pain management

Hypnosis for Pain Management

“The empirical support for hypnosis for chronic pain management has flourished over the past two decades. Clinical trials show that hypnosis is effective for reducing chronic pain, although outcomes vary between individuals. The findings from these clinical trials also show that hypnotic treatments have a number of positive effects beyond pain control. Neurophysiological studies reveal that hypnotic analgesia has clear effects on brain and spinal-cord functioning that differ as a function of the specific hypnotic suggestions made, providing further evidence for the specific effects of hypnosis. The research results have important implications for how clinicians can help their clients experience maximum benefits from hypnosis and treatments that include hypnotic components.”

This is the abstract from an excellent article* describing how hypnosis can be a highly effective adjunct therapy in pain management,

You can read the entire article here

At my practice in Highgate Hill, I  consistently achieve excellent results with helping my clients to effectively and positively overcome chronic pain.

To learn more, you can find my contact details here. I’ll be happy to answer any questions you might have about how hypnotherapy can help you to overcome your chronic pain.

*    Hypnotic Approaches for Chronic Pain Management – Clinical Implications of Recent Research Findings. Mark P. Jensen and David R. Patterson, University of Washington

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Hypnosis for Pain Management

Pain that persists for longer than 6 months is referred to as chronic pain (Keefe, 1982). Unrelieved chronic pain can cause considerable suffering, physical limitations, and emotional distress493x335_low_back_pain_overview_slideshow (Turk, 1996). Further, chronic pain is one of the most common reasons for seeking medical care but often persists despite treatment with analgesics and physical modalities. For example, epidemiologic studies indicate that approximately 11% to 45% of individuals in the United States experience chronic back pain (LeResche & Von Korff, 1999), 75% of patients with advanced cancer suffer persistent pain (Bonica, 1990), and chronic pain is the most common reason for the use of complementary and alternative therapies (Astin, 1998; Eisenberg et al., 1993).

Interest in hypnosis for pain management has increased with recent evidence that hypnosis can reduce pain (and costs) associated with medical procedures (Lang et al., 2000), and there are now an adequate number of controlled studies of hypnosis to draw meaningful conclusions from the literature regarding chronic pain (Jensen & Patterson, 2006; Montgomery, DuHamel, & Redd, 2000; Patterson & Jensen, 2003).

Hypnosis in the treatment of chronic pain generally, but not always, involves a hypnotic induction with suggestions for relaxation and comfort. Posthypnotic suggestions may be given for reduced pain that can continue beyond the session or that the patient can quickly and easily create a state of comfort using a cue (i.e., taking a deep breath and exhaling as eye lids close). The focus of hypnosis in the treatment of chronic pain also often involves teaching the patient self-hypnosis or providing tape recordings of hypnosis sessions that can be used to reduce pain on a daily basis outside the sessions. Some patients experience an immediate reduction in pain severity following hypnosis treatment, whereas others can obtain reduction in pain with repeated practice of self-hypnosis or hypnosis sessions.

A recent study compared the effectiveness of hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Thirty-six patients with osteoarthritis pain were randomly assigned to one of three conditions: hypnosis, relaxation training, and a no-treatment/standard-care control condition. The hypnosis intervention consisted of eight weekly sessions that began with a standard relaxation induction followed by suggestions for positive imagery, as well as a memory from childhood that involved joint mobility. The subjects in the standard-care control condition were administered the outcome measures and were offered treatment after their last follow-up assessment. Patients in the hypnosis treatment showed a substantial and significant decrease in pain intensity after 4 weeks of treatment, which was maintained through 3 months and 6 months of follow-up. In comparison, patients in the no-treatment control condition reported little change in pain during the 6 months of this trial.

In addition to being of proven benefit in the management, control and reduction of chronic pain, Hypnotherapy has the added benefit of being entirely free of any side effects.

 

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Hypnosis with Breast Surgery

Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue.

In this study, a randomized clinical trial involving 200 patients undergoing breast surgery  tested the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective.

The study concluded that, “Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.”

You can read the complete study here.

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Hypnosis Works for Pain Control

The US Institute for the Study of Healthcare Organizations & Transactions has a study on the effectiveness of Hypnosis in Pain Management.

As you can see from their graph, Hypnosis achieved a higher level of pain reduction than Acupuncture, Morphine or the Placebo. Hypnosis not only helps to relieve pain but it helps to preserve the dignity and well-being of patients without the dependence on large amounts of prescription medications .

Remember, ALL medications have side effects and people develop a tolerance eventually leading to increased dosages and possible addiction.

The US National Institutes of Health recommends using hypnosis as a tool in pain management! 26 million Americans have frequent or persistent back pain and 50 million Americans are partially or fully disabled from some form of chronic pain?How about the fact that 1 out of every 6 Americans have a form of painful arthritis.

The evidence suggests that, per capita, the  situation is much the same in Australia.

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Hypnosis and Surgery

This study*, published the medical journal Lancet in 2000,  explored how hypnosis used in preparation for surgery might affect outcomes, in particular subsequent pain and anxiety levels.

As you can see from the graphs, the results were dramatic to say the least. Where hypnosis was used, patients were far less anxious and experienced far less pain.

What is especially interesting about this study is that all patients had access to a patient controlled analgesia device, so the amount of medication each group requested, (a strong indicator or pain levels),  and received was very precisely measured.

Lang and colleagues conducted a randomised controlled trial on 241 patients undergoing invasive surgery to the arteries, veins, or kidneys. Three test treatments were compared: self-hypnotic relaxation, attention control, and standard care. Approximately 80 patients were randomised to each of these groups, matched for disease severity.

The surgery was conducted under conscious sedation – patients were given Midazolam which leaves them awake but sedated. The standard treatment group consisted of treatment as usual.

The attention control condition included an additional member of the surgical team paying special attention to the patients needs, providing the feeling of control and swift response to the patients requests. The hypnotic condition involved an additional member of the surgical team acting as in the attentional control condition, but additionally administering a rapid hypnotic induction, giving suggestions for a sensation of floating, and encouraging the patient to use self-generated imagery.

Pain, anxiety and drug use were assessed.

In particular, after the surgery patients had access to a ‘patient controlled analgesia’ device which delivered pain medication at the touch of a button – the amounts requested an delivered were recorded.

These graphs show the average pain and anxiety scores reported by patients in each of the three groups as the time of the operation went on. The time it took to complete the procedure was significantly shorter in the hypnosis group compared to the standard treatment group, with the attention group in between.

Patients in the attention and standard treatment group reported that their pain got steadily worse as the operation went on, but in comparison patients in the hypnosis group continued to remain relatively pain free over the same period.

Patients in the hypnosis and attention groups requested and received approximately half the amount of pain medication than patients in the standard care group.

 

 

* Lang, E. V., Benotsch, E. G., Fick, L. J., Lutgendorf, S., Berbaum, M. L., Berbaum, K. S., Logan, H., Spiegel, D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. The Lancet, 355, 1486-1490.

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Hypnosis for Pain Management

Within the realm of medicine, the method of hypnoanalgesia can be adapted for various situations. In most cases, the intervention consists of four main stages (Chaves, 1994). The first stage involves preparation of the patient. As can be expected, most patients come into hypnosis with various expectations. In order to obtain the maximum gain, the therapist works to direct the patient toward the most realistic goals. The second stage involves the hypnotic induction.

As studies have not shown that differences exist between indirect and direct suggestions, most therapists make use of a mixture of the two. In this stage, the therapist needs to help the patient enter into a focused and relaxed state. The third stage involves therapeutic suggestions. This is the most important stage in which the therapist focuses the attention of the patient. In the context of pain reduction, the therapist helps the patient develop
imaginary situations (regardless of feasibility) which will achieve the goal of less pain.

BackPain_zpsbb50a1b7An example is dissociation, in which the patient imagines the hand separate from the body or made of a different material. The fourth stage involves posthypnotic suggestions and termination. The posthypnotic suggestions allow the patient to retain achievements (i.e. pain reduction abilities) outside of the hypnotic state (e.g. with a tap on the shoulder).

The most researched form of acute (short-term) pain in the context of hypnosis is that associated with burn patients. The use of hypnosis is important at the outset as well as throughout the healing process.

For burn patients, the use of hypnotic induction as close as possible to the time of injury is essential as it helps to limit the amount of inflammatory reaction to the injury. Furthermore, the minds of the patients are focused upon entry into the emergency room which makes hypnosis easy to induce.

According to earlier studies, signs of inflammation are affected by the attitude of the patient toward the injury (Chapman et al., 1959). Therefore, the perception of heat at the burn site leads to increased inflammation and the perception of coolness leads to decreased inflammation.

Applied before the initiation of the natural response, hypnotic suggestions of cooling and anesthesia limit and prevent inflammation. Burn patients who accept the suggestions that the wounded area is ³cool² and ³comfortable² are easier to treat, more optimistic, and heal faster (Ewin, 1978).

As burn patients go through the healing process, the pain of caring for the wound is reported to be more severe than the pain of sustaining the wound. In order to prevent infection, patients must undergo daily debridement, which involves scraping necrotic tissue off the wound and applying antiseptic. The procedure causes excruciating pain. Since the frequency of wound care prohibits regular use of general anesthesia, the use of hypnoanalgesia is highly applicable (Patterson et al., 1996).

In a study done by Patterson et al. (1992), 30 burn patients undergoing debridement were randomly assigned to three groups: hypnosis, attention/pseudohypnosis (placebo), and no intervention (control).

The hypnosis condition included suggestions for relaxation, analgesia, amnesia, and comfort when touched on the shoulder. The placebo condition involved pseudohypnosis (closing your eyes, counting to 20, imagining yourself in a relaxing place), the touch on the shoulder, and instructions to distinguish between sensations of healing and signals of harm. The control condition provided no other procedures to alleviate pain.

The results showed that only the group which underwent true hypnosis reported a significant reduction in pain. The true hypnosis group reported a 46% decrease in pain from the baseline, the placebo group reported a 16% decrease, and the control group reported a 14% decrease.

Even though the placebo group believed that they underwent hypnosis, those assigned to that group did not report much less pain than those assigned to the control group. Therefore, the results discount the
effects of expectancy and reveal that pain reduction due to hypnoanalgesia goes beyond relaxation.

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Hypnosis for Pain Management

pain-mapHypnosis can be used for all patients for pain relief including, in some instances, as a form of analgesia for surgery, a Perth conference of anaesthetists and pain specialists was told in 2012.

New Zealand psychiatrist and pain medicine specialist, Dr Bob Large, from the Auckland Regional Pain Service said about 10 to 15 per cent of the population is highly hypnotisable and could potentially undergo surgery, such as gallbladder or thyroid removal, without anaesthetic.

However, Dr Large told an Australian and New Zealand College of Anaesthetists conference in Perth, the rest of the population can still benefit from hypnosis to control their pain levels through suggestions made by a specialist that can change a patient’s expectations of pain. This has been shown to be effective in child birth and for dealing with cancer and chronic pain and pain following medical procedures.

Hypnosis is now well established as a highly effective, side effect free form of pain management.

Hypnosis is particularly beneficial for children dealing with chronic pain, as they usually take to hypnosis easily and quickly become skilled at self hypnosis.

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