Pain is a signal
Pain is experienced for a purpose.
It is usually a signal or message saying, “please look after me”. Pain is a way of
reminding the client to take care of a particular part of the body. Even
psychosomatic pain is a message.
Pain Removal or Re-interpretation
In most cases the Therapist should not attempt to remove pain entirely.
Instead he should change the way it is perceived by the client, and hypnosis is one of the best ways of doing this.
Clients can be taught to re-interpret their pain as a different sensation and to develop an attitude of not being bothered about the discomfort rather than developing total anaesthesia for what is an important signaling system.
The
only time
when it might be appropriate to remove pain altogether is
when the client is receiving surgery or has a terminal illness, or similar
circumstances.
Pain is a
psycho-physiological experience
Clients experience pain mentally and physically and hypnosis can be applied to bring about both psychological and physiological changes. Clients perceive their pain according to how it is classified, so a client's perception of acute pain will most likely be different from their perception of chronic pain and this will influence their expectations regarding recovery.
The
client’s perception of pain can also be
influenced by time
and context; they will have
remembered pain, present pain and anticipated
pain. The Therapist
can change this perception with amnesia, dissociation and other hypnotic phenomena that can separate the experience of pain perceived as
memory, actual experience or expected pain.
Definitions of Pain – Acute and Chronic Pain
A client experiences acute pain through injury or surgery. Acute pain has a beginning, middle and an end. The client can see an end to the pain after the healing process has occurred.
Chronic
pain is different because it is an ongoing experience. Chronic pain is the term
used for pain experienced in illnesses
of an organic nature such as terminal illness.
Clients
experience the remembered pain of yesterday,
the actual pain of today and
the anticipated pain of tomorrow as
part of their psychological perception of chronic pain. The therapist
needs to identify whether the client has chronic or acute an appropriate treatment approach.
Referred Pain
Sometimes clients experience a pain in one part of the body from a cause in another part of the body, this is known as referred pain.
It is important for therapists to identify the source of referred pain and find out the cause before attempting to alter the client’s perception of the pain. When the Therapist is not medically qualified to make a diagnosis he should always refer the client to a doctor before proceeding.
Psychosomatic Pain
When
no obvious physiological cause can be identified the therapist (or doctor)
should also test to see if the pain is
psychosomatic. With psychosomatic pain there is no
physiological cause for the pain although the pain is felt in a
real way.
Most clients who request psychotherapy for pain have already been diagnosed as psychosomatic by their doctor. In some cases the client has been told that the pain is “all in their mind”. You must be sympathetic because the client does experience real hurt even though the pain is psychological.
Psychosomatic pain is different from chronic and acute pain. Its purpose is not to protect an injury or alert the client to an organic illness, it is a message or a cry for help at a psychological level. It is an hysterical response to a problem, maybe from the past, and sometimes abreactions are helpful in evoking the source or cause of the psychosomatic pain, but should only be attempted with some experience in this approach.
Sometimes psychosomatic pain occurs in a
specific part of the body because of convenience or a physical weakness in that
part of the body. For example, a client who, when a child, had aching feet
which excused him from
participating in sport at school might find himself having pain when walking as
an adult, should his unconscious later have the
need to produce a convenient psychosomatic pain as a cry for
help.
Organic Metaphors
Sometimes a pain may occur in the body in the form of an organic metaphor (such as a pain in the neck).
The Hypnotic Treatment of Pain
Changes
in pain perception should be
induced gradually, starting with a part of the body, such as the hand as this
is easiest to achieve for most hypnotic subjects and can then be spread to
other parts of the body as the client’s confidence in hypnotic anaesthesia develops.
Glove Anaesthesia
The client is first asked to recall naturally occurring anaesthesias that have occurred in the client's life. Memories of waking in the night and with a numb arm, playing with snow etc. can be brought to mind to initiate a re-experiencing of these contexts (see “analogies” below).
Using repeated hypnotic suggestions the Therapist
then induces “glove anaesthesia” by repeating suggestions for changes in
sensation, temperature and numbness in one hand. Analogies can also be given to help the client
feel as if the hand is wearing a thick glove.
These
suggestions are continued
until the client confirms that the hand is numb. When numbness is achieved, the
client is asked to place the numb hand onto the painful part of the body and transfer the numbness into that part of the body.
If
the client has alternating periods of comfort and pain, time distortion
can be used to change the client’s perception of time
by expanding the periods of comfort and reducing the periods of pain. See the unit
on time distortion
for more information.
The
client can be asked to imagine seeing himself as if he were another person.
As
the client looks at himself as another person with the pain, he has the experience of being free
of the pain.
If this is carried over post-hypnotically into the everyday life with a good hypnotic subject the person will have a profound sense of being separate from their own reality. While this is a technique that can be applied to hospitalized clients or those with terminal illness it is not appropriate for clients needing to function normally in everyday life as they may become disoriented.
Analogies
Therapists can tell stories to the client about times when the client would have naturally had an anaesthetised hand, for example the experience of waking up in the night and discovering that the arm is numb having been slept on. Another might be the experience of throwing snowballs.
Another approach might be to describe the process of becoming hardened or insensitive to pain. The therapist can talk about runners who develop blisters on their feet while running and then how these blisters harden so that pain is longer felt.
The
therapist is suggesting to the client that they develop a resistance to the pain by being
exposed to it, this is a utilization technique.
This
re-framing is actually including the pain as an
educational tool for the purpose of pain relief. The
therapist can tell stories about other clients who have been successful with pain control.
A client
who wishes to learn self-hypnosis for pain-free childbirth
can be told about the ease with which an earlier client achieved the same
results. If the actual induction
and hypnotic phenomena is described in detail then the client will develop
the same pain control
spontaneously as they respond to the indirect suggestion.
Visualization
The client can be asked to visualize the pain and visualize some way of combating it. For example if the pain is a stabbing pain, the client can be asked to visualize cushioning the stabs with cushions. By numbing the pain and deadening it with visualized cushions the client can bring about a change in their psychological perception of the pain. If the client is asked to describe their pain they will usually give a representation that suggests a way of working in this way, for example, a throbbing pain suggests that it has a rhythm, so the therapist can aim to change the rhythm, slow it down etc. A burning pain suggests that it is hot, so the Therapist can think of visualizations that would cool it down. Likewise for stabbing, dull or angry pain etc.
Distraction
The client can be distracted from the pain by finding
things to do as an alternative. By distracting the client from the discomfort,
his attention is re-directed. Analogies can be given about how much easier it
is for headaches to disappear when one is distracted or absorbed in something
else instead of sitting and concentrating on wanting the headache to go.
Re-framing
Another approach would be to use the Reframing of parts work technique as a way of re-framing the pain. Since pain is a signal or a message the therapist can ask the client to develop the creative abilities to generate alternatives to pain as a way of meeting the needs of the signal.
