Hypnosis for chronic pain

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drusso

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We have a relatively strong hypnosis presence in our practice and it is a helpful tool. I use it with some regularity for patients. It is important to understand that it is a tool that works in conjunction with everything else, it is not a stand alone treatment for chronic pain. I also use a lot of hypnotic language with procedures to make them go more smoothly. Again a useful tool to be used in combination with everything else. At this years national hypnosis conference there is specific presentation about the role of hypnosis in the opiate crisis.
 
my experience is also positive. self-hypnosis as taught by pain psychologist. those who are accepting find it a helpful adjunct.



also, I do self-hypnosis all the time myself - when a patient waxes on about how they cant live without vics, how it gives them back their lives...
 
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How and where do you learn it? What kind of patients do you think mostly benefit from it?
 
There is evidence it can be helpful in pain (Integr Cancer Ther 2015 Jan; 14(1):5-15). Self hypnosis training results in significant reduction in chronic low back pain (Eur J Pain 2015 Feb;19(2):271-80). Mechanisms research support the efficacy and positive side effect profile of hypnosis, and that multiple neurophysiological processes are influenced by hypnosis to interrupt pain. There is some evidence in meta-analysis that hypnosis does help significantly with many aspects of post operative pain. Cancer pain treatment is aided by hypnosis. Fibromyalgia in a randomized trial does exhibit some improvement in sleep and global impression of change (Int J Clin Exp Hypn 2013;61(1):111-23). The Cochrane analysis of hypnosis did NOT show effectiveness for smoking cessation (Cochrane Database Syst Rev. 2010 Oct 6;(10). Hypnosis is not covered by some insurances including Aetna despite the positive evidence.
 
I learned hypnosis during a medical school elective. One of the instructors was the doctor who invented StatLock, who is also a skilled hypnotist and really changed my mind about the potential of hypnosis. I'm able to use simple scripts for anxiolysis for procedures. It was useful during anesthesia residency for awake craniotomies. Most pain procedures are shorter than my usual script, but I use some elements to distract patients who are on the anxious side.

I'm not good enough to use hypnosis to produce long-term behavioral change. I think I worked with about 5 or 6 doctors during my hypnosis elective, but other than the StatLock guy, none of the other doctors had the skills to really manipulate human behavior.

The main text that I used during the elective was The Practical Application of Medical and Dental Hypnosis by Milton Erickson. I'm not sure how much one could get out of it without seeing it in action.
 
So going back to question, how do you learn it ? I dont think it reimbursed in any form.
 
You will have nothing but good things to say about it.
You will have nothing but good things to say about it.
You will have nothing but good things to say about it.

You will have nothing but good things to say about it.
You will have nothing but good things to say about it.
You are a chicken. Cluckcluckcluck.
 
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I agree with the start of this one. Tools do not help unless everything else required for it to work is there. The leading proponents of this type of hypnosis are the pain psychologists. However, you need to consult someone who has practiced it so that you can get the desired results.
 
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.
 
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