Hypnosis For Pain Management

Moss D, Willmarth E. Hypnosis, anesthesia, pain management, and preparation for medical procedures. Ann Palliat

Abstract: Hypnosis has a long history of use for anesthesia and pain management, as well as in assisting patient to prepare for medical procedures. This article reviews the history of hypnosis applications in clinical medicine and dentistry. Research on hypnotic susceptibility or hypnotic ability shows that the ability to respond effectively to hypnosis is a relatively stable trait, partially heritable, and measurable by means of several standard procedures. Persons low in hypnotic ability may benefit from alternative therapeutic interventions; however, the majority of medical patients will benefit from the integration of adjunctive hypnotic therapies into their medical and dental care. The article closes with a discussion of the stronger evidence-based applications of hypnosis in healthcare, and the need for well-trained certified hypnosis practitioners.

History

Hypnosis has long had a role in anesthesiology and pain management. James Esdaile, a Scottish surgeon, utilized hypnosis (then known as “Mesmerism”) in hospitals in India, and performed 261 painless surgeries using hypnosis, described in his book, Mesmerism in India, and its Practical Application in Surgery and Medicine (1). The introduction of chloroform and ether into medical practice in India in 1848 reduced the impact of Esdaile’s discoveries. Nevertheless, hypnosis continued to be used as sole anesthetic and in combination with ether and chloroform. In 1906, Magaw reported on 14,000 surgeries completed at the Mayo Clinic, utilizing a combination of hypnosis and chemical anesthesia (2).

Since the time of Esdaile, hypnosis has been applied widely for pain relief and to facilitate patient cooperation in medical procedures.

Hypnosis in obstetrics

Ralph August applied clinical hypnosis to facilitate delivery of 295 babies, in a clinical series from 1957 to 1958. In 94% of the cases, hypnosis was the sole form of anesthesia. In the remaining 6% of cases, hypnotic anesthesia was not adequate, and was supplemented with local or general anesthesia. August reported on his methods and the results, emphasizing the decreased anesthetic hazard to mother and infant, and the enhanced rapport between patient and physician (3,4). More recently, Werner et al. (5,6) conducted a randomized controlled trial (RCT) with 1,222 first time mothers, and those women in the group receiving brief self-hypnosis training reported a better experience of childbirth. There were no differences across groups in duration of labor, but the women in the hypnosis required fewer emergency C-sections.

Hypnosis in dentistry

The first documented application of hypnosis in dentistry was a dental extraction under hypnotic anesthesia, reported in 1829 (7). By 1900, hypnosis was commonly used by dentists for managing dental patients’ fears and pain. Today, hypnosis is widely used by dentists to effectively moderate fears of dental procedures, excessive gag reflex, treatment of orofacial pain conditions, moderating bleeding and salivary flow, and managing procedural pain (8,9). Hypnotic strategies such as distraction, re-framing, and imagery are also useful in managing pediatric patients (10).

Hypnosis for acute pain

In 2010, The American Psychological Association published Clinical Hypnosis for Pain Control by David Patterson (11). In this book Patterson presented a table of 21 controlled hypnosis studies (18 randomized) with acute pain disorders. These studies included the treatment of burn wounds and debridement pain, bone marrow aspiration pain, labor pain, pain following chemotherapy for cancer, pain during angioplasty, pain during plastic surgery, pain related to large core needle biopsies of the breast and multiple other surgical pain situations. The outcome of these studies showed that in all cases hypnosis was at least equal to the existing standard of care and in the majority of studies hypnosis proved more beneficial than the standard of care or other treatment controls which included attention control, relaxation, emotional support, medication (Lorazepam), cognitive behavioral therapy (CBT), deep breathing and non-directed play (for children).

Kendrick et al. (12) completed a similar review of RCTs related to surgical procedural pain. Their results were consistent with the Patterson findings. The authors observed that: “Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies” (p. 75).

While the use of hypnosis or trance-like states for pain relief has been documented for hundreds of years (13), the modern era of hypnosis for pain management was energized by a statement from the NIH Consensus Development Program (14) that “The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong” and by books such as Hypnosis in the Relief of Pain by Ernest Hilgard and Josephine Hilgard (15) and Hypnosis and Suggestion in the Treatment of Pain by Joseph Barber (16). More recently this focus has been maintained by Mark Jensen’s Hypnosis for Chronic Pain Management (17).

Hypnosis for chronic pain

Similar to his table related to acute pain, Patterson (11) presented a table related to chronic pain that included 14 controlled studies of hypnosis (12 randomized), in chronic conditions including fibromyalgia, headaches, cancer-related pain, back pain, and irritable bowel syndrome (IBS)-related pain. Again, all studies found that hypnosis was equal to or better than standard care treatments which included group support, biofeedback, medication, relaxation, Autogenic training, attention control and CBT. In a video interview (18), Michael Yapko pointed out that the salient question isn’t whether hypnosis is better than other treatments, but rather whether the addition of hypnosis to existing treatment enhanced the treatment effects. In his understanding of the literature, “the answer is clearly yes!” This approach is described by Willmarth, Davis, and Fitzgerald (19) who for over 30 years have combined traditional medical interventions offered by anesthesiologists with the treatment of physical therapists, social workers, and psychologists who offer group therapy, hypnosis, biofeedback, and individual psychotherapy for patients suffering from chronic pain conditions.

Hypnosis for pre-surgical preparation

The use of hypnosis for anesthesia during surgery has already been mentioned. Hypnosis has proven to be one of the most powerful tools in enhancing surgical recovery. Montgomery et al. (20) reviewed the evidence on hypnosis as an adjunctive approach for surgery patients: “Patients receive standard surgical and anesthesia care according to protocol but with hypnosis added to the treatment package” (p. 1,639). Montgomery et al. reviewed 20 well-controlled research studies, using meta-analytic techniques, and concluded that hypnosis is an effective adjunctive treatment for patients undergoing surgery.

The meta-analysis showed a broad beneficial impact of hypnosis with surgical patients, across outcome categories. Subjective measures such as anxiety and pain, objective measures such as analgesia use, physiological measures, recovery time, and treatment time, all showed comparable beneficial outcomes for patients in the groups receiving hypnosis. The patients in the hypnosis groups showed better medical and psychological outcomes than 89% of the patients who did not receive hypnosis. Later research by Montgomery et al. (21) showed that not only could hypnosis reduce patients suffering, enhance healing, and optimize recovery time, but that the savings to the hospital were substantial, mainly in reduced time in surgery.

APM Annals of Palliative Medicine Vol 8,No 4 September 2019

Hypnosis, anesthesia, pain management, and preparation for medical procedures

Donald Moss, Eric Willmarth