Approaches of hypnotic pain relief

Keys – always in the last place you look.

There are 10 broad approaches I can think of that are useful for hypnotic pain relief. Each of the things listed will just be a general approach. For any given approach, there are many techniques to accomplish the desired effect.

This list is meant to pique interest in hypnosis as a clinical tool as well as illustrate that their are many ways to accomplish your goals. If one approach doesn’t work for you, there are several other avenues a clinician can go down with you. People tend to naturally respond to certain hypnotic phenomenon better than other ones. Someone may not respond to dissociation suggestions but can achieve anesthesia easily. In the end, the same result is accomplished – pain relief.

Below I’ve listed the 10 broad approaches as well as some general information on them and common usages.

  1. Analgesia. This is the classic and most straightforward approach. Analgesia is changing your body’s sensory processing so that you don’t feel the sensation of pain. However, you are still able to feel other sensations such as pressure and temperature.
  2. Anesthesia. This is taking analgesia a step further. The body’s sensory processing is altered so that you don’t feel anything at all. In other words, it’s inducing numbness. This is the effect most commonly used for preparing people for surgery. The difference between hypnotic analgesia and anesthesia is mostly just a matter of scale. Here are 4 common ways of producing this effect. Direct suggestion – once trance is induced, you can directly suggest that their hand/body part will go numb. Chemical anesthesia – you can have them visualize receiving a chemical anesthesia such as gas or a numbing cream. Cold anesthesia – you can have them visualize dipping their hand/body into an ice cold river/body of water and feeling it go numb from the cold. Nerve conduction anesthesia – you can have them visualize a circuit metaphor where the circuits are their nerves and they can control the switches to the nerves. By ‘turning off’ the switch to the back (for example), the nerve would no longer carry the signal from that area, resulting in numbness.
  3. Sensory shift. This is similar to analgesia/anesthesia, but instead of taking away a sensation, it relies on just altering the sensation. A specific example is in hypnobirthing classes (hypnosis to help with childbirth) the suggestion is often given that contractions will be perceived as ‘baby hugs’ and every contraction brings you closer and closer to getting to see your baby for the first time. This alteration helps change contractions towards being a positive sensation. A more general usage of this approach is to help someone change the focus of the pain sensation. Most people can describe their pain in a particular way using pain descriptors – burning pain, squeezing pain. With a sensory shift, you suggest they notice the pain by focusing on the descriptor, but then you add an adjective. So if the descriptor is burning, you could draw their attention to notice that it’s a quick burning. If they don’t agree with that adjective (quick in this case), you can just keep trying other ones until they agree. You then shift their attention towards focusing on the adjective (the quickness). Ultimately this changes their pain experience (which is almost always helpful) and often changes it to something much less distressing, here going from a burning pain to a ‘quick’ feeling.
  4. Alter sensitivity. If you twisted your ankle, it would hurt. If you twisted it while a car was coming at you, it wouldn’t. This is because, at that moment, the signals coming from the ankle would be relatively unimportant compared to the car. The brain would filter out these ankle sensations to prevent them from grabbing your attention. Imagine if it didn’t – your attention would be focused on the ankle and you’d likely get run over. The brain can learn to filter some sensations out by altering the nerves’ sensitivity to that information. Often the nerves of a certain region have become hypersensitive. Hypnosis can be used to return that area back to a normal level. Technically, this is probably a very similar, if not identical, application as analgesia or even anesthesia, if all sensation is filtered out. I make it a separate approach for 2 reasons. First, this is used to return hypersensitive regions to normal sensitivity, while analgesia/anesthesia both remove sensation. Second, altering sensitivity can actually be used in the opposite direction. Some people expect sensitivity with an experience, so the idea of numbness is inconceivable. An example is going to the dentist or getting an operation. For some people, it’s too much to believe that they can just have that done without any pain and so they can’t accomplish hypnotic anesthesia. In these cases, you can suggest hypersensitivity of a different region and tell them they will need to protect that area. Dr. Erickson did this with someone who was getting dental work done. He induced hypersensitivity of one of the man’s hands and the man was so focused on protecting his hand from being touched that he developed a spontaneous anesthesia of the mouth (which he previously hadn’t been able to do).
  5. Dissociation. This is the feeling of being out of your body. You can be dissociated from your entire body – feeling like you’re in two places at once or you are outside of your body. You can also be dissociated from a part of your body – like you can see your arm, but it doesn’t feel like it’s part of you. This is a very useful approach, especially for anyone who participates in guided visualizations very well. When you get involved in a visualization, say a relaxing trip to the beach, you are automatically dissociated because you can feel yourself at the beach but you’re also aware that you’re in the room in trance. Many hypnosis techniques that are used suggest some form of dissociation, often floating out of your body. This adds the comfortable feeling of floating as well as dissociation.
  6. Association. While this sounds like the opposite of dissociation, it is actually closely related because you cannot have one without the other. Association is becoming completely immersed in a separate experience. You can become so immersed that you don’t notice what’s happening to your body. An everyday example is being so absorbed in a movie you forget the headache you had. In hypnosis, this can be doing a guided visualization and they become so immersed that they feel like they are actually there. This would be the association effect, while the dissociation effect is feeling like they are there but also feeling like they are in the room with you. If someone associates into a pleasant visualization, like relaxing on the beach, then they won’t have pain. You can also give suggestions to associate into a feeling, like the feeling of comfort or relaxation.
  7. Time distortion. How fast or slow time feels is subjective. If you’re having a great time, 2 hours can feel like 10 minutes. Sometimes you might feel like you just went to sleep, only for your alarm to wake you up 6 hours later. This effect can be recreated with hypnosis. It is used for people who have waves of pain (often due to a severe illness like cancer or a neurological disease). The unpredictability of the waves of pain makes it very hard to use medication and often medication won’t help that much without very high doses. Hypnosis is used in these cases to distort the person’s sense of time so that the hour of pain they actually have only feels like a few seconds/minutes of pain. Some people are also strong responders to hypnotic amnesia which can be paired with time distortion so that they don’t remember their wave of pain. This can considerably reduce their suffering. From the outside it would appear that their pain begins and they go into trance for the duration of the wave. From their perspective, they just briefly zone out (go into trance) and then go on with their day like nothing happened (even though in real time an hour might have passed).
  8. Ideomotor effects. This is the name for hypnotic suggestions that affect the muscles. A general application of this is deep relaxation. Many hypnotic inductions and routines contain suggestions for relaxation. Deep relaxation can help pain in a general way, but you can also associate into the relaxed state so that you only notice the relaxation and not the pain. In deep hypnosis, some call this the Esdaile state – a state of hypnosis that people have been able to perform surgery in without chemical anesthesia. A more specific application is called catalepsy which refers to being unable to consciously move. An example would be suggesting that someone’s arm can’t move, even if they try to lift it. If a person responds to these types of motor suggestions, you can suggest they ‘lose’ their arm, meaning they can’t feel it or even be aware of it. This often is accompanied by spontaneous anesthesia since they have ‘lost’ all awareness or connection to that body part.
  9. Behavior modification. Hypnosis is probably most often used to make changes to behavior automatic and pain management is a great place for this. There are certain behaviors that can be helpful (like exercise) and some that can be harmful (like lifting with your back). Hypnosis can help people change their behaviors much more easily and this can help significantly reduce pain, or even eliminate it completely depending on the cause.
  10. Healing. Probably pretty much any hypnotist you talk to has had both professional and personal experiences with using hypnosis for healing. The most scientific explanation I can give you is that hypnosis has been demonstrated to affect blood flow to certain areas and this may help the healing process. In any case, it’s never harmful to give suggestions for healing. While healing isn’t directly a pain control technique, it is indirectly (in that, once an  a healed area won’t hurt in the future). Also, adding suggestions of healing tends to have a natural pain control effect even without suggestions for pain control because of the natural association between healing and pain going away.

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