Wednesday, November 3, 2010

Using Hypnosis to Help Patients Manage Pain

Guest Author
By guest author, Michael Ellner, MSH, CHt

A quick thanks for the invitation to write this guest blog. I welcome the opportunity to give readers of some insights and practical hands-on advice, much of it taken from the 6 hours of CME training on Mind-Body Medicine that Dan Cleary and I recently taught at PAINWeek 2010. This was the 4th year that Dan and I taught the Hypnosis Track at this event on behalf of the International Medical and Dental Hypnotherapy Association (IMDHA), and we want to thank the hundreds of frontline clinicians who attended our courses.

My focus here is two-fold. First, I want to introduce you to the benefits and advantages of using certified hypnosis professionals in the management, amelioration, and even elimination of pain. Second, I want to review the basic tools and concepts of effective communication and rapport building that can improve your patient-interaction skills.

Rethinking Hypnosis
All of our courses focused on how suggestion, conversational hypnosis, and certified hypnosis professionals can play a supplemental role in a wide range of pain management settings and practices. We wanted to help pain clinicians understand that nearly all of their patients can be helped with hypnosis. This and self-hypnosis have been shown to help with cancer-related pain, chronic pain, back pain, and functional pain conditions — like irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS).

Our work is predicated on the evidence-based belief that changing your patient's relationship with pain also will change their sensory experience of pain. This change in belief and expectations is not an “all or nothing” proposition. Even a small reduction in pain can translate into giving your patients the ability to work, play with their children, or enjoy a night out and/or sexual relations with their partner.

A particularly relevant aspect of this approach is self-hypnosis. This is a type of focused attention in which people demonstrate significantly greater control over both mental and physical functions — control that they've otherwise lost to their chronic condition. Unlike medications, talk therapy, and medical devices, self-hypnosis is a skill that, once learned, is always available for use by people living with chronic pain at any moment. Plus, there is no risk that one might have a serious adverse “side effect,” forget to take a medication, have batteries fail, or have a pain flare-up without having helpful resources available.

People living with chronic pain often fear that they won't be able to control their pain, and that it will worsen over time. Indeed, focusing on their pain tends to actually increase it. But if they can increase their pain by focusing on it then they can also decrease the pain by focusing on it. Pain is part of a broader functional process. Since no one exists independent of this process, they have a choice: relate to the pain as a victim of the process or as a participant in the process.

Self-hypnosis — that is, intentional relaxation and creative stress management skills — can, under the guidance of a certified hypnosis professional, help patients recover a participatory role in their pain management process. The best part is that, once learned, there is no continuing reliance on the hypnosis professional.

Hypnosis Basics
Imagine a slice of lemon. See it… smell it… imagine picking it up and holding it in your hand. Now imagine rolling it on a counter top. Hear yourself tasting it. You probably actually changed your physiology by simply imagining tasting a lemon and, if so, you have a high Mind-Body IQ.

But even if someone is unable to taste that imaginary lemon on their own, a certified hypnosis professional has the skills to help them (eg, your patients) develop their imagination and creative self-help skills. In this case, by simply having the person practice the exercise with an actual lemon, and then practice remembering and imagining that they taste it, just about anyone's Mind-Body IQ can be increased. In the same way, your patients can be taught to use their memory and imagination to release feel-good peptides that help to relieve pain.

Finding a Hypnosis Practitioner
The practice of hypnosis is self-regulated rather than being a state-licensed profession. Our services are not yet covered by insurance and our clients generally pay for our services out-of-pocket.

As with any profession, it is important to consider the qualifications and experience of the practitioner when making referral decisions. The International Medical and Dental Hypnotherapy Association (IMDHA) has been training and certifying medical and dental hypnosis professionals for helping people to increase their coping and self-regulating skills and abilities since 1989. IMDHA-certified hypnosis professionals with specialty training in hypnotic pain-relief education act as self-help coaches engaged in training your patients in self-hypnosis, intentional relaxation, and creative stress management.

Effective Communication and Rapport Building
Aside from prescribing effective pain therapy, your ability to connect with your patients and even with coworkers is one of the most important skills a pain clinician can possess. Your patients are likely to be frightened, confused, and feeling vulnerable. Rapport building and effective communication are essential ingredients to developing your patients’ trust and relieving unnecessary anxiety, which are prerequisites for managing pain.

The great news is that if you are relaxed and at ease, it will help your patients become relaxed and at ease. You set the tone for the context of your practice; however, if left unchecked, your own stress and that of the people around you can act as a contaminant that can not only take the joy out of life for you, it can also have a deleterious effect on the therapeutic environment and effectiveness of your treatments.

Think about it. Imagine that you are being assisted by a person who is agitated, stressed, preoccupied, or in a bad mood. How would that affect your behavior? Remember that when you are stressed-out your patients will feel it. Enhanced rapport and communication with patients equals better care for your patients, not to mention better working conditions for you, your staff, and other medical professionals you may be collaborating with.

Take a 3 to 5 minute break to relax, to recharge and refocus your attention before working with patients. Try this simple exercise. First, find a quiet place, close and open your eyes and imagine and/or remember the sights, sounds, smells, tastes, and touches associated with a past experience in which you were genuinely feeling energized, at ease, and happy. This personalizes the experience.

Now, imagine that you are soaking up that sense of energy, ease, and happiness. With practice, you will be able to reconnect to this “center” in an instant, bringing your attention back to everyday consciousness and the moment. If practiced for 3 to 5 minutes several times a day, feeling upbeat and being in a good mood will become a habit and all of your experiences will reflect your "good" mood. Similarly, as your patients are taught these techniques for releasing feel-good peptides they will automatically reduce or eliminate their pain. It really can be that easy!

When Should Hypnosis Be Recommended?
Quite simply, people who feel better heal better and faster. The best time to recommend the practice of self-hypnosis, intentional relaxation, and creative stress management for your patients is right now. You also can download my peer-reviewed paper on “Hypnosis in Disability (Pain) Settings” at [PDF here] for additional insights and references on how using hypnosis professionals can help patients to become both motivated and rehabilitated for returning to work more effectively.

> Tan G, Alvarez J and Jensen M. Complementary and Alternative Medicine Approaches to Pain Management. J Clin Psych Session. 2006;62(11).
> Hypnosis is effective in relieving chronic pain: JAMA. 1996(Jul);276:313-318.
> Hypnotherapy relieves cancer related pain: JAMA. 2000(Jan);283:118-119.
> Hypnotherapy relieves IBS related pain. Amer J Gastroenterol. 2002;97:954-961.
> Mind-Body Medicine. J Am Board Fam Pract. 2003;16:131-147.

About the Author: Michael Ellner, MSH, CHt, is a certified medical hypnotist in private practice in New York. He teaches advanced courses in medical hypnosis at schools throughout North America and South Africa and is a featured instructor of Hypnotic Pain Relief at the annual PAINWeek conference. Ellner has conducted webinars in Patient Interaction and Rapport Building for radiologists, internists, psychiatrists, ophthalmologists, cardiologists, plastic surgeons, and doctors for ExecSense, the world's leading webinar publisher for medical and top business professionals. For more information you can e-mail him at or visit his websites:;; or

Editor’s Addendum: Beneficial effects of hypnosis for pain have been increasingly investigated and verified by brain imaging. For example, an upcoming research report in the December 2010 edition of the journal PAIN found that hypnosis reduced perceptions of pain in patients with chronic temporomandibular disorders via selective suppression of cortical activity in key somatosensory areas. This, and other research through the years, has confirmed that hypnotism alters processing of pain and its perception at the highest neurophysiological levels. Reference: Abramsen R, et al. Effect of hypnotic pain modulation on brain activity in patients with temporomandibular disorder pain. Pain. 2010(Dec);151(3):825-833 [
abstract here].