Considerations Concerning Pain
Taken from Milton H. Erickson & Ernest L. Rossi, Hypnotherapy – An exploratory casebook, pag. 94, Irvington Publishers, Inc., New York
While pain is a subjective experience with certain objective manifestations and accompaniments, it is not necessarily or solely a conscious experience. It occurs without conscious awareness in states of sleep, in narcosis, and even under certain types of chemoanesthesia as evidenced by objective accompaniments and as has been demonstrated by experimental hypnotic exploration of past experiences of patients. But because pain is primarily a conscious subjective phenomenon, with all manner of unpleasant, threatening, even vitally dangerous emotional and psychological significances and meanings, an approach to the problem can be made frequently through the use of hypnosis, sometimes easily, sometimes with great difficulty. Furthermore, the extent of the pain is not necessarily a factor.
In order to make use of hypnosis in dealing with pain, one needs to look upon pain in a most analytical fashion. Pain is not a simple uncomplicated noxious stimulus. It has certain temporal, emotional, psychological, and somatic significances. It is a compelling motivational force in life's experience. It is a basic reason for seeking medical aid.
Pain is a complex, a construct, composed of past remembered pain, of present pain experience, and of anticipated pain in the future. Thus, immediate pain is augmented by past pain and enhanced by the future possibilities of pain. The immediate stimuli are only a central third of the entire experience. Nothing so much intensifies pain as the fear that it will be present on the morrow. It is likewise increased by the realization that the same or similar pain was experienced in the past, and this and the immediate pain render the future even more threatening. Conversely the realization that the present pain is a single event which will definitely come to a pleasant ending serves greatly to diminish it. Because pain is a construct, it is more readily vulnerable to hypnosis as a successful treatment modality than it would be were it simply an experience of the present.
Pain as an experience is also rendered more susceptible to hypnosis because it varies in its nature and intensity and hence, through life experiences, it acquires secondary meanings resulting in varying interpretations of the pain. Thus the patient may regard his pain in temporal terms, such as transient, recurrent, persistent, acute, or chronic. These special qualities each offer varying possibilities of hypnotic approaches.
Pain also has certain emotional attributes. It may be irritating, all-compelling, troublesome, incapacitating, threatening, intractable, or vitally dangerous. Each of these aspects leads to certain psychological frames of mind with varying ideas and associations, each offering special opportunities for hypnotic intervention.
One must further bear in mind certain other very special considerations. Long continued pain in an area of the body may result in a habit of interpreting all sensations in that area as automatically painful. The original pain may be long since gone, but the recurrence of that pain experience has been conducive to a habit formation that may in turn lead to actual somatic disorders painful in character.
In a somewhat similar category are iatrogenic disorders and disease arising from a physician's poorly concealed concern and distress over his patient. Iatrogenic illness has a most tremendous significance because in emphasizing that there can be psychosomatic disease of iatrogenic origin, its converse cannot be overlooked: that iatrogenic health is fully as possible and of far greater importance to the patient. And since iatrogenic pain can be produced by fear, tensions, and anxiety, so can freedom from it be produced by the iatrogenic health that may be suggested hypnotically.
Pain as a protective somatic mechanism should not be disregarded as such It motivates the patient to protect the painful areas, to avoid noxious stimuli and to seek aid. But because of the subjective character of the pain, there develop psychological and emotional reactions to it that eventually result in psychomatic disturbances from unduly prolonged protective mechanisms. These psychological and emotional reactions are amenable to modification and treatment through hypnosis in such psychosomatic disturbances.
To understand pain further, one must think of it as a neuro-psychophysiological complex characterized by various understandings of tremendous significance to the sufferer. One need only ask the patient to describe his pain to hear it variously described as dull, heavy, dragging, sharp, cutting, twisting, burning, nagging, stabbing, lancinating, biting, cold, hard, grinding, throbbing, gnawing, and a wealth of other such adjectival terms.
These various descriptive interpretations of the pain experience are of marked importance in the hypnotic approach to the patient. The patient who interprets his subjective pain experience in terms of various qualities of differing sensations is thereby offering a multitude of opportunities to the hypnotherapist to deal with the pain. To consider a total approach is possible. But more feasible is the utilization of hypnosis in relation first to minor aspects of the total pain complex and then to its increasingly severe and distressing qualities. Thus, minor successes will lay a foundation for major successes in relation to the more distressing attributes of the neuro-psycho-physiological complex of pain, and the understanding and cooperation of the patient for hypnotic intervention are more readily elicited. Additionally, any hypnotic alteration of any single interpretive quality of the pain sensation serves to effect an alteration of the total pain complex.
Another important consideration in the comprehension of the pain complex is the recognition of the experiential significances of various attributes or qualities of subjective sensation, and their differing relationships in such matters as remembered pain, past pain, immediate pain, enduring pain, transient pain, recurrent pain, enduring persistent pain, intractable pain, unbearable pain, threatening pain, etc. In applying these considerations to varying subjective elements of the pain complex, hypnotic intervention is greatly accelerated. Such analysis offers greater opportunity for hypnotic intervention at a more comprehensive level. It becomes easier to communicate ideas and understandings through hypnosis and to elicit the receptiveness and responsiveness so vital in securing good response to hypnotic intervention. It is also important to acknowledge adequately the unrecognized force of the human emotional need to demand the immediate abolition of pain, both by the patient himself and by those attending him.