The following is based on a paper I gave at the 22nd annual conference
of the NZ Hypnotherapy
Federation in September 2009.
The use of hypnosis and related techniques for pain management
is very well researched, and has a history of over 150 years, going
back to James Esdaile. Esdaile, in the days before chemical
anaesthetics, performed many surgeries using only the relatively
primitive hypnotic techniques of the time. At Yale University in the
1930s, researcher Clark Hull confirmed the reality of hypnotic
anaesthesia, along with a number of other hypnotic phenomena, through
his careful scientific studies.
The classic text in the field is Hilgard,
E.R., Hilgard, J.R. and Barber, J. Hypnosis in the Relief of
Pain,
revised edition 1994, published by Brunner/Mazel. The Hilgards were a
research scientist and a clinical psychologist at Stanford University.
Research into hypnosis in the relief of pain continues today.
For example, a study entitled
"A randomized clinical trial of a brief hypnosis intervention to
control side effects in breast surgery patients" by G.H. Montgomery and
colleagues was published in the Journal
of
the National Cancer Institute 99 (17) in 2007. (The
link is to the full text at
oxfordjournals.org). They concluded that 15 minutes of simple hypnosis
pre-surgery, compared with a control condition of 15 minutes of
empathic listening by the same psychologist, showed clear
benefits on a number of important outcome measures: use of
particular
anaesthetic drugs, reported pain intensity, pain unpleasantness,
nausea, fatigue, discomfort, emotional unpleasantness and time in
surgery. They also did a cost-benefit analysis and concluded that, in
that particular (US) hospital, the 15-minute intervention led to a
saving of about 9% of the total cost of surgery. The study had 200
participants, which is a good number for a valid scientific study.
Montgomery was also the lead author for a 2002 article in the
major journal Anesthesia
and Analgesia, called "The
Effectiveness of Adjunctive Hypnosis with Surgery Patients: A
Meta-Analysis" (link is again to the full text). A
meta-analysis looks at multiple previous studies (20 of them, in this
case) and tries to extract their overall significance. In this case,
the researchers concluded that “patients in hypnosis
treatment groups had better clinical outcomes
than 89% of patients in control groups. These data strongly support the
use of hypnosis with surgical patients.” The effect sizes
were “medium
to large” - this isn’t just a slight improvement
that’s only visible to
close statistical analysis over a large group.
Pain is, of course, not the only benefit of hypnosis around
surgery and medical treatment. Others include reduced anxiety, control
of other symptoms (such as nausea from anti-cancer treatments), reduced
bleeding, and more rapid healing and recovery.
Unfortunately, patients, doctors and even hypnotherapists are
not as well informed as they could be about the benefits of this
simple, natural intervention.
Turning now to some of the techniques, I will present
not only the seven techniques I was aware of at the time of preparing
my paper, but also some additional techniques that emerged from the
discussion. There were many experienced hypnotherapists present, and I
was pleased to be able to draw on their depth of knowledge in this
field.
First of all, a note of caution. Pain is a warning that something is
wrong, an alarm. Just turning off the alarm, without investigating why
it went off, is likely to lead to negative consequences. Always check
with a doctor if you have unexplained pain of any kind.
Dissociation (for mild pain)
Dissociation involves moving your attention away from the pain and onto
something else. Your breathing is a good candidate, and is always
available (at least, for as long as you're concerned about pain). One
method that I teach is simply to choose a positive word, then sit for a
few minutes and mentally say your word every time you breathe out. When
(and it's when, not if) your thoughts wander, just bring them gently
back to that word on every outbreath.
Association (for severe pain)
Sometimes the pain is bad enough that you can't turn your attention
away. In these cases, since your attention wants to go to the pain -
let it. But notice the pain as a phenomenon. Cultivate what Ernest
Hilgard calls the "hidden observer" who watches the pain. Rather than
experiencing the pain as suffering, being carried along with it like
someone in a car driving along the road, step out of the car and stand
by the road and watch the traffic. Experienced meditators will find
this technique familiar, but others may find it takes a while to learn.
Imagery of the Pain (for unexpected pain)
This technique involves attributing a shape, a colour, a sound, a
texture or whatever comes most naturally to you to the pain, and then,
by manipulating the mental representation, manipulating the pain
itself. It can be remarkably effective. For example, you might imagine
the pain as being red and spiky, and gradually smooth it and cool it
until it is blue and bumpy. You can also shrink the pain using imagery.
Imagery of Positive Outcome (for surgery etc.)
This technique (which I got from a colleague at my talk) is good for
situations like surgery or dentistry, where the pain is part of a
healing process that is for your benefit. Imagining the positive
outcome and holding firmly onto it can help you to go through the
process (this is true generally in life, of course).
Glove Anaesthesia (for surgery etc.)
Glove anaesthesia involves
imagining a "glove" of numbness developing around your dominant hand
(the one you write with). Once the numbness is thoroughly developed,
you can transfer it to another body part, such as your jaw if you are
having dental work done.
Displacement of the Self (for surgery, etc.)
This technique is sometimes referred to as "going to your happy place".
One of the most remarkable things I've ever seen is a movie made in
black and white in the 1960s (I think, by the clothing), in which a
surgeon who was also a hypnotist took a woman through a caesarian
section with no anaesthetic other than hypnosis. Her "happy place" was
singing and playing the piano, and seeing her singing cheerfully while
the surgical team made a 20cm incision in her abdomen and extracted a
baby was, let's say, a memorable sight.
Letting Go (surgery, dental etc.)
This technique involves "letting go" of the body part, such as a tooth,
which is being removed and allowing it to go without pain. Another one
from a colleague at my talk.
Healing Imagery (when there is body damage)
Healing imagery can range from imagining a healing white or blue light
pervading the whole being to imagining parts of your body (including
the immune system cells) carrying out their healing work. It's not
necessary for the images to be medically accurate for them to be
effective. The attention and the exercise of your imagination are the
important things.
Talking to the Bodymind (all kinds of changes)
Body and mind are a single system - this is the basis of medical
hypnosis. Sometimes just speaking directly to the bodymind and asking
it to do what needs to be done is all that is needed. (Another
technique from a colleague.)
Control Panel (for long-term pain and other issues)
The control panel is a specific piece of imagery that I have found very
effective, not only with pain but with other issues where some signal
is coming through at, as it were, the wrong volume. I used it with one
client who was experiencing constant hunger as a side effect of a
medication. We were able to successfully reduce his hunger feelings to
a more appropriate level. I've also seen this done with Parkinson's
tremors (by Gil Boyne, on one of his videos). The technique is to
imagine a dial or a slider such as you might see in a sound booth at a
radio station or concert, marked from 1 to 10. You locate your pain (or
whatever) on that scale, and adjust it. First, turn it up a little (to
show yourself that you have control), and then turn it down. You will
have to continue to use the technique from time to time at first, but
depending on the issue your brain may actually adapt itself so that it
is receiving the appropriate level of signal all the time.
Displacement of the Pain (for long-term pain)
Some people can "displace" the pain they feel to another part of their
body that is more convenient, and even turn it into an itch so that
they can get relief from scratching it. It's also possible to displace
it outside your body entirely, so it floats in the air nearby.
Pain in the Total Life Context
It's important to note, of course, that pain management occurs
in the context of a person's whole life, just like the pain does. Body
parts don't have pain; people have pain. The pain, particularly if it
is long-term, may be playing an important role for the person, and
techniques alone may not be effective if the total context of the pain
is not properly addressed.
Additional Resources
I sell a CD intended to guide you through most of the above
pain management and healing techniques in my shop
on the Hypno NZ website. If you are a practitioner, let me
know when you order and I'll also send you the written scripts of the
10 tracks on the CD, at no extra charge.
I'm very happy to licence the CD content to groups and
organizations whose members would benefit. Email me (mikerm at
hypno.co.nz) and we'll talk about distribution, licensing and possible
co-branding at attractive terms.
If you're in Auckland, New Zealand, I'd love to see you
individually and help you with your pain issues. I'm also happy to talk
to patient, disability support or medical groups about the potential of
hypnotherapy for the relief of pain. Again, email me (mikerm at
hypno.co.nz) or phone on 021 160 6953.
