HYPNOSIS AND SELF HYPNOSIS TO CONTROL PAIN
Neuroscience demonstrated that pain perception is regulated by networks whose nodes reside, for a significant part, on cerebral cortex, a structure that is continuously modified by experience1. This finding constitutes a theoretical basis that can finally explain the effectiveness of psychological interventions that aim to manage pain. Among these, hypnosis and self-hypnosis attracted the attention of researchers during the last ten years, because teaching self-hypnosis to suffering patients means providing them a technique that they can autonomously use2,3,4,5. Derbyshire’s study on fibromyalgia patients is especially interesting: after a short training in self-hypnosis, fibromyalgia patients proved to be able to raise, lower and stabilize their pain more effectively than patients in waking state3. Other researches demonstrate also that results obtained with hypnosis tend to be stable and they are accompanied by changes in neural activity, - especially if the intervention begins in early phases of the illness6,7. These results are explained by the fact that patients are not just merely undergoing a treatment, but, learning self-hypnosis, they acquire proactive symptom-management strategies that they can use when needed8,9,10,11.
One of the most promising applications of hypnotic techniques concerns chronic pain, a symptom that can be caused by many medical conditions: for instance, patients who suffer from spinal chord injuries because of accidents. Almost one third of them suffers from chronic pain that rarely regresses12,13 and that doesn’t always respond to pharmacological treatment14,15. A research conducted in 2009 by researchers of the university of Washington and Miami, demonstrated that hypnosis can rapidly lower levels of perceived pain and stabilize them on the long term. Interestingly, results were obtained regardless of the hypnotisability level of patients. Pain is an impairing symptom not only for patients who are affected by chronic conditions, but also, for instance, for patients who survived major burns. Impairments caused by burn pain are so big that it is often necessary to use massive quantities of opioids to contain them16,17. These drugs are not always effective18 and they may cause side effects. Furthermore intense pain slows the healing process17,19, it may cause delirium20,21 or it may favour the onset of a Post Traumatic Stress Disorder22. A recent study19 compared a group of patients who were under standard care protocol and a group that received additional hypnotic interventions to manage pain. In the latter group a faster improvement was observed both from the physical point of view, with soothing of pain, increased drug efficiency, reduced need of general anaesthesia and less occurrence of drowsiness; and from the psychic point of view, with remarkable reductions of anxiety levels, especially related to physical therapies, lower levels of depression and higher levels of well being. Furthermore, patients in the hypnosis group healed more rapidly and considered certain physical therapies, that provoked strong anxiety states in participants from the control group, as pleasant. In other words, hypnosis can be used to reduce pain even when it is caused by medical procedures 23 or by events that are not necessarily connected to severe pathologies or traumas. Another interesting application of hypnosis concerns anaesthesia for childbirth. A review of the literature made in 201124 reports examples in which this kind of approach gave excellent results for recruited subjects. The idea of childbirth often comes with fear of a kind of pain that is usually depicted as one of the most intense ever25. Furthermore subjective pain perception seems to increase along with anxiety levels, thus creating a mechanism that may cause an unpleasant vicious circle26,27. Data indicate that almost all pregnant women ask for anaesthesia28 that is usually carried out using substances or procedures that, in some cases, have side effects that may cause complications in the delivery or hurt the newborn. Researchers of the University of Hartford concluded that, compared to a standard care program 29,30,31,32,33, to supportive counselling sessions34,35, or to prenatal courses36,37,38, hypnosis reduces pain more effectively, especially when carried out in the delivery room. Additionally, a reduction of the first phase of labour, which is often described as the most painful one, can be observed, together with an increase of the newborn’s APGAR score24.
Finally, one of the most common painful chronic syndromes is recurrent headache. Almost 13% of adult population and 20% of children/adolescents have it. Also in this case, hypnosis is very effective, as demonstrated by a research conducted in 201040. This kind of pain, that can become very intense, has consequences on attention, on professional, academic or recreational activities and may lead, especially in children and adolescents, to problems in familial relationships41-45. Even if drugs can often be useful, especially in young patients, they are not always effective and they may cause side effects46. A study conducted by the University of Minneapolis has examined the effects of self-hypnosis in the treatment of such condition. Patients, after a hypnosis session, have reported relief from pain in terms of intensity and frequency. Furthermore, participants, while continuing to use self-hypnosis to control pain, have generalized its use to other situations: dental operations, as an aid to athletic performance and as stress and anxiety management strategy.
In conclusion, we can state that hypnosis represents an useful tool to control intensity, duration and frequency of pain. It can be used both for chronic and acute pain, such as that caused by traumas or medical procedures and for minor conditions that can occur during everyday life. While improving psychological experience of pain, controlling anxiety, stress and depression states, it qualifies itself as a cheaper technique compared to drugs19, which allows patients, after a short training, to autonomously achieve a better state of well being.
Bibliografia
1. Jensen MP. Hypnosis for chronic pain management: A new hope. Pain. 2009;146:235-237.
2. Derbyshire SW, Whalley MG, Stenger VA, Oakley DA. Cerebral activation during hypnotically induced and imagined pain. NeuroImage. 2004;23:392-401.
3. Derbyshire SWG, Whalley MG, Oakley DA. Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis. European journal of pain. 2009;13:542-550.
4. Hofbauer RK, Rainville P, Duncan GH, Bushnell MC. Cortical representation of the sensory dimension of pain. Journal of Neurophysiology. 2001; vol. 86 no. 1: 402-411.
5. Rainville P, Duncan GH, Price DD, Carrier B, Bunshell MC. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science. 1997;277:968 - 71.
6. Apkarian AV, Bunshell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. European journal of pain. 2005;9:463-84.
7. Seifert F, Mainhofer C. Central mechanisms of experimental and chronic neuropathic pain: findings from functional imaging studies. Cellular and molecular life sciences. 2009;66:375-90.
8. Jensen MP, Barber J, Romano JM, Molton IR, Raichle KA, Osborne TL, Engel JM, Stoelb BL, Kraft GH, Patterson DR. A Comparison of Self-Hypnosis Versus Progressive Muscle Relaxation in Patients with Multiple Sclerosis and Chronic Pain. International Journal of Clinical and Experimental Hypnosis. 2009 April;2(57):198-221.
9. Jensen MP, Barber J, Romano JM, et_al. Effects of self-Hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury. International Journal of Clinical Hypnosis. 2009;57:239-268.
10. Jensen MP, Patterson DR. Hypnotic treatment of chronic pain. Journal of behavioral medicine. 2006;29:95-124.
11. Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychology bullettin. 2003;129:495-521.
12. Ehde DM, Jensen MP, Engel JM, Turner JA, Hoffman AJ, Cardenas DD. Chronic pain secondary to disability: A review. Clinical journal of pain. 2003;19:3-17.
13. Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury. A survey and longitudinal study. Spinal cord. 2005;43:704-712.
14. Cardenas DD, Jensen MP. Treatments for chronic pain in persons with spinal cord injury: a survey study. Journal of spinal cord medicine. 2006;29(109-117).
15. Warms CA, Turner JA, Marshall HM, Cardenas DD. Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful. Clinical journal of pain. 2002;18:154-163.
16. Everett J, Patterson DR, L. BG, Montgomery B, Heimbach D. Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award. Journal of Burn Care & Rehabilitation. 1993;14:676-83.
17. Broadbent E, Petrie KJ, Alley PG, Booth RJ. Psychological stress impairs early wound repair following surgery. Psychosomatic medicine. 2003;65:865-9.
18. Patterson DR, Hoffman HG, Weichman SA, Jensen MP, Sharar SR. Optimizing control of pain from severe burns: a literature review. American journal of clinical hypnosis. 2004;47:43-54.
19. Berger MM, Davadant M, Marin C, Wasserfallen J, Pinget C, Maravic P, Koch N, Raffoul W, Chiolero RL. Impact of a pain protocol including hypnosis in major burns. Burns. 2010;36:639-646.
20. Devlin JW, Fong JJ, Fraser GL, Riker RR. Delirium assessment in the critically ill. Intensive care medicine. 2007;33:929-40.
21. Pun BT, Ely EW. The importance of diagnosing and managing ICU delirium. Chest. 2007;132:624-36.
22. Bras M et al. cute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries. Journal of Burn Care & Research. 2008;29:22-35.
23. Porter LS, Keefe FJ. Psychosocial issues in cancer pain. Current Pain and Headache Reports. 2011;15:263-270.
24. Landolt AS, Milling LS. The efficacy of hypnosis as an intervention for labor and delivery pain: A comprehensive methodological review. Clinical psychology review. 2011;31:1022-1031.
25. Niven C, Murphy-Black T. Memory for labor pain: A review of the literature. Birth: issues in perinatal care. 2000;27:244-253.
26. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief. American academy of family physicians. 2003;68:1109-1112.
27. Simkin P. Commentary: The meaning of labor pain. Birth issues in perinatal care. 2000;27:254-255.
28. Waldenstrom U, Bergman V, Vasell G. The complexity of labor pain: Experiencesof 278 women. Journal of psychosomatic obstetrics and gynecology. 1996;17:215-228.
29. Cyna AM, Andrew MI, McAuliffe GL. Antenatal self-hypnosis for labor and childbirth: A pilot study. Anesthesia Intensive Care. 2006;34:464-469.
30. Guthrie K, Taylor DJ, Defriend D. Maternal hypnosis induced by husbands. Journal of Obststrics and Gynaecology. 1984;5:93-96.
31. Jenkins MW, Pritchard MH. Hypnosis: Practical applications and theoretical considerations in normal labour. British Journal of Obstetrics and Gynaecology. 1993;100:221-226.
32. Rock N, Shipley T, Campbell C. Hypnosis with untrained, nonvolunteer patients in labor. International Journal of Clinical and Experimental Hypnosis. 1969;17:25-36.
33. VandeVusse L, Irland J, Berner M, Fuller S, Adams D. Hypnosis for childbirth: A retrospective comparative analysis of outcomes in one obstetrician's practice. American Journal of Clinical Hypnosis. 50:109-119.
34. Letts PJ, Baker PRA, Ruderman J,KK. The use of hypnosis in labor and delivery: A preliminary study. Journal of Women's Health. 1993;2:335-341.
35. Mehl-Madrona L. Hypnosis to facilitate uncomplicated birth. American Journal of Clinical Hypnosis. 2004;46:299-312.
36. Davidson JA. An assessment of the value of hypnosis in pregnancy and labour. British Medical Journal. 1962;2:951-953.
37. Harmon T, Hynan M, Tyre T. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of consulting clinical psychology. 1990;5:93-96.
38. Mairs D. Hypnosis and pain in childbirth. Contemporary Hypnosis. 1995;12:111-118.
39. Headache Classification Sub-Committee of the International Headache Society. International classification of headache disorders (2nd ed). Cephalgia. 2004;24(suppl. 1):24-49.
40. Kohen DP. Long-term follow-up of self-hypnosis training for recurrent headaches: What the Children Say. International journal of clinical and experimental hypnosis. 2010;58(4):417-432.
41. Brna P, Gordon K, Dooley J. Canadian adolescents with migraine: Impaired health-related quality of life. Journal of Child Neurology. 2008;23:39-43.
42. Carlsson J, Larsson B, Mark A. Psychosocial functioning in schoolchildren with recurrent headaches. Headache. 1996;36:77-82.
43. Karwautz A, Wöber C, Lang T, Bock A, Wagner-Ennsgraber C, Vesely C, et_al. Psychosocial factors in children and adolescents with migraine and tension- type headache: A controlled study and review of the literature. Cephalgia. 1999;19:32-43.
44. Mazzotta G, Gallai B, Mattioni A, Florid F, Foti F, Allegretti M, et_al. Cost assessment of headache in childhood and adolescence: Preliminary data. Journal of Headache Pain. 2005;6:281-283.
45. Rohner AD. Headache in adolescence inAdolescent Health Update American Academy of Pediatrics. 2006;18(2):1-9.
46. Fisher P. Help for headaches: A strategy for your busy practice. Contemporary pediatrics. 2006;22:34-41.
One of the most promising applications of hypnotic techniques concerns chronic pain, a symptom that can be caused by many medical conditions: for instance, patients who suffer from spinal chord injuries because of accidents. Almost one third of them suffers from chronic pain that rarely regresses12,13 and that doesn’t always respond to pharmacological treatment14,15. A research conducted in 2009 by researchers of the university of Washington and Miami, demonstrated that hypnosis can rapidly lower levels of perceived pain and stabilize them on the long term. Interestingly, results were obtained regardless of the hypnotisability level of patients. Pain is an impairing symptom not only for patients who are affected by chronic conditions, but also, for instance, for patients who survived major burns. Impairments caused by burn pain are so big that it is often necessary to use massive quantities of opioids to contain them16,17. These drugs are not always effective18 and they may cause side effects. Furthermore intense pain slows the healing process17,19, it may cause delirium20,21 or it may favour the onset of a Post Traumatic Stress Disorder22. A recent study19 compared a group of patients who were under standard care protocol and a group that received additional hypnotic interventions to manage pain. In the latter group a faster improvement was observed both from the physical point of view, with soothing of pain, increased drug efficiency, reduced need of general anaesthesia and less occurrence of drowsiness; and from the psychic point of view, with remarkable reductions of anxiety levels, especially related to physical therapies, lower levels of depression and higher levels of well being. Furthermore, patients in the hypnosis group healed more rapidly and considered certain physical therapies, that provoked strong anxiety states in participants from the control group, as pleasant. In other words, hypnosis can be used to reduce pain even when it is caused by medical procedures 23 or by events that are not necessarily connected to severe pathologies or traumas. Another interesting application of hypnosis concerns anaesthesia for childbirth. A review of the literature made in 201124 reports examples in which this kind of approach gave excellent results for recruited subjects. The idea of childbirth often comes with fear of a kind of pain that is usually depicted as one of the most intense ever25. Furthermore subjective pain perception seems to increase along with anxiety levels, thus creating a mechanism that may cause an unpleasant vicious circle26,27. Data indicate that almost all pregnant women ask for anaesthesia28 that is usually carried out using substances or procedures that, in some cases, have side effects that may cause complications in the delivery or hurt the newborn. Researchers of the University of Hartford concluded that, compared to a standard care program 29,30,31,32,33, to supportive counselling sessions34,35, or to prenatal courses36,37,38, hypnosis reduces pain more effectively, especially when carried out in the delivery room. Additionally, a reduction of the first phase of labour, which is often described as the most painful one, can be observed, together with an increase of the newborn’s APGAR score24.
Finally, one of the most common painful chronic syndromes is recurrent headache. Almost 13% of adult population and 20% of children/adolescents have it. Also in this case, hypnosis is very effective, as demonstrated by a research conducted in 201040. This kind of pain, that can become very intense, has consequences on attention, on professional, academic or recreational activities and may lead, especially in children and adolescents, to problems in familial relationships41-45. Even if drugs can often be useful, especially in young patients, they are not always effective and they may cause side effects46. A study conducted by the University of Minneapolis has examined the effects of self-hypnosis in the treatment of such condition. Patients, after a hypnosis session, have reported relief from pain in terms of intensity and frequency. Furthermore, participants, while continuing to use self-hypnosis to control pain, have generalized its use to other situations: dental operations, as an aid to athletic performance and as stress and anxiety management strategy.
In conclusion, we can state that hypnosis represents an useful tool to control intensity, duration and frequency of pain. It can be used both for chronic and acute pain, such as that caused by traumas or medical procedures and for minor conditions that can occur during everyday life. While improving psychological experience of pain, controlling anxiety, stress and depression states, it qualifies itself as a cheaper technique compared to drugs19, which allows patients, after a short training, to autonomously achieve a better state of well being.
Bibliografia
1. Jensen MP. Hypnosis for chronic pain management: A new hope. Pain. 2009;146:235-237.
2. Derbyshire SW, Whalley MG, Stenger VA, Oakley DA. Cerebral activation during hypnotically induced and imagined pain. NeuroImage. 2004;23:392-401.
3. Derbyshire SWG, Whalley MG, Oakley DA. Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis. European journal of pain. 2009;13:542-550.
4. Hofbauer RK, Rainville P, Duncan GH, Bushnell MC. Cortical representation of the sensory dimension of pain. Journal of Neurophysiology. 2001; vol. 86 no. 1: 402-411.
5. Rainville P, Duncan GH, Price DD, Carrier B, Bunshell MC. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science. 1997;277:968 - 71.
6. Apkarian AV, Bunshell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. European journal of pain. 2005;9:463-84.
7. Seifert F, Mainhofer C. Central mechanisms of experimental and chronic neuropathic pain: findings from functional imaging studies. Cellular and molecular life sciences. 2009;66:375-90.
8. Jensen MP, Barber J, Romano JM, Molton IR, Raichle KA, Osborne TL, Engel JM, Stoelb BL, Kraft GH, Patterson DR. A Comparison of Self-Hypnosis Versus Progressive Muscle Relaxation in Patients with Multiple Sclerosis and Chronic Pain. International Journal of Clinical and Experimental Hypnosis. 2009 April;2(57):198-221.
9. Jensen MP, Barber J, Romano JM, et_al. Effects of self-Hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury. International Journal of Clinical Hypnosis. 2009;57:239-268.
10. Jensen MP, Patterson DR. Hypnotic treatment of chronic pain. Journal of behavioral medicine. 2006;29:95-124.
11. Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychology bullettin. 2003;129:495-521.
12. Ehde DM, Jensen MP, Engel JM, Turner JA, Hoffman AJ, Cardenas DD. Chronic pain secondary to disability: A review. Clinical journal of pain. 2003;19:3-17.
13. Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury. A survey and longitudinal study. Spinal cord. 2005;43:704-712.
14. Cardenas DD, Jensen MP. Treatments for chronic pain in persons with spinal cord injury: a survey study. Journal of spinal cord medicine. 2006;29(109-117).
15. Warms CA, Turner JA, Marshall HM, Cardenas DD. Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful. Clinical journal of pain. 2002;18:154-163.
16. Everett J, Patterson DR, L. BG, Montgomery B, Heimbach D. Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award. Journal of Burn Care & Rehabilitation. 1993;14:676-83.
17. Broadbent E, Petrie KJ, Alley PG, Booth RJ. Psychological stress impairs early wound repair following surgery. Psychosomatic medicine. 2003;65:865-9.
18. Patterson DR, Hoffman HG, Weichman SA, Jensen MP, Sharar SR. Optimizing control of pain from severe burns: a literature review. American journal of clinical hypnosis. 2004;47:43-54.
19. Berger MM, Davadant M, Marin C, Wasserfallen J, Pinget C, Maravic P, Koch N, Raffoul W, Chiolero RL. Impact of a pain protocol including hypnosis in major burns. Burns. 2010;36:639-646.
20. Devlin JW, Fong JJ, Fraser GL, Riker RR. Delirium assessment in the critically ill. Intensive care medicine. 2007;33:929-40.
21. Pun BT, Ely EW. The importance of diagnosing and managing ICU delirium. Chest. 2007;132:624-36.
22. Bras M et al. cute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries. Journal of Burn Care & Research. 2008;29:22-35.
23. Porter LS, Keefe FJ. Psychosocial issues in cancer pain. Current Pain and Headache Reports. 2011;15:263-270.
24. Landolt AS, Milling LS. The efficacy of hypnosis as an intervention for labor and delivery pain: A comprehensive methodological review. Clinical psychology review. 2011;31:1022-1031.
25. Niven C, Murphy-Black T. Memory for labor pain: A review of the literature. Birth: issues in perinatal care. 2000;27:244-253.
26. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief. American academy of family physicians. 2003;68:1109-1112.
27. Simkin P. Commentary: The meaning of labor pain. Birth issues in perinatal care. 2000;27:254-255.
28. Waldenstrom U, Bergman V, Vasell G. The complexity of labor pain: Experiencesof 278 women. Journal of psychosomatic obstetrics and gynecology. 1996;17:215-228.
29. Cyna AM, Andrew MI, McAuliffe GL. Antenatal self-hypnosis for labor and childbirth: A pilot study. Anesthesia Intensive Care. 2006;34:464-469.
30. Guthrie K, Taylor DJ, Defriend D. Maternal hypnosis induced by husbands. Journal of Obststrics and Gynaecology. 1984;5:93-96.
31. Jenkins MW, Pritchard MH. Hypnosis: Practical applications and theoretical considerations in normal labour. British Journal of Obstetrics and Gynaecology. 1993;100:221-226.
32. Rock N, Shipley T, Campbell C. Hypnosis with untrained, nonvolunteer patients in labor. International Journal of Clinical and Experimental Hypnosis. 1969;17:25-36.
33. VandeVusse L, Irland J, Berner M, Fuller S, Adams D. Hypnosis for childbirth: A retrospective comparative analysis of outcomes in one obstetrician's practice. American Journal of Clinical Hypnosis. 50:109-119.
34. Letts PJ, Baker PRA, Ruderman J,KK. The use of hypnosis in labor and delivery: A preliminary study. Journal of Women's Health. 1993;2:335-341.
35. Mehl-Madrona L. Hypnosis to facilitate uncomplicated birth. American Journal of Clinical Hypnosis. 2004;46:299-312.
36. Davidson JA. An assessment of the value of hypnosis in pregnancy and labour. British Medical Journal. 1962;2:951-953.
37. Harmon T, Hynan M, Tyre T. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of consulting clinical psychology. 1990;5:93-96.
38. Mairs D. Hypnosis and pain in childbirth. Contemporary Hypnosis. 1995;12:111-118.
39. Headache Classification Sub-Committee of the International Headache Society. International classification of headache disorders (2nd ed). Cephalgia. 2004;24(suppl. 1):24-49.
40. Kohen DP. Long-term follow-up of self-hypnosis training for recurrent headaches: What the Children Say. International journal of clinical and experimental hypnosis. 2010;58(4):417-432.
41. Brna P, Gordon K, Dooley J. Canadian adolescents with migraine: Impaired health-related quality of life. Journal of Child Neurology. 2008;23:39-43.
42. Carlsson J, Larsson B, Mark A. Psychosocial functioning in schoolchildren with recurrent headaches. Headache. 1996;36:77-82.
43. Karwautz A, Wöber C, Lang T, Bock A, Wagner-Ennsgraber C, Vesely C, et_al. Psychosocial factors in children and adolescents with migraine and tension- type headache: A controlled study and review of the literature. Cephalgia. 1999;19:32-43.
44. Mazzotta G, Gallai B, Mattioni A, Florid F, Foti F, Allegretti M, et_al. Cost assessment of headache in childhood and adolescence: Preliminary data. Journal of Headache Pain. 2005;6:281-283.
45. Rohner AD. Headache in adolescence inAdolescent Health Update American Academy of Pediatrics. 2006;18(2):1-9.
46. Fisher P. Help for headaches: A strategy for your busy practice. Contemporary pediatrics. 2006;22:34-41.
