Journal of Pain & Palliative Care Pharmacotherapy. 2014;28:174–176. Copyright© 2014 Informa Healthcare USA, Inc. ISSN: 1536-0288 print / 1536-0539 online DOI: 10.3109/15360288.2014.911792
PATIENT EDUCATION AND SELF-ADVOCACY: QUESTIONS AND RESPONSES ON PAIN MANAGEMENT
Medical Hypnotherapy for Pain Management J Pain Palliat Care Pharmacother Downloaded from informahealthcare.com by University of Utah on 11/25/14 For personal use only.
´ and Mark S. Avnet Yvette Colon AB STRACT Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Hypnotherapy, its uses and process, and certification and training of hypnotherapy professionals are addressed. KEYWORDS complementary, hypnotherapy, medical hypnosis, mind-body intervention
Hypnosis is considered a mind-body intervention.1 These interventions also include relaxation, meditation, biofeedback. and behavior modification. Common to these approaches is the belief that people have the ability to manage some aspects of their pain by changing attitudes, thoughts, feelings, or behaviors. Hypnosis consists of two parts: an induction or trance including an invitation for the patient to focus his or her attention on a single sensory experience, followed by a suggestion or set of suggestions for changes in thoughts, emotions, sensory experiences, or behaviors.2 Hypnosis is a way to enter a “trance,” a natural, yet altered state of mind in which the judgmental part of the mind is relaxed while the fully aware subconscious mind is highly receptive and responsive to all beneficial suggestions. And because it’s a natural state of mind, anyone who wants to enter a trance can do so. Although the mind-body connection has been understood to exist for thousands of years, more recently it’s been the subject of scientific research that shows that what people think and believe can directly impact the way their bodies function—and also how their minds interpret the messages sent by the body.3 Hypnosis is a useful, important, and widely practiced complementary intervention in pain management. Because of the way it’s portrayed in movies and on television, hypnosis is often misunderstood, and it’s important to know a little about what hypnosis is not. It is not mind control, it is not unconsciousness, it is not truth serum, and it is not sleep. People who enter hypnosis are in complete control (no one can
QUESTION FROM A PATIENT A friend with chronic pain is seeing a hypnotherapist as part of her pain management program. What is hypnotherapy and how can it help me with my pain? Isn’t it just for entertainment? Does it work for everybody? How can I find a reputable hypnotherapist?
RESPONSE Hypnotherapy, simply put, is using hypnosis for therapeutic purposes, to help people with specific emotional, psychological, or physical issues. Pain is an essential alerting mechanism to let you know that something is wrong, that some tissue is being damaged. However, once you get that message, or if the message is being sent in error, there’s no need to continue to interpret the message from the nerves in the same way. Medical hypnosis is a way to direct one’s focused attention inward to achieve benefits such as the lessening of pain. It works to block, reduce, or eliminate pain. ´ PhD, ACSW, BCD, is Assistant Professor, Eastern MichiYvette Colon, gan University School of Social Work, Ypsilanti, Michigan, USA. Mark S. Avnet, CHt, is a certified clinical hypnotherapist, with special training and practice in medical hypnosis, and is the founder of the New England Hypnotherapy Center. He currently is Dean of 360i, a global advertising agency. Address correspondence to: Yvette Col´on, PhD, ACSW, BCD, Eastern Michigan University School of Social Work, 317 Everett Marshall Building, Ypsilanti, MI 48197, USA (E-mail: [email protected]).
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J Pain Palliat Care Pharmacother Downloaded from informahealthcare.com by University of Utah on 11/25/14 For personal use only.
Patient Education and Self-Advocacy
make you do anything you don’t want to do), and they can choose to remember everything that happens during the trance. For many people, just spending time in a hypnotic trance is a relaxing, rejuvenating, and pain-free experience. In fact, most people have been in a natural trance, often many times a day, without even knowing it. Maybe you can remember being in school, staring out the window, not really paying attention, and letting your mind drift—that’s a trance state. Some people get into that state of mind by praying, or dancing, or gardening, or listening to music so deeply they get lost in it. Most of us have had experiences with “highway hypnosis,” when we’re driving on a road we’ve driven many times, our mind thinking about whatever it wants to, and we suddenly “snap out of it” and wonder if we’ve made that important left turn—and it turns out we have. In each of these cases, the conscious mind is doing one thing while the subconscious mind is paying attention to another. Hypnosis, either with the assistance of a hypnotherapist or as self-hypnosis, is a way to enter that state of mind—and once you’re in that state of mind, it becomes easy to make and accept suggestions about how your mind and body should behave or what it should believe. At this point one might think, “Well, I can see how that might help with things like eating less or quitting smoking because that’s just something people can choose to do. But my pain is real—how can this help?” Hypnosis for pain relief can be amazingly powerful. We can stop the sensation completely, as we do with hypnoanesthesia, which is often used for dental work and minor surgery. There are even some people who have undergone major surgery with only hypnosis as anesthetic.4 We can also reduce or transform the pain sensation. This is often done for a pain signal that still serves a purpose, such as reminding people who have had hip replacement that they need to be careful turning when they walk. What would have been felt as acute pain can be transformed into a soft buzzing or another sensation. Although hypnotherapy may not be able to cure the cause of pain, in many cases it can help patients manage it more effectively. Although hypnosis has been shown to reduce pain perception, it is not clear how the technique works. It is clear, however, that hypnosis is effective with many different kinds of pain, often producing significant decreases in pain associated with a variety of chronic pain conditions.3,5 The effects of hypnosis on pain perception and processing can be similar to those obtained by using medication, and can last longer than most medications. In addition, hypnosis may reduce anxiety and depression. We do, however, acknowl C
2014 Informa Healthcare USA, Inc.
175
edge that there is a lack of standardization in hypnosis intervention studies and lack of large samples with long-term follow-up. Just as you would not self-medicate without advice of a physician, any medical hypnosis, including hypnosis for pain control, should be done with full knowledge by your physician. Your physician may want to alter your medications and other treatments as you progress with your hypnotic pain reduction, so she or he must be part of the process. Some approaches span various treatment settings and specialists. For example, some psychosocial interventions, such as hypnosis and guided imagery, may also be advocated for and used by specialists in complementary medicine. Social workers, psychologists, and nurses are in excellent positions to learn and use hypnosis with patients to reduce pain and enhance self-esteem.6,7 Finding a good hypnotist or hypnotherapist with training and experience in pain management is essential. Your physician, the hospital in which she or he works, or other complementary and integrative care professionals may be able to make appropriate recommendations. Because hypnosis is not a stateregulated profession, there are no licensed hypnotists or hypnotherapists. In some states, the use of the term hypnotherapist is limited to medical doctors or state-licensed psychotherapists, so practitioners with hypnotherapeutic training may identify themselves as hypnotists. There are several large professional organizations that certify members with specific hypnotherapy training. Certification with the American Society of Clinical Hypnosis (http://www.asch.net/Home.aspx), American Association of Professional Hypnotherapists (http://aaph.org/), American Psychotherapy and Medical Hypnosis Association (http://apmha.com/), Wellness Institute (http://www.wellness-institute. org/), American Council of Hypnotist Examiners (http://hypnotistexaminers.org/), or National Guild of Hypnotists (http://ngh.net/) indicates a high level of professional training and continuing education. A skilled hypnotherapist can help you explore the potential for greater control over your experience of pain. Once you have practiced with your hypnotherapist, you can learn and practice self-hypnosis. You should meet with and feel comfortable with your hypnotist before getting started, as you should with all health professionals with whom you consider working. Hypnosis can be a powerful complement to traditional pain therapies and, as part of the program you work out with your physician, may provide relief for chronic or acute pain that eludes traditional treatments.
176
Journal of Pain & Palliative Care Pharmacotherapy
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES
J Pain Palliat Care Pharmacother Downloaded from informahealthcare.com by University of Utah on 11/25/14 For personal use only.
[1] Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004;20:27–32. [2] Jensen MP. Psychosocial approaches to pain management: an organizational framework. Pain. 2011;152:717–725.
[3] Elkins G, Jensen MP, Patterson DR. Hypnotherapy for the management of chronic pain. Int J Clin Exp Hypnosis. 2007;55:275–287. [4] Erickson MH, Hershman S, Secter II. Practical Application of Medical and Dental Hypnosis. New York: Routledge; 2014. [5] Jensen M, Patterson DR. Hypnotic treatment of chronic pain. J Behav Med. 2006;29:95–124. [6] Valente SM. Hypnosis for pain management. J Psychosoc Nurs Ment Health Serv. 2006;44:22–30. [7] Gant L, Benn R, Gioia D, Seabury B. Incorporating integrative health services in social work education. J Soc Work Educ. 2009;45:407–425.
Journal of Pain & Palliative Care Pharmacotherapy
PATIENT EDUCATION AND SELF-ADVOCACY: QUESTIONS AND RESPONSES ON PAIN MANAGEMENT
Medical Hypnotherapy for Pain Management J Pain Palliat Care Pharmacother Downloaded from informahealthcare.com by University of Utah on 11/25/14 For personal use only.
´ and Mark S. Avnet Yvette Colon AB STRACT Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Hypnotherapy, its uses and process, and certification and training of hypnotherapy professionals are addressed. KEYWORDS complementary, hypnotherapy, medical hypnosis, mind-body intervention
Hypnosis is considered a mind-body intervention.1 These interventions also include relaxation, meditation, biofeedback. and behavior modification. Common to these approaches is the belief that people have the ability to manage some aspects of their pain by changing attitudes, thoughts, feelings, or behaviors. Hypnosis consists of two parts: an induction or trance including an invitation for the patient to focus his or her attention on a single sensory experience, followed by a suggestion or set of suggestions for changes in thoughts, emotions, sensory experiences, or behaviors.2 Hypnosis is a way to enter a “trance,” a natural, yet altered state of mind in which the judgmental part of the mind is relaxed while the fully aware subconscious mind is highly receptive and responsive to all beneficial suggestions. And because it’s a natural state of mind, anyone who wants to enter a trance can do so. Although the mind-body connection has been understood to exist for thousands of years, more recently it’s been the subject of scientific research that shows that what people think and believe can directly impact the way their bodies function—and also how their minds interpret the messages sent by the body.3 Hypnosis is a useful, important, and widely practiced complementary intervention in pain management. Because of the way it’s portrayed in movies and on television, hypnosis is often misunderstood, and it’s important to know a little about what hypnosis is not. It is not mind control, it is not unconsciousness, it is not truth serum, and it is not sleep. People who enter hypnosis are in complete control (no one can
QUESTION FROM A PATIENT A friend with chronic pain is seeing a hypnotherapist as part of her pain management program. What is hypnotherapy and how can it help me with my pain? Isn’t it just for entertainment? Does it work for everybody? How can I find a reputable hypnotherapist?
RESPONSE Hypnotherapy, simply put, is using hypnosis for therapeutic purposes, to help people with specific emotional, psychological, or physical issues. Pain is an essential alerting mechanism to let you know that something is wrong, that some tissue is being damaged. However, once you get that message, or if the message is being sent in error, there’s no need to continue to interpret the message from the nerves in the same way. Medical hypnosis is a way to direct one’s focused attention inward to achieve benefits such as the lessening of pain. It works to block, reduce, or eliminate pain. ´ PhD, ACSW, BCD, is Assistant Professor, Eastern MichiYvette Colon, gan University School of Social Work, Ypsilanti, Michigan, USA. Mark S. Avnet, CHt, is a certified clinical hypnotherapist, with special training and practice in medical hypnosis, and is the founder of the New England Hypnotherapy Center. He currently is Dean of 360i, a global advertising agency. Address correspondence to: Yvette Col´on, PhD, ACSW, BCD, Eastern Michigan University School of Social Work, 317 Everett Marshall Building, Ypsilanti, MI 48197, USA (E-mail: [email protected]).
174
J Pain Palliat Care Pharmacother Downloaded from informahealthcare.com by University of Utah on 11/25/14 For personal use only.
Patient Education and Self-Advocacy
make you do anything you don’t want to do), and they can choose to remember everything that happens during the trance. For many people, just spending time in a hypnotic trance is a relaxing, rejuvenating, and pain-free experience. In fact, most people have been in a natural trance, often many times a day, without even knowing it. Maybe you can remember being in school, staring out the window, not really paying attention, and letting your mind drift—that’s a trance state. Some people get into that state of mind by praying, or dancing, or gardening, or listening to music so deeply they get lost in it. Most of us have had experiences with “highway hypnosis,” when we’re driving on a road we’ve driven many times, our mind thinking about whatever it wants to, and we suddenly “snap out of it” and wonder if we’ve made that important left turn—and it turns out we have. In each of these cases, the conscious mind is doing one thing while the subconscious mind is paying attention to another. Hypnosis, either with the assistance of a hypnotherapist or as self-hypnosis, is a way to enter that state of mind—and once you’re in that state of mind, it becomes easy to make and accept suggestions about how your mind and body should behave or what it should believe. At this point one might think, “Well, I can see how that might help with things like eating less or quitting smoking because that’s just something people can choose to do. But my pain is real—how can this help?” Hypnosis for pain relief can be amazingly powerful. We can stop the sensation completely, as we do with hypnoanesthesia, which is often used for dental work and minor surgery. There are even some people who have undergone major surgery with only hypnosis as anesthetic.4 We can also reduce or transform the pain sensation. This is often done for a pain signal that still serves a purpose, such as reminding people who have had hip replacement that they need to be careful turning when they walk. What would have been felt as acute pain can be transformed into a soft buzzing or another sensation. Although hypnotherapy may not be able to cure the cause of pain, in many cases it can help patients manage it more effectively. Although hypnosis has been shown to reduce pain perception, it is not clear how the technique works. It is clear, however, that hypnosis is effective with many different kinds of pain, often producing significant decreases in pain associated with a variety of chronic pain conditions.3,5 The effects of hypnosis on pain perception and processing can be similar to those obtained by using medication, and can last longer than most medications. In addition, hypnosis may reduce anxiety and depression. We do, however, acknowl C
2014 Informa Healthcare USA, Inc.
175
edge that there is a lack of standardization in hypnosis intervention studies and lack of large samples with long-term follow-up. Just as you would not self-medicate without advice of a physician, any medical hypnosis, including hypnosis for pain control, should be done with full knowledge by your physician. Your physician may want to alter your medications and other treatments as you progress with your hypnotic pain reduction, so she or he must be part of the process. Some approaches span various treatment settings and specialists. For example, some psychosocial interventions, such as hypnosis and guided imagery, may also be advocated for and used by specialists in complementary medicine. Social workers, psychologists, and nurses are in excellent positions to learn and use hypnosis with patients to reduce pain and enhance self-esteem.6,7 Finding a good hypnotist or hypnotherapist with training and experience in pain management is essential. Your physician, the hospital in which she or he works, or other complementary and integrative care professionals may be able to make appropriate recommendations. Because hypnosis is not a stateregulated profession, there are no licensed hypnotists or hypnotherapists. In some states, the use of the term hypnotherapist is limited to medical doctors or state-licensed psychotherapists, so practitioners with hypnotherapeutic training may identify themselves as hypnotists. There are several large professional organizations that certify members with specific hypnotherapy training. Certification with the American Society of Clinical Hypnosis (http://www.asch.net/Home.aspx), American Association of Professional Hypnotherapists (http://aaph.org/), American Psychotherapy and Medical Hypnosis Association (http://apmha.com/), Wellness Institute (http://www.wellness-institute. org/), American Council of Hypnotist Examiners (http://hypnotistexaminers.org/), or National Guild of Hypnotists (http://ngh.net/) indicates a high level of professional training and continuing education. A skilled hypnotherapist can help you explore the potential for greater control over your experience of pain. Once you have practiced with your hypnotherapist, you can learn and practice self-hypnosis. You should meet with and feel comfortable with your hypnotist before getting started, as you should with all health professionals with whom you consider working. Hypnosis can be a powerful complement to traditional pain therapies and, as part of the program you work out with your physician, may provide relief for chronic or acute pain that eludes traditional treatments.
176
Journal of Pain & Palliative Care Pharmacotherapy
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES
J Pain Palliat Care Pharmacother Downloaded from informahealthcare.com by University of Utah on 11/25/14 For personal use only.
[1] Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004;20:27–32. [2] Jensen MP. Psychosocial approaches to pain management: an organizational framework. Pain. 2011;152:717–725.
[3] Elkins G, Jensen MP, Patterson DR. Hypnotherapy for the management of chronic pain. Int J Clin Exp Hypnosis. 2007;55:275–287. [4] Erickson MH, Hershman S, Secter II. Practical Application of Medical and Dental Hypnosis. New York: Routledge; 2014. [5] Jensen M, Patterson DR. Hypnotic treatment of chronic pain. J Behav Med. 2006;29:95–124. [6] Valente SM. Hypnosis for pain management. J Psychosoc Nurs Ment Health Serv. 2006;44:22–30. [7] Gant L, Benn R, Gioia D, Seabury B. Incorporating integrative health services in social work education. J Soc Work Educ. 2009;45:407–425.
Journal of Pain & Palliative Care Pharmacotherapy
