Hypnosis and Pain Management
What follows is an investigative report into the use of hypnosis to assist in pain management. This report is based upon a review of ten studies made on the subject of hypnosis and pain management. The goals of this work are to define some of the major terms and procedures that are involved in the subject and make a general but accurate assessment of the effectiveness of hypnosis as a tool for pain management. An annotated bibliography follows the conclusion.
To start with, what exactly is pain management and why would people turn to alternative procedures such as hypnosis? Everybody knows what physical pain is, but to many people chronic pain is a long-term negative life detractor that can also cause clinical depression (Nickelson et al., 1999). One researcher stated that chronic pain causes “… delayed healing, prolonged hospitalization, and reduced participation in rehabilitation…” (Valente, 2006). Of the many millions that suffer chronic pain in America and are issued pain killers to help manage that pain, it has been estimated that more than 40% will ultimately abuse their pain medicine in often vain and desperate attempts to find relief (Nickelson et al., 1999). When prescription drugs ultimately fail to provide adequate pain relief, many will become depressed, and that is when a good physician will seek and offer alternative options for pain control such as “…relaxation therapy, biofeedback, guided imagery, and hypnosis” (Nickelson et al., 1999).
Yet another sort of pain is psychologically perceived. Take, for example what researcher Christina Liossi (2006), and no doubt confirmed by millions of cancer suffers worldwide, have to say about the reality of psychological pain:
A growing body of scientific evidence suggests that a cancer diagnosis itself in combination with associated invasive procedures renders patients at risk for long term psychological distress sometimes manifesting itself in compromised treatment compliance. (p. 47)
On another level of pain is the apprehension and phobia of medical situations such as a visit to the dentist’s office or the site of needles as was the case of a 31 year old female who had an extreme phobia of dental surgery to the extent that she neglected needed dental care. The dentist effectively used hypnosis to allow the patient to easily overcome the phobia and get the needed dental procedure completed (Gow 2006). Therefore, pain management can be defined as finding and using the individual means necessary to effectively manage pain so that a normal life, happiness levels, and the healing processes are maximized.
In regards to understanding its use in pain management, how is hypnosis defined? Hypnosis is described as “… focused attention, an altered state of consciousness, or a trance accompanied by relaxation and comfort…” (Valente, 2006). The American Psychological Association defines hypnosis as something that:
…typically involves an introduction to the procedure during which the subject is told that suggestions for imaginative experiences will be presented and that following this introduction one person (the subject) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought, or behavior. (Jensen & Patterson 2006)
In the studies that were reviewed in making this report, hypnosis was tried in the management of almost every sort of pain conceivable. Doctor Sharon Valente’s research (2006) found that hypnosis can be used to assist those suffering from: “painful procedures, treatments, or diseases… and pain from surgery, tumors, injuries, and chemotherapy”. Hypnosis has been found to be highly effective in alleviating symptoms and pain of Irritable Bowel Syndrome (Gholamrezaei et al., 2006). Hypnosis has been used to try and boost the body’s immune response (Liossi 2006). Hypnosis has been used with the terminally ill to fight depression and pain (Liossi & White 2001). As stated, hypnosis is a tool in pain management of those who suffer psychological pain and phobias. Most often, hypnosis has been used to assist in pain management of those who suffer from chronic/operant pain.
Pain enters a clinically chronic stage when it has gone on so long that the “… sensation of pain may no longer serve an adaptive function, and psychosocial factors frequently exacerbate or maintain the experience beyond what would be expected on the basis of physical findings” (King et al., 2001). According to King at al (2001), when this stage of chronic pain has been reached, the conditions that the sufferer previously associated with pain, though they cause no physical injury, are enough to set off a real pain attack. These conditions are the ‘operants’ of the chronic pain as they operate to produce the effect of pain.
In just about any situation that calls for pain management, hypnosis has been used; and the use of hypnosis for pain management is nothing new. Researcher Brenda King (et al) states that for over a century surgical procedures have been (and sometimes
still are) performed with hypnosis as the sole source of pain relief (2001). Researcher Christine Liossi (2006) takes this assertion a long step further by stating that hypnosis “… under various names has been used for as long as records have been kept… [and] suggestive therapy is probably the oldest of all therapeutic methods”. Any person who has ever experienced a toothache or childbirth knows the level of individual desperation to escape pain. It is no wonder that before the advent of modern pain medicines humans turned to alternatives such as the power of suggestion or hypnosis. How does hypnosis work in pain management?
There are apparently many diverse methods to induce hypnosis in pain management, not the very least of which is self-hypnosis. Regardless of which method is employed, the mechanics are the same. When a person enters a hypnotic trance, they are aware of everything around them “… but may selectively focus on pleasant sensations and ignore discomfort” (Valente 2006). The author Sharon Valente (2006) is a physician and an advocate of hypnosis and gives the following example of how hypnosis works to help disarm fear and pain: “… when a nurse ﬁnds it difficult to start an intravenous line on a screaming five year-old child, the nurse can use hypnosis to help the child refocus his or her attention, and effectively ignore the needle”.
Author and physician Connie Nickelson (et al) states that fighting pain with hypnosis is a matter of introducing successfully competing stimuli to the extent that the mental perception of pain has been cancelled out (1999). Nickelson stated that “… highly hypnotizable individuals can eliminate totally the perception of both sensory and emotionally distressful pain by altering brain activity in both attentional systems” (1999).
A problem exists in hypnotism for pain management in that not all people are highly open to the power of suggestion – or hypnotism.
According to Nickelson (et al), “most patients with any level of hypnotizability and pain severity can potentially benefit from hypnotic treatment' ' when they are in the hands of trained physicians and there are no contraindications for its use"(1999). This statement implies that there are exceptions. Some reasons that may cause a physician not to recommend hypnosis for pain management include situations where patients who are suffering from chronic pain “… also have neurological disorders, chronic fatigue syndrome, major depression, and uncompensated job injuries where potential litigation interferes with recovery from injuries…” (Nickelson et al., 1999). Patients in these situations may not be mentally receptive enough to hypnosis. In like manner, patients who have ideological or psychological resistance, distrust in the physician, or significant psychopathology, ie, psychoses, paranoia, and suicidal ideation…” may not be receptive to hypnosis either (Nickelson et al., 1999). Clearly, this indicates a clear link between the success of using hypnosis for pain management and the receptiveness and the responsiveness of the sufferer to hypnosis. But for those who are responsive to hypnosis, the potential benefits are alluring.
According to doctor Brenda King (et al., 2001), hypnosis as a pain management tool provides dramatic improvement to patients who are moderately to highly responsive to hypnotic suggestion. These same individuals will also respond most rapidly to hypnotic suggestions in pain intervention and experience the most favorable outcomes in the objective of pain management (King et al., 2001). Also according to King, the trait of being highly responsive to hypnosis is akin to how people score on IQ tests in that this trait does not change much over the decades (2001). However, in yet another study involving a control group, researchers have provided evidence that hypnotizability can be improved through training (Gfeller 1987).
There are tests that physicians can use to help determine whether or not a patient is highly responsive to hypnosis. One way doctors can measure a patient’s responsiveness to hypnosis is called the Hypnotic Induction Profile (HIP) (King et al., 2001). In this test, the patient undergoes a five to ten minute time period where they are asked to keep their eyes closed and look up. Meanwhile, the physician gives the patient a number of suggestions with the purpose of assessing their responsiveness to structured hypnotic experiences (King et al., 2001).
The Stanford Hypnotic Clinical Scale is another test that can be used to assess a patient’s hypnotizability. In this test, the patient is first hypnotized and then a number of suggestions are given in a progressive order starting with what is a relatively easy hypnotic suggestion (such as posture sway and eye closure) up to what would require a very high level of a hypnotic trance (such as evoking a hallucination like flying or total amnesia of an event) (King et al., 2001). Variants of the Stanford Hypnotic Clinical Scale operate along the same lines.
A third test, called the Computer Assisted Hypnosis Scale, for assessing hypnotizability involves interaction with a computer program. In this test, the computer takes the patient into hypnotic induction and administers twelve test suggestions (King et al., 2001). Purportedly, this test is as reliable and valid as “… those of comprehensively researched scales” (King et al., 2001). The Computer Assisted Hypnosis Scale has the additional benefit of being faster and easier to administer than other means.
Such test to measure an individual’s susceptibility to hypnotic suggestion may not actually be necessary. According to some researchers, anybody can be hypnotized as a state of hypnosis “… begins with relaxation and then includes a refocusing, or change in cognition, memory, perception, and attention” (Valente 2006).
People enter various levels of a hypnotic trance when they become “… so involved in an activity (e.g., concert, movie, ball game, daydream) that they lose awareness of time and surrounding events… everyone who can concentrate can be hypnotized” (Valente 2006). Concerning who can perform the hypnosis is another issue with an equally open answer.
According to doctor Golan of the National Hemophilia Center in Tel-Hashomer, Israel, all “…medical and psychosocial staff can be taught the various techniques of hypnosis…” (2000). Furthermore, Golan states that not only can care providers learn to induce hypnosis, but the patients and their families can learn self hypnosis to help themselves. Self hypnosis is useful in helping family and staff of patients cope with emotional stress (Golan 2000). Self hypnosis was a reoccurring theme throughout much of the literature reviewed for this report. Because the duration of the effects of clinically-induced hypnosis may wear thin in time, it would be highly useful for patients and stressed family and caregivers to be able to call upon and reintroduce the favorable suggestions of the hypnotic state.
Describing in detail how hypnosis or self hypnosis is induced is beyond the scope of this paper. There are also many techniques used to induce hypnosis. However, the topic warrants a cursory overview and therefore a broad explanation of the general procedure follows. First, before a physician (or therapist) hypnotizes, there are preliminary steps involved. The physician should ask the client “… to identify the activities they consider the most relaxing (e.g., walking on the beach, sitting by a lake, climbing a mountain) and explore clients’ values and beliefs and goals so clinicians may weave these into the hypnosis” (Valente 2006). The physician should also take care to explain the purpose and the procedures of hypnosis and that at no time will the patient lose control over their will or the treatment and that they will not be made willing to do anything while hypnotized that they would not normally do and finally that they can stop the hypnosis any time they wish (Valente 2006). Next, the patient should be asked to relax into a physically and mentally calm and comfortable state (Valente 2006). At this point, the physician would verbally suggest things that would draw the patient into deeper stages of relaxation and separation from the peripheral senses to the point that the patient is open to suggestion. Though the ideal setting for hypnosis is a quiet place, “… if a noisy setting cannot be avoided, the hypnotists can suggest that client ignore the noise” (Valente 2006).
Concerning hypnosis for pain relief, doctor Sharon Valente (2006) suggest that “…clinicians avoid using pain-linked words during the trance (e.g., pain or hurt) and emphasize positive words (e.g., comfort, relaxation, numbness, warmth). Also, the hypnotized patient is free to walk, talk, and interact with the physician during the hypnosis (Valente 2006). Once the hypnotic trance has been established, patients are guided to a favorite place in their mind; this can be an actual place or an imaginary place (Valente 2006). At this point, the patient is hypnotized and open for suggestion. Doctor Sharon Valente offers a detailed list of suggestions that can be employed to block, desensitize, or reinterpret pain. Table 1 on page nine lists some of doctor Valente’s (2006) methods of suggestion for pain management.
GOAL ACTIVITY INSTRUCTIONS Block awareness of pain Alter the perception of pain
by suggesting that the area
becomes numb, cool, or
anesthetized. You will begin to notice that you feel a numbness moving from your hips up to your chest. In a few moments, you will feel nothing at all in your hips. Substitute another feeling Suggest another feeling to
replace the discomfort. If the pain is sharp and burning and associated with nausea, suggest
soft, cool images. Imagine you have entered the elegant tower of a fascinating castle, and you are walking down a staircase.
Notice how pleasantly cool everything feels. Notice the ancestors’ pictures on the wall as you descend the cool,
comfortable staircase. Displace the sensation Suggest the discomfort is
moving outside the body or is shrinking. Imagine the discomfort is a large chunk of ice. The sun shines on the ice and melts and evaporates it. Notice as
the ice chunk shrinks.
Finally, the question stands as to how effective is hypnosis for pain management?
For decades, doctors and researchers have reported that “… hypnosis effectively controls acute and chronic pain and also relieves depression" (Liossi & White 2001). In fact, research has shown that “even when hypnosis is used only for stress reduction and relaxation, without suggestions of analgesia, the pain threshold is increased by 20% to 40%” (Liossi & White 2001). The words of people who have used hypnosis for pain management also strongly support its use. One patient had the following comments to make on her use of hypnosis for pain management: “When in hypnosis I feel as if I leave my sick painful body behind and move freely anywhere I want, real or imaginary” (Gow 2006). Another stated, “I have never felt like this before, it is as if something is happening to my mind, I switch to a different mode” (Gow 2006).
Conclusions about hypnosis for pain management are easy to come by. First, it is highly apparent that the success of hypnosis as a pain management tool is equal to the susceptibility of the patient to hypnosis. If a person is not very receptive to hypnotic suggestion, some studies show that training can make a positive difference. Considering the amount of tragedies that occur on a regular day-to-day basis of people overdosing on pain killers, hypnosis offers an attractive and free alternative. How effective it is for each individual varies greatly, yet it should be tried and it cost nothing to try. In the dentist’s office alone hypnosis could be of great help where anxieties among needle-squeamish children run high in the dental chair.
So why does there seem to be such a dearth of physicians who offer hypnosis to patients? Perhaps medical schools and circles generally view hypnosis as something out of the empirical realm of science and into the world of quackery. Perhaps there is a shortage of qualified individuals to teach hypnosis for pain management. When one realizes that perception is all in the mind, it only makes sense to take the management of pain to the mind in the form of controlling perception.
Gfeller, J. D., Lynn, S. J. & Pribble, E. W. (1987). Enhancing hypnotic susceptibility:
Interpersonal and rapport factors. Journal of Personality and Social Psychology,
In this study, the authors undertake an investigation to determine whether or not an individual’s susceptibility level to hypnosis can be improved with training. Their methods are given in detail and the results discussed. Their findings strongly indicated that an individual’s susceptibility level to hypnosis can be improved with training.
Gholamrezaei, A., Khanpour, S. & Emami, M. (2006). Where does hypnotherapy stand in
the management of irritable bowel syndrome? A systematic review. The Journal
of Alternative and Complementary Medicine, 12(6), 517-527.
In this study, the authors are physicians at hospitals and universities in Iran who focus on the effectiveness of hypnosis in alleviating symptoms and discomfort of Irritable Bowel Syndrome. The studied 22 cases, made use of a control group, and found hypnosis effective in this use.
Golan, G. (2000). Pain management. Haemophilia, (6), 407.
The author of this brief article is an Israeli physician who endorses the use of hypnosis in the pain management of hemophiliacs. Furthermore, the physician also recommends it to alleviate the stress of families and care providers for hemophiliacs.
Gow, M. (2006). Hypnosis with a 31-year old female with dental phobia requiring an
emergency extraction. Contemporary Hypnosis, 2(23), 83-91.
Author and dentist Michael Gow discusses in detail the case of a woman who had an extreme phobia of needles and how the dentist used hypnosis successfully to allow her to easily overcome her phobia. The study goes into a great amount of detail and discourse on how the patient felt and reacted to the treatment.
Jensen, M. & Patterson, D. R. (2006). Hypnotic treatment of chronic pain. Journal of
Behavioral Medicine, 29(1), 95-134.
The authors of this comprehensive study are lecturers at rehabilitation and pain management centers. The study compares and analyzes hypnosis to many other factors in pain management such as biofeedback and attention control. In this study, hypnosis as a pain management tool gets a favorable nod.
King, B., Nash, M. & Jobson, K. (2001). Hypnosis as an intervention in pain
management: A brief review. International Journal of Psychiatry in Clinical
Practice, 5(6), 97-101.
The authors investigate and compare the effectiveness of hypnosis in chronic pain management. They also present a viable argument that hypnosis is underrepresented and misunderstood by many health practitioners.
Liossi, C. (2006). Hypnosis in cancer care. Contemporary Hypnosis, 23(1), 47-57.
Doctor Christina Liossi is the senior lecturer in Health Psychology at the University of South Hampton. She discusses in relative detail the impact of hypnosis on patients with cancer. Her research and discussion cover more than hypnosis and physical pain, but also emotional as well.
Liossi, C. & White, P. (2006). Efficacy of clinical hypnosis in the enhancement of quality
of life of terminally ill cancer patients. Contemporary Hypnosis, 18(3), 145-160.
In this collaborative work, the authors undertake a study into the impact of hypnosis upon the psychologically painful aspects of terminally ill cancer patients. The study tracked a group of new patients for six months making assessments of quality of life, anxiety and depression before and after interventions and made comparisons through semi-structured interviews with patients in a group using hypnosis. The findings support the use of hypnosis in this setting.
Nickelson, C., Brende, J. & Gonzales, J. (May 1995). What if your patient prefers an
alternative pain control method? Self-hypnosis in the control of pain. Southern
Medical Journal, 92(5), 521-523.
The doctors who authored this study examine a case in detail that makes a strong argument for the use of hypnosis in pain management. A cursory overview of the subject of hypnosis in pain management is presented as well.
Valente, S. M. (February 2006). Hypnosis for pain management. Journal of Psychosocial
Nursing, 44(2), 1-9.
The author, who is the Associate Chief of Nurse Research and Education for the Department of Veterans Affairs is also a practiced in the use of hypnosis in pain management, offers her own experience with research to promote the use of hypnosis in pain management. She offers how-to advice as well as specific patient cases to help inform the reader as to the best approaches for different scenarios.