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Explainer: how does hypnosis relieve pain?

Hypnosis is a state of conscious awareness which most people experience many times each day. Beyonder

Hypnosis in one form or another has been around for thousands of years, but until recently, evidence to support its biological and clinically powerful effects have been lacking. Today hypnosis is used by clinicians around the world to help manage pain, childbirth, phobia and anxiety – particularly in children.

What is hypnosis?

Hypnosis is thought to be a state of conscious awareness which most people experience transiently many times each day.
Hypnotic experiences and responses tend to involve:

  • absorption or a state of focused concentration or attention;
  • dissociation, where the patient’s perception of the external environment diminishes; and
  • suggestibility (the ability of an individual to respond, in a non-volitional way, to a verbal or non-verbal communication).

People describe the hypnotic mindset in different ways such as, “being beside oneself”, “out of body experiences”, “daydreaming”, “tuning out” or a meditative state.

Until the 19th century, hypnosis was the only means of having surgery comfortably. James Braid, a Scottish surgeon working in Bengal in the 1840s, operated on several hundred patients using hypnosis and his success subsequently received widespread acclaim.

Over the years, clinicians have reported dissociation from pain, decreased bleeding and reduced infection, suggesting an evolutionary basis for why we have the ability to enter a hypnotic “trance-like” state when under extreme stress.

Following the establishment of pharmacological anaesthesia – with its greater effectiveness and reliability – the practice of hypnosis languished for decades, becoming little more than a parlour trick. It was almost forgotten until relatively recently.

Unfortunately, the term “hypnosis” has many negative connotations and its use by stage hypnotists as entertainment has probably contributed to many doctors not taking the clinical use of hypnosis seriously.

How it works

Contrary to popular belief, hypnosis is not sleep; hypnotic responses can be elicited in minutes or less; and a conscious belief that it will be effective is not required to achieve a benefit. Patients experiencing hypnosis can hear what’s happening around them and can halt the process at any stage if they wish.

The success of hypnosis in a clinical setting requires trust between doctor and patient to go along with the process. But a borderline, and sometimes frank, hypnotic state frequently occurs spontaneously in hospital patients where the overwhelming stress of the external environment – or the thought of painful procedures, or feelings of being a victim to illness – can facilitate an internal focus of attention.

Contrary to popular belief, hypnosis is not sleep. P:B!rch

This can make patients highly responsive to suggestions, positive or negative. And it means that when a doctor says, before a potentially painful procedure, “this is going to sting”, the communication can function as a hypnotic suggestion and is likely to increase pain. In contrast, the positive suggestion, “the local anaesthetic will numb the area and allow us to perform the procedure more comfortably” is likely to decrease pain of local anaesthetic injection.

What the research say?

Advances in brain function imaging using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scanning techniques have allowed us to see that hypnosis modulates activity in the anterior cingulate cortex, which links the limbic (emotions) and sensory cortical areas of the brain during hypnotic pain relief. This appears to allow sensations that would normally be experienced as painful to no longer have the suffering or negative emotions that would normally be associated with them.

A labour contraction, for example, can be felt as either the most terrifying and painful of sensations or a wonderfully fulfilling experience that tells the mother she is getting closer to her baby. These very different perceptions may be experienced despite the intensity of uterine contractions being identical.

Anaesthetists in Belgium have successfully used hypnosis to help thousands of patients minimise their need for general anaesthesia during thyroidectomy (surgical removal of they thyroid gland), mastectomy (removal of the breast) and plastic surgery.

Anaesthetists. johnnyalive

Meanwhile, US researchers are currently investigating the effectiveness of hypnosis and suggestion in the management of chronic and procedural pain including burns.

And our own institution is researching the effectiveness of hypnosis in managing childbirth pain, along with investigators in Denmark, the United Kingdom and the University of Tasmania.

How is it used?

Hypnosis in the formal sense – where a patient receives an induction, treatment, and an alerting procedure – is more commonly practiced by clinical psychologists and not widely used in hospitals. Although a number of hospitals around the world use hypnotic techniques, the main clinical application is to use suggestions to supplement anaesthesia drugs and techniques as part of a multimodal approach to patient care.

Hypnosis has been used at Adelaide’s Women’s and Children’s Hospital for more than three decades, since Dr Graham Wicks, a medical hypnotherapist at the hospital, pioneered its use. Over the years, hypnosis has been used to treat thousands of children with problems as diverse as bedwetting, pain, and helping children comfortably use hypnotic anaesthesia with needles and renal dialysis.

Today, several paediatricians and anaesthetists at our institution are trained in hypnosis and use it to supplement patient care where indicated.

As anaesthetists, we use hypnotic techniques to help patients feel more in control and to supplement and enhance their anaesthesia experience. Common examples include assisting children and adults with their induction of anaesthesia, burns dressings, treatment of needle phobia, assistance with childbirth pain and preparation of patients for surgery.

It’s very rare for procedures to be performed entirely using hypnosis.

The main value of hypnosis as a technique is to assist patients having drips and needles inserted more comfortably and usefully supplement a less than perfect local anaesthetic. The belief that the patient can do more than he or she thinks (and more than the doctor believes is possible) is likely to generate surprising therapeutic responses.

Further reading: Handbook of Communication in Anaesthesia & Critical Care: A Practical Guide to Exploring the Art

See more Explainer articles on The Conversation.

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