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HYPNOSIS IN PAIN MANAGEMENT
By Karen L. Koeppe, B.F.A., C.Ht.
Ethical practice requires that Hypnotherapists have the technical knowledge to adequately evaluate client needs. The non-physician treating pain patients must be familiar with medical evaluation and treatment alternatives. Pain clients are required to obtain a physical examination, diagnostic studies, and referral prior to hypnotherapy. Particularly with chronic pain clients, multidimensional assessment is required, taking into account the physical-sensory, behavioral, affective, interpersonal-environmental, and cognitive components of the pain experience.
The first step, interview evaluation may include: a description of the pain; history of the pain and whether it is acute or chronic; prior treatments, surgeries and medications and their effects; the impact of the pain problem on relationships, vocation, leisure activities, and sexual activities; and the potential benefits of the pain to the client. Pain is a complex disorder and we must work with extreme care and not neglect the thorough medical or psychological evaluation with pain patients.
Hypnotherapy’s treatment of pain is facilitated by a detailed sensory description of the pain. This provides the therapist with clues to information that may be invaluable if techniques are used for replacement, substitution of sensations, or for hypnotic reinterpretation of the pain experience.
As a second step, it is important to help newly referred pain clients to understand why they have been referred by physicians who determined that conventional medical treatment resources have been exhausted or that they may be open to additional complementary alternatives. In fact, the client may have been told, “There is nothing more I can do for you; you have to learn to live with the pain.” Although it is not meant to be so, this is often a negative suggestion.
I let clients know that I believe they are in pain, that they feel the pain, and that they are not seeing me because they are crazy or imagining things. Then I explain that I am here to help them to change this pain pattern. Pain is a behavior similar to all other types of learned behaviors, some of which are productive and others that are non-productive.
Pain is sometimes a productive behavior when it protects us. Alternatively, when it is reinforced and perpetuated by negative emotion such as anxiety and fear it becomes self-perpetuating. Pain can produce negative emotions. These negative emotions then produce tension, and tension produces more pain. As a result of the subconscious mind’s established program of pain, the memory of pain adds to the perceived pain.
Thirdly, Hypnosis is not about the Hypnotherapist exerting power over their clients: rather it’s about people taking control of their own minds and bodies. We introduce the role of ego-strengthening as part of our hypnotic work with chronic pain clients, who sometimes develop feelings of low self-esteem and self-worth, and may be responsive to hypnotic suggestions. Another tool, self-hypnosis, provides such clients with an active self-management strategy that can return some sense of control and mastery to their lives.
Most importantly, as Hypnotherapists working with pain, we must assume a realistic posture concerning the role of hypnosis. Hypnosis is similar to any other medical or psychological technique; some clients may obtain tremendous pain relief and others may find it clearly helpful but are in need of still other methods of relief. In other words, some clients find that it reduces the affective components of pain, allowing the sensory pain more to become more tolerable.
When it comes to the treatment of pain, the Hypnotherapist should not work in a vacuum. Along with ethical values, a multidisciplinary team is ideal, and interdisciplinary cooperation is imperative. Complete communication, disclosure with the pain client, and interdisciplinary cooperation will yield the best possible results in the strategy for pain management.
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