Response of anginal pain to hand warming

Abstract

In 1972 while working with a patient with a history of cardiac surgery (saphenous vein bypass) and chronic angina, I asked him to explore the possibility of whether or not he could perform the hand-warming task that had been used at the Menninger Clinic. The veteran was already quite skilled at using a relaxation technique (modified Jacobsonian) in stress management procedures. He quickly was able to raise his hand temperature (left hand) from 89 ° F to approximately 943⁄4 ° F utilizing visual images and relaxation. One week later during a subsequent visit, the patient was again practicing hand warming when he called my attention to the rather startling behavior of the temperature indicator, a needle gauge electric thermometer. The needle was registering rapid, erratic fluctuations between 88°F and 93 o F. Temperature variations of up to 2 ° 4 ° were occurring within 1 3 seconds (actual timing of the phenomenon was not attempted). When questioned if he had any idea what was causing that, the patient responded rather laconically, "Yes, it started doing that as soon as I started having an 'a t tack. ' " The fluctuations of the needle were so dramatic and rapid that a physician, called to observe the phenomenon, indicated "that has to be an instrument error." The instrument recorded stable temperature when shifted to the finger of the writer and resumed its erratic behavior when returned to contact with the patient. The physician was persuaded that this was not an instrumentation phenomenon. On further questioning, the patient reported that the onset of a spasm of chest pain was immediately followed by a rapid temperature drop, while the easing of the pain was associated with a temperature rise. He observed that as long as the temperature registered around 93 ° F he was free of pain. It seemed to the writer that the temperature fluctuation could have been