What is Pain?
Authors note: Before working with any client who suffers from pain the hypnotherapist must be certain the client has sought a medical diagnosis of the cause of the pain. If you work with a client without a prior medical diagnosis, you are probably practicing medicine without a license. NEVER work with a client for ANY pain without your client having seen a medical doctor for the specific issue she is presenting to you, first.
Pain is any sensation that is magnified to an uncomfortable level that includes a component of suffering from a cluster of negative emotions.
This article will touch on several important ideas. Did you know that pain can be culturally influenced? (Where you live can determine whether something will cause you to suffer from pain or not!) You may also be surprised to learn that not all pain can be alleviated but that most people who suffer from pain can experience a reduction in their level of pain.
Understanding pain and why we experience it helps us to optimize our work with our clients in therapy. Over the years you have read in my articles here in the Journal of Hypnotism that an effective modality for helping those who suffer from pain is combining regression hypnosis with ego state therapy. Others who write for the Journal advocate a cognitive behavioral approach to therapy. Still others advocate the utilization of hypnotherapy scripts and guided imagery in relieving pain. This article will help you understand why all of these tools are effective to some degree or another.
Pain is to be understood in two continuums of experience. The first is whether the pain is chronic (long term vs. something that is a new experience) or not. The second is the suffering the individual experiences because of the pain.
Pain travels through the body on two general pathways, the central nervous system (brain and spine) and the peripheral nervous system (everything else). It would take a book to describe the numerous incomplete theories about how and why people experience pain. For this article we will simply consider this two facts: Pain is a process and that is good news because even if you can’t stop a process you can probably alter it. Second, pain is always at least partially “in the mind” or “emotional” in nature. This to is good news for the client and the therapist.
Advanced Certification Research
At our most recent six-day intensive advanced hypnotherapy certification training we did a research project involving pain that reinforces current cutting edge medical research about pain and relieving it. Chris McAtee, C.I., led a research project where we first measured an individual’s threshold and tolerance of pain. (The balance of the next three paragraphs will share with you the highlights of the experiment. We will publish all of the data gathered at a later date.) We wanted to compare pain levels experienced by participants in a “normal state” with their experience in trance.
We began by filling an ice chest with ice-cold water. The temperature was maintained at 34 degrees. The first time each subject (mostly advanced hypnotherapy students) placed their arm in the bucket of ice water it was found to be very cold and in a matter of about one half of a minute, found to be very painful by most everyone involved in the project. Each person reported their level of pain using a number scale of 1-10. The experimenter (McAtee) asked for reports of pain intensity every 9 seconds and the information was recorded.
Later, all the participants were put in trance and again reported their level of pain to the experimenter. What we found was that approximately 1/3 of the participants experienced anesthesia (no pain) for the excruciatingly cold water while in trance. In addition, all of the remaining students experienced analgesia (significant pain reduction) while in trance. The results are encouraging but inconclusive as to how hypnosis will help those who suffer from chronic pain. The results also need to be compared to future research that examines hypnosis in the relief of pain to see if they might be replicated. (Other results were recorded that are not important to this discussion. They will be reported at a future date in this forum.)
Secondary Gain and Suffering from Pain
People’s reaction to pain and even their level of suffering can be related to something as unusual as the culture they live in. Did you know that if you lived in Lithuania you probably would never suffer from whiplash? It’s true! It just so happens that in Lithuania there are no laws allowing for financial compensation for something called whiplash. In a study of 200 people who survived serious car accidents in Lithuania, it was found that only 1/3 of these people reported headache or neck pain and most said they had the pain before the accident! There were no reported cases of whiplash. None.
The difference between Lithuania and the United States is that in the USA we compensate people for whiplash and therefore the secondary gain provided is often enough to culturally validate the extension and suffering of pain. When you work with your clients using ego state therapy you will ultimately discover what secondary gain is evident from the pain the person is experiencing. You should also be aware that the elimination of secondary gain (or any hypnotic experience or process) will not necessarily eliminate pain. You will likely find however that secondary gain does reduce pain.
It has recently been shown that emotions are inextricably linked to pain. If a person is suffering from depression and they are also in pain, they are far more likely to suffer from pain than someone who is not suffering from depression. Some scientists believe that depression has such a complex impact on the body that it suppresses the ability to tolerate pain.
Reducing the symptoms of depression, anxiety, stress, panic attacks and other emotional problems tends to raise tolerance to pain. This can be done through medication, psychotherapy, relaxation, increased or decreased interaction with people, or even hypnotherapy! (A combination of the above is normally the most effective overall therapeutic plan of attack.)
On my quest for discovering evidence to validate the mindbody connection I came across the work of Dr. John Sarno. Sarno specialized in working with people who suffered from back pain using conventional methodologies. Sarno now treats his patients with cognitive therapies and achieves better results for the vast majority of his clients than when he used conventional methods of treating back pain. Part of Sarno’s message is that of having the client recognizing that stress and emotions play a significant role in the experience of back pain. They also play a significant role in the reduction of pain.
Phrases like “bulging disks” or “spine out of alignment” have become equated with the word “pain.” This however is another example of cultural influence. Pain does not necessarily flow from a herniated disk, a bulging disk or a spine that is out of alignment. In fact, one recent study revealed that thousands of individuals with bulging disks suffer absolutely no pain.
These facts do not mean that bulging or herniated disks can’t cause pain. A bulging disk can cause excruciating pain and it may need to be surgically repaired.
Relieving Chronic Pain
It is truly a miracle when someone experiences a remission from pain after decades of bitter suffering. The documented reports of complete remission from multi-decade chronic pain are few and far between. However, you can rest assured that miracles do sometimes happen and when they don’t reducing chronic pain is often not only possible, it is likely.
You will likely find that people who suffer from disorders as diverse as fibromyalgia, headaches and foot pain can almost all can experience improvement with hypnotherapy.
Regression therapy allows a client a couple of key benefits. First, the client comes to understand why they suffer thereby taking the mystery out of the illness. Second, the client will become desensitized (in many cases) to the disorder and therefore reduce their negative emotional response to the pain. This allows the persons emotional state of mind to lift and the pain to reduce. These improvements rarely happen quickly and they are rarely complete as far as remission, but the changes are normally significant enough that a client can return to work and lead a normal life.
The Power of Suggestion
In previous articles we have discussed the power of the placebo (and it’s opposite, the nocebo) effect. A placebo is not just a sugar pill. A placebo is generally considered to be an inert substance given to someone presenting a specific symptom. All placebos are not the same however. The authority of the person administering the placebo changes the results of whether the person will improve or not. The medical doctor (or hypnotherapist) is a assigned an unconscious mental value, so to speak. If the patient/client perceives the practitioner to be “excellent” or “best doctor in town” then the person is more likely to respond positively to the inert substance (placebo). If the practitioner has no credibility or very little prestige, the placebo effect is not as great.
In addition to these elements of the placebo effect is the practitioner’s expectation about the client’s improvement. A low prestige practitioner stating with certainty that a person is likely to be cured because of the use of a placebo or a bogus therapy will not likely get the results hoped for. On the other hand, a practitioner with high prestige will be more likely to get positive results if they are certain in their prognosis (Always remember that a prognosis is only to be given by a medical doctor, unless state law requires otherwise. If you are a hypnotherapist and you tell your client that they will get well because of your therapeutic intervention, you are practicing medicine without a license.)
People who suffer from chronic pain are not going to want to hear that, “your pain is all in your mind.” You will need to articulate to the client that their pain is very real and what they experience is very real. If you validate the client’s experience they are more likely to accept suggestions from you.
Your prestige in a local community or field is also important to helping someone work through the difficulties of chronic pain. The more prestige that you develop (appearances on television and in media, additional trainings, competence and command of a niche market, etc.) the more powerful your suggestive therapeutics are likely to be.
Working with client’s who suffer from chronic pain is not for the person who is unwilling to work in conjunction with the medical community. Each client you see must see a medical practitioner for a complete diagnosis of what specifically the client is experiencing. You must never attempt to work with any client who has not first been to a medical practitioner for the same reason they are seeing you.
Hypnotherapy is certainly a useful modality in helping most clients reduce their intensity and suffering of pain. However, it certainly is not likely to be the only modality needed. Always recommend your client seek out treatment for related symptoms of depression, anxiety and other emotional problems.
Finally, remember that all pain is not psychosomatic in nature. Just because you can reduce a person’s pain with hypnosis doesn’t mean you addressed the physical and emotional causes of that pain. If their headache comes from brain tumor and you successfully mask the pain, the person will still die. Pain is a signal. Remember that a medical doctor is the person to decide what that signal is.
Our role as a hypnotherapist is an exciting one. The skills we learn to help others heal give us great reward and those we help, very often, a new life.
Kevin Hogan is the author of eight books including The Hypnotherapy Handbook and Talk Your Way to the Top, and Tinnitus: Turning the Volume Down.