Altering the Pain Experience: Hypnotherapy for Pain Management
By Cynthia Lindner, MS
Hypnotherapy is a recommended treatment for chronic pain patients. Strong evidence has been gathered by a 1995 panel of physicians of the National Institutes of Health that show hypnotic interventions are beneficial in the management of cancer pain, temporal-mandibular disorders, tension headaches, and irritable bowel syndrome. Relaxation techniques are also shown to be very useful for reducing chronic pain. A review of more recent literature also reveals that hypnosis is being successfully used for management of acute pain associated with invasive procedures, treatments such as burn dressing changes, labor and childbirth, and some surgical procedures.
Chronic pain affects over 34 million Americans. Most are significantly disabled by it, and some are permanently disabled. Over $40 billion is spent annually in the U.S. on treatments and over 25% of all sick days are taken to deal with pain. Indeed, chronic pain is a global issue, and the World Health Organization supports efforts to relive pain for all of humanity. Pain patients may experience an increase in stress, metabolic rate, blood clotting, and water retention. Pain patients can have delayed healing, hormonal imbalances, impaired immune systems and gastro-intestinal functioning, mobility difficulties, loss of appetite, sleep disturbances, suffering, low self-esteem, and depression. (Bedard, 1997)
As a participant in an integrated medicine approach, therapists can help patients to understand the physiological processes of the body while taking into consideration the patient's belief system, perspective and response to pain.
The goal of hypnotherapy for pain management is to produce deep relaxation for the reduction or amelioration of fear, tension and anxiety that is concomitant with pain. (Longacre, 1997) Suggestions for comfort and suggestions that aid with cognitive restructuring can help the patient to modify their experience of the pain and thus diminish or end the suffering. Imagery can provide distraction and relief from pain. There is evidence for a change in brain activity which apparently mitigates pain sensations. Recent research provides us with substantial evidence that hypnosis is an effective pain management tool. The advantages of incorporating hypnotic strategies into a management plan for unremitting acute or chronic pain are the following: Firstly, the patient can begin to regain a sense of control over their well-being. Secondly, patients may require less medication, and therefore avoid or limit undesirable side effects. Thirdly, patients successfully learn to do self-hypnosis can independently alleviate their pain. Thereby gaining a stronger sense of well-being by being able to “take charge” of their comfort and reduce medical office visits.
PSYCHOLOGICAL INTERVENTIONS FOR CHRONIC PAIN:
1. Evaluate the impact of negative self-talk.
2.2. Develop self-soothing, and calming inner dialog.
1. Progressive muscle relaxation.
2.2. Visualization and breath work.
3.3. Teach self-hypnosis.
4.3. Meditation / Yoga.
5.5. Self-Regulation. (Biofeedback)
1. Proper nutrition, exercise, and rest.
2.2. Time management / prioritizing.
3.3. Relaxation training.
4.4. Participation in pleasurable activities.
Address Issues of Control:
1. Facilitate identification of choices.
Explore Body Image Issues:
1.Encourage grieving for any losses related to changes in functioning.
2.2. Encourage self-acceptance.
3.3. Provide positive feedback for efforts and accomplishments in self-care.
THE PROBLEM OF DEPRESSION:
Several studies have shown a significant rate of depression in chronic pain patients. Some research finding between 31% and 100% of chronic pain patients have a diagnosis of depression (Romano & Turner, 1985), with ranges of 50% - 65% being more typical (Kramlinger et al., 1983). There are several possible explanations for the pain/depression relationship. These possibilities include: Chronic pain causes depression; depressed patients are more likely to experience depression; chronic pain and depression are mediated by other variables (Averill, Novy, Nelson & Berry, 1996) Regardless of the reason for this relationship, it is accepted that the co-occurrence of depression with chronic pain effects treatment outcomes. Research has shown that non-depressed pain patients tend to benefit from treatment more than depressed patients, and that back pain patients free from depression do more activities than their depressed counterparts who tend to avoid more activities.
While major depression during the circumstances of personal loss and serious physical illness is considered normal and is expected, it should be treated by a qualified mental health professional. Whenever a deep depression is present suicide prevention is a concern. In this author's opinion, depression must also be addressed when depression interferes with physical and vocational rehabilitation.
As in any situation where hypnosis is used, care should be taken to utilize the attributes, likes and dislikes that the client brings into the session. A client centered permissive approach is how this author typically works, however a classical authoritarian approach which can also be delivered in respectful manner, is also effective with some clients. A self-assessment of pain (Discomfort Survey) can be completed by the patient during the initial comprehensive visit, rating the pain on a 1-10 scale, mapping the location and type of pain they are experiencing, and selecting descriptive words for the pain from a list of adverbs. Teaching a progressive muscle relaxation is useful, however tensing and clenching muscles then releasing is a relaxation technique which can aggravate certain types of musculoskeletal pain, and should be avoided.
Suggestibility testing and eliciting hypnotic phenomena are useful to the client and enhance treatment outcomes. In several studies, patients scoring high on tests of hypnotic suggestibility often showed more improvement with non-hypnotic psychological measures such as autogenic training, relaxation, and cognitive-behavioral treatment. It appears the association between clinical effect and suggestibility exists for a range of psychological treatments. (Kessler, 2004)
Various techniques in self-regulation are helpful in reducing pain and suffering in patients. Hypnosis is useful in mitigating chronic and acute pain, and can be effective for children and adults. The literature supports both hypnotic and relaxation interventions for reduction of pain with hypnosis appearing to be the stronger intervention having a positive effect for both chronic and acute pain. (Kessler, 2004)
While hypnosis has not consistently been shown to be more effective for pain than other treatment options, there are other benefits to consider such as fewer medical visits, less medication may be needed and by managing pain through self-hypnosis medication side effects are reduced because less medication is consumed. It is psychologically pleasing for many patients who use hypnotic intervention to take charge of their sense of well-being and be an active participant in their treatment.
Averill, Novy, Nelson, & Berry , Correlates of depression in chronic pain patients: A comprehensive examination, Pain , 65 (1996) 93-100
Bedard, Marcia E., PhD (1997, July) Fact Sheet on Chronic Nonmalignant Pain
Caudill, Margaret, Managing Pain Before It Manages You, Copyright, 1995, The Guilord Press
Kessler, Rodger S., Is It Time to Propose a Continuum of Self-Regulation Treatments for the Control of Pain? Evidence for Effectiveness of Hypnosis and Relaxation, Pain Bulletin March/April 2004 • Vol 14, Number 2, American Pain Society
Kramlinger KG, Swanson DW, Maruta T. Are patients with chronic pain depressed? Am J Psychiatry. 1983;140:747-750.
Longacre, R.D., Visualization and Guided Imagery in Complementary Medicine , Copyright 1998, Kendall/Hunt Publishing
Romano, J. & Turner, J. (1985) Chronic pain and depression: does the evidence support a relationship? Psychology Bulletin , 97 , 18-32.
Cynthia Lindner, MS is a certified hypnotherapist (1985) and hypnoanaesthesia therapist (1993) with many years of experience working in the mental health professions. She has specific expertise in applying the complementary modalities of guided imagery, hypnosis, and biofeedback for the purpose of attaining wellness, self-improvement, and with Doctor's referral, relief of pain and symptoms. Cynthia has taught hypnotherapy workshops at international conferences, has authored several published articles, and is a Past President of the American Psychotherapy & Medical Hypnosis Association. She is a highly skilled professional in private practice on Long Island , NY with a talent for using mind-body techniques as an enhancement to the standard therapeutic process. Website: http://www.clinicalhypnotism.com/