Just back from the
ASCH conference last weekend. A number of great talks from a group of very intellectually curious people. I am more convinced that the majority of chronic pain patients have improvement in their pain by addressing their mental health issues, and for some they will not feel better unless these are addressed. You cannot inject attachment issues.
Some Highlights:
Clinical hypnosis is the treatment for refractory IBS. 24 studies 12 RTCs showing on average 70% of patients with >50% improvement for 5 years after 7-12 sessions. The lead investigator can no longer get funding from the NIH to look at this because they believe there is enough evidence to support its use and that they should be funding other treatments. The script has been refined over the last 20 years so that even someone without hypnosis training could use it with good effect. It is recommended to be used by those with hypnosis training.
The hypnosis/opioid talk was great too. A lot of discussion on how opioids allow people to dissociate and not connect to their bodies which leads to worsening pain. A path to feeling better is to connect in a positive way and regulate the autonomic nervous system. People need experiences that are positive to leverage neuroplasticity. The hypnosis part is used in many ways, but mostly to enhance self care skills so that the patient can replace the opioids with self-care techniques. The focus here was on people with complex mental health issues, pain, and opioid use.
Not at the conference but to address previous post regarding procedural hypnosis use:
I attended a workshop by Elvira Lange a few years ago. She is a radiologist that developed hypnosis scripts for radiology procedures. Some great results from her studies. She has a book Patient Sedation without Medication that I bought that has the scripts (I have no relationship with her financial or otherwise). I tried using them but our interventional procedures are so quick that it doesn't always make sense to use it. Maybe for some longer procedures it may make sense. I do find that I use a lot hypnotic language while doing the procedure which seems to help not only the patient but the rad techs/staff as well. Some considerations: What you place as expectations for the patient will color their experience. If I tell them that the numbing medicine is going to burn, well they are expecting a burning sensation. How do I know what someone might experience? I don't. So I just say here is the numbing medicine. If I tell them it will sting or feel like a bee sting I am setting them up for that feeling. If they are allergic to bees I have just primed their autonomics to go into high gear. People undertaking procedures are vulnerable. High stress or vulnerable situations make people highly suggestible, and often switches their understanding of language to more literal. I have people focus on their breathing a lot. "You can just focus on your breathing, taking nice, easy breaths. Everything is going well." "Thanks for staying so still for me, you are making this injection go smoothly." If they are tense, with a lot of muscle activation it is not helpful to tell them to relax. If you do the patient starts trying to relax, the trying leads to more muscle activation, and anxiety "Am I relaxing? I'm trying to, what if I can't relax, etc." Instead I ask that they direct their attention to the feeling of the table. "Feel the table supporting you, holding you here while you take nice, natural breaths. Let the table do all the work and you can begin to feel more comfortable, more loose, more heavy...or some variation like that. These are just ideas, but maybe gives some sense of how this might work. The formal hypnosis as in the book can be extremely effective, just maybe not quite as practical for Interventional pain procedures.
Having hypnosis as a tool I think is very valuable, not just for using it in formal sessions, but also in just how interacting with patients can be done in a way that can move them towards healing.