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Hypnosis and pain management

Article  in  The Nursing journal of India · July 2006

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Suresh K Sharma
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 }iYPNOSIS AND PAIN MANAGEMENT
Suresh K. Sharma & Dr. (Mrs.) Jasbir Kaur

Intnxluction: surgeon James Braid revisited sible but still the health care
Hypnosis is a process involv- the phenomenon of Mesmer- community continue to ignore
ing a hypnotist and a subject rvho ism. and renamed it hypnosis, a relatively easy and effective
agrees to be hypnotized. Being hyp- after the Greek god of sleep, form of pain management, al-
notized is usually characterized by Hypnosis. He was the first per- though hypnosis proponents
- intense concentration, extreme relax- son to attribute the phenom- are growing in numbers.
ation, and high suggestibility. Hyp- enon to psychological rather
nosis has long been understood to than physical variables. His HOW HYPNOSIS WORI(S:
produce varied effects in Unfortunately, there is no
subjects. Although the one on Earth who can con-
Summary: Nurses have used complementary thera-
public at large tends to pies for many years to relieve anxiety, promote com- clusively explain the
associate hypnosis with mechanisms by which hyp-
fort, and reduce oralleviate pain. Physicaltherapies
stage performances and nosis works! There is,
are most commoniy used in our scenario but behav-
bad sircom episodes. the however, scattered litera-
ioralapproach had been less customary since famil-
health community has iarity of health personnel is very less (36%)with these ture which attempts to de-
approached the topic in a scribe the mechanism for
techniques (Zaza et al, 1999). Hypnosis is empiri-
different ways. Originally hypnosis's effectiveness.
cally proved best therapy for pain management. Hyp-
viewed as a magical cure- The most common psy-
nosis is a process involving a hypnotist and a subject
all, hypnosis has under- chological explanation for
who agrees to be hypnotized. Being hypnotized is
gone tremendous usually charaeterized by intense concentration, ex- how hypnosis works is
anlounts to scientific test- based upon a dissociation
treme relaxation and high suggestibility. This paper
ing in modern times. initially address hypnosis from an historical perspec- model. This model has
When used in an appro- been seen in patients with
tive to give the reader a decent background in which
priate manner, hypnosis mu ltip le personality disor-
to view current trends in research in the field. Then
has proven itself to be an der. Dissociation eliminates
will explain how hypnosis work followed by the em-
effective tool in the man- piricalevidences and problems encountered in use of pain by placing it in a sort
agement of pain and pain
hypnosis when used for pain management. of psychological storage
perception. area, away from ttre primary
findings renewed interest in the consciousness of the patient. This
Historical Perspective Of sdbject, especially in France. model of dissociation is commonly
Hypnosis where hypnosis gained popu- retbrred to as the "hidden observer"
r Ilypnosis was discovered by a larity agdin as a fbrm of pain rnodel of cognition.
\,r ir,)r iilesc physician, Fr!ederich reduction during suiger)/. \\ir:tkins and Watkins (1990) sug-
,dnlon Mesmer, in tho late tiventualll'. Braid's technique urstcd that ther dissociation which
1700's, He used hypnosis and rvas found to be unsatisfac- rrccurs in multiple personality pa-
calied Mesmerism. tory, and hypnosis drifted out tients can be analogously induced
o In 1784. Louis XVI fornrerl a offavo:once again (Hall. 1986i. in nrinnal lrvpnosis patients. They
commissiorr io investigate In the !;rre 1800's Benrhcim anii refbrrt:ii to the dissociation as the
Mesmer's Findings al:ctit hyp- Liebeault camc upon hypnosis usr: of'an "ego state", and that in a
nosis, unttrrtunately, therr. af- as a ffeatment for phy'sical ancl norrnal persolr tiiis state is iltalleable,
ter Mesmerism fell from popu- functional diseases. as scen in varying mood states. In
larit"v (Hall. 1986) Later once again the scientitic son-rc moods, we are susceptible to
+ In F.ncland around i843, the method has been applied to do things which in other moods we
h1'pnosis" it has be.:n shc'rvrr are not. It is rvhen this ego state is
Attthors are Lecturer anci Principal, to be increasingl5, ei'tective in a laultv tir"i. il Lrreaks offinto the "hid-
Callegeof Nurslng. Davanand Medicat wider variety of maladies than den observer" model. But hypnosis
College & Hospitql, Ludhian a. anyone had ever thought pos- can induce placement of pain into a

CJUNE 2cJcJ6 VtrIL. XtrVII NE.6 129

.. G
 "covert" ego state which is hidden
away. Because of this model, it is
noted that the pain is still there, it is
simply tucked away so that it is not
dealt with The pain, however may
resurface later in an undesirable
form, such as a neryous habit or fear.
So far, no support to this resurfac-
ing theory has been shown,
Unfortunately, this model of
hypnosis mechanism is not very
satisfying. Although it may explain
where the pain goes to, it does not
provide a definite road map for ex-
plaining the effectiveness of h1p-
nosis. Why can't an awake patient
simply "bury" the pain into a covert
ego state? Why is hypnosis neces-
sary to access such an ego state?
Watkins and Watkins acknowledge
these limitations, and claim that fur-
ther research is required, especially
in regards to their resurfacing theory.
Another interesting study
compared the use of biofeedback
with hypnosis to reduce test anxi-
ety. Becairse both groups scored
simi'larly, there may be a similarun-
derlying mechanism responsible for
their effectiveness. These results
were compared to uses of desensi-
tization and relaxation ffaining, and
were all foundto be similar. Because
all ofthose methods involve a form
of a relaxation technique, that may
be the underlying key to under-
standing hypnosis's effectiveness
(Spies, 1979). Comprehension of
relaxation may lead to a better un-
derstanding of al I these techniques,
including hypnosis. Once hypno-
sis is understood in regards to re-
laxation, it may yield the clues
needed to explain its pain manage-
ment capabilities. Once again, fur-
ther research is required.
The physiological explanations
forthe mechanism bywhich hypno-
sis controls pain management are
even less understood than the psy-
chological models. This avenue of
study has not been pursued by
tilany researchers, and almost noth-
130 THE NUREiING.'OURNAL CIF INDIA
rIi?r*i
l. I
ing is known in this area.
Weinstein and Au (1991) no-
ticed ttrat norepinephrine levels were
significantly higher during
angioplasty of hypnotized patients
in comparison to non-hypnotized
controls. Because norepinephrine
has an effect on sleep stiates, it is
therefore possible that [lpnosis in-
creasethese levels dueto its similar-
ity to an REM sate of sleep. This
would imply that hypnosis provides
a measurable chemical inhibitory ef-
fect on pain conduction. This shows
that psychological and physiologi-
cal mechanisms by which hypnosis
operates are ngt well characterized
nor understood. Therefore future
research is required before any defi-
nite conclusions can be drawn.
EIVIPIRICALEVIDH\MS
ABOUTIIYPNOSIS:
Is hypnosis alleviate pain? The
body of literature which has inves-
tigated whether hypnosis can re-
duce pain sensitivityhas been over-
whelmingly supportive. An ex-
ample of the many instances in
which hypnosis has reduced pain
sensitivity is in the Hajek, et al
(1990) study of cutaneous pain
threshold. In the study, eczemic
subjects under hypnosis reported
a higher amount of applied pres-
sure before pain was experienced
than non-hypnotized subjects; In
fact, hypnosis was shown to cure
the patients quicker than those
without! In 1990, Evans investi-
gated the possible ways in which
hypnosis effectiveness varies ac-
cording to different types of pain.
He determined thatthe style ofhyp-
nosis was more important than the
type ofpain. Foracute pain, he sug-
gested hypnotic suggestions focus-
ing on anxiety-reduction and empha-
sis an minimizingthe importance of
the pain. For chronic pain, Evens
suggested directly confronting the
pain under hypnosis, dealing with
both the pain's physical and psy-
chological effects on the patient.
Where to use hypnosis?
In investigations of what types
of pain hypnosis is effective and
which types are not, most seem to
indicate that hypnosis is universally
successful in pain management. H1p.,.
nosis has been shown effective in
management ofmany varied types of
pain, including pain associated with
childbir.th, angioplasty (Weinstein &
Au, l99l), leukemia, and evenhead-
aches (VanDyc( et al, I 991).
Is hypnosis curative or analgesic or
both?
There is controversy involving
the discrepancy between a curative
and analgesic approach to hypnosis.
At present this issue may be debat-
able. In a case study Morris (1985)
described that ayoung girl attempted
to use liquid nitrogen, cureffage, and
electro-dessication to remove the
warts. on her hands, she used a hyp-
notic technique involving visualiza-
tion ofa wart-free hand. Within three
months, the warts on her hand were
completely eliminated, and continued
to be gone for up to four months fol-
lowing her last treatment. This sur-
prising case illustrates how hypno-
sis can do it, in fact, it may be pos-
sible but one can only say after fur-
ther more research in this direction.
Problems Encountered With
Hypnosis Therapy:
A main difficulty in the wide-
spread use of hypnosis involves the
problem of hypnotizability ratings in
patients. (VanDyck, et al, l99l). In
the case of subjects who do not
know language which spoken by
therapist will cause a greatproblem.
Regardless of the problems
mentioned, hypnosj5 has been
shown to be a useful tool for pain
management in many situations.
Most of the problems presented are
surmountable, provided that the
therapist is careful to avoid the pit-
 falls of incorrect imagery and low
hypnotizability in patients.
Conclusion: Even though exact
mechanisms of action about hypno-
sis is unknown, but still it has merit.
Fortunately, the body of knowledge
regarding hypnosis continues to
grow, and hopefully will one day
address these issues. The trend will
hopefully lead to an examination of
the neurochemical basis for hypno-
sis pain management. Understand-
ing ofthis mechanism can also lead
to advances in comprehension of
other relaxation and dissociative
states. Obviously, the use of pain
management via hypnosis should be
rigorously examined, so that it can
be available to patients, nurses and
physicians as a useful and safe al-
tetnative tool for pain management.
Recommendation : Extensive large
experimentaltrails are needed to ex-
plore various dimensions and effec-
tiveness of hypnosis as an pain
management therapy.
References:
l. ZazaC, Sellick SM, Willan A,
Reyno L, BrowmanGP. Health care
professionals' familiarity with non-
pharmacological strategies for man-
aging cancer pain Psychooncology
I 999 I\nar-Apr; 8(2):99-l I l.
2. Hall, H. (1986). Hlpnosis, sug-
gestion, and the psychology ofheal-
ing : A historical perspective. Ad-
vances, 3(3),29-37.
3. Watkins, J. G, & Watkins, H. H.
(1990). Dissociation and displace-
ment : where goes the ouch?Ameri-
can Journal of Clinical Hypnosis,
33(l), l-10.
4. Spies, G (1979). Desensitization
of test anxiety: hypnosis compared
with biofeedback. The American
Joumal of Clinical Hypnosis, 22(2),
108-l I l.
5. Weinstein, E.J., & Au,
P.K.(I99I). Use ofhypnosis during
angioplasty: American Journal of
Clinical Hypnosis, 34(l), 29-37.
6. Hajek, P., Radil, T., & Jakoubeh
B. (1991) . Hlpnotic skin analgesy in
healthy individuals and patients with
atopic eczema. Homeostasis in
Health and Disease, 33(3). I 56-1 57.
7. Evans, F.J.(1990). Hypnosis,and
pain control. Australiin Joumal of
Clinical and Experimental Hypnosis,
33(l), l-10.
8. VanDyck, R., Zitman, F.G.,
Linssen, A.C., & Spinhoven, p.
Autogenic taining and future
( 199 I ).
oriented hypnotic imagery in the
treatment oftension headaches. In-
ternational Journal of Clinical and
Experimental Hlpnosis, 39( l), GA3.
9. Morris, B,A.(1985). Hypno-
therapy ofwarts usingthe Simonton
visualization technique American
Journal of Clinical Hypnosis, 27 (4),
237-240. I

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