Hypnosis In The Relief Of Pain
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I closed my eyes and focussed on the agony. I decided to tag that pain with a colour - the first to come to mind was red. Next I gave it a texture - it was jagged, and in my mind's eye, its shape was like forked lightening. There are other ways to reframe pain. One man who had been badly injured in a motorbike pileup had excruciating pain in his back and the soles of his feet as a result of an almost completely severed spinal nerve.
I asked him what kind of temperature the pain would be if it were a heat and he said, "Boiling. Next I graded the pain as a number: If the worst possible pain is 10, this pain was around an 8, I decided. Then I visualized the pain gradually turning from a bright red to a dull pink, then into a dark blue, and finally into a pale blue.
I saw its jagged edges begin to soften and its texture become more rounded, less sharp. I noticed that the pain had gone from an 8 to a 6. I was no longer thinking in terms of 'pain' or 'agony', but of numbers, shapes, and colours. Still with eyes closed, I pictured snow - from long ago, a time drifted into mind when, as a boy, I'd been playing in the snow without gloves.
Inevitably, my hands had become numb. I couldn't even tie my shoelaces or lift a door key from my pocket. As I strongly recalled this time, I noticed both my hands getting number and actually feeling colder. I then visualized what a whole barrel of ice might look like and hypnotically plunged my injured hand deep into it.
Now, for the first time since the slamming what a painful word 'slamming' is! Re-evoking times when you've been chemically or naturally anaesthetized is a great way of bringing those numb feelings back again. Recalling being at the dentist and having a gum injection where suddenly your gums feel like cardboard as the anaesthesia takes effect, and then having that numbness spread to wherever it's needed can work wonders.
One young woman I worked with - being allergic to chemical anaesthetic - was able to have major facial surgery purely via hypnotic anaesthesia. The groundbreaking psychiatrist Dr Milton Erickson relates a case in which he helped a woman with intractable cancer pain hypnotically leave her pain-racked body in one room while she experienced going into another room to watch TV.
This hypnotic 'out of body' experience meant that she could take regular breaks from the relentless intractable pain she'd been experiencing.
Strong disassociation sometimes happens quite naturally when we go into shock and is perhaps nature's way of making it more psychologically manageable. I imagined floating out of and above my own body and seeing my hand looking fine, with the swelling having disappeared. As I imagined detaching from my own body, I noticed how the pain in the hand began to recede further.
This disassociation exercise works excellently for pain, but also for anxiety or any strong unpleasant experience. Hypnosis is a great way to get your own mind to accelerate healing. Orthopaedic hand surgery is notoriously painful; yet in one study, the benefits of using hypnosis included much less post-surgery discomfort or pain and fewer complications generally 2.
I had to drive hundreds of miles the next day, not easy with a painful hand. Faymonville et al. When a stress reduction method and hypnosis were randomly allocated to patients receiving plastic surgery, the patient group, who underwent hypnosis, had lower pain and anxiety, as well as a lower use of analgesics and higher patient satisfaction.
For a long time, after "the specific theory" of Descartes, pain was thought to start from the pain receptors at the ends of the body, traveling to the pain nucleus in the brain to be sensed [ 11 ]. However, with this point of view, there were many limitations in understanding and treating chronic pain. Gate control theory, presented in , emphasized the importance of the psychological function in pain control, as in the process of conveying peripheral pain stimulation to the center, the pain is controlled by ascending and descending inhibitory control circuit in the spinal cord [ 12 ].
Afterwards, as neuroimaging techniques developed, it was revealed that various parts of the brain were important for the experience and control of pain. The brain areas that are activated when pain is experienced are the thalamus, primary somatosensory cortex SI , secondary somatosensory cortex SII , insula, forebrain eg. These brain areas are called the neuromatrix [ 12 ]. Each brain area has different functions, the thalamus, SI, SII, and the posterior parts of the insula are responsible for the sensory-discriminatory experience, the amygdale, ACC, and anterior parts of the insula are responsible for the affective-motivational components of pain, and the PFC is responsible for the cognitive-evaluative aspects of pain [ 13 ].
These brain areas are also closely related to the functions of emotional processing and thinking in humans, so the multi-dimensional characteristics, where pain experience is decided by several factors, can be explained. In the functional brain image research using H 2 15 O-PET positron emission tomography , when subjects in hypnotic state were directed to recall happy memories, several areas such as occipital, parietal, precentral, prefrontal, and cingulated cortex were activated [ 14 ].
On the other hand, when subjects were directed to recall happy memories in the awakened non-hypnotic state, both the temporal lobes and basal forebrain were activated. This suggests that the state of the brain, when recalling during hypnosis, is different to the brain performing episodic memory in the general awakened state. When normal people are hypnotized and suggested to feel pain, not only do they experience pain, but the activity of the thalamus, ACC, insula, prefrontal, and parietal cortices are increased. The degree of pain and the increase in brain activity were larger than when directed to imagine without inducing hypnosis [ 15 ].
These brain areas are also activated when actual pain is experienced.
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When pain was suggested, after inducing hypnosis to patients of chronic pain who were already suffering pain, the pain became more severe than usual [ 16 ]. When the patients of chronic pain were hypnotized and suggested for the pain to be weak, moderate, or severe, the degree of pain and brain activity changed according to the direction of the suggestion, and the degree of change was larger than just imagining without the hypnotic induction [ 16 ]. Hypnosis not only affects pain intensity, but it also affects the emotional responses to pain.
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In the brain, ACC is responsible for processing emotion. During hypnosis, when an unpleasantness due to pain is suggested to increase or decrease, the unpleasantness changed in accordance to the suggestions, and the ACC activity also changed accordingly.
In contrast, when the pain intensity was suggested to increase or decrease after hypnosis, SI and SII activity changed in accordance, but there were no changes in ACC activity at that point. When hypnosis was induced in fibromyalgia patients and relaxation was ordered, the degree of pain was reduced compared to the awakened state, and the cerebral blood flow of the bilateral orbitofrontal, right thalamus, and left inferior parietal cortex increased, while the cerebral blood flow of the bilateral cingulated cortex decreased [ 18 ]. These findings imply that the cortical modulation is involved in the pain control effect of hypnosis.
Kosslyn et al. After inducing hypnosis, when color cards were suggested to be perceived as grey cards, and grey cards to be perceived as color cards, the activity of the lingual gyrus, which is the brain area that processes color, increased or decreased according to the suggestions. This implies that, not only with the pain experience, but other sensations as well, can be controlled, and that the activity of the relevant brain area changes according to the suggestions during hypnosis.
Hypnosis is effective in various acute medical settings. In a randomized controlled trial, which observed the anesthetic effects of hypnosis during interventional radiology, the control group experienced intensifying pain as the procedural time became longer, but the hypnosis treatment group, who had learned self-hypnosis, had reduced pain and the amount of analgesia used through the patient-controlled analgesia pump, also decreased. Montgomery et al. Hypnosis not only has analgesic effects in acute pain, but it also serves to relieve chronic pain such as fibromyalgia, cancer pains, and headaches [ 24 ].
There are also randomized controlled trials reporting that the treatment effect is heightened when hypnosis is merged with other psychotherapy techniques. When hypnotherapy is merged into a group psychotherapy program for patients with metastatic breast cancer, not only does anxiety and depression decline, but better coping is enhanced, while the pain is relieved as well [ 25 ].
Muscle tension often accompanies the occurrence of pain. When there is pain, the painful area is instinctively withdrawn, and as muscle tension increases, the pain intensifies. Therefore, when there is an absorption in images that arouse physical relaxation, such as 'floating' or 'lightness', the muscles become relaxed and the pain is reduced [ 26 ]. Different techniques should be used in perceptual alteration depending on the hypnotic susceptibility of the patient.
People with low hypnotic susceptibility respond better to distraction techniques, which concentrate on competing sensations in other body regions which do not feel pain. Imaginative suggestions can be used on those who are not induced into hypnosis due to low hypnotic susceptibility. This situation has the patient imagine, while suggestions are given without inducing hypnosis [ 27 ].
For patients with high hypnotic susceptibility, suggestions of numbness in the painful region can be used. For example, a feeling of receiving an analgesic injection or anesthesia at the dentist is recalled, and it is then suggested that this feeling spreads to the painful area. Also, suggesting that the pain is like a bad liquid that flows around the body and can flow out of the body, suggestions of separating the painful area from the body, and suggesting that the patient can separate from the body in order to be separated from the pain, can all be used during the hypnotherapy.
The temperature metaphor is a helpful and commonly used technique. It is effective when hypnotic susceptibility is more than moderate.
Images of ice cold water, lumps of ice, and cold creek water coming down the mountain can be used to suggest that the painful area is becoming gradually colder, or in contrast, images of the sun, a warm bath, and an electric blanket can be used to suggest that the painful area is becoming warmer. Pain sensation and temperature sensation all pass through the lateral spinothalamic tract, which supports the usefulness of this technique.
This technique helps the patient transform pain signals. There are a few principles in the images and metaphors used in pain relief. First, pain may continue for the patient, but the patient should be able to feel the difference between the pain signal itself and the aroused discomfort, and then be able to filter the hurt out of the pain.
Second, through hypnosis, the patient should have the experience where the pain signal is transformed into something less uncomfortable. Before hypnosis, it was either pain or no pain, but through hypnosis, the pain can be transformed into the different perception by competing sensations such as tingling, numbness, warmth, and coolness.
Finally, the patient should not fight the pain.
Fighting with the pain is actually concentrating more on the pain, so anxiety and depression intensifies, and physical tension is increased, which leads to more severe pain. Self-hypnosis is performing the induction of hypnosis to own self. In the earlier 20 th century, hypnosis induction was thought to be achieved by passing energy from the inducer to the subject. However, after the mid 20 th century, it was determined that hypnosis was due to the natural hypnotizability of the subject, and therefore, it was revealed that there was no need for another person to experience the hypnotic state.
To relieve habitual pain through suggestions and imagination in chronic pain, the hypnotic state must be frequently induced to extend the pain reduction during everyday life. However, it is practically impossible for a therapist to induce hypnosis several times a day, so applications of self-hypnosis are essential. Nevertheless, a problem present in pain treatment is that most Koreans do not practice self-hypnosis.