LAS VEGAS—Hypnosis can be an effective tool for relieving pain, even the extreme pain associated with burn wound debridement, says David R. Patterson, PhD, Professor in the Department of Rehabilitation Medicine at the University Washington, Seattle.
“It seems to address pain in a way that no other modalities can,” Dr. Patterson said. “Although it doesn’t work with everyone, you can really get some pretty remarkable effects… It’s as if you’re able to communicate directly with the pain centers [of the brain].” Examples of hypnotic pain management suggestions include dimming pain, changing sensations, putting pain in a box, amnesia, and moving pain to the background.
Dr. Patterson informed PAINWeek attendees about the potential usefulness of hypnosis in pain management in a session title, “Medical Hypnosis for Chronic Pain.” Clinicians can learn the basics in just a weekend as long as they are trained in pain control, he said. Basic traditional hypnosis includes focused attention, relaxation, deepening, suggestion, and alerting, he said. He emphasized, though, that learning medical hypnosis does not entitle clinicians to treat any clinical problem. “Whoever is using hypnosis should be trained in the clinical problem that they’re treating,” Dr. Patterson said.
Medical hypnosis is better for acute rather than chronic pain, but “once you get into the chronic realm, it is in generally better for neuropathic rather than musculoskeletal pain.” With neuropathic pain, the goal is to reduce pain signals resulting from nerve damage. “With musculoskeletal pain, very often the goal is to increase activity and strengthen muscles and ligaments.”
Painful medical procedures are usually predictable and generate anxiety that is enhanced by environmental cues. Induction for painful medical procedures includes identifying the threat, determining absolute environmental cues, deep relaxation, and anchoring suggestions to threatening cues with posthypnotic suggestion.
Literature supporting the efficacy of hypnosis for pain control, including a meta-analysis of 18 studies published in 2000 in the International Journal of Clinical and Experimental Hypnosis, were reviewed. Of the 17 studies of controlled acute pain in which hypnosis was compared with standard control, hypnosis was better than control in eight studies, equaled control in three and, in 1, results were mixed. Of 12 studies in controlled chronic pain, hypnosis was superior to no treatment and equivalent to alternatives such as relaxation and autogenics, he concluded. According to the researchers, results showed “a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management.”
Two or three decades ago, almost no evidence from randomized, controlled trials was available to support the use of hypnosis for pain control. Today, the evidence is “pretty impressive, and it’s somewhat paralleling the evidence that’s coming out about how the brain processes pain,” said Dr. Patterson, who has been receiving funds for medical hypnosis research from the National Institutes of Health since 1989.