The role of hypnotherapy in chronic pain management
Acute pain is usually characterised by its sudden onset and short duration. Chronic pain persists for several months, years, or in some cases, pain that can last a lifetime. It is a complex, debilitating and life-changing condition.
Estimates vary, but it is thought that the number of chronic pain sufferers in the UK runs into the millions, at great cost to the economy in terms of days lost at work, increased reliance on state benefits, and the substantial financial burden on the NHS. However, the personal toll on the individual chronic pain sufferer is even more difficult to quantify. Depression, lack of self-worth, lack of confidence, a breakdown in relationships, a sense of hopelessness and increasing social isolation may lead to many chronic pain sufferers turning to complementary practitioners in a bid to ease their pain.
Conventional medical treatments for chronic pain are often protracted and multi-disciplinary and may include powerful medication, physiotherapy, surgery and talking therapies. For some chronic pain sufferers, a combination of mainstream medical treatments may result in an alleviation of their pain, but what alternatives are there for those for whom nothing else seems to work? Is hypnotherapy of use in the management of chronic pain?
It is essential that anyone considering consulting a hypnotherapist for support in managing their chronic pain condition should already have a formal diagnosis from a qualified medical practitioner. Pain is the body’s signal that something is wrong, and the causes of chronic pain should be thoroughly investigated before a hypnotherapist is consulted.
The hypnotherapist may ask the chronic pain client to rate their pain on a Pain Scale so that their experience of pain can be recorded from one therapy session to the next, to measure progress. Pain Scales are invaluable because the experience of pain is very subjective. The way the brain perceives and interprets pain signals may vary from person to person so that what might be unbearable for one client might be tolerable in another.
Clients can be taught self-hypnosis techniques as part of the hypnotherapy sessions so that they can practise at home, often with the support of a personalised CD. Hypnotherapy techniques used in pain management hypnotherapy sessions often include some form of progressive relaxation induction, distraction techniques, the use of visualisations of the pain itself, together with post-hypnotic suggestions and cues for increased control over the chronic pain, and a focus on recovery and wellness.
The progressive relaxation induction technique, in itself, may be of benefit to the chronic pain client as many clients describe their pain as being worse when they are stressed and their muscles are tensed up. Also, many chronic pain clients find the progressive relaxation technique easy to learn, so can leave the hypnotherapy session feeling that they already have a tool to help them manage their pain. This is an essential part of pain management and hypnotherapy. Clients need to feel that they will be able to learn to manage their pain outside of the hypnotherapy session and this is more likely to be achievable the more the client practises self-hypnosis techniques at home.
It is also important for the client to be given time to describe their experience of pain in detail, including what makes the pain better or worse, the duration of the symptoms and what words most describe the sensation of pain; stabbing, aching, burning, pins and needles etc. The very act of a hypnotherapist taking time to listen to the chronic pain client may be therapeutic in itself, but it is also invaluable for the therapist in planning the hypnotherapy sessions and using appropriate visualisations and language.
To use a simplistic example, a chronic pain client who describes their pain as a hot, burning pain may respond better to visualisations involving cool, soothing imagery and colours usually associated with coolness; blue, turquoise, silver, white etc., whereas a client describing their pain as a dull, continuous ache might relate better to warming imagery and associated colours; red, yellow, orange, gold etc.
Hypnotherapy has several tools in its armoury to support chronic pain clients and what one client finds useful may not necessarily work for another. It may be useful for the hypnotherapist to test the client’s ability to visualise images prior to commencing hypnosis. This is because not everybody interprets the world around them in the same way. Some clients, for example, may find that representing their pain in their minds as a sound that can be made louder or softer, rather than an image that can be made larger or smaller, is a more effective route to managing chronic pain.
The point is that there is no one-size-fits-all approach to the use of hypnotherapy for pain management. The chronic pain client is also likely to benefit from a holistic approach to their condition. The interrelated issues of anxiety, sleep disturbance, lack of confidence and low self-esteem are all conditions that can affect chronic pain clients and these issues should be addressed as part of the hypnotherapy sessions in an attempt to improve quality of life and well-being.
The effectiveness of hypnotherapy in supporting clients with managing their pain is likely to be influenced by the expectations and motivation of individual clients. Whilst some chronic pain clients might consider any perceived reduction in their pain as a ‘success’, others might consider anything less than the permanent, complete relief of their pain as a ‘failure.’ Therefore it is important that the hypnotherapist discusses possible outcomes (and factors that might influence outcomes) with the client before embarking upon hypnotherapy sessions, in order that goals are realistic and achievable.
It is hoped that eventually, medical science will be able to find a cure for all chronic pain, but in the meantime, there is a role for hypnotherapy in supporting chronic pain sufferers to manage their distressing and debilitating condition. As clinical trials both in the UK and abroad look at quantifying the efficacy of hypnotherapy in supporting clients in managing their chronic pain, the role of hypnotherapy may change.
Perhaps in the future hypnotherapy will be regarded as a front line treatment, rather than as a last resort for those with the most life-changing and previously intractable pain conditions.