Hypnosis and Pain Control

There is nearly 200 years of scientific study of hypnosis and pain control. Hypnosis has a fantastic track record with pain control across a startling array of health conditions. Although sometimes thought of as a method of  alternative pain relief, hypnosis can be the primary and exclusive method in many cases to great success.

Pain is a multi-dimensional phenomena. To understand hypnosis and pain control, and why hypnosis is such an effective intervention, we must talk about how pain happens.

Pain sometimes (but not always) starts with stimulation of nociceptors. Nociceptors are specialized neurons in the peripheral nervous system that encode and transmit ‘noxious stimuli’ to the brain. The activation of nociceptors does not necessarily result in pain, but the brain often does respond to interpret nociceptor activation with the perception of pain. There are several different types of nociceptors in the body.

Mechanical nociceptors send pain signals up to the brain when they are stretched, squashed, or when the skin is cut.

Silent nociceptors signal pain when an inflammation response occurs in damaged tissue.  This is particularly relevant to hypnosis and pain control because hypnosis is an excellent tool to reduce inflammation and swelling.

Temperature or thermal nociceptors are activated when certain thresholds of temperature (both hot and cold) are reached.

Another type which may come as a surprise is chemical nociceptors. These are custom made to activate upon exposure to certain chemicals. The most common of these chemicals is capsaicin. Capsaicin is the chemical which makes food spicy. To some this is pleasure, and others pain. This is both a process of interpretation as well as that of endorphin release (which is released both into the blood stream as well as in the brain).

The pain signals travel from the peripheral nervous system into the spinal cord and up to the brain. Two main regions in the brain are involved in the perception of pain. The somatosensory cortex and the anterior cingulate cortex. The somatosensory cortex receives physical sensation nerve impulses from the entire body. It registers the texture, temperature, pressure and vibration. It also registers impulses from the pain nerves (nociceptors). The second area, the anterior cingulate cortex, also receives pain input. The anterior cingulate cortex is a key in the perception of pain. The ACC can be thought of as being in charge of the emotional-perceptual experience of pain. The somatosensory cortex is what tells us ‘yes, I feel the needle go through the skin’, while the anterior cingulate cortex is the part that goes ‘That hurts!!’ (Rainville, Duncan, Price, Carrier, & Bushnell, 1997). This area is key in the affective / emotional experience of pain.  When we experience emotional pain (anguish), the anterior cingulate cortex is at work (while the somatosensory cortex is not). This is an important key in hypnosis and pain control because hypnosis is well documented in its ability to inhibit and change the way the anterior cingulate cortex works.

Now that we have laid out the way pain happens, we can talk about hypnosis and pain control. In particular, we can talk about the ways and levels that hypnosis can stop pain.

First, hypnosis can control pain by stimulating the release of endorphins. Endorphins work both as a neurotransmitter in brain blocking perception of pain, and also by working at the site of discomfort in the body by release into the bloodstream (OLNESS, WAIN, & NG, 1980). Although hypnosis and pain control can be achieved through the release of of endorphins, that is not its only method of pain control. Researchers found that hypnosis could be used for pain control even when the chemical endorphin antagonist (blocker) naloxone was administered (Spiegel & Albert, 1983). This is really quite a phenomenal point, so take a moment to think about it… hypnosis provides endorphins on command!

A second way hypnosis and pain control work is by reducing inflammation and irritation to an area. If you’ll recall, one type of nerve cell sends pain signals to the brain when the surrounding tissue behaves as though it is damaged. The main mechanism here is inflammation. Hypnosis can dramatically reduce inflammation symptoms (Laidlaw, Booth, & Large, 1996; Zachariae & Bjerring, 1990), thus eliminating the additional pain created by the inflammation.

A third way hypnosis and pain control work is via relaxation of the muscle tissues (Edmonston, 1981). This is especially important in refractory or chronic pain therapy (Elkins, Jensen, & Patterson, 2007). Muscle tightness reduces the flow of nutrients, oxygen and medication to an injured area. Tightness of the muscles also creates hypersensitivity in the nerves, making pain control more difficult. As the muscle gets tighter, it becomes easier to feel pain, and more difficult to control pain. Hypnosis can directly influence spastic and tight muscles (Chappell, 1964; Vickers, 1999). As the muscles relax, the mind automatically perceives less pain (Lang, Joyce, Spiegel, Hamilton, & Lee, 1996), and the body is better able to heal and correct any biomechanical dysfunction.

A fourth way hypnosis and pain control work is via moderation of particular areas of the brain. Remember, the two areas most important to pain perception in the brain are the somatosensory cortex and the anterior cingulate cortex. Hypnosis can effect pain control by modulating the response of the somatosensory cortex to painful or noxious stimuli (Spiegel, Bierre, & Rootenberg, 1989).  Hypnosis can control pain by altering the anterior cingulate response to pain signals as well (Faymonville et al., 2000; Ploghaus, Becerra, Borras, & Borsook, 2003). Interestingly, hypnosis can do one, the other, or both, depending on how it is applied to control pain (dissociation, analgesia, anesthesia, pleasure substitution etc).

Amazingly, hypnosis is able to intervene at any point in the cycle of physical, electrical (nerve), and perceptual/interpretive (brain) interactions that result in the experience of pain. Hypnosis is also highly effective for reducing anxiety, another key point in pain control when it is chronic pain. This powerful flexibility not only makes hypnosis and pain control a natural match, it also means that healing will be sped up or opened up as a possibility even in someone with a longstanding, debilitating illness. While medical treatment should always be sought for pain, hypnosis is a powerful method of pain control that can be used in nearly any injury or illness.

References

Chappell, D. T. (1964, July). Hypnosis and Spasticity in Paraplegia. The American journal of clinical hypnosis.

Edmonston, W. E. (1981). Hypnosis and relaxation: Modern verification of an old equation. Wiley.

Elkins, G., Jensen, M. P., & Patterson, D. R. (2007). Hypnotherapy for the management of chronic pain. The International journal of clinical and experimental hypnosis, 55(3), 275.

Faymonville, M. E., Laureys, S., Degueldre, C., DelFiore, G., Luxen, A., Franck, G., et al. (2000). Neural mechanisms of antinociceptive effects of hypnosis. Anesthesiology, 92(5), 1257.

Laidlaw, T. M., Booth, R. J., & Large, R. G. (1996). Reduction in skin reactions to histamine after a hypnotic procedure. Psychosomatic medicine, 58(3), 242. Am Psychosomatic Soc.

Lang, E. V., Joyce, J. S., Spiegel, D., Hamilton, D., & Lee, K. K. (1996). Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. The International journal of clinical and experimental hypnosis, 44(2), 106-19.

OLNESS, K., WAIN, H. J., & NG, L. (1980). A pilot study of blood endorphin levels in children using self-hypnosis to control pain. Journal of Developmental & Behavioral Pediatrics, 1(4), 187.

Ploghaus, A., Becerra, L., Borras, C., & Borsook, D. (2003). Neural circuitry underlying pain modulation: expectation, hypnosis, placebo. Trends in Cognitive Sciences, 7(5), 197-200.

Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, M. C. (1997). Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science (New York, N.Y.), 277(5328), 968-71.

Spiegel, D., & Albert, L. H. (1983). Naloxone fails to reverse hypnotic alleviation of chronic pain. Psychopharmacology, 81(2), 140–143. Springer.

Spiegel, D., Bierre, P., & Rootenberg, J. (1989, June). Hypnotic alteration of somatosensory perception. The American journal of psychiatry.

Vickers, A. (1999). Hypnosis and relaxation therapies. BMJ, 33(11), 923-926. doi: 10.1016/j.drugalcdep.2011.05.036.

Zachariae, R., & Bjerring, P. (1990). The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test. Archives of dermatological research, 282(8), 539–543. Springer.

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