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Hypnotic Techniques For Managing Chronic Pain

Several types of hypnotic suggestion have been cited as particularly helpful in managing physical pain. These include suggestions for escape or distraction, analgesia and or anesthesia, sensory transformation, decreased perception of pain intensity, displacement to another part of the body, substitution of another sensation, alteration of the meaning of the pain, dissociation from awareness of the pain, time condensation, enhancement of competing sensations of comfort, and amnesia to forget pain (Syrjala & Roth-Roemer, 1996). These types of suggestions can be applied by trained dentists, physicians, nurses, and anesthetists, as well as by psychotherapists, to help patients prepare for invasive procedures, as an adjunct to anesthesia during surgery, to improve recovery from surgery, to assist in emergency medical situations, for palliative care, and for ongoing management of chronic pain conditions. Earlier in this chapter, emotional and physical pain were linked in terms of...

Hypnosis And Chronic Pain Management Useful Clinical Strategies

The typical chronic pain patient will be taking several medications, and will have been treated unsuccessfully by several specialists before considering hypnosis. These may have included neurologists and (neuro)surgeons ('when in doubt, cut it out'), manipulative procedures by orthopedic and chiropractic specialists ('when in doubt, pound it out'), physical therapists ('when in doubt, walk it out'), mental health professionals ('when in doubt, talk it out'), and extensive pharmacological intervention ('when in doubt, medicate'). For these patients, the demand, 'hypnotize me and get rid of my pain', is often an invitation to failure. When the burden of cure is abrogated to the implicit magic of the technique, any initial attempt to use hypnosis at best would be unsuccessful, and at worst, would precipitate an early termination of the therapeutic encounter. Most pain patients have been unable to accept their current reduced functionality, and angrily demand to be helped 'return to the...

Transition From Acute To Chronic Pain Anxiety To Depression

The laboratory findings of a one-to-one correlation between the intensity of short-lasting, noxious stimulation and reported pain do not hold true for chronic pain. With most chronic pain patients, the intensity of the pain is not correlated with the intensity of the wound or lesion. The psychological or emotional significance of the pain may be the primary determinant of its perceived intensity. Even acute pain is not a simple matter of stimulus intensity in the clinical situation. Beecher (1946, 1959) observed, on the Anzio beachhead during World War II, that wounded soldiers did not typically report pain as they waited to be removed from the battlefield, in spite of gunshot and shrapnel wounds that eventually may have needed major surgery, amputation, and long-term convalescence. He contrasted the wounded soldier's mild euphoria with similarly injured civilians in a hospital emergency setting, who typically expressed considerable pain and suffering. The soldier knew he was going...

Hypnosis With Chronic Pain And Ptsd Patients

Hypnosis has been used much more commonly with both chronic pain and PTSD patients than with depressed individuals. In fact, one of the most frequently applied and effective uses of hypnotic suggestions is to create analgesia and anesthesia for all kinds of painful conditions. In a recent analysis of the benefits of hypnotically induced analgesia, researchers found that hypnosis provided significant pain relief for about 75 of their population (Montgomery, DuHamel, & Redd, 2000). There is also evidence to suggest that when hypnotic suggestion is added to patient-controlled standard medications, hypnosis provides greater pain relief than medication alone without unwanted side effects, such as addiction (Lang et al., 2000). In addition, hypnosis appears to be empowering to the patient and encourages a proactive role in managing pain (Chaves, 1989). Thus, hypnosis used in the service of pain management can also have the effect of reducing depression arising from pain-related feelings of...

Management Of Chronic Pain

The proper management of the patient presenting with chronic pain includes a proper diagnosis followed by the most effective therapeutic strategy. This requires knowledge of the aetiology, mechanism, pathophysiology and symptomatology of the various pain syndromes, and the availability of the various modes of therapy. In most cases, success will depend on multidisciplinary collaboration (Working Party on Management of Severe Pain, 1988). Sternbach (1968) pointed out the importance of determining whether there are treatable psychological or physical abnormalities, particularly in chronic intractable pain in which both forms of disorder usually are present. Adequate management of patients with chronic pain requires much time and effort, without which optimal results will be difficult to achieve, and iatrogenic problems may well be produced. In Australia, excellent teaching programmes for doctors, dentists and psychologists in hypnosis, are run by the Australian Society of Hypnosis in...

Neurophysiological Evidence For Hypnotic Analgesia Effects

Hypnosis is one of the best documented behavioral interventions for controlling acute and chronic pain in adults and children (for reviews, see Barber & Adrian, 1982 Chaves, 1989, 1994 Crawford, 1994a, 1995a,b Crawford, Knebel & Vendemia, 1998 Crawford, Knebel, Vendemia, Horton & Lamas, 1999 Evans, 1987 Evans & Rose, chapters 18a, 18b this volume Ewin, chapter 19 this volume Gardner & Olness, 1981 Hilgard & Hilgard, 1994 J. R. Hilgard & LeBaron, 1984). The reader is referred to two special issues (October 1997 January 1998) on 'Hypnosis in the Relief of Pain' in the International Journal of Clinical and Experimental Hypnosis (Chaves, Perry & Frankel, 1997, 1998). This section will address (a) recent advances in the understanding of the neurophysiology of pain relevant to our understanding the effectiveness of hypnotic analgesia interventions and (b) neurophysiological studies of hypnotic analgesia. Furthermore, of particular relevance to clinicians, we documented the development of...

Thumbnail Sketch of the Mind and Brain

Later, all the participants were put in trance and again reported their level of pain to the experimenter. What we found was that approximately 1 3 of the participants experienced anesthesia (no pain) for the excruciatingly cold water while in trance. In addition, all of the remaining students experienced analgesia (significant pain reduction) while in trance. The results are encouraging but inconclusive as to how hypnosis will help those who suffer from chronic pain. The results also need to be compared to future research that examines hypnosis Relieving Chronic Pain It is truly a miracle when someone experiences a remission from pain after decades of bitter suffering. The documented reports of complete remission from multi-decade chronic pain are few and far between. However, you can rest assured that miracles do sometimes happen and when they don't reducing chronic pain is often not only possible, it is likely. People who suffer from chronic pain are not going to want to hear that,...

Tinnitus and Chronic Illness

Would you be interested in experiencing a full slate of clients, everyday Did you know there are 40,000,000 chronically ill Americans These people suffer from everything from chronic fatigue to chronic pain. Almost all of these chronic illnesses are essentially medically unbeatable.

Assessment Strategies

How do professionals screen effectively for PTSD, chronic pain, and depression Because of the common link between chronic pain and depression, experts who specialize in chronic pain commonly recommend the use of a formal instrument to rate chronic pain experience and obtain pain history information along with an evaluation of depression by a formal scale such as the Beck Depression Inventory II (Beck, Steer, & Brown, 1996 Eimer & Freeman, 1998). For example, one woman I treated for pain management following a complex car accident could easily see that earlier physical trauma sustained when she had fallen off a horse was linked to her current injuries. Yet, she failed to understand that earlier traumatic experiences in her family life had set the stage for some of her traumatic responses and the related chronic pain and depression. I asked Sue about depression and trauma, which I do routinely with chronic pain patients. Sue told me that she had been treated for depression at the time...

Q What is it that you would like me to do

At other times the answers to the last question can clarify the goal. It may be that a person suffering from a chronic pain, which seems at first to be the central problem, does NOT expect it to be removed, but rather hopes to be able to sleep soundly in spite of it, or to be able to be less frightened of it, or simply to reduce it to manageable proportions. In such cases the focus of intervention is likely to be different according to the different goal.

Evaluation And Discussion Of Hypnotic Treatment

Sue's case illustrates some important principles of hypnotic treatment for post-traumatic distress conditions (Levine, 2005), which often include chronic pain and depression. First, it is essential to use hypnosis in the early stages of therapy so that both the focus and outcome are ego strengthening (Phillips, 2001a, 2001b Phillips & Frederick, 1995 Schwartz, 2002). Experts are virtually unanimous in advocating a staged approach to treatment of trauma with initial emphasis on strengthening, stabilization, safety, and education (Phillips, 2000, 2001a, 2001b Schwartz, 2002 van der Kolk, 2003). During this phase, work with symptoms is solely for the purpose of teaching the client self-regulation strategies to manage them effectively, rather than to uncover information about their origin.

Depression Pain And Ptsd

Recent advances in psychoneuroimmunology (PNI) research have indicated a strong connection between emotional and physical pain (Dillard, 2002 Melzack & Wall, 1973). For example, antidepressants that increase levels of serotonin and norepinephrine in the limbic system can also decrease chronic pain for many individuals. Pain and emotions share common nerve pathways from the periphery of the body to the spinal cord, where they are sorted for intensity and forwarded to the brain. Positron emission tomography (PET) scans of chronic pain patients that record blood flow in the brain show simultaneous activation of two areas of the brain the sensory-motor cortex, where sensation is registered, and the limbic system, the center of emotions (Dillard, 2002). There is also evidence to link PTSD and chronic pain. In fact, many experts believe that trauma is one of the bridges between the multiple mechanisms of pain (Scaer, 2001). A large percentage of chronic pain is the result of physical trauma...

Indications And Contraindications

Sacerdote, expanding on the work of Fogel, Hoffer and Aaronson, provides us with two unique perceptual change techniques for eliciting mystical states. These methods are intended for patients suffering with protracted or recurrent physical pain and with accompanying emotional pain (anxiety, depression). They may hold particular value for patients with severe chronic pain problems, for example, from cancer and migraine. It is recommended that these techniques only be used by highly experienced hypnotherapists, after establishing a trusting rapport with the patient, with patients without severe psychopathology. These meth

How You React to Stress

Almost every system in your body can be damaged by stress. Suppression of the reproduction system can cause amenorrhea (cessation of menstruation) and failure to ovulate in women, impotency in men, and loss of libido in both. Stress-triggered changes in the lungs increase the symptoms of asthma, bronchitis, and other respiratory conditions. Loss of insulin during the stress response may be a factor in the onset of adult diabetes. Stress suspends tissue repair and remodeling, which in turn causes decalcification of the bones, osteoporosis, and susceptibility to fractures. Inhibition of immune and inflammatory systems makes you more susceptible to colds and flu and can exacerbate some diseases such as cancer and AIDS. In addition, a prolonged stress response can worsen conditions such as arthritis, chronic pain, and diabetes. There is also some evidence that the continued release and depletion of norepinephrine during a state of chronic stress can contribute to depression.

Outline Of Hypnotic Strategies And Techniques For Managing Pain

When it has been determined that psychological and unconscious factors do not play a role in the problem, suggestive hypnosis may then be introduced. Thus it is next recommended that you determine whether strategy II techniques (e.g., suggestions for anesthesia, ideomotor turn-off of pain, imagery modification) are successful in alleviating or managing the distress. When these more straightforward techniques are not entirely effective, we may then experiment with the more complex techniques that fall under strategies III and IV. These techniques will be particularly beneficial when pain is chronic and where several pain sites are identified. Certain techniques (e.g., time dissociation, imagining pleasant scenes) are primarily useful with patients who can be inactive, at least for segments of the day. For instance, if a patient is imagining a future or past time when they were not in pain, this inward absorption precludes simultaneous interaction with people or the performance of...

Evaluation and Assessment of Pain

Similarly, it is vital for physicians and dentists to learn to evaluate more than the biophysical aspects of pain. Particularly with chronic pain patients, multidimensional assessment is required (Hammond & Stanfield, 1977), taking into account the physical-sensory, behavioral, affective, interpersonal-environmental, and cognitive (and adaptive function) components of the pain experience.

Watch for physiological evidence of hypnosis

REM is commonly observed in clients experiencing the deeper levels of hypnosis and is commonly observed in clients when they are in deep levels of natural sleep. If the client becomes unresponsive, you will need to check to make sure that the client is not asleep or in a deeper level of hypnosis than is useful, for example the Esdaile State (commonly know as Hypnotic Coma State). These deeper levels of hypnosis are perfectly safe, but are not ideal for hypnotherapy (unless the hypnotherapist intends to guide the client into a state of hypnotically-induced anesthesia for a medical procedure or for working on chronic pain).

Graham D Burrows and Sandra G Boughton

Depression is a frequently occurring disorder with estimates of the lifetime risk for Major Depressive Disorder varying from 10 to 25 for women and from 5 to 12 for men. Significant levels of depression are also associated with many other major disorders, such as chronic pain. There appears to be a widespread assumption that hypnosis has no role, indeed is inappropriate, in the management of depression. In Australia, over the past 10 years, material presented for examination by the Australian Hypnosis Society or for publication in the Australian and New Zealand Journal of Hypnosis has not included any detailed description of clinical or experimental work on the use of hypnosis in the treatment of depression. The understanding has been that expert opinion regards hypnosis as contraindicated for the management of individuals presenting with depression. It would seem that the situation has not significantly changed since Burrows (1980) concluded that

The Scientific Mongraphs

Biofeedback and Self-Control (Aldine Publishing Company), an annual on the regulation of bodily processes and consciousness also has numerous reports on the beneficial effects of biofeedback, relaxation and meditation n hypertension, abnormal heart rate, headaches, chronic pain, asthma, insomnia, epileptic seizures, stroke patients, eating disorders and peripheral blood circulation. This annual is of a highly technical nature, consisting entirely of scientific papers. The Reports will bring you excerpts in layman languge in future volumes.

Have other hypnotherapists to whom you can refer clients

Work only within your training and abilities. If you do a great deal of hypnosis sessions for smoking and a client comes in with chronic pain, you need to do the right thing. If you are fully trained and qualified in an area, do it. But, if you are great at breaking habits and only have a vague idea about how to work with chronic pain (or some other issue), refer it out to someone who is qualified.

Flexibility In The Hypnotic Management Of Pain

Hypnosis frequently contributes to anxiety reduction but this effect can be distinguished from pain reduction. Anxiety is strongly associated with pain but separate from it a person in acute pain will often be anxious whereas chronic pain is usually associated with depression. Benzodiazepine drugs have been shown to reduce pain by relieving anxiety but they do not affect the pain threshold or the physical sensation of pain. Pain tolerance is something beyond sensory pain and suffering so that, in some cases, hypnosis substitutes for a tranquillizer rather than acting as an analgesic.

Hypnosis and Cognitive Behavioral Therapy

The available evidence indicates that hypnosis can enhance the effectiveness of empirically supported approaches. Meta-analyses have shown that hypnosis augments the effectiveness of cognitive behavioral psychotherapies (Kirsch, Montgomery, & Sapirstein, 1995). A special issue of the International Journal of Clinical and Experimental Hypnosis on the topic of hypnosis as an empirically supported clinical intervention documented the effectiveness or promise of combining hypnosis with a variety of interventions in treating psychological and medical conditions ranging from acute and chronic pain to obesity (see Lynn, Kirsch, Barabasz, Carde a, & Patterson, 2000).

Employing Hypnosis In Clinical Interventions

One study we found specifically related to children used hypnosis and acupuncture in the treatment of chronic pain (Zeltzer et al., 2002). Of the 23 children enrolled in the study, none met criteria for depression prior to treatment, and this remained unchanged at follow-up. Certainly, the dearth of research suggests a need for prospective trials of hypnosis and self-hypnosis in the treatment of depression, especially in children and adolescents.

Chapter Six JMental development

e importance of the mind has also been recognized by scientists, psychologists, and even physicians. You may be aware of a number of visualization techniques now being used by therapists in the West. Psychiatrists and physicians are successfully employing methods very similar to well-known techniques of meditation to help patients overcome mental disorders, chronic pain, and diseases. is approach is now an accepted practice within the therapeutic community.

Meditation Relieves Pain

One of the best-documented clinical uses of meditation is the application of mindfulness for the alleviation of chronic pain. During the 1980s, Dr. Jon KabatZinn and his colleagues published several studies proving its effectiveness. According to a report in the Journal of Behavioral Medicine (Kabat-Zinn et al., 1985), 90 chronic-pain patients who were trained in mindfulness meditation in a 10-week stress reduction and relaxation program experienced significant reductions in present-moment pain, negative body image, and the inhibition of activity. Not only that, they popped fewer pain pills and felt better about themselves. At a 15-month follow-up, they were still doing better on all measures except present-moment pain, and the majority continued to meditate not a surprising finding, given that chronic pain can be one of the most debilitating conditions imaginable, and one of the most difficult to treat. This one's a sure thing If you suffer from chronic pain, mindfulness meditation...

Encouragement Of Images And Fantasies That Emphasize Choice And Alternatives

As a common feeling elicited from the chronic pain patients in the group was that of being locked in and overwhelmed by the pain, the use of a technique that emphasized choices and alternatives seemed important. Thus, patients were encouraged to have a dream while in trance of two roads, one leading to health, the other to sickness and disability. They were asked to image both roads, to describe them, to image choosing the road to health and what that entailed. Patients were given the following suggestion

Utilizing Hypnosis With Depressed Patients

As stated earlier, hypnosis has not been addressed extensively in the literature on the treatment of depression. One of the problems in the treatment of depression in general has been the fact that, because of unremitting despair and hopelessness, a significant number of patients drop out of therapy before the resolution of symptoms can take place (Johnson, 2001). Gafner (2005) commented, To turn around chronic depression, I believe you have to practice the equivalent of the full-court press in basketball, or the 'full code' in medicine (p. 170). Thus, because of the nature of depression itself (i.e., the apathy and numbing fueled by hopelessness and helplessness) and the complexities of its interactions with chronic pain and trauma, therapists must be prepared to utilize all the tools within their psychotherapy toolbox. The good news is that not only can both formal and indirect hypnotic suggestion facilitate rapport and alliance with the therapist for the depressed patient, but its...

Advanced Workshop Approved And Acceptable By Aschandsceh

Four months later, an advanced workshop in Clinical Methods in Hypnosis and Psychotherapy Integration and Applications is offered. The art of psychotherapy depends on the individual therapist as well as his or her individual patients. The advanced workshop as given is different from the workshops usually given in annual meetings of the National Constituent Societies of the International Society of Hypnosis. Usually an intermediate workshop is given to further one's experience with deepening techniques and using hypnosis in more complicated clinical cases, before advanced workshops in treating specific syndromes such as chronic pain, cancer, post-traumatic stress disorders, sexual problems, anxiety disorders, and dissociative identity disorders (formerly Multiple Personality Disorders) are presented. My own advanced workshop, presented here, shifts the emphasis from the problems of the patient client to the professional development of the therapist. Let us examine what an 'ideal'...

Pain Stress And The Immune System

Most data describe the physiological effects of acute pain. We know much less about the physiological effects of chronic pain. On the other hand, the effects of chronic pain on psychological health are well known. Chronic pain produces depression, anxiety and fear. These adverse psychological consequences affect the person, the family, and, because of the great costs of medical and social care, all of society. To treat chronic pain, which has such devastating psychological and social effects, we must use all the techniques at our disposal, but we often fail to do so, producing the tragedy of needless pain. (Melzack, 1990)

Hypnotizabilityand Clinical Populations

Although some investigators have reported a relationship between high hypnotiz-ability and good outcome with hypnotic treatment the results have not been uniform among all disorders. Hypnotizability has been related positively to the degree of improvement in chronic pain problems, psychosomatic conditions such as asthma, and various dermatological conditions (Hilgard, 1975) and dental phobic disorders (Gerschman, Burrows & Reade, 1987).

Pain and the Relief of Pain

In humans, chronic pain can improve for several weeks after the central gray substance is stimulated high up near the posterior commissure just behind the third ventricle. It is clear that opioids contribute to this analgesia. The facts are that naloxone blocks the pain relief, and that the stimulation releases beta-endorphin.8 Serotonin nerve cells also appear to be involved in this pain relief mechanism, because stimulation to the central gray relieves pain more effectively after the patients are given tryptophan, the ST precursor.5


The specific applications of hypnosis in pain management will be different depending on the nature and history of the patient's pain. Acute pain is best managed by anxiety-reducing strategies. Chronic pain has gradually become a weapon in the control of contingencies in the sufferer's interaction with the external world. It requires strategies that deal with handling one's psychological environment effectively. In such cases the pain may have no clear organic basis, even though from the patient's viewpoint 'it hurts'. Several powerful hypnotic strategies relaxation, imagery, ideomotor action, dissociation, self-hypnosis are available to teach self-control and cognitive mastery (Evans, 1989, 2001).

Richard B Garver EdD

It is important, first, to help newly referred chronic pain patients to understand why they have been referred by a physician who determined that conventional medical treatment resources have been exhausted. In fact, the patient has often been told, There is nothing more I can do for you you have to learn to live with the pain. Although it is not meant to be so, this is often a negative suggestion.

Training In Hypnosis

This chapter also reports on preliminary neurophysiological research in the role of opioid and nonopioid neurotransmitters and modulators which may be involved in hypnoanalgesia. Recent fMRI research by the author (Crawford, Knebel & Vendemia, 1998) has certainly found shifts in thalamic, insular and other brain structure activity. Future neuroimaging and neurochemical studies will greatly contribute to our expanded knowledge of how hypnotic analgesia is so effective as a behavioural intervention for acute and chronic pain. The several chapters dealing with painful conditions highlight the differences between acute and chronic pain, and therefore the need for different strategies in their management. Whereas acute pain is best managed by anxiety-reducing strategies, chronic pain requires strategies that deal with effective handling of one's psychological environment. In many cases chronic pain may have no clear organic basis, but secondary gain issues typically exist with the chronic...

Hemispheric Amnesia

As stated elsewhere, chronic pain patients claim they always have pain. Since their left-hemisphere reality is one of remembering pain, where there is no pain there is nothing for them to remember. They have amnesia for no-pain (Erickson and Rossi, 1979). In the same vein, most of us have little or no left-hemisphere memory for all the ways we utilize hemispheric balance gracefully and efficaciously. Even so-called dysfunctioning people have such a balance in the trouble-free areas of their lives. Since their left-hemisphere reality is focused and locked into their problem where there is little or no balance, they tend to have forgotten all of their balanced areas driving a car, riding a bicycle, reading, writing, recognizing a friend, tying shoelaces, and on and on.

Sample Pretalk

Dave Elman brought acceptance to hypnosis from the medical profession in the U.S. when the Council on Medical health of the American Medical Association accepted the use of hypnotherapy in 1958, recognizing hypnotherapy as a compelling medical procedure. Since 1995, the National Institute for Health has recommended hypnotherapy as a treatment for chronic pain. Hypnosis is used for many conditions, including phobias, depression and addictions.

Peace in Pain

Peace in Pain

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