Hypnosis has been dimonstrated being a powerful and succesfull tool in the treatment of pain (acute and chronic). However the success of hypnosis in the relief of pain is not empiric but supported by hundreds of papers in literature (Lee at al, 2012). Hypnotic analgesia has been shown as a quick and safe technique that can be used in any environment (Patterson DR et al, 2003), in any situation with anyone and it is extremely flexible and completely tailored on patients’ symptoms and necessities.

 

The fields of application include:

  • Musculoskeletal pain (acute and chronic): low back pain, neck pain, shoulder pain, temporomandibular pain . (Simon EP et al, 2000)  (Elkins et al, 2007)
  • Headaches and migraines (Hammond DC, 2007)
  • Reflex sympathetic dystrophy (Complex Regional Pain Syndrome) (Siddiqui et al. 2000) (Lebon J et al, 2017)
  • Fybromialgia (Haanen HC et al, 1991) (Bernardy et al, 2011) (Picard P et al, 2013)
  • Burning pain and hypersensitivity of the skin
  • Post-Herpetic neuralgia
  • Irritable Bowel Syndrome (IBS) and general abdominal pain (Tan G et al, 2005) (Chiarioni et al, 2008) (Palsson OS et al, 2015)
  • Pelvic Pain
  • Cancer related pain (Montgomery GH et al, 2010)
  • Uncomfortable or painful medical and minor surgical procedures (Montgomery GH et al, 2002) (Elkins G et al, 2006) (Schnur JB et al, 2008) (Accardi MC et al, 2009)

 

However hypnosis doesn’t work exclusively directly on pain but it can be used to change all the factors we know are involved with pain. Negative beliefs and expectations, negative limitations, catastrophization, pain anticipation, central sensitization, kinesiophobia, fear avoidance etc.. Hypnosis offers great and several techniques to work these aspects out having a indirect impact on pain experience

“Hypnosis not only affects pain intensity, but it also affects the emotional responses to pain. 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.” Lee et al, 2012

There are hundreds of techniques that can be used to help the patient to manage pain. However the session has to be tailored completely on patient’s necessities and symptoms. Some patient would react better to direct suggestions and others to indirect ones and metaphors, some patients would work better with “time distortion suggestions” and others with dissociative techniques. The beauty of hypnosis is that is extremely flexible and follows no protocols.

The most famous techniques used in pain management are:

  • Distraction
  • Time distortion
  • Suggestions of numbness and insensitivity (usually in the hand and then spread on the painful spot)
  • Paradoxical injuction (to be used with caution)
  • Metaphors
  • Dissociation (out of body experience)
  • Displacement (the therapist ask the patient to imagine the painful spot moving towards another area in which pain can be managed better)
  • Reinterpretation
  • Relaxation

Hartland’s, Medical and Dental Hypnosis, fourth edition

Some authors suggest it is necessary a deep state of trance to have a successful outcome, however excellent results can be achieved even with a light state of trance. At the end of the session the patient will be taught to do self-hypnosis in order to improve and maintain the results.

Hypnosis goes together with medical interventions like drugs and physiotherapy and it can only be done after the patient is examined by a medical doctor to exclude any red flag.

In conclusion we can say that hypnosis is an effective and successful tool that can be used in pain management as literature says. It can be done anywhere, in any moment, without side effects and it takes few minutes only (from 5 minutes to 30 minutes depending on the patient). Regrettably, there are not so many health professionals who integrates hypnosis in their daily practice, therefore would be marvellous to see an increase in the use of this beautiful technique.

 Thanks for reading

Davide Lanfranco

“I could be bounded in a nutshell and count  myself a King of infinite space”  Shakspeare, Hamlet

 

 

REFERENCES:

1) Jing Seong Lee, Young Don Pyun (2012). Use of Hypnosis in the treatment of pain

2) Patterson, D. R., & Jensen, M. P. (2003). Hypnosis and clinical pain. Psychological Bulletin, Vol. 129, pp. 495-521.

3) Simon EP, Lewis DM. Medical hypnosis for temporomandibular disorders: Treatment efficacy and medical utilization outcome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2000;90:54–63.

4) Gary Elkins, Mark P. Jensen, and David R. Patterson “Hypnotherapy for the Management of Chronic Pain” The internation journal of clinical and experimental hypnosis  2007 Jul; 55(3): 275–287

5) Hammond DC (2007).  Review of the efficacy of clinical hypnosis with headaches and migraines. The internation journal of clinical and experimental hypnosis 2007 Apr;55(2):207-19.

6) M Siddiqui, S Siddiqui, J Ranasinghe, F Furgang. Complex Regional Pain Syndrome: A Clinical Review. The Internet Journal of Pain, Symptom Control and Palliative Care. 2000 Volume 2 Number 1.

7) Lebon J et al, 2017. Physical therapy under hypnosis for the treatment of patients with type 1 complex regional pain syndrome of the hand and wrist: Retrospective study of 20 cases. Hand surgery & rehabilitation 2017 Jun;36(3):215-221

8) Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. Journal of Rheumatology. 1991;18:72–75.

9)   Bernardy et al. 2011. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome – a systematic     review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders 201112:133

10)    Picard P et al. 2013 Hypnosis for management of fibromyalgia. The internation journal of clinical and experimental hypnosis  2013;61(1):111-23.

11)  Tan G, Hammond DC, Joseph G. Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action. Am J Clin Hypn. 2005;47:161–178.

12) Chiarioni et al. 2008, Hypnosis and upper digestive function and disease. World Journal of Gastroenterology 2008  Nov 7; 14(41): 6276–6284.

13) Palsson OS et al, 2015 Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence. The American Journal of Clinical Hypnosis. 2015 Oct;58(2):134-58.

14) Montgomery GH, Hallquist MN, Schnur JB, David D, Silverstein JH, Bovbjerg DH. Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress. J Consult Clin Psychol. 2010;78(1):80–88

15) Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: A meta-analysis. Anesth Analg. 2002;94(6):1639–1645.

16) Elkins G, White J, Patel P, Marcus J, Perfect MM, Montgomery GH. Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancer screening: Case studies and possible benefits. Int J Clin Exp Hypn. 2006;54(4):416–431.

17)Schnur JB, Kafer I, Marcus C, Montgomery GH. Hypnosis to manage distress related to medical procedures: A meta-analysis. Contemp Hypn. 2008;25:114–128.

18) Accardi MC, Milling LS. The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review. J Behav Med. 2009;32(4):328–339.