Cultures have utilised trance states to bypass pain for millennia. The Ancient Greeks used trance which they called 'incubation' to attain deep states of healing. The Romans also took on the Greek sleep temples later where trance states were induced for days, one such 'temple of hypnosis' was unearthed in Gloucestershire, UK. Many Africanand Asian cultures use or have used trance states, induced by hours of rhythmic drumming and dancing, for many reasons including enduring painful rituals as with the Hindu Thaipusam festival in India or Thailand's Nine Emperor Gods festival where devotees pierce their bodies with sharp hooks and push spears and swords through their cheeks after, of course, inducing a trance state. The Egyptians, Persians, Sumerians, Chinese, and New World Indians, from the Inuit in the north right through the Americas, also knew about and utilised the state of trance.
In the 1840s James Esdaile, a Scottish surgeon employed by the East India Company at Hooghly Imambara Hospital, India and also as a medical officer at Hooghly Gaol Hospital, performed well over 300 'pain-free' major surgeries and 2000 minor ones, including amputations, removal of cataracts and the removal of massive tumours using, what he called mesmerism, though what is known today as hypnosis, or more accurately hypno-analgesia and hypno-anaesthesia. It is also significant that the same official records reveal the unanticipated consequence that Esdaile’s hypno-analgesia surgeries not only prevented what would have been excruciating pain but also a huge reduction in the post-surgical mortality rate, from 50% to 5%, due to the significant lessening of post-operative shock.
"Pain is not a condition of the body, like hypnosis it is a condition of the mind"
Clearly, being in a trance state can remove pain, but can a trance state be used to turn pain down, diminish it, keep it low or give a patient the means to lessen pain whenever it flares up? In my experience as a hypnotherapist the answer is most certainly yes. Pain is not a condition of the body, like hypnosis it is a condition of the mind. Researchers have revealed our subconscious minds are 30,000 times more powerful than our conscious minds, hypnotherapy is simply a method to gain access to that power. We dip in and out of our subconscious constantly, it's our operating system, the storehouse of our life experiences, our deepest beliefs and rules that we, under normal circumstances, can't easily access or change. For example, a harmless little mouse may induce total panic if there's a belief within the subconscious linking mice with complete terror. No amount of logical talking, thinking it through or common-sense advice will change that, not until that corrupted pathway has been rerouted or rewritten, then change can be virtually instantaneous; such is the power of the subconscious mind and therefore such is the power of hypnosis.
"Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain"
Fortunately, over the past twenty years hypnosis research regarding the alleviation of pain has boomed. In a recent 2021 meta-analysis of 'Hypnosis and the alleviation of pain', Leonard Milling concluded, "Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain" and from Neuroscience & Biobehavioural Reviews, a 2019 paper by Trevor Thompson states, "Findings suggest that hypnotic intervention can deliver meaningful pain relief for most people and therefore may be an effective and safe alternative to pharmaceutical intervention". In a meta-analysis of 18 studies, it was shown hypnosis can produce "A moderate to large hypno-analgesic effect" which supports the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain (GH Montgomery, 2000). The website of the American Psychological Association, the largest scientific and professional organization of psychologists in the United States with over 122,000 members currently states, "Hypnosis is likely to be effective for most people suffering from diverse forms of pain, with the possible exception of a minority of patients who keep themselves resistant to hypnotic interventions".
"Findings suggest that hypnotic intervention can deliver meaningful pain relief for most people and therefore may be an effective and safe alternative to pharmaceutical intervention"
Hypnosis has been found to be more effective than other non-pharmacologic interventions, such as physical therapy and pain education. It can provide analgesia, reduce stress, relieve anxiety, improve sleep and mood, and potentially reduce the need for opioids. Hypnosis can also enhance the efficacy of other well-established treatments for pain.
"Clinical trials show that hypnosis is effective for reducing chronic pain, although outcomes vary between individuals. The findings from these clinical trials also show that hypnotic treatments have a number of positive effects beyond pain control"
The hypnotherapeutic process used for pain reduction is, on one level, the same as any hypnotherapy treatment; a trance state is attained along with a deep state of relaxation, but each patient is different therefore different hypnotherapeutic imaginative tools are used according to each individual's condition. Personality type and compliance levels are important, for example, some patients will gladly listen to recordings or practice techniques at home whilst others will not, Although it's really down to the hypnotherapist to be so convincing as to the importance of homework that the patient willingly takes on any self-help tasks. Age has also been shown not to be an issue as Susan Lutgendorf concludes in a 2007 study, "Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures".
Hypnotisability, or how easily a subject goes into deep trance, is something that crops up in a few studies where they suggest the more hypnotisable a patient is, the more the pain reduction. My personal opinion ties in with Leonard Milling's 2008 paper in 'Current Pain and Headache Reports' where he concludes, "High hypnotic suggestibility is not necessary for successful hypnotic pain intervention" and I believe most hypnotherapists would agree to a degree as this issue is really more about the skills of the therapist. A subject in a deep trance not given adept guidance may not do as well as a subject in a light trance led by a skilful hypnotherapist, but either way, hypnotherapy changes pain.
Nick Malyon MSc. BHSc. Dip.(hypno).
REFERENCES:
The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials.
Thompson, Terhune, Oram, Sharangparni, Rouf, Solmi, Veronese, Stubbs. Neurosci Biobehav Rev. 2019 Apr;99:298-310.
The current meta-analysis aimed to quantify the effectiveness of hypnosis for reducing pain and identify factors that influence efficacy. Six major databases were systematically searched for trials comparing hypnotic inductions with no-intervention control conditions on pain ratings, threshold and tolerance using experimentally-evoked pain models in healthy participants. Eighty-five eligible studies (primarily crossover trials) were identified, consisting of 3632 participants (hypnosis nö=ö2892, control nö=ö2646). Random effects meta-analysis found analgesic effects of hypnosis for all pain outcomes (gö=ö0.54-0.76, p's<.001). Efficacy was strongly influenced by hypnotic suggestibility and use of direct analgesic suggestion. Specifically, optimal pain relief was obtained for hypnosis with direct analgesic suggestion administered to high and medium suggestibility subjects, who respectively demonstrated 42% (pö<ö.001) and 29% (pö<ö.001) clinically meaningful reductions in pain. Minimal benefits were found for low suggestibility subjects. These findings suggest that hypnotic intervention can deliver meaningful pain relief for most people and therefore may be an effective and safe alternative to pharmaceutical intervention. High quality clinical data is, however, needed to establish generalisability in chronic pain populations.
Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis
Leonard S. Milling, Keara E. Valentine, Lindsey M. LoStimolo, Alyssa M. Nett & Hannah S. McCarley. Int J Clin Exp Hypn. p297-322 May 2021
This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen’s guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials—the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.
A meta-analysis of hypnotically induced analgesia: how effective is hypnosis?
G H Montgomery, K N DuHamel, W H Redd Int J Clin Exp Hypn. 2000 Apr;48(2):138-53.
Over the past two decades, hypno-analgesia has been widely studied; however, no systematic attempts have been made to determine the average size of hypno-analgesic effects or establish the generalizability of these effects from the laboratory to the clinic. This study examines the effectiveness of hypnosis in pain management, compares studies that evaluated hypnotic pain reduction in healthy volunteers vs. those using patient samples, compares hypno-analgesic effects and participants' hypnotic suggestibility, and determines the effectiveness of hypnotic suggestion for pain relief relative to other non-hypnotic psychological interventions. Meta-analysis of 18 studies revealed a moderate to large hypno-analgesic effect, supporting the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain. The overall results suggest broader application of hypno-analgesic techniques with pain patients.
Is high hypnotic suggestibility necessary for successful hypnotic pain intervention?
Leonard S Milling. Curr Pain Headache Rep. 2008 Apr;12(2):98-102.
"High hypnotic suggestibility is not necessary for successful hypnotic pain intervention".
Hypnosis for the Relief and Control of Pain. American Psychological Association (2004)
Hypnosis is likely to be effective for most people suffering from diverse forms of pain, with the possible exception of a minority of patients who are resistant to hypnotic interventions.
Hypnotic Approaches for Chronic Pain Management: Clinical Implications of Recent Research Findings
Mark P. Jensen and David R. Patterson Department of Rehabilitation Medicine, University of Washington. Am Psychol. 2014 ; 69(2): 167–177 The empirical support for hypnosis for chronic pain management has flourished over the past two decades. Clinical trials show that hypnosis is effective for reducing chronic pain, although outcomes vary between individuals. The findings from these clinical trials also show that hypnotic treatments have a number of positive effects beyond pain control. Neurophysiological studies reveal that hypnotic analgesia has clear effects on brain and spinal-cord functioning that differ as a function of the specific hypnotic suggestions made, providing further evidence for the specific effects of hypnosis. The research results have important implications for how clinicians can help their clients experience maximum benefits from hypnosis and treatments that include hypnotic components.
The Neurophysiology of Pain Perception and Hypnotic Analgesia: Implications for Clinical Practice.
Jensen, Mark P. (Oct 2008). American Journal of Clinical Hypnosis, Vol 51(2), 123-148.
Although there remains much to be learned, a great deal is now known about the neurophysiological processes involved in the experience of pain. Research confirms that there is no single focal “centre” in the brain responsible for the experience of pain. Rather, pain is the end product of a number of integrated networks that involve activity at multiple cortical and subcortical sites. Our current knowledge about the neurophysiological mechanisms of pain has important implications for understanding the mechanisms underlying the effects of hypnotic analgesia treatments, as well as for improving clinical practice. This article is written for the clinician who uses hypnotic interventions for pain management. It begins with an overview of what is known about the neurophysiological basis of pain and hypnotic analgesia, and then discusses how clinicians can use this knowledge for (1) organizing the types of suggestions that can be used when providing hypnotic treatment, and (2) maximizing the efficacy of hypnotic interventions in clients presenting with pain problems.
Hypnosis for Pain Management.
In Weintraub, Fass, Arthur. (2008). Michael I. (Ed); Mamtani, Ravinder (Ed); Micozzi, Marc S. (Ed).
Complementary and Integrative Medicine in Pain Management, (pp. 29-40). New York, NY: Springer Publishing Co.
Hypnosis has earned a secure place in the modern armamentarium against pain. Given its long and somewhat chequered history this may seem an unlikely
development. However, in spite of a somewhat mysterious quality, and its occasional use in some decidedly unscientific quarters, the medical community has
maintained a continued interest in its clinical use. In the course of recent years, the science of hypnosis has greatly expanded. There are now abundant reports
published in the medical literature describing the benefits of hypnotherapy for a variety of medical conditions. In addition, numerous controlled studies of its effects have appeared. The technique has found important applications in the treatment of such varied disorders as migraine headaches, irritable bowel syndrome, anxiety, phobias, as an aid to smoking cessation, as well as in the relief of chronic and acute pain. With the advent of sophisticated brain imaging techniques, such as MRI and PET scanning, it has been possible for the first time to understand some of the physiologic changes that accompany a hypnotic state. This chapter will deal primarily with the use of hypnosis in the management of pain. The anxiety-relieving properties of hypnosis are intimately associated with its analgesic effects and will also be discussed. Whenever possible, reference will be made to prospective, controlled studies, the foundation of clinical research, in validating therapeutic applications. The authors start with a look back on the fascinating history of hypnosis and its evolution as a modern therapeutic technique.
Effects of Age on Responsiveness to Adjunct Hypnotic Analgesia During Invasive Medical Procedures.
Lutgendorf, Susan K.; Lang, Elvira V.; Berbaum, Kevin S.; Russell, Daniel; Berbaum, Michael L.; Logan, Henrietta; Benotsch, Eric G.;
Schulz-Stubner, Sebastian; Turesky, Derek; Spiegel, David. (Feb-Mar 2007).Psychosomatic Medicine, Vol 69(2), 191-199.
Objectives: To assess the effects of age on responsiveness to self-hypnotic relaxation as an analgesic adjunct in patients undergoing invasive medical
procedures. Material and Methods: Secondary data analysis from a prospective trial with 241 patients randomized to receive hypnosis, attention, and standard care treatment during interventional radiological procedures. Growth curve analyses, hierarchical linear regressions, and logistic regressions using orthogonal contrasts were used for analysis. Outcome measures were Hypnotic Induction Profile scores, self-reported pain and anxiety, medication use, oxygen desaturation = 89%, and procedure time. Results: Hypnotisability did not vary with age (p = .19). Patients receiving attention and hypnosis had greater pain reduction during the procedure (p = .02), with trends toward lower pain with hypnosis (p = .07); this did not differ by age. As age increased, patients experienced more rapid pain control with hypnosis (p = .03). There was more rapid anxiety reduction with attention and hypnosis (p = .03). Trends toward lower final anxiety were also observed with attention and hypnosis versus standard care (p = .08), and with hypnosis versus attention (p = .059); these relationships did not differ by age. Patients requested and received less medication and had less oxygen desaturation = 89% with attention and hypnosis
(p < .001); this did not differ by age. However, as age increased, oxygen desaturation was greater in standard care (p = .03). Procedure time was reduced in the attention and hypnosis groups (p = .007); this did not vary by age. Conclusions: Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures.
Adjunctive Self-hypnotic Relaxation for Outpatient Medical Procedures: A Prospective Randomized Trial with Women Undergoing Large Core Breast Biopsy.
Lang, Elvira V.; Berbaum, Kevin S.; Faintuch, Salomao; Hatsiopoulou, Olga; Halsey, Noami; Li, Xinyu; Berbaum, Michael L.; Laser, Eleanor; Baum, Janet. (Dec 2006). Pain, Vol 126(1-3), 155-164.
Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical centre were prospectively 4110 Journal of Heart-Centred Therapies, 2010, Vol. 13, No. 1 randomized to receive standard care (n = 76), structured empathic attention (n = 82), or self-hypnotic relaxation (n = 78) during their procedures. Patients’ self-ratings at 10 min-intervals of pain and anxiety on 0-10 verbal analogue scales with 0 = no pain/anxiety at all, 10 = worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women’s anxiety increased significantly in the standard group (logit slope = 0.18, p < 0.001), did not change in the empathy group (slope = -0.04, p = 0.45), and decreased significantly in the hypnosis group (slope = -0.27, p < 0.001). Pain increased significantly in all three groups (logit slopes: standard care = 0.53, empathy = 0.37, hypnosis = 0.34; all p < 0.001) though less steeply with hypnosis and empathy than standard care (p = 0.024 and p = 0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/$161 for standard care, 43 min/$163 for empathy, and 39 min/$152 for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.
Hypnosis to Manage Anxiety and Pain Associated with Colonoscopy for Colorectal Cancer Screening: Case Studies and Possible Elkins, Gary; White, Joseph; Patel, Parita; Marcus, Joel; Perfect, Michelle M.; Montgomery, Guy H. (Oct 2006). Benefits.International Journal of Clinical and Experimental Hypnosis, Vol 54(4), 416-431.
This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and
instruction in self-hypnosis on the day of their colonoscopy. Patients’ levels of anxiety were obtained before and after the hypnotic induction using Visual
Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient
satisfaction with medical care. Hypnotisability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care. Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and
recovery time.
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