Chronic pain has profound effects upon a person’s quality of life and level of functioning in both personal and work related situations.
People generally do well in tolerating pain for limited periods of time. Knowledge that there soon will be relief from pain allows people to handle painful injuries, illnesses and medical or dental procedures successfully. However, when pain persists for long periods of time and medical care does not provide sufficient relief, the effects of the continuing pain can be intolerable. It can cause severe secondary symptoms, including depression, feelings of hopelessness, sleep and appetite disturbances, irritability, decreased libido and a loss of interest in normal activities. It becomes difficult to think about anything other than the pain, which makes it even worse.
It is at this point that appropriate forms of psychological intervention can help a patient get some relief. The proper application of hypnotherapy or other psychotherapeutic procedures can relieve the secondary symptoms listed above. It can also help by reducing the intensity or frequency of the primary symptom of pain. Allowing patients to get some relief from pain can improve the overall quality of their lives and their ability to function more normally.
Most people are aware that medication for pain relief can work by interrupting the transmission of the pain signal to the brain. Few people realize that a person’s psychological state and certain patterns of mental activity can also block the the sensation of pain. It is a common misconception that pain caused by injury or disease can be relieved only by medication.
When patients are referred by physicians for hypnotherapy or other forms of psychological intervention,
they sometimes misunderstand the purpose of the referral. Some patients think that their doctor is rejecting them, or that he thinks the pain is “not real,” or that it’s “all in their head,” or that he no longer wants to help them.
Quite the opposite is true. A concerned physician who is treating pain is strongly motivated to provide every possible kind of help for the patient. If medical treatment has not provided sufficient relief, a conscientious physician will recommend other treatment modalities that can help the patient. Unfortunately, some patients take such a referral as an insult. This prevents them from accepting help that has the potential of providing significant pain relief. They may even get so angry and insulted that they terminate treatment with their physician.
Because of this kind of negative reaction, some physicians hesitate to recommend psychological intervention for patients who can benefit from such help. Helping the patient recognize that psychological factors have a profound influence upon the level of pain caused by a physical problem is often extremely difficult.
Some patients may understand how this works because they have had personal experience with the effects of psychological factors upon the intensity of their pain. For example, they may have noticed that bright light, noise, stress or efforts to concentrate on a problem makes their pain worse. Some may have heard about the successful use of hypnosis to block pain during dental procedures or childbirth.
My treatment approach for chronic pain involves psychological methods
of reducing the level of the pain to allow people to live a more normal life. One of the methods I use is a form of hypnotherapy addressing the specific symptoms the patient is experiencing. I start with an initial consultation directed at clearly defining the nature, extent and pattern of the pain, identifying stress factors in the patient’s life and identifying relevant motivational factors that can be built upon to provide relief from the symptoms of pain.
I then explain to my patient how hypnotherapy can be used to help them, and what it feels like. It is important to correct some of the common misconceptions and fears that many patients have about hypnosis in order to allow them to maximize the benefits of the hypnotic procedure. I then design a hypnotic procedure to fit the patient’s symptoms, motivation and needs. The hypnotic procedure is done during an office visit, and it is recorded. I then give the patient instructions about how to use the recorded procedure at home. Using the recording of the hypnotic procedure at home provides positive reinforcement, and often allows a patient to get a significant degree of relief from pain after a brief series of office visits. After a number of repetitions of the recorded procedure, I teach my patients psychological coping skills they can use to relieve pain on an ongoing basis in their daily lives.
The fact that they start to establish some power over the pain restores the feeling that they have some control over their own lives. This corrects some of the most damaging effects of chronic pain, such as feelings of helplessness, hopelessness and the feeling that there is no foreseeable relief in sight.
In addition to hypnotherapy, there are other methods of psychological intervention that may be used to provide pain relief, including cognitive therapy and other forms of psychotherapy. I explain and discuss alternative treatment plans with my patient in order to set priorities and to arrive at the best possible approach to helping the patient get relief from his or her pain.