The use of hypnoanalgesia (the use of hypnotic suggestion to alleviate pain) can be traced back to the 15th century, although the first clinically detailed literature on hypnosis for pain is attributed to the famous Spanish physician, Santiago Ramón y Cajal. During his time at the University of Valencia (1884-1887), he conducted several hypnotic experiments with both healthy people and those with mental disorders, as well as individuals who claimed to have mental powers (e.g., spiritual mediums). He explored several types of hypnotic phenomena, including analgesia, visual, auditory and tactile hallucinations, cataplexy and amnesia. In addition to effectively treating patients, Cajal utilized hypnosis in his personal life. With the consent of his wife, she was hypnotized when she gave birth to their sixth and seventh children and he published a paper on the entire process.
Hypnosis or hypnotherapy is a set of techniques designed to enhance concentration, minimize distractions and heighten responsiveness to suggestions to alter thoughts, feelings, behavior or physiological states. Since Cajal’s early clinical contributions on hypnoanalgesia, scientific interest has gradually increased on the efficacy of its clinical application compared to other analgesic methodologies. Today, hypnosis is considered one of the most recognized non-pharmacological pain management techniques. Despite its long medical history, mechanisms of hypnotic pain relief are still being debated, with two major discordant theories. The first one focuses on dissociative processes, emphasizing the importance of hypnotic susceptibility and an altered state of consciousness. The second one suggests social and cognitive processes are responsible for hypnosis-induced analgesia, highlighting the significance of contextual variables, compliance with instructions, expectancies, cognitive strategies and role enactment.
The Four Stages of Hypnotherapy
In most cases, hypnotherapy consists of four main stages.
- The first stage involves preparation of the client. In order to obtain maximum benefits, the therapist helps direct the client toward the most realistic goals.
- The second stage involves hypnotic induction, in which the therapist helps the individual enter into a focused and relaxed state.
- The third and most important stage involves therapeutic suggestions. For pain reduction, the therapist helps the client develop imaginary situations (regardless of feasibility) to achieve the goal of less pain. For example, in dissociation, the individual imagines their painful arthritic hand is separate from their body or made of a different material.
- The fourth stage involves post-hypnotic suggestions to help the client retain learned pain reduction methods, followed by termination of the hypnotic state.
A number of research studies have been done on hypnoanalgesia, many of which have been retrospective analyses of past studies.
- A 2000 meta-analysis of 18 published studies showed 75% of clinical and experimental participants with different types of pain obtained substantial pain relief from hypnotic techniques.
- A 2002 cost analysis comparing intravenous conscious sedation to hypnotic sedation during radiology treatment found the cost of hypnotic intervention was twice as inexpensive as that of standard sedation.
- A 2003 review of controlled clinical studies found hypnoanalgesia was associated with significant reductions in ratings of pain, need for analgesics or sedation, nausea, vomiting and length of hospital stay.
- A 2007 review confirmed hypnosis was effective at reducing pain for a wide variety of chronic pain conditions (e.g., cancer, low back pain, arthritis pain, sickle cell disease, temporomandibular pain and disability-related pain), although the authors cited weaknesses including small study size and lack of robust controls.
- A 2008 meta-analysis found an estimated 82% of individuals undergoing medical procedures who received hypnosis exhibited lower levels of emotional distress relative to controls. Emotional distress causes direct suffering, and has been linked to greater levels of pain, analgesic requirements, post-surgery nausea and fatigue and poorer recovery.
Chronic pain is a complex phenomenon, potentially impacted by emotional, cognitive, behavioral and physiological responses. Opioids are highly addictive and dangerous when misused, and they also can cause hyperalgesia, a state in which individuals become more sensitive to certain painful stimuli. I In light of the prescription opioid epidemic, the potential for addiction and a wide array of health problems, hypnosis is a valuable option in the full spectrum of pain management techniques. It should be used as a complementary therapy in context with psychotherapy, meditation, mindfulness, yoga, exercise and other techniques. A multimodal, interdisciplinary treatment approach is needed for many individuals, especially those with chronic pain. If an individual is dependent on opioids for pain management, medically supervised detox is warranted. Clinical experience suggests individuals who are more actively involved in self-hypnosis reap greater benefits and longer-lasting gains.