situation is particularly troublesome due to the high prevalence of
these conditions. Although progress has been made over the last few decades in
understanding mechanisms underlying the mind-body relationship, disparities remain
between research and its clinical implementation. One possible reason for this is the
lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial
framework and is rooted in an understanding of the various psychobiological pathways.
Such a model would enable better communication between physicians and MHPs,
allowing them to provide coordinated, stratified treatment. In this paper, four archetypal
case studies, together with standard care options are presented to illustrate the
current state of affairs. A four-tiered conceptual model of mind-body interrelationships
based on pathophysiological and psychopathological mechanisms is suggested to help
optimize the treatment of somatic complaints. This Four-Cluster model consists of:
(1) Organic Conditions: Structural, or degenerative processes that can affect mood
and psychological responses but are not clearly exacerbated by stress. (2) Stress
Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as
inflammatory or autoimmune diseases, whose progression is clearly exacerbated by
stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to
stimuli together with hyper-reactivity of the autonomic system form a “vicious cycle” of
mutually enhancing learning processes. These processes involve biological mechanisms,
such as central sensitization and psychological mechanisms such as catastrophization
and selective attention. (4) Conversion Disorder: Physical manifestations of psychological
distress, expressed somatically. Symptoms are solely an expression of problems in
patients’ psychic functioning and are not caused by biological pathology. Finally,
suggested management of the aforementioned case studies is presented through
the lens of the Four-Cluster model and a proposed integration of our model with
existing theories is discussed. As it is rooted in an understanding of psychobiological
pathways of illness, the proposed model enables a new way to discern which form
of mind-body interaction is manifesting in different diseases and proposes a way to
coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.
mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic
disorders. This situation is particularly troublesome due to the high prevalence of
these conditions. Although progress has been made over the last few decades in
understanding mechanisms underlying the mind-body relationship, disparities remain
between research and its clinical implementation. One possible reason for this is the
lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial
framework and is rooted in an understanding of the various psychobiological pathways.
Such a model would enable better communication between physicians and MHPs,
allowing them to provide coordinated, stratified treatment. In this paper, four archetypal
case studies, together with standard care options are presented to illustrate the
current state of affairs. A four-tiered conceptual model of mind-body interrelationships
based on pathophysiological and psychopathological mechanisms is suggested to help
optimize the treatment of somatic complaints. This Four-Cluster model consists of:
(1) Organic Conditions: Structural, or degenerative processes that can affect mood
and psychological responses but are not clearly exacerbated by stress. (2) Stress
Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as
inflammatory or autoimmune diseases, whose progression is clearly exacerbated by
stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to
stimuli together with hyper-reactivity of the autonomic system form a “vicious cycle” of
mutually enhancing learning processes. These processes involve biological mechanisms,
such as central sensitization and psychological mechanisms such as catastrophization
and selective attention. (4) Conversion Disorder: Physical manifestations of psychological
distress, expressed somatically. Symptoms are solely an expression of problems in
patients’ psychic functioning and are not caused by biological pathology. Finally,
suggested management of the aforementioned case studies is presented through
the lens of the Four-Cluster model and a proposed integration of our model with
existing theories is discussed. As it is rooted in an understanding of psychobiological
pathways of illness, the proposed model enables a new way to discern which form
of mind-body interaction is manifesting in different diseases and proposes a way to
coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.
patients express various somatic symptoms that are not explained by
electrophysiological investigations. These include various painful syndromes, such as chronic tension
headaches and fibromyalgia, as well as non-painful syndromes, such as dizziness, tinnitus and
paresthesias.
Objective: To review the difficulties of medical practitioners in communicating about and treating MUS.
Methods: A systematic search of the medical literature using the keywords: medically unexplained
symptoms, chronic pain, functional symptoms, and somatic symptoms.
Results: The term "MUS" reflects a dichotomous view that medical conditions are either "real" biological
diseases or "merely psychological" manifestations of emotional distress. This view results in dismissing
any condition that cannot be described in terms of a specific pathophysiology, as "unexplained". Such
labels are inaccurate and detrimental to the therapeutic process and to doctor-patient relationships,
leading to feelings of mistrust, animosity and isolation.
Conclusion: We suggest replacing the term Medically Unexplained Symptoms (MUS) with one that is more
accurate and respectful by adopting the term "Low Threshold Syndrome" (LTS). The term LTS refers to one of the
central clinical characteristics of these disorders – a lowering of the threshold of neuronal sensitization mediated by
the limbic system and affecting inhibitory sensory pathways. Inasmuch as the name LTS refers to joint psychological
and physiological processes and avoids vague or accusatory language, it has the potential to create better
communication between patients and physicians, enabling a more efficacious therapeutic process.