Hypnosis: Tool for Pain Management
In almost all cases, a comprehensive approach to chronic, non-cancer pain should occur within the context of a multidisciplinary setting. In our article on pain education, we outlined the 12 education modules that go over 23 different modalities of pain management care. We start the series off with a look at hypnosis and biofeedback.
As new modalities are considered, the practitioner should focus on an individual’s physical and emotional reactions to their pain perception because they remain the avenues through which treatment approaches can provide relief. Some providers may want to begin practicing “integrative” medicine by adding more modalities to their existing repertoire, whereas others might be more comfortable informing their patients about other treatment modalities available for chronic pain.
The current evidence suggests that hypnosis2 and biofeedback3 are increasing in popularity as modalities of interest in the treatment of chronic, non-cancer pain. Although hypnosis and biofeedback rarely will provide a “cure” for chronic, non-cancer pain, they help patients self-regulate and influence their pain perception.4
Hypnosis Through the Ages
The earliest case reports describing hypnotic strategies for chronic pain management originally were published in the 1950’s,5,6 a time that also witnessed the release of biofeedback technology that helped individuals attain similar physiologic states.7
During the next few decades, knowledge about the stress response and its effects on an individual’s physiology greatly increased. As a result, a large number of studies were conducted investigating the efficacy of hypnosis and biofeedback in the treatment of several pain conditions, including chronic pelvic pain,8 fibromyalgia,9-12 headaches,13,14 irritable bowel syndrome/gastrointestinal conditions,15-17 lower back pain,18 multiple sclerosis,19 and temporomandibular pain.20
What Is Hypnosis?
Hypnosis is a procedure involving cognitive processes (such as imagination) in which a patient is guided by a health professional to respond to suggestions for changes in perceptions, sensations, thoughts, feelings, and behaviors.21 According to the Society of Psychological Hypnosis (Division 30), hypnosis involves learning how to use your mind and thoughts to manage emotional distress (such as anxiety); unpleasant physical symptoms (such as pain); and certain habits or behaviors (such as smoking). Sometimes, people also are trained in self-hypnosis, through which they learn to guide themselves during a hypnotic procedure.
There are many myths and misconceptions and much misinformation about hypnosis—more than about any other treatment for chronic pain (Table 1). This most likely is due to the privileged position that hypnosis holds in popular culture via movies, television, books, rumors, and stage performers that make no attempt to tell the truth about hypnosis. Many patients will have preconceived notions about hypnosis from popular TV shows (Doctor Who, Monk), movies (Office Space, Shallow Hal, Zoolander), and books (The Manchurian Candidate). These types of cultural references to hypnosis tend to provide misinformation and/or embellish to create a more dramatic effect for entertainment purposes. In addition, medical hypnosis generally is not taught as part of medical or health provider curriculums; this lack of knowledge adds to superstition even in the medical community.
Hypnosis has a long history of being used as a therapeutic tool. During ancient times, the treatment of physical ailments was shrouded by mystical practices. Egyptians used “dream temples” and the Greeks used sleep temples, or “hypnos,” to treat ailments. Druids, Vikings, Indian Yogis, Hindu priests, and holy men of all religions used chants, drumming, and dancing rituals. Evidence of the practice of hypnosis can be found in the Bible and Hindu Vedas dating back to 1500 BC.
The practice resurfaced in the late 18th century with Mesmer’s use of the imagination and magnet baths, and, in 1795, Braid finally introduced the term “hypnosis” to describe the treatment process. In the beginning of the 19th century, hypnosis was being used as anesthesia until chloroform started being used in 1831. Freud also discontinued his use of hypnosis around this time, and instead developed his free association method soon thereafter.
In the 20th century, hypnosis re-emerged as a conventional treatment modality, being used in clinical psychotherapy by Erickson, as well as in dentistry and medicine.22 Hypnosis continues to be used in modern medicine, but questions remain about this modality.
How does it feel to be hypnotized?
At its most basic, hypnosis treatment consists of 4 ordered stages: an “induction” (usually to focus one’s attention), a deepening (usually to deepen one’s relaxation of the body), suggestions (usually for changes in the client’s experience of pain), and a debriefing.
Beyond this basic structure, there are several variations in features of its practice. For example, if one used hypnosis for chronic pain, one could focus on changing the sensations from pain to something else or on shifting the patient’s attention away from the pain. Sometimes underlying dynamics, motivations, or unresolved feelings may influence pain and hypnosis can aid in this unconscious exploration and contribute to the resolution of these underlying issues.
In addition, individuals may be instructed to practice self-hypnosis outside of the treatment setting, or may be given audio recordings of the sessions to help with home practice.
Everyone responds differently to hypnosis. Some patients report their experience as a “trance-like” state. Others may experience it as imagery or the soothing of body sensations.
Most people describe hypnosis as a pleasant experience, associated with a feeling of being focused and absorbed in the experience, as well as being more alert, relaxed, comfortable, and peaceful. No matter what the experience, patients consistently report better health and happiness after using these techniques.
Imaging data has indicated that hypnosis affects cognitive control by modulating activity in specific brain areas. Hypnotized subjects have shown reduced brain activity in both visual areas and the anterior cingulate cortex, which plays a role in a wide variety of autonomic and cognitive functions.23
How can hypnosis help my patients cope with chronic pain?
Hypnosis has been found to be generally more effective than other non-pharmacologic interventions, such as physical therapy and pain education.24-27 There is growing evidence to suggest that hypnosis has greater influence on the affects of pain rather than the sensation of pain.28,29
Hypnosis may be able to provide analgesia, reduce stress, relieve anxiety, improve sleep, improve mood, and reduce the need for opioids. Further, hypnosis can enhance the efficacy of other well-established treatments for pain.25