Hypnotic anaesthesia

Hypnosis can be a divisive topic with polarised views about its legitimacy, efficacy and place within mainstream medicine (whatever that is). The following story that appeared online recently triggered some thoughts and musings (and a bit of a long post)

Moment woman has wisdom tooth extracted using nothing but HYPNOSIS to deal with the pain

“This remarkable footage shows a hypnotist having her wisdom tooth removed without any pain relief. Sharon Waxkirsh, who works in north London, said she felt no pain during or after the procedure. Two incisions were made using a scalpel and she had one stitch, as well as having the tooth removed. But the hypnotist said she felt nothing after putting herself into a trance while she was in the dentists chair.”

Hypnosis for pain management is nothing new, but perhaps it’s slowly gaining more interest within the scientific community and losing some of its undeserved woo status (there is still a LOT of rubbish out there of course).

Professor Mark Jensen who spoke about hypnosis at the recent Explain Pain3 in Melbourne has authored numerous papers on the use of hypnosis in pain, including this open access paper which provides a nice overview of hypnosis and the neurophysiology of pain. It also contains the following statement that should gladden the hearts of noijam readers

“The stimulation or damage that excites these receptors, and the information about this stimulation transmitted along the C, A-delta, and A-beta fibres, is not pain. Pain does not occur until structures in the brain become activated and involved”

Professor Jensen has been to our shores previously, sharing and promoting the research and benefits of hypnosis for pain:

‘Professor Jensen says there is physical evidence that hypnosis works to alleviate chronic pain.

“Imaging studies have shown that hypnotic therapy influences all of the cortical areas and neuro-physiological processes that underline pain,” he said.

“Helping patients manage pain can have a significant psychological impact. What people do to manage pain and what they think about pain, and their social environment, can all influence pain and its negative impact on functioning.”

Professor Jensen says clinical trials have shown hypnosis can reduce daily pain intensity for patients.

“Hypnosis still has a certain stigma to it,” he said. “However we are seeing this treatment option used to manage debilitating physical and psychological conditions including phobias and addiction.

“It may be that physicians are not recommending hypnosis to their patients due to a lack of understanding of the process, or it may be that patients are wary of hypnosis.”‘

 

Milton Erickson, quite rightly recognised as one of the key pioneers in the medical use of hypnosis (although his work is not without controversy and critics) famously dealt with both pain and a wary patient in one of his many documented case studies (more on this below)

Erickson’s approach to hypnosis was rather unique. His methods for inducing hypnotic states have had volumes written about them, but once a hypnotic state was achieved his ‘method’ would generally involve the use of story and metaphor.

In one of my favourite Erickson stories, he was asked by a relative to try and help “Joe”, a florist who had undergone radical surgery for a facial tumour after which he had been told the tumour was malignant and that he had approximately one month to live. Joe was experiencing excruciating pain in his final weeks and days of life. Erickson recounted his interaction with Joe in one of his many writings, a fuller account can be found here, but following are some excerpts.

“I was introduced to Joe, who acknowledged the introduction in a courteous and friendly fashion. I doubt if he knew why I was there. Upon inspecting him, I noted that much of the side of his face and neck was missing because of surgery, ulceration, maceration, and necrosis. Severe pain distressed him continuously, and he could not understand why the doctors could not handle their business as efficiently and competently as he did his floral business.

After the introduction, Joe wrote, “What do you want?” Despite my doubts about being able to help him, I felt that if I was genuinely interested in him and desired to help him, this would be some comfort both to him and to the family members within listening distance in the side room.

I began an approach to hypnosis which I call the interspersal technique. It is a way of talking as if in a casual conversation, but certain words and phrases are given special emphasis so they will be effective suggestions.

I said, “Joe, I would like to talk to you. I know you are a florist, that you grow flowers, and I grew up on a farm in Wisconsin and I liked growing flowers. I still do. So I would like to have you take a seat in that easy chair as I talk to you. I’m going to say a lot of things to you, but it won’t be about flowers because you know more than I do about flowers. That isn’t what you want. Now, as I talk, and I can do so comfortably, I wish that you would listen to me comfortably as I talk about a tomato plant.

That is an odd thing to talk about. It makes one curious. Why talk about a tomato plant? One puts a tomato seed in the ground. One can feel hope that it will grow into a tomato plant that will bring satisfaction by the fruit it has. The seed soaks up water, not very much difficulty in doing that because of the rains that bring peace and comfort and the joy of growing to flowers and tomatoes.

You cannot see it grow, you cannot hear it grow, but grow it does-the first little leaflike things on the stalk, the fine little hairs on the stem. Those hairs are on the leaves too, like the cilia on the roots; they must make the tomato plant feel very good, very comfortable if you can think of a plant as feeling, and then, you can’t see it growing, you can’t feel it growing, but another leaf appears on that little tomato stalk and then another. Maybe-and this is talking like a child-maybe the tomato plant does feel comfortable and peaceful as it grows.

Quite some time later, Joe’s wife came tiptoeing into the room carrying a sheet of paper on which was written the question, “When are you going to start the hypnosis?” I was continuing the description of the tomato plant uninterruptedly, and Joe’s wife, as she looked at Joe, saw that he was not seeing her, did not know that she was there, that he was in a somnambulistic trance. She withdrew at once.

I wonder if the tomato plant can, Joe, feel, really feel, a kind of comfort. You know, Joe, a plant is a wonderful thing, and it is so nice, so pleasing just to be able to think about a plant as if it were a man. Would such a plant have nice feelings, a sense of comfort as the tiny little tomatoes begin to form, so tiny, yet so full of promise to give you the desire to eat a luscious tomato, sun-ripened, it’s so nice to have food in one’s stomach, that wonderful feeling a child, a thirsty child has and can want a drink. Joe, is that the way the tomato plant feels when the rain falls and washes everything so that all feels well?” (Pause.)

You know, Joe, a tomato plant just flourishes each day, just a day at a time. I like to think the tomato plant can know the fullness of comfort each day. You know, Joe, just one day at a time for the tomato plant. That’s the way for all tomato plants.” 

While this pain state was an extreme one, the story highlights Erickson’s method of conversational and ‘gentle’ hypnosis- no swinging watches, no orders or demands, just gentle suggestions and invitations to feel at peace, to feel comfortable.

Professor Jensen suggested during Explain Pain3 that hypnosis could be used in this way for pain, but also combined with an Explain Pain education approach to make the new ideas more “sticky” – there are some key ideas of his in a previous post summarising Day 3 of ep3.

It would be great to hear from any therapists or practitioners out there using hypnosis to help people in pain – how you use it, your experiences, successes or otherwise. I’m also interested in what others think of the place of hypnosis in the treatment of pain – should it be left just for dentists, psychiatrists and psychologists?

 

-Tim Cocks

www.noigroup.com

 

 

Explain Pain 2nd Ed, the Graded Motor Imagery Handbook and all noigroup courses are all bursting at the seams with the latest and greatest neuroscience nuggets and educational excellence; click on the links to get your hands on a copy or to find a course near you.

10 Responses to “Hypnotic anaesthesia”

  1. Efwef Gwerb

    Her Facebook page is impressive. Nothing like repeated live demonstrations to prove a point. But there’s an obvious question that I would like to ask her and that is: “Why wouldn’t you simply suggest to patients that the tooth fixes itself?” Dentists won’t tell you this, ($$$) but the body has the capacity to heal cavities just as it has the capacity to hear torn muscles. I just saved you a couple of hundred dollars a year (Google it). You’re welcome.

    Lately I’ve been wondering whether a formal induction and deepening (closed eyes, muscle relaxation, guided imagery, etc.) is even necessary. The placebo effect I wrote about a while back tends to indicate that it is not. It’s also been my own experience having practised both a very formal/direct and a completely covert/indirect method. A trusted “authority” is essential. Steely confidence is essential. Aside from that I’m not sure I can say anything else is needed.

    This is from master hypnotist Derren Brown:
    “The consensus [amongst researchers in the field of hypnosis], and certainly my own model, seems to be as follows: nothing can be done under hypnosis that a person cannot achieve when not hypnotised. When we are highly motivated, for example, we can sometimes do extraordinary things which we would find extremely hard, if not impossible, to carry off in a ‘normal’ state. I think here of a friend wanting to prove a point that you didn’t need to be hypnotised to eat a raw onion and enjoy it (a classic stage hypnosis stunt). He went to my fridge, and tucked into a raw onion with, as it were, relish. Motivated by that desire to prove a point, he was able to do something that would have been hugely uncomfortable otherwise. His breath was also considerably improved”.

    LOL.

    At the current rate of change, Physio will not exist as a profession in 30(?) years time. The whole health care landscape will have changed enough to permit the possibility that mind directs everything. If you thought the “pain as output” paradigm was hard to sell, try selling someone on the “entire physical universe as output” paradigm. It’s coming.

    EG

    Reply
    • timcocks0noi

      Thanks EG
      I thought this post might have resonated a bit with you.
      My understanding of how Erickson used hypnosis was as a (for want of a better phrase) ‘means to an end’, rather than the end itself. In other words, Erickson used hypnosis to achieve a certain kind of state – a state in which a person was more open to positive and useful suggestions, a state in which his metaphorical stories might have more traction and stickiness and a state in which the individual could access resources (creativity, bravery, confidence etc).

      I’d be interested in hearing how you (or any other therapists using hypnosis with people experiencing pain) use hypnosis to achieve therapeutic goals – ie. is the outcome desired less pain, greater understanding, relaxation, change in behaviour etc etc?

      (PS, I tend towards philosophical realism so I’d argue that our *experience* of the entire physical universe is a construction of the human being, but that the physical universe exists independent of our experience of it or even our existence within it. I’m very sympathetic to the relatively young (in the West at least) enactive tradition, particularly Varela, Thompson, O’Regan and Noë who suggest, very roughly, that there is a physical world ‘out there’ and as a result of the particular kinds of biology and bodies we have, we “enact” the world, or have “access” to this world. This results in a “lived world” or ümvelt. But enough rambling – any further conversation on this would definitely need some Shiraz).

      Thanks again for dropping by
      Tim

      Reply
  2. Efwef Gwerb

    Hi Tim,

    I see what you’re saying re: Erickson, and I think most people would view it the same way – ie. induce a certain state so that the words will then stick. My only point of difference would be the weighting I would give to each component. I reckon therapeutic presence (which creates the receptive state) can stand on its own if need be, but words help a lot. Whereas words without a receptive state can miss the mark.

    What makes me say this is the following scenario, which all practitioners would have seen many times: A new patient comes in and tells you he has seen the physio/GP/chiro up the road and he wasn’t happy with the treatment. You ask what happened. “Oh he didn’t know what he was talking about”. But then if you quiz the patient for details, often you find that the other practitioner was perfectly reasoned and sensible in what he said and did! The words “didn’t know what he was talking about” often seem to mean “he didn’t say it with the sort of conviction or confidence that would make me trust him”.

    So I try to gain this trust by being congruent. Knowledge also seems to help a lot with trust. I bet David’s patients can feel knowledge oozing out of his pores!

    In regards to trance states, I’m actually a bit confused right now. I don’t know whether they are necessary. Deep rapport and trust, yes. Trance – not sure. I need to get back to some more study on this. Or maybe someone reading can direct me on this.

    I know you have studied NLP Tim. I’d like to hear your experiences.

    Regards,

    EG

    PS. Just for interest, here’s DB freaking some people out with gaze alone. No words. http://www.youtube.com/watch?v=o6gzuKti1-I

    Reply
    • timcocks0noi

      I think that idea of a person “knowing what they are talking about” is a great point – great sales people seem to know this.

      I have read that when Bandler and Grinder first started sharing Erickson’s patterns and techniques at courses, one would stand at the front and say “there is no such thing as hypnosis” the other would stand beside him and say “everything is hypnosis”. I understand that their point was that both of these statements were in fact true- it is not so much about whether a person is in some trance state or not, but more about just *which* trance state a person is in. This breaks down the dichotomy of being in or out of a trance state – i suspect that those times when you have deep rapport and trust would have “trance” like aspects to them – whether preceded by any kind of formal induction or not. I have seen very deep trance states accessed by requesting a peron to recall a time in their history when they were driving a car, perhaps going home along very familiar roads, and then some time later becoming aware that they were home without any recollection of the journey itself. There is also the “getting lost in a good book” trance or the “standing in an elevator after the doors shut” trance.
      My interest and initial period of study of hypnosis coincided with a move out of a ‘clinical’ setting as a physio so my experience in this context is minimal, and in my roles since the performance of a formal trance induction would have been inappropriate with clients… however i have frequently witnessed the observable signs that are often discussed in association with altered states – changes/deepening in breathing, changes in skin tone/colour, changes in movement etc when interacting with people (during education sessions or other exchanges) and i have often taken the opportunity to leave the person(s) with an invitation to experience deep peace and relaxation, or perhaps a wonderful sleep that night with interesting, vivid dreams and waking the next morning with a feeling of refreshment and energy.
      Cheers
      Tim

      Reply
  3. davidboltononoi

    Sharing an experience, in my thirties I decided to have a necessary arthroscopic procedure to my own knee done with zero anaesthesia. I was a Maitland “Groupie” at the time and wanted to know what a joint felt like from the inside……… I know utter madness………. Yes, what an idiot but it was the era of Don Johnson, Miami Vice, padded shoulders and mullet haircuts………Anyway my experience was definitely more one of “Pressure” rather than pain…….The experimental high obviously over riding all else, when being able to report back to Geoff with my “Inside knowledge”…….and I didn’t want to mess up my “Mullet”……

    Reply
  4. timcocks0noi

    Wow!
    I’m picturing a surgeon in a white suit jacket with rolled up sleeves and a pale blue t-shirt (and peroxide assisted mullet of his own) doing this operation…
    Not even a local around the incision sites?

    Reply

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