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Physiotherapy

Hypnosis For Chronic Pain

Pain is defined as:

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”

(Treede, 2006).

How Does Hypnosis Work For Chronic Pain?

Pain is such a difficult state to manage in both the acute and chronic setting, as it is subjective, meaning every person has a different experience that is influenced by biological, emotional and social factors.

Chronic pain is a debilitating condition that affects both physical and mental health through negatively impacting an individual's lifestyle long term. This ranges from limited ability to exercise to complete disability where one can no longer work or perform basic tasks like cleaning.

 

Chronic pain is defined by the experience of pain beyond the expected healing time after an injury (musculoskeletal, medical, post-surgical etc), experienced most days for 3-6 months. Chronic pain affects approximately 1 in 5 Australians (1.6 million people), with a cost of an estimated $139 billion in Australia in 2018 (Australian Institute of Health and Welfare, 2020).

Pain caused by an acute injury or illness is the body’s alert system to ensure action is taken to maintain survival. Pain is appropriate to stop us from causing further injury, such as walking on a broken leg, and to seek healing. It is necessary and essential for human survival. However, once the immediate life threat has passed, the pain no longer serves a purpose and becomes a complex and intricately woven syndrome involving physical, psychological, social and emotional factors.  

Pharmacological pain relief can only help so much. Medications include paracetamol, NSAIDs and in persistent cases, Opioids. While opioids are not first-line treatment for chronic pain, they are still widely prescribed. This presents a significant problem in society due to dependence, accidental overdose and, more significantly, the fact there is lacking evidence that opioids are effective in managing chronic pain. With the high-risk profile for both short-term and long-term opioid use, focus in research is now on alternative ways to manage this chronic condition. 

A LITTLE BIT OF SCIENCE:

Nociceptors are the sensory neurons that detect stimuli such as temperature, pressure and stretch that alerts the brain to potential damage. The signal is sent to the dorsal horn in the spinal cord, then onto the thalamus in the brain where it is directed to the somatosensory cortex where the brain decides where the signal is coming from. In response, the amygdala, anterior cingulate cortex and insula are alerted to commence a top-down response to the stimuli (Tracey 2017). Signals are sent back to the spinal cord where an internal opiate neuron is stimulated to release noradrenaline, serotonin and endorphins that act as endogenous opioids, suppressing the signals of pain (Kupers, 2006), acting like a natural pain relief system.

 

Multiple areas in the brain are involved in the processing of pain, including autonomic function, emotional input, memory and cognitive appraisal and motor and sensory processing. In fact, almost every area of the brain is involved in the whole process.

Acute pain causes activation of sensory and limbic areas of the brain. As acute transitions to chronic pain over time (3-6 months), studies have demonstrated a reduction in these areas and an elevation in the medial prefrontal cortex and amygdala. This suggests chronic pain becomes more subjective and personal as it basically moves from one area of the brain to another (Baliki & Apakarian, 2015). This is why Loeser (2006) describes chronic pain as a “disease” where acute pain is a “symptom”.

The difficult part of this is that nociception can occur without the sensation of pain and pain can occur in the absence of nociception (psychosomatic pain). In addition, the areas of the brain that are alerted to physical pain, are also the same areas that are associated with emotional pain such as rejection and heartbreak, demonstrating the diversity and complexity of the process. Brain imaging studies have even shown activation in specific areas of the brain where participants were just watching others in pain, indicating an additional layer of complexity where anticipation and empathy affect pain perception. This is further supported by studies that demonstrated higher activity in this area of the brain for subjects who had higher suggestion of the feeling of pain. Those who were told the pain would be worse, had higher anticipation of pain which was reflected in the increased brain activity (Kupers, 2006). Attention and focus on pain, as well as the anticipation and fear of pain, produces an increased sensation of pain, indicating stress and anxiety are a causal/exacerbating factor.

Still not convinced pain can be affected by suggestion? Then consider the interesting phenomena of postamputation pain. It is extremely pertinent in the understanding of psychosomatic or individualised perceptions of pain. Studies have shown 60-80% of patients who have had a limb amputated will experience pain most frequently in the distal part of the missing limb. Brain imaging reflects genuine pain signals in specific pain areas of the brain. This is not just imagined but actually felt by the individual (Nikolajsen & Brandsborg, 2006). The experience of pain is very REAL, despite the limb no longer being there!

In addition to this phenomenon is the novel research around visualisation of exercise to improve athletic performance and increase muscle strength. One experiment compared two cohorts, where the first performed a certain exercise, while the second merely visualised performing the exercise. The results showed that the physical group increased muscle strength by 30%, while the “visualisers” increased muscle strength by 22%. This demonstrates that the relationship between the brain and muscle that is created in performing a movement, is also created when visualising (Hynes & Turner, 2020). Research is still ongoing as to whether the actual muscle is directly affected or whether it is the neural pathways of the skill that allows for more efficient performance. Regardless, the results are consistently positive in supporting performance visualisation as a complementary measure to improving physical performance.

Likewise, when a particular body part reduces activity or becomes immobile, the associated brain area input will decrease. If the body part is less active, the brain part becomes less active (Hynes & Turner, 2020). Injury or illness may hinder effective physical exercise and potentially reduce neural connections and performance capability.

 

What does this mean for chronic pain sufferers? Visualising exercise is scientifically proven to maintain or improve strength and function of a body part. If you are unable to exercise efficiently due to pain,  visualising could potentially assist in maintaining or even improving your physical strength during periods of rest and recovery.

*I would still recommend forming an injury specific exercise programme with an exercise specialist or physiotherapist, even for visualisation to ensure the appropriate exercises for your injury recovery*.

 

HOW HYPNOSIS CAN HELP WITH PAIN

It is worth noting that the complete removal of pain is not advisable. The aim is to reduce the experience of pain or change the sensation enough to enable a better quality of life for the individual. Hypnosis in the chronic pain setting should be considered only when all medical investigations and interventions have been exhausted. Remember the body feels pain to alert there is a danger. Only when we are positive there is no danger (like an undiagnosed pathology), can hypnosis be considered to assist with pain management.

 

The more time that chronic pain is experienced, the more a person's lifestyle can deteriorate. It is important to commence holistic and supportive therapy (such as hypnosis, as well as appropriate exercise, meditation, good diet etc.) as soon as possible.

Every individual will require a personalised approach to their pain management. Due to research demonstrating the significant impact stress, anxiety and fear have on the experience of pain, this is an important target in the therapeutic process. The brain is not broken. Individuals are not broken. Things can and will change with time and focus.

Psychotherapy and clinical Hypnosis (over a course of sessions) aims to :

  • Change expectations of the pain experience

  • Improve stress management

  • Divert attention and focus from the pain to a more pleasant sensation

  • Predict recovery and manifest wellness

  • Visualise repair and recovery

  • Change physical response (eg. Relax muscles to reduce tension that could increase pain sensation).

  • Develop breathing patterns that reduce stress and relax the body.

  • Address any emotional connection to the pain (eg. Anger or PTSD around the event that caused the injury. Fear of relapse or return of illness/injury. Low mood or depression associated with lifestyle restrictions).  

While there is still much research to be done around hypnosis for chronic pain, the multiple trials that have been conducted have shown hypnosis to be “significantly more effective than a no-treatment condition in reducing pain in chronic pain patient's…. The efficacy (in reducing pain) was consistently confirmed in a wide variety of different chronic pain conditions”, (Elkins, Jensen & Patterson, 2009).

 

Reducing anxiety and fear, creating a positive future projection, finding acceptance of past events and improving overall mood and well being will have a significant positive impact on a persons life. While complete removal of pain is unlikely and often undesirable, creating an active, positive life where you can work and be functional at home while feeling energised and happier for yourself and your loved ones is achievable.

If you would like to discuss how this style of therapy may assist you with chronic pain, you are welcome to book a free, no obligation phone call to answer any questions you may have.  

 

References

Treede, R., (2006). Pain and hyperalgesia: definitions and theories. Handbook of Clinical Neurology, Elsevier: (81):3-10. https://doi.org/10.1016/S0072-9752(06)80005-9

Chronic Pain in Australia, (2020). Australian Institute of Health and Welfare. Cited from www.aihw.gov.au

Tracey, W., (2017). Nociception. Current Biology; 27:123-138. https://doi.org/10.1016/j.cub.2017.01.037

Kupers, R., (2006). Brain imaging of pain: Neurophysiological examinations in neuropathic pain. Handbook of clinical neurology; 81(3): 481-503. https://doi.org/10.1016/S0072-9752(06)80036-9

Baliki, MN., Apakarian, AV., (2015). Nociception, Pain, Negative Moods and Behaviour Selection. Neuron; 87: 474-491. doi: 10.1016/j.neuron.2015.06.005

Loeser, JD., (2006). Pain as a disease. Handbook of clinical neurology; 81(2): 11-20. https://doi.org/10.1016/S0072-9752(06)80006-0

Nikolajsen, L., Brandsborg, B., (2006). Postamputation pain. Handbook of clinical neurology; 81(3):679-686. Doi: 10.1016/S0072-9752(06)80049-7

Elkins, G., Jensen, MP., Patterson, DR., (2007). Hypnotherapy For The Management Of Chronic Pain. Int J Clin Exp Hypn; 55(3):275-287

Hynes, J., & Turner, Z., (2020). Positive Visualisation an Its Effects on Strength Training. Impulse Neuroscience Journal: 1-10

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