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Hypnosis for Pain

By Evelyn Strauss
WebMD Medical News

Medically reviewed by Dr. Jeannie Brewer

Sept. 4, 2000 -- for me, cramming in college wasn't about mastering material before an exam. It was about squeezing in my studies before a migraine knocked me flat. When the fuzziness started creeping into my head, I knew it was just a matter of time. Leaning over my chemistry book, I'd race to memorize before the thumping began. Learning chemical reactions was not an option in my darkened bedroom, hammers whacking the inside of my head for days at a time.

What freed me from those hammers was hypnosis, a practice that people have used for medical purposes for more than a century. In the last several decades, researchers have subjected hypnosis to the scrutiny of clinical trials - - and it has passed with flying colors. It's been successfully used to soothe acute and chronic pain stemming from surgery, cancer, kidney stones, back conditions, and invasive medical and dental procedures. Still, many people who might benefit from the techniques don't explore it. For some, hypnosis carries a stigma, perhaps because of the "performer" hypnotists, who make people cluck or moo in front of large audiences.

Fortunately for me, these were not my only associations with the technique. A friend had told me about her success using hypnosis to control pain from Crohn's Disease, and I went to see her hypnotherapist. We taped a 10 minute session, and I listened to it every morning and evening. Within a couple of months, my migraines were gone.

"If this were a drug, everyone would be using it," says David Spiegel, M.D., a psychiatrist at Stanford University. "Changing your mental set can change what's going on in your body."

"Most patients benefit from the use of hypnotic suggestion for pain relief," says Guy Montgomery, PhD, a behavioral scientist at the Mount Sinai School of Medicine in New York. (Montgomery published a meta-analysis on the subject in the April 2, 2000 issue of the International Journal of Clinical and Experimental Hypnosis.)

Tapping the Power of Suggestion

During hypnosis, subjects enter a state of innerabsorption, concentration, and focused attention., in which they pick up suggestions particularly well. In this condition, they can tap into normally unused mental powers to create new possibilities of experience. "Hypnosis is simply a refined form of applied imagination," says Donald F. Lynch Jr., M.D., a urological oncologist at the Eastern Virginia School of Medicine, who has used the technique to help patients alleviate the pain, anxiety ,and depression associated with cancer.

Results from several papers have recently furnished compelling new evidence for the powers of hypnosis. The April 29, 2000 issue of the journal Lancet, reported that hypnosis reduced pain, anxiety, and blood pressure complications in patients undergoing invasive medical procedures. (Hypnosis was compared with standard care and supportive attention, such as encouragement and active listening.) In addition, the procedures took significantly less time in the hypnosis treatment group, probably because the health care workers didn't have to interrupt their activities to deal with the patients' pain or to stabilize blood pressure, says Spiegel. patients in the hypnosis group also required less than half as much painkilling medication as those in the standard group.

Patients most commonly employ the technique in addition to other treatments, but it can also be used by itself. Alexander A. Levitan, M.D., MPH, a medical oncologist in Minneapolis, has participated in numerous surgeries, including hysterectomies and tracheotomies, in which hypnosis was used as the sole agent for pain control.

How Does It Work?

No one know exactly how hypnosis works, but scientists have several ideas. "Hypnosis changes your expectations about how intense the pain will be," says Montgomery. "That alters your experience of the subsequent pain."

Spiegel offers and alternative explanation. "You focus your attention on a competing image that blocks your perception of the pain," he says.

Researchers are currently testing these theories by way of various experimental approaches. Some studies, for example, are documenting the physiological changes that occur under hypnosis. The process activates certain parts of the brain, including the portion that focuses attention. "By concentrating elsewhere, a person inhibits the pain from coming to conscious awareness," says Helen Crawford, and experimental psychologist at Virginia Polytechnic Institute and State University.

In a study by Spiegel and Harvard psychologist Steven Kosslyn, PhD, published in the August 2000 issue of the American Journal of Psychiatry, subjects were hypnotized and told that the black-and-white pictures they were looking at were color. Blood flow increased in the part of the brain that processes color vision. In other words, although the subjects were viewing black- and-white photos, their brains behaved as if they were seeing colors.

Hypnotizing Yourself

For my anti migraine campaign, the idea was to create an experience of calm. At my appointment with the hypnotherapist, I listened to his voice saying that the muscles in my body might begin to lengthen, that I could discover just how comfortable I could become. "how pleasant it is to have a moment when doing nothing is the right thing to be doing," he said. He suggested that when I became completely conscious, I would discover that I could enjoy all of these comforts, even with my eyes open.

I suspect my sessions allowed me in incorporate a deepened sense of relaxation into my daily life, which alleviated the stress that was partly responsible for triggering my migraines. People often picture specific images to achieve a goal. To soften a headache, for example, I might have conjured up an ice pack on my head. "For general pain relief," says Lynch, "you might focus on a part of the body as a control center. Then you turn down pain as you would turn down the volume of a radio."

Clinicians use a variety of tests to determine susceptibility to hypnosis, but chances are that if you can immerse yourself in your imagination -- if you easily get absorbed in novels, for example -- you can be hypnotized. The technique employs powers of attention similar to those involved in watching a film. "When you enter a theater, you're aware of the other 200 or 300 people." says Levian. "But when the movie begins, you concentrate on it and lose track of the audience. You choose to switch your focus" Motivation plays a key role in hypnosis, and the best way to find out if it will help you is to try it. "My experience has been that most people who need hypnosis for pain control can use it successfully," he says.

It's possible to induce a hypnotic state in yourself and conduct your own session -- which is the goal for many people. A licensed practitioner can facilitate learning the technique, however. "Most people do better for the first time with someone helping," says Lynch. But he stresses, "All hypnosis is really self-hypnosis. The hypnotherapist is guiding you to so something for yourself."

For me, that something was reclaiming my time. Finally, I could delve into my books without the fear that advancing hammers would chase me through the pages.

Evelyn Strauss is a science and health writer based in Santa Cruz, Calif.