[Objectives] We conducted this study to determine how the subjects would respond mentally and physiologically to music, measuring the cerebral blood flow and various parameters related to the autonomic nervous system, and the findings were analyzed. The investigator who made these measurements had previously well comprehended the theory of music(what meaning the rhythm, organization of tone, tune and melody have). The subjects included 10 students(sex : female, mean age : 20 years).

[Methods] The music piece chosen was “For Elise”(4 minutes)by Beethoven. This music piece takes the ternary form(A rondo form : A-B-A-C-A). This form is characterized by progression in a cycling manner with the motif A incorporating the development parts B and C. Both before and after listening to music, one each resting phase lasting one minute was placed. As the musical instrument, a digital piano was used. Measuring methods : Cerebral activities while the subjects were listing to music were measured by the near-infrared spectroscopy(NIRS). For ECG recordings, subjects were applied with Mem-Calc/Tarawa, and heart rate variability(HRV)was recorded. The spectral analysis was done to determine HF amp. and LF/HF ratio. The correlation between these physiological response as measured by this method and the component elements of music was studied.

[Results] Individual differences were seen in the findings obtained. However, in general a tendency as described below was seen. With respect to the motif, at the cadence phase of its final stage the sympathetic nervous system became less active, with the parasympathetic nervous system predominating. These findings may indicate that subjects were relaxed. During the development phases of B and C, the parasympathetic nervous system was activated and the activity of the sympathetic nervous system decreased. Thus, the subjects seemed to be in a comfortable state during these development phases. From the analysis of these findings, we considered that the musical elements constituting the motif produced a feeling of relief and a world of harmony in subjects. On the other hand, the change in tone in the development phase provided a feeling of refreshment and expectation to the listeners. As to the cerebral blood flow, the response to listening to music appeared after occurrence of changes in the autonomic nervous system. Increase in the cerebral blood flow was seen at the final stage of the motif. This increase was still observed even after the resting phase started. It is considered from these findings that the brain activities go on incorporating and classifying various information.

[Discussion] It takes a little more than four minutes to perform this music, and we found that it has a deep complicated structure. When the tune moves, there is some unnoticed manipulation of sound unique to Beethoven. Beethoven created harmoniously unified world by combining simple but beautiful materials as if he had woven a fabric. It is conceivable that the accumulation of such kind of technique shook the depth of paradoxical human psychology, ultimately attracting audience to his musical world. Musical compositions have two functions : straining and loosening of human heart.

The objective of this study is to show why psychotherapy is effective based on the cases of the patients whom the author actually treated. The author paid attention to a marked therapeutic change(MTC)in the processes of psychotherapy. An MTC connotes dramatic curative dynamics(DCD), which are the clarified, pre-conditional elements of an MTC and four therapeutic situations where an MTC is brought about. However, elucidation of DCD did not progress. Thus, the author focused on steady therapeutic changes of the patients instead and developed a new method of psychotherapy, considering that people as multi-dimentional beings cannot be sufficiently treated based on only one theory. The author coined this method of psychotherapy diversified task-oriented psychotherapy(DTOP). After that, the five therapeutic changes as the ingredients of DCD were clarified as follows : (i)emotional arousal, (ii)empathy with the therapist, (iii)self-examination caused by empathy, (iv)the accordance of the patient's recognition of the problem with that of the therapist, (v)a change of how the therapist is perceived by the patient. Furthermore, (vi)operation of will should be added here. The author examine in this paper the case of a patient who was said to have been highly likely to murder his own father-in-a-law after release from prison, and the case of a patient who was on the verge of retiring from work. The patients have been newly reborn after the application of DTOP. The author needed three sessions for the former case and six sessions for the latter. This shows the effectiveness of psychotherapy. What made these patients newly reborn is two mental functions : one is the reflective function(Fonagy)which is(ii)and(iii)mentioned above, and the other is the coping function which is(iv), (v)and(vi).

The author has made a new dermatome which is applicable to clinical care. Its application to diagnoses and treatmant for pain is described in this paper.

Dermatome is important as an application of pain clinic for diagnosis and treatment.

The old dermatome only shows the distribution of the nerves and thus it is impractical to try to apply it to medical practice. In this study, the author tries to explain the method of making a new dermatome and the relationships between a dermatome, the autonomic nerves and acupuncture points. Dermatome is necessary and indispensable to decide a treatment part and diagnosis of the pain by the pain clinic. In medical practice, the vertebral body(spinal nerve)responsible for the pain can be easily detected if the pain lesion is reflected in the dermatome. In 2011, the International Association for the Study of Pain has introduced the diagnostic algorithm of neuropathic pain, which says : “The range of pain is neuroanatomically plausible and symptoms suggesting somatosensory injury on neurological disease are present.” Pain has become the very confirmation of a dermatome as this shows us.

Autonomic nervous responses induced by noxious stimuli are one of the causes of chronic pain. Therefore, management of them is clinically important. We found in humans and animals that the gentle skin touch can suppress somato-cardiovascular reflexes induced by noxious heat stimulation. The effect is produced by a touch of microcone which has orderly arranged micro-projections. A touch of a flat disk made of the same material is ineffective. Tactile perception, metabolism of somatosensory cortices, and activity of cutaneous mechanoreceptor afferent Aβ-nerve fibers, essential for the perception of touch, do not differ between a microcone touch and flat disc touch. However, the metabolism of anterior cingulate cortex and low-threshold mechanoreceptive afferent Aδ-and C-nerve fiber activities are higher if caused by a microcone touch than by a flat disc touch. The inhibitory effect of somato-cardiovascular reflex by microcone disappears with a local(intrathecal)application of an opioid receptor blocker to the spinal cord. These results suggest that microcone-induced excitation of low-threshold mechanoreceptive Aδ and C skin afferents produces the release of endogenous opioids in the spinal cord, resulting in the inhibition of nociceptive transmission that contributes to cardiac sympathetic reflexes.

Pain is a necessary and vital sign for life-and for the protection of human life. Normally daily life should be free of pain, when our body-system is working correctly.

The “meaning” of pain can be found in its function, to show the body-and the person-that something in its system is not working in a good way. Also pain, caused by psychic disorders like obsessive compulsive disorders or depression expresses the need for change in the way of life and for treatment.

The perception of pain depends on the immunological level and on the level of stress, that a patient is exposed to.

Due to the research of Viktor E. Frankl and also in the perspective of modern psychoimmunology we increasingly are convinced that the perception of pain can be controlled by psychological aspects, by changing the inner attitude towards a fate and by using techniques of hypnosis, meditation and music therapy as well as art therapy(if necessary of course in addition to medical and pharmaceutical treatment).

Logotherapy has an armament of interventions to help patients suffering from pain, to learn how to control the impact and intensity of pain. Music therapy can be a very helpful amplifier to induce the defiant power of the spirit(Frankl)and to activate the inner potential of the patient, to influence his condition.

Since the author met counselling, I have been trying to find the essence and the art of counselling. This paper aims to show some tips for counselling which was once presented in the lecture for International Logotherapists. The outline is how the author encountered counselling and existential therapy and his own practice of these. Showing such experiences, the author hopes to present his personal opinion on what he thinks is counselling and logotherapy.

[Background] In the case of pseudoneurosis(Frankl¹⁾), physical illnesses(functional or organic disorders)are left unnoticed and diagnosed as psychological disorders(depression or neurosis)instead rather carelessly and hastily. This paper is a study of a pseudoneurotic patient whose condition caused a misdiagnosis and misprescription. The patient had inadequately treated Hashimoto's thyroiditis and arteriosclerosis obliterans. Her former physician, however, had misdiagnosed her illness as depression and prescribed medications accordingly, which led to a marked decline in her ability to perform activities of daily living(ADL)and her quality of life(QOL).

[Subjects] The patient was a 75-year-old female. Her chief complaint was pain spreading all over her lower limbs. Having been diagnosed with depression and given antidepressants and anticonvulsants by her former physician, she was troubled with the sense of fatigue and double vision. Her life was eventually disrupted, which brought her to our hospital. While adequately treating her Hashimoto's thyroiditis, we administered physiotherapy(acupuncture)and psychotherapy(logotherapy)within the framework of our integrative medical practice.

[Results] Our treatment was aimed at improving the function of thyroid glands, homeostasis, and haemodynamics of the patient. The combination of the therapies helped to reduce her lower limb pain from which she had suffered for 10 years. Exercise therapy also contributed to pain relief, which led to her realization that active involvement in pain management through physical activities was worth the effort. Subsequently, she came to be able to manage her symptoms. There was a correlation between the changes in her haemodynamics and pathological conditions(and particularly the values of systemic vascular resistance).

[Conclusion] Patients with pseudoneurosis do not respond well to treatment with psychotropic medication. They rather suffer from side effects of medicine. As a result, patients tend to report a wider range of complaints and the assessment of their condition becomes more difficult. This case gave us a conviction that successful treatment of pseudoneurosis would require a correct diagnosis and bio-psycho-social-existential understanding, or comprehensive knowledge of each patient.

We will report an efficacious case of physical and existential approach for the treatment of a patient with psychogenic pain. The patient was a 67-year-old female who was diagnosed as bipolar affective disorders and has been suffering from the persistent bilateral lower extremity pain. Her QOL was reduced by pain on the biopsychosocial-existential level. Then she was referred to our outpatients clinic for the treatment of pain.

[Present condition] Hight : 154cm, weight : 67kg(BMI : 30, obesity), BP : 106/70mmHg, HR : 89bpm, Schellong's tilting test : dysdynamisches syndrome(Delius L), Laboratory data : hyperlipidemia, Imaging studies : Lumbar X-P ; lumbar spondylosis, MRI findings : thoracolumbar canal stenosis, Findings of traditional Oriental medicine : kyo-kyo-kuman, oketsu, Psychosocial-existential findings : stress, anxiety, domestic violence from her husband, psychiatric care and existential loss of the meaning of life. Prescription : Zolpidem Tarttrate 10mg/day, Trazodone 50mg/day, Quazepam 30mg/day, Mirtazapine 30mg/day, Levomepromazine 25mg/day, Lamotrigine 100mg/day(Multiple psychotropic treatment was performed).

[Progress] To establish a good relationship between a doctor and patient, the attitude of active listening with empathy, receptivity, support and assurance was performed. To understand her pain, finger-and-palm palpation was performed, which was the first experience for her in the past five years. She was applied a trigger point injection, caudal nerve block by local anesthetics and we performed Xe-light therapy, acupuncture, and so forth. As a result, not only a good doctor-patient relationship was established but also multiple psychotropic medication was reduced by physical treatment. Moreover, by application of existential approach, the patient was able to recover the meaning of life. These approaches made patient's pain reduced.

[Discussion] We assumed that the cause of pain was long-time psychogenic factors and a disturbance of hemodynamics due to multiple psychotropic medication. What made her pain reduced is the improvement of hemodynamics due to the reduction of multiple psychotropic medication and her getting out of an existential vacuum due to an existential approach. Moreover, we considered that establishment of a doctor-patient relationship based on trust was prerequisite for pain management. That was also the specificity concerned with chronic pain treatment. Finally, we think that the role of physical approach in this case was to help with establishing a good, trustful relationship of trust between a doctor and patient.