Resources – Hypnosis and Pain

BOOKS

Bruce Eimer (2008). Hypnotize Yourself Out of Pain Now!

Maggie Phillips (2012). Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain

LINKS

A helpful website put together by Dr. Stephen Grinstead, a psychologist in Sacramento who works extensively with chronic pain issues, is here:

For a medical perspective on pain click here.

The Australian Hypnotherapist Association has an excellent survey of research on hypnosis for many painful medical conditions. Click here to access it.

SOME EXAMPLES OF RESEARCH

Harvard Medical School Research Finds Healing Faster With Hypnosis

Two studies from Harvard Medical School show how hypnosis significantly reduces the time it takes to heal.

With hypnosis:

  • Study One: Patients healed 41% faster from fracture. Six weeks after an ankle fracture, those in the hypnosis group showed the equivalent of eight and a half weeks of healing.
  • Study Two: Patients healed significantly faster from surgery. Three groups of people studied after breast reduction surgery. Hypnosis group healed “significantly faster” than supportive attention group and control group

Harvard Medical School, Carol Ginandes, and Union Institute in Cincinnati, Patricia Brooks. For more information check out the Harvard University Gazette.

Brain Imaging Studies Investigate Pain Reduction By Hypnosis

University of Iowa News Release, March 14, 2005

University of Iowa Health Science Relations, 5135 Westlawn, Iowa City, Iowa 52242-1178

Although hypnosis has been shown to reduce pain perception, it is not clear how the technique works. Identifying a sound, scientific explanation for hypnosis’ effect might increase acceptance and use of this safe pain-reduction option in clinical settings.

Researchers at the University of Iowa Roy J. and Lucille A. Carver College of Medicine and the Technical University of Aachen, Germany, used functional magnetic resonance imaging (fMRI) to find out if hypnosis alters brain activity in a way that might explain pain reduction. The results are reported in the November-December 2004 issue of Regional Anesthesia and Pain Medicine.

The researchers found that volunteers under hypnosis experienced significant pain reduction in response to painful heat. They also had a distinctly different pattern of brain activity compared to when they were not hypnotized and experienced the painful heat. The changes in brain activity suggest that hypnosis somehow blocks the pain signal from getting to the parts of the brain that perceive pain.

“The major finding from our study, which used fMRI for the first time to investigate brain activity under hypnosis for pain suppression, is that we see reduced activity in areas of the pain network and increased activity in other areas of the brain under hypnosis,” said Sebastian Schulz-Stubner, M.D., Ph.D., UI assistant professor (clinical) of anesthesia and first author of the study. “The increased activity might be specific for hypnosis or might be non-specific, but it definitely does something to reduce the pain signal input into the cortical structure.”

The pain network functions like a relay system with an input pain signal from a peripheral nerve going to the spinal cord where the information is processed and passed on to the brain stem. From there the signal goes to the mid-brain region and finally into the cortical brain region that deals with conscious perception of external stimuli like pain.

Processing of the pain signal through the lower parts of the pain network looked the same in the brain images for both hypnotized and non-hypnotized trials, but activity in the top level of the network, which would be responsible for “feeling” the pain, was reduced under hypnosis.

Initially, 12 volunteers at the Technical University of Aachen had a heating device placed on their skin to determine the temperature that each volunteer considered painful (8 out of 10 on a 0 to10 pain scale). The volunteers were then split into two groups. One group was hypnotized, placed in the fMRI machine and their brain activity scanned while the painful thermal stimuli were applied. Then the hypnotic state was broken and a second fMRI scan was performed without hypnosis while the same painful heat was again applied to the volunteer’s skin. The second group underwent their first fMRI scan without hypnosis followed by a second scan under hypnosis.

Hypnosis was successful in reducing pain perception for all 12 participants. Hypnotized volunteers reported either no pain or significantly reduced pain (less than 3 on the 0-10 pain scale) in response to the painful heat.

Under hypnosis, fMRI showed that brain activity was reduced in areas of the pain network, including the primary sensory cortex, which is responsible for pain perception.

The imaging studies also showed increased activation in two other brain structures — the left anterior cingulate cortex and the basal ganglia. The researchers speculate that increased activity in these two regions may be part of an inhibition pathway that blocks the pain signal from reaching the higher cortical structures responsible for pain perception. However, Schulz-Stubner noted that more detailed fMRI images are needed to definitively identify the exact areas involved in hypnosis-induced pain reduction, and he hoped that the newer generation of fMRI machines would be capable of providing more answers.

“Imaging studies like this one improve our understanding of what might be going on and help researchers ask even more specific questions aimed at identifying the underlying mechanism,” Schulz-Stubner said. “It is one piece of the puzzle that moves us a little closer to a final answer for how hypnosis really works. “More practically, for clinical use, it helps to dispel prejudice about hypnosis as a technique to manage pain because we can show an objective, measurable change in brain activity linked to a reduced perception of pain,” he added.

In addition to Schulz-Stubner, the research team included Timo Krings, M.D., Ingo Meister, M.D., Stefen Rex, M.D., Armin Thron, M.D., Ph.D. and Rolf Rossaint, M.D., Ph.D., from the Technical University of Aachen, Germany.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online.

Depression, Pain and Opioids (November 16, 2009)

Chronic pain patients with a history of depression are three times more likely to receive long-term prescriptions for opioid medications like Vicodin compared to pain patients who do not suffer from depression, according to new research.

The study published in the November-December issue of the journal General Hospital Psychiatry, analyzed the medical records of tens of thousands of patients enrolled in the Kaiser Permanente and Group Health plans between 1997 and 2005. Together, the insurers cover about 1 percent of the U.S. population. Long-term opioid use was defined as a patient receiving a prescription for 90 days or longer.

“It’s very widespread,” said Mark Sullivan, M.D., a study co-author and professor of psychiatry at the University of Washington. “It’s a cause for concern because depressed patients are excluded from virtually all controlled trials of opioids as a high risk group [for addiction], so the database on which clinical practice rests doesn’t include depressed patients.”

The connection between pain and depression is complicated. First, no one really knows how often chronic pain and depression co-occur: 46 percent of patients seeing primary care doctors for ongoing pain have a history of depression and the vast majority of those seeing pain specialists have suffered both disorders, according to the authors.

“If you study depressed people, they tend to have lot of pain complaints that are poorly responsive to a lot of things so it’s not surprising that they end up on opioids,” Sullivan said.

Being depressed might make pain hurt more. “Emotional and physical pain aren’t all that different,” Sullivan added. “The same brain zones light up [in imaging studies].”

“Depression is mediated in some significant part by the brain’s opioid receptor systems; these things run together at every level that you look at them,” said Alex DeLuca, M.D., a consultant on pain and addiction and former chief of the Smithers Addiction Research and Treatment Center. He has no affiliation with the new study.

Consequently, it is impossible to tell whether pain is causing or exacerbating depression – or vice versa. To Sullivan, the bottom line is that “it is very important that opioid treatment for chronic pain does not replace or distract from treating mental disorders. ‘Both’ works better than ‘either/or.'”

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177 (206) 543-7177.

“Trends in long-term opioid therapy for noncancer pain among persons with a history of depression.”
Braden JB, et al., Gen Hosp Psychiatry 31(6), 2009.

Chronic Pain and PTSD Among Vetrans (October 1, 2009)

The wars in Iraq and Afghanistan have resulted in a growing number of soldiers evacuated to the United States for comprehensive care for physical and psychological trauma. Given the number of physical injuries often experienced by soldiers, it is not surprising that chronic pain is a frequent problem among returning soldiers from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF). Common sources of pain are in the head (traumatic-brain injury or post-concussion syndrome), legs (fractures, amputations, burns) and shoulders. Other physical injuries include spinal-cord and eye injuries as well as auditory trauma. In addition, veterans are reporting high rates of mental health issues, including post-traumatic stress disorder (PTSD), depression and alcohol use disorders.

Boston University School of Medicine (BUSM) researchers have developed an integrated treatment program for veterans with co-morbid chronic pain and PTSD. This study appeared in the October issue of Pain Medicine.

BUSM researchers found in this pilot study that soldiers have shown great benefit from receiving the integrated treatment for pain and PTSD. BUSM researchers used components of cognitive processing therapy (CPT) for PTSD and cognitive-behavioral therapy (CBT) for chronic pain management.

The CBT approach has been shown to be highly effective in treating a range of disorders, from PTSD to chronic pain in children and adults. Using CBT for chronic pain involves challenging maladaptive beliefs and teaching patients’ ways of safely reintroducing enjoyable activities into their lives.

Researchers used different methods for treating chronic pain and PTSD, including teaching veterans cognitive restructuring, relaxation training, time-based activity pacing so that veterans become more active without overdoing it, and lastly graded homework assignments designed to decrease patients’ avoidance of activity and reintroduce a healthy active lifestyle.

Lead researcher was John D. Otis, PhD an assistant professor of psychiatry and psychology at Boston University School of Medicine and clinical psychologist in the Research Services at the VA Boston Healthcare System. “Participants reported that they liked the format of treatment, appreciated learning about the ways that chronic pain and PTSD share common symptoms and how the two disorders interact with one another,” said Otis.

Upon completing the 12-week integrated treatment, several participants no longer met diagnostic criteria for PTSD and reported reductions in symptoms of chronic pain, and disability.