Applications of Hypnosis: Pain Management

1. Applications of Hypnosis: Pain Management • mfm

2. Pain is an experience in the soul of the patient • Plato

3. Pain . . . “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” • Merskey, Bugduk, 1994

4. Pain is private and personal. It is subjectively experienced and includes both mental and emotional suffering and distressing physical sensations. • Kuttner

5. Pain is the sensation that arises from nociception

6. Types of Pain • Nociceptive • Inflammatory • Neuropathic • Functional

7. Components of Pain • Sensory Pain – actual way the individual feels the pain • Suffering – amount of unpleasantness that occurs as a result of sensory pain

8. Pain, Suffering, Pain Behavior • Pain • Sensation that can arise from nociception • Suffering • Affective response to pain • Disruptions in work, relationships, activities, QOL • Pain Behavior • Actions that communicate suffering • Independent of nociception

9. hipnosis • Hipnosis pada umumnya terkait dengan pengenalan sebuah prosedur selama subjek tersebut disugesti untuk mengalami suatu pengalaman imajinatif

10. Induksi hipnosis •  Induksi hipnosis merupakan sugesti inisial yang luas menggunakan imajinasi seseorang dan mungkin mengandung perincian lebih lanjut pada introduksinya

11. Prosedur hipnosis •  Sebuah prosedur hipnosis biasanya digunakan untuk memberikan dukungan dan mengevaluasi respon sugesti

12. hypnotist • Ketika menggunakan hipnosis, seseorang (subjek) dipimpin oleh orang lain (hypnotist) untuk memberikan respon terhadap sugesti untuk berubah pada pengalaman subjektifnya, perubahan persepsi, sensasi, emosi, pikiran atau tingkah laku. • Orang tersebut dapat juga mempelajari hipnosis diri sendiri (self hypnosis) yang merupakan tindakan untuk mengatur prosedur hipnosis atas kemauan orang tersebut

13. Hypnotic interventions for pain control began when the first mother kissed her child’s booboo and made it all better. • Franz Baumann

14. Humans have limited amount of conscious attention available • When involved in a hypnotic trance experience there are less cognitive resources available to devote to evaluation of nociceptive pain

15. There is an interplay of thoughts, beliefs, emotions and attitudes with the sensations occurring in the body that create the sensation of pain • This same interaction of mind and body enables us to increase or decrease pain

16. It is not simply mind over matter, but it is clear that mind matters. • David Spiegel • JAMA, 1999

17. Factors affecting pain perception and hypnosis • Age and developmental stage • Previous experience with pain • Context of symptom, emotional significance of pain • Physical and emotional state • Culture • Gender and individual differences • Candy Erickson

18. Factors Affecting Efficacy of Hypnosis • Coping style – attender or avoider • Acceptability of hypnosis • Medication • Hypnotic susceptibility

19. Other Factors Affecting Efficacy of Hypnosis • Attitude of family toward symptom and hypnosis • Attitude of medical staff toward symptom and hypnosis • Therapist’s attitude toward symptom, belief in hypnosis, and skill

20. Physiologic markers of pain appear to persist even when a person feels no pain or decreased pain after hypnotic suggestionPerhaps pain is not being processed by cognitiveprocesses during hypnosis

21. Mechanism of Hypnotic Analgesia • Poorly understood • Pain activates the anterior cingulate cortex • Anger activates the anterior cingulate cortex • Hypnosis activates the anterior cingulate cortex • The same structure may both respond to pain and participate in pain control

22. Hypnosis for Procedures • Safe • Ease of administration • Creates analgesia and amnesia • Gives patient skills instead of pills • Promotes self-mastery, self-efficacy and self-esteem

23. I know you want to scream because you can scream as loud as you want till you are all done and don’t need the scream any more and it doesn’t bother you

24. The Language of Healing • Use words of encouragement and reassurance • “You are doing this very well” • When possible let patient know that what they are experiencing is normal, not life-threatening or the result of some terrible disease • Remind patient that pain will come to an end • Kohen

25. Procedural Hypnosis • Induction with deep relaxation • Anchor suggestions to threatening cues with post-hypnotic suggestion • When you feel _____, then ________

26. Pain Management Program • Change in lifestyle • Psychological Therapy • Physical Therapy • Medication • Must include the family • Kuttner

27. Reduction of pain is often a secondary goal or side effect

28. Hypnotic Pain Coping Strategies • Methods which • Achieve neurophysiologic alterations • Change or reorganize the cognitive-emotional understanding • Improve behavioral patterns • Promote new useful perceptions of time and space

29. Pain is . . . • a warning signal; it is neither good nor bad; but it is important. • “Once everything that can be done and should be done has been done, there is no reason for it to continue.” • Kay Thompson

30. Be the Boss of Your Pain • Skill # 1 • Belly Breathing • relaxes muscles • calms nerves • releases endorphins

31. Skill # 2 • Imagine That - Re-program the Brain’s Computer • TV - you are in charge of the remote CONTROL, change the channel • Imagine something Fun - sports, games, amusement park • Change the image • change the color, shape or texture • Switches in a control room • Jettison technique - throwing it away

32. Be the Boss of Your Pain • Skill # 3 • You’re the Coach • Positive Attitude - replace negative thought with a helpful one

33. Be the Boss of Your Pain • Skill # 4 • Aromatherapy • use smells to help you feel better • imagine healing scent traveling through body sending out healing messages • Skill # 5 • Acupressure • releases endorphins to relieve symptoms

34. General Principles of Pain Management • Emphasize patient’s control and mastery • Use language of hope, courage, and possibilities • Convey message that pain will get better

35. General Principles of Pain Management • Reinforce whatever happens • Get feedback from the subject • Let patient determine what method will work best

36. General Principles of Pain Management • If at first you don’t succeed - change techniques • Address anxiety as well as pain • Use other cognitive, behavioral strategies as well

37. Stress Hypothalamus Hyphofisis ACTH Psikoneuroimunologi Adrenal cortisol Imun sistem tonus Nyeri

38. Hypothalamus Hyphofisis Kegembiraan, cinta, kenyamanan, Perasaanpuas Endorfin Psikoneuroimunologi Imun sistem relax Nyeri

39. Caveat • Chronic/recurrent pain may be a symptom of PTSD, sexual or physical abuse or depression • Physical pain may protect the individual from severe psychological pain • If pain is protective, then hypnosis may be ineffective and contraindicated without psychotherapeutic intervention

40. Goals for hypnotic intervention for pain • Instill a new paradigm regarding reasons for the pain – reframe • Increase the patient’s effectiveness of his or her own natural pain control system • Reduce focus on self so that the patient can be open to possibilities of altered sensations, emotions and beliefs • Enhance perceptions of controllability of pain by facilitating feelings of control and the belief that physical changes are possible • Facilitate increased functionality