Pain management

We often take for granted feeling physically well and fit, so when we experience pain for prolonged periods of time, it can have reverberating effects on our lives in terms of our work and relationships.

With chronic pain, pain signals consistently being sent from the nervous system for weeks, months and sometimes even years. Often chronic pain begins with an initial injury or illness, such as a long-term serious condition like cancer, an ear infection, arthritis or a sprained limb. Even in situations where these injuries and illnesses have healed, pain signals may still remain in the nervous system for long periods of time and thus chronic pain persists. Some people also suffer from chronic pain despite no past injury or evidence of damage to the body.

Chronic or acute pain?

A sudden onset of pain is referred to as acute pain and is usually met with a response triggered by the nervous system to make you aware of a possible threat of injury. This response could be delivered in the form of a jerk reflex which makes you move your hand off a hot iron without really realising what you are doing, or it could involve the elevation of an injured limb or cooling a swollen ankle to prevent the condition from worsening and causing more pain. Generally acute pain tends to disappear when the underlying cause has healed sufficiently, though there are cases in which it is more severe and can last for weeks or months (occasionally progressing to chronic pain if left untreated).

Chronic pain is pain that lasts for longer than six months. In some cases untreated pain may worsen as the nerve fibers which transmit pain signals to the brain become more efficient and effective at sending these messages to the brain. This means that the intensity will increase to more than is necessary to get your attention and thus your brain will become more sensitive to pain. If this persists then the usefulness of the pain will diminish and could instead lead to preventing individuals from going about their everyday activities.

How is pain measured?

Because pain is an extremely common side effect of numerous illnesses and ailments, it is challenge for healthcare providers to measure pain objectively and to differentiate chronic pain from what could be a natural response.

In addition to this, each person will experience pain in a different way and at a different level, meaning that developing diagnosis criteria is also difficult. It may take a period of months to accurately diagnose a chronic pain condition and the process may involve a number of consultations and tests with your doctor.

The World Health Organisation have recommended a pain ladder which helps healthcare providers to determine the appropriate treatment for chronic pain so that unnecessary prescriptions for strong drugs are avoided.

According to the criteria mild pain is self-limited and goes away with either no therapy use at all or with the use of nonprescription medications.

Moderate pain is categorised as worse than mild pain to the point that it interferes with function and can’t be ignored during daily life and will also require stronger medication than mild. Severe pain is defined as pain which interferes with daily life and may confine the sufferer to bed rest. This pain does not go away over time and instead requires continuous treatment.

Types of pain

General somatic pain

General somatic pain is the awareness of bodily harm, for example the pain caused by your body reacting to a stimulus such as a physical fight or a chemical irritant. This kind of pain will usually improve in a few days but some people develop pain which does not go away so easily. Fibromyalgia and chronic back pain fall into this category and common treatments for this form of pain include anti-inflammatory medicines.

Visceral pain

Visceral pain is the term used to describe discomfort caused by the internal organs. This pain is often difficult to determine as the connections between the pain sensors in the internal organs and the brain are not as effective as the nerves in the outer body.

Most people will have experienced a mild form of this pain when suffering from acid indigestion, which is common and easy to treat using non prescription medications. More serious forms include chronic pancreatitus which is inflammation of the pancreas, gallstones and appendicitis.

Bone pain

Temporary bone pain can be caused by a fracture or bruise and will usually result in a throbbing sensation. This kind of pain can also be long term, occurring in individuals suffering from bone cancer, osteoporosis, osteomyelitis or arthritis. In cases such as these individuals may require long-term pain treatment.

Muscle spasm

Muscle cramps and spasms can cause severe pain and may require muscle relaxants and pain medication in combination.

Peripheral neuropathy

Peripheral neuropathy is caused by a problem with the nerves which carry information to and from the brain and spinal cord and throughout the rest of the body. This process can lead to pain, inability to control muscles and a sensation similar to that of pins and needles among other side effects. This kind of nerve pain can be treated using tricyclic antidepressants and more severe nerve pain such as sharp and stabbing pains is sometimes treated with anticonvulsants.

Often individuals who have lost a limb experience peripheral neuropathy as for some people it will feel like the limb which has been lost is still present. This causes a huge amount of discomfort which is known as deafferentation, or ‘phantom limb pain’. The pain can be treated with clonidine (Catapres), which is a blood pressure medicine which is effective at relieving nerve pain.

Peripheral neuropathy can also be caused by ruptured discs in the spine, cancer which effects nerves and causes irritation, infections such as shingles and diseases such as diabetes and AIDS.

Circulatory problems

Poor circulation can be caused by excessive tobacco use, diabetes and various autoimmune diseases such as lupus. If left untreated poor circulation can lead to chronic pain, which in many cases is caused by that particular part of the body being starved of oxygen and nourishment.

Poor circulation can also be caused by reflex sympathetic dystrophy (RSD), which is characterised by painful nerve transmissions which cause the blood vessels to become narrower. This process means that not enough oxygen is able to reach the part of the body which is affected. This problem can be treated using an operation which stops the nerve impulses from narrowing the blood vessels.

Headaches

Headaches exist in many forms and occur as a result of numerous illnesses. There are also various types of headaches, ranging from migraines and tension headaches through to cluster headaches. Recommended treatment will depend entirely on the kind of headaches and the severity of the pain experienced.

Treatment options

Though it may not always be possible to completely get rid of chronic pain, there are various treatment options out there which could help you to manage pain relief more effectively.

Often a health care provider will prescribe medications such as long-acting opioids to keep pain under control most of the time and short-acting opioids to help throughout the day when the pain worsens. Though these drugs can be extremely effective for many, unfortunately there are some side effects which include dizziness and tiredness which mean alcohol consumption, machinery operation and driving are not recommended.

Other avenues of treatment could include non prescription medications such as paracetamol, nerve blocks, electrical stimulation, physiotherapy, surgery, psychological counselling, behaviour modification and alternative treatments such as acupuncture, relaxation and hypnotherapy.

Hypnotherapy for pain management can either be used either alongside prescribed medication or alone, but if you are considering hypnosis then it is essential you have been to visit your GP for an appropriate medical evaluation before proceeding. As discussed in the above, pain is often a warning signal of a more serious underlying medical condition, for example a serious case could see an individual experiencing migraines which are a symptom of a brain tumour. If a hypnotherapist was to then go on and treat the migraines before the root cause of the problem had been found, this could lead to the tumour remaining undiagnosed.

Once the patient has been to see the doctor and the pain has been diagnosed with more serious causes having been eliminated, it is then fine for hypnotherapy treatment to commence.

Hypnotherapy has been used by many to manage numerous instances of pain, including irritable bowel syndrome, sciatica, spinal stenosis, burns, joint pain, neck pain and a variety of other injuries and illnesses. The basic premise of hypnotherapy is to change the way individuals perceive pain messages in order to reduce the intensity of what they are feeling.

This can be achieved using a number of techniques which may either be used alone or in combination depending on your individual circumstances and the specialist areas of your practitioner. As well as using certain hypnotherapy techniques such as suggestion hypnotherapy, analytical hypnotherapy and visualisation, some practitioners may also use Neuro-Linguistic Programming (NLP) and Psychotherapy to enhance their treatment.

Many hypnotherapists will also include self-hypnosis as part of your treatment plan, meaning that they will teach you to practice techniques so that once your sessions have come to an end you will be able to continuing using the skills your have learnt in daily life.

 

What is Hypnotherapy?

What is hypnosis and How does hypnotherapy work?

What is hypnosis?

Within science, there is no debate as to whether hypnosis exists or works.  Science simply cannot agree on what it is and how it works, although as The British Society of Clinical and Experimental Hypnosis states:

“In therapy, hypnosis usually involves the person experiencing a sense of deep relaxation with their attention narrowed down, and focused on appropriate suggestions made by the therapist.”

These suggestions help people make positive changes within themselves.   Long gone are the days when hypnosis was seen as waving watches and controlling people’s minds.  In a hypnotherapy session you are always in control and you are not made to do anything.  It is generally accepted that all hypnosis is ultimately self-hypnosis.  A hypnotist merely helps to facilitate your experience – hypnotherapy is not about being made to do things, in fact it is the opposite, it is about empowerment.  If someone tells you they can hypnotise you to do something, ask them to hypnotise you to rob a bank, and when they can’t, ask them to stop making ridiculous claims.

The following four extracts from Dr Hilary Jones’ book, “Doctor, What’s the Alternative?”, provide an accurate and accessible wonderful description of what hypnotherapy is, how it works and how hypnotherapy can help you change and grow.

Definition of hypnotherapy

Contrary to popular belief, hypnosis is not a state of deep sleep.  It does involve the induction of a trance-like condition, but when in it, the patient is actually in an enhanced state of awareness, concentrating entirely on the hypnotist’s voice.  In this state, the conscious mind is suppressed and the subconscious mind is revealed.

The therapist is able to suggest ideas, concepts and lifestyle adaptations to the patient, the seeds of which become firmly planted.

The practice of promoting healing or positive development in any way is known as hypnotherapy.  As such, hypnotherapy is a kind of psychotherapy.  Hypnotherapy aims to re-programme patterns of behaviour within the mind, enabling irrational fears, phobias, negative thoughts and suppressed emotions to be overcome. As the body is released from conscious control during the relaxed trance-like state of hypnosis, breathing becomes slower and deeper, the pulse rate drops and the metabolic rate falls.   Similar changes along nervous pathways and hormonal channels enable the sensation of pain to become less acute, and the awareness of unpleasant symptoms, such as nausea or indigestion, to be alleviated.

How does it work?

Hypnosis is thought to work by altering our state of consciousness in such a way that the analytical left-hand side of the brain is turned off, while the non-analytical right-hand side is made more alert.  The conscious control of the mind is inhibited, and the subconscious mind awoken.  Since the subconscious mind is a deeper-seated, more instinctive force than the conscious mind, this is the part which has to change for the patient’s behaviour and physical state to alter.

For example, a patient who consciously wants to overcome their fear of spiders may try everything they consciously can to do it, but will still fail as long as their subconscious mind retains this terror and prevents the patient from succeeding.  Progress can only be made be reprogramming the subconscious so that deep-seated instincts and beliefs are abolished or altered.

What form might the treatment take?

Firstly, any misconceptions a potential patient may have about hypnosis should be dispelled.  The technique does not involve the patient being put into a deep sleep, and the patient cannot be made to do anything they would not ordinarily do.   They remain fully aware of their surroundings and situation, and are not vulnerable to every given command of the therapist.  The important thing is that the patient wants to change some behavioural habit or addiction and is highly motivated to do so.  They have to want the treatment to work and must establish a good clinical rapport with the therapist in order for it to do so……

The readiness and ability of patients to be hypnotised varies considerably and hypnotherapy generally requires several sessions in order to achieve meaningful results.  However the patient can learn the technique of self-hypnosis which can be practiced at home, to reinforce the usefulness of formal sessions with the therapist.  This can help counter distress and anxiety-related conditions.

What problems can be treated by hypnotherapy?

Hypnotherapy can be applied to many psychological, emotional and physical disorders.  It is used to relieve pain in surgery and dentistry and has proved to be of benefit in obstetrics.  It can shorten the delivery stage of labour and reduce the need for painkillers.  It can ease the suffering of the disabled and those facing terminal illness, and it has been shown to help people to overcome addictions such as smoking and alcoholism, and to help with bulimia.  Children are generally easy to hypnotise and can be helped with nocturnal enuresis (bedwetting) and chronic asthma, whilst teenagers can conquer stammering or blushing problems which can otherwise make their lives miserable.

Phobias of all kinds lend themselves well to hypnotherapy, and anyone suffering from panic attacks or obsessional compulsive behaviour, and stress-related problems like insomnia, may benefit.  Conditions exacerbated by tension, such as irritable bowel syndrome, psoriasis and eczema, and excessive sweating, respond well, and even tinnitus and clicky jaws (tempero-mandibular joint dysfunction) can be treated by these techniques.

Related sites:

How Hypnosis Works – articles on how hypnosis works for all sorts of problems

Hypnotherapy works for bowel pain – BBC news article on hypnosis for IBS

Dr Hilary Jones, “Doctor, What’s the Alternative?” Hodder and Stoughton: London (1988)

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