The control of blood, saliva flow and pain management using hypnosis
The mouth presents many challenges to dentists. Many holistic factors affect both their and the patient’s experience of surgery. Specifically, in the local of the mouth, you are often faced with blood, saliva and the sometimes occasional, sometimes frequent movements of the patient as they anticipate pain. As I have discussed before, with the use of reciprocal inhibition suggestion in hypnotherapy, replacing the anxiety in situations with a level of relaxation in the same situation, an additional benefit can be derived. In this instance, if your patient is experiencing a state of trance, the localised slowing of blood and saliva flow, as well as analgesia, can be achieved.
Pain Sensation and Management
Are you wearing shoes? I am pretty certain that if you are, in a moment, your attention and awareness is drawn to the feeling of the shoes/boots/trainers/clogs wrapped around your feet. For the most part, you can walk down the street with shoes on your feet and not even feel the friction of movement as your attention is elsewhere. Walk around the room, bar, surgery and become aware of your paper-thin skin rubbing against your socks and the friction increasing the temperature in your shoes. Perhaps you can feel the pressure on the joints in your metatarsals, your ankle twisting to compensate and keep you balanced. Now, if you have, for example, a torn toenail or mild sporting injury you will start to feel the inconvenience increase, you will become aware of the pain even whilst sitting down. Add to this a mild to medium level of anxiety or stress and see how you get on.
Hypnosis offers a therapeutic approach to counter the above suggestion of increasing pain. I am demonstrating to you how conscious awareness to a part of your body increases your perception of ‘feeling’. Pain, no matter it being of organic or psychogenic source is still a subjective experience. There are several theories of pain and pain reduction. The gate control theory states that the experience of pain can be increased or decreased according to the person’s needs. In other words, we have our own pain control system that we can turn up or down. This may be a partial explanation of why acupuncture works and why women in some cultures do not experience pain during labour. The second theory is ‘the concept of the hidden observer’. This discovery was made by Ernest and Josephine Hilgard and is generally accepted as a valid explanation not so much for a lowering of pain threshold but of the subject’s failure to report suffering from pain under hypnosis. In other words, the pain is registered but ignored. Hilgards experiments involving laboratory-induced pain either with ice-cold water or tourniquet identified under hypnosis a subject’s ability to feel normal pain in one area but no pain at all in the hypnotised part. The hidden observer is a metaphor for the part of the subject that feels the covert pain even when the subject experiences little distress. In other words, direct suggestion under hypnosis does not take the pain away but it does change the subjective experience. As with sensing the shoes on your feet this splitting of consciousness, known as dissociation, is an act of distraction with the exception that surgical analgesia does require a deep level of trance. My experience is that the patient needs 2 sessions with the hypnotherapist, 1 week apart and daily practice to ensure the deepest level of trance. Dissociation, in this case, is the subject being aware on one level but becomes an ‘observer’ of themselves on another without feeling the subjective pain. This approach is useful in combination with needle phobic patients as well as general pre-surgery relaxation techniques.
There are several hypnotic techniques to achieve analgesia all of which have none of the toxic side effects that chemical anaesthetics can have and the patient’s level of response to the surgery stay the same, EG the cough reflex. Suggestions of spitting out or washing out their mouth will be safely acted upon and levels of postoperative pain or discomfort are relieved as post-hypnotic suggestion will increase the time limit of localised analgesia. As the patient has experienced hypnosis at least 3 times prior to surgery a deep trance can easily be achieved. Analgesia is induced in first the fingertips and then into the whole hand. The patient transfers this to the area to be treated by placing their hand there. To keep the trance as deep as possible the hypnotherapist can communicate with the patient through the use of ideomotor responses such as the lifting of the index finger on the hand non hypnotised hand when analgesia is achieved. This can be ratified by simply pinching the hand and asking for an IMR response from the patient if they feel pain. Permission to touch the patient must always be given prior to induction.
Controlling blood and saliva flow during surgery
In trance, the hypnotherapist can influence the organs of the body through suggestion. I discussed before the unconscious mind controls many of the body’s functions including the thalamus, autonomic nervous system, circulatory and respiratory, alimentary and excretory, and endocrine systems. There is a definitive link between emotions and organ activity, such as Adrenalin increasing a subject’s heart rate as a result of anxiety or fear. Direct suggestion in hypnosis can have the same effect especially if linked with the subject’s emotions. The autonomic nervous system can be controlled to a certain degree and as a subject’s degree of suggestibility increases in trance, organ activity can be increased or decreased. As well as heart rate, Lloyd Huckey observed that the smaller arteries and capillaries invariably contracted in hypnosis. He found that even in deep wounds had little or no haemorrhage. David Waxman writes that many dentists have reported a definite decrease in bleeding following extraction of teeth under deep hypnosis. He also writes that subsequent investigations confirm that suggestion can have a certain amount of influence over the blood vessels. (Hartland's Medical and Dental Hypnosis, 3rd Edition, David Waxman). In the same way, a patient’s salivation can be controlled during surgery. With the use of direct suggestion in a deep trance that the patient’s saliva will dry up has the effect of decreasing the flow of saliva during surgery. The hypnotherapist will link the flow of saliva to being controlled by a ‘tap’ and by turning the tap off, the flow is slowed. It is vital that upon awakening the ‘tap’ is turned back on.
Through hypnosis, the sensation of pain can be managed prior to, during and post surgery. Anaesthesia is rarely achieved with hypnosis and in clinical terms, it is unlikely to be of relevance for routine practice. However, hypnosis can be used in the preparation of the patient for local and general anaesthesia and it has been noted that the quantity of local anaesthetic for surgery is greatly reduced.
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