Pain - Chronic Pain Relief Therapy
Chronic pain is complex and is influenced by many factors.
A report from The Australian Institute of Health and Welfare states that chronic pain affects 1 in 5 people over the age of 45 in Australia.
Those who experience chronic pain, have found that their pain and the resulting exhaustion has had a profound impact on their lives. Often sufferers of Chronic Pain reporting that their experience of pain has been dismissed by others and has also had huge impact on their physical and mental health, on their quality of life and on their relationships.
It is important to note that many who have chronic pain often feel like that pain will always be their unwelcome intruder on their life. That perhaps they are not able to be understood, helped and that the level of pain experienced will be constant. But the good news is that your relationship with pain and how you experience it can be changed.
Many chronic pain sufferers have attempted different treatments and often lose faith in processes due to the complexity or slow progress.
Perhaps you have also tried many different treatments or therapies, and are still seeking relief.
Pain may seem to be just something you have to put up with, however, as complex as pain may be - your ability to change those related sensations into a different and workable
Having only one pain management approach only is usually not enough. So, we work with what you know works, with what you do and what you do not yet know how to do - to create a more pain free way to be!
While pain may be a part of your life, it doesn't have to rule your life.
We will use a combination of Strategic Psychotherapy, Clinical Hypnotherapy and Neuro Linguistic Programming (NLP) along with other modalities - as a combination of approaches that allows you to retrain your brain and your body, so you can control your pain and not have it control you.
You could manage your unique strategies so you can decide where you place your focus and where you get to interpret what you pay attention to - and the way you process this in a way that empowers you.
You get to determine and respond to pain in a new way, training your brain and your body to experience sensations in a way that allows skills and strategies that will work for you - to work for you.
You've Come To The Right Place- You can be Chronic Pain Free.
Some source material for your reading reference:
Hypnosis: Standard-of-Care Relief for Physical Pain
Dr. Fredric Mau. D.Min., M.A., M.Div., LPCS, BC-NCC, BC-TMH, BC-H (Paraphrased)
Physical pain relief is one of the most life-changing and beneficial things a hypnotherapist can provide for a client.
The presence of physical pain makes all other problems worse. Pain relief is perhaps one of the most effective things that can be done with hypnosis, and is so powerful that suggestibility is not even a factor (even low suggestible people can experience relief from pain)
Hypnotherapy can assist clients to developing practical skills to assist pain relief, (see the neurology of hypnotic pain relief)
There are various types of pain – acute and subacute, chronic, and neurological – as well as the interaction of physical and emotional pain (such as depression).
Of course hypnotic pain relief should be offered only following a medical diagnosis, and is not a replacement for medical treatment.
In the mid-Nineteenth Century, Scottish physician James Esdaile famously performed hundreds of surgeries in India using animal magnetism, Mesmer’s forerunner to modern hypnosis, for anesthesia.
Since 1995 the United States National Institutes of Health has strongly recommended hypnosis to treat chronic pain; though even at that time the exact working of the process was not well understood.
With the advent of neuroimaging hypnotic pain relief recognized as an empirically-based, standard-of-care treatment by the United States Department of Health and Human Services. Medical studies have shown that hypnotic pain relief used with chemical anaesthesia decreases the need for anaesthetic medications and reduces the length of hospital stays following surgery.
Pain research & the IASP - Definition of Pain 2020
- Pain perception is complicated
• “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
•Pain and nociception(*) are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
•Through their life experiences, individuals learn the concept of pain.
•A person’s report of an experience as pain should be respected.
•Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
•Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
* What is the meaning of nociception(*(?
Nociception refers to the central nervous system (CNS) and peripheral nervous system (PNS) processing of noxious stimuli, such as tissue injury and temperature extremes, which activate nociceptors and their pathways. Pain is the subjective experience one feels as a result of the activation of these pathways.
See study - Individual Differences in PAIN reactivity - •Coghill, McHaffie, and Yen, (2001) - Coghill, Robert C. et al. (2003) Proc. Natl. Acad. Sci. USA 100, 8538-8542
Pain changes the brain
& hypnotherapy can help you to
get back the pre-pain brain state
(Source: Jeffrey Feldman PHD - 2023)
Shut Down - Reboot & Restart
Finding pathways to painfree or pain-less living
Chronic Pain and Central Sensitization
Being in pain for a while - Central Sensitization now termed “Nociplastic Pain"
•“Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain”. (IASP Terminology)
•Persistent pain appears to be mediated by neural plasticity or sensitization, particularly in the medial pain system. The medial thalamus is the principal relay of nociceptive input to the anterior cingulate cortex, and persistent stimulation of this pathway by pain in peripheral tissues changes neurons in the cingulate cortex (Shyu & Vogt, 2009; Zhuo, 2007). Thus, persistent pain, particularly when initiated by peripheral injury or stimulation, is associated with long-term changes in the morphology, neurochemistry, and gene expression in the anterior cingulate cortex, which contribute to the maintenance and exacerbation of pain. (Cao et al., 2009).
•Such central sensitization is characterized by an enhanced pain response to normally painful stimuli (hyperalgesia), a decrease in pain threshold to normally nonpainful stimuli (allydonia), and an increase in spontaneous activity (spontaneous pain).
•Lumley et al. (2011), Pain and Emotion: A Biopsychosocial Review of Recent Research. Jour of Clinical Psych. , 67, 942-968.
Key Cognitive Concerns
Words that Convey Negative Pain Affect::
•Anger – aggravated, irritated, ill, “at my last nerve”, agitated, nasty, unpleasant, uptight, hot, bitter, sore, hair-triggered, fed up, upset.
•Sadness/Depression – sad, hurt, depressed, down, low, blue, dragging, drained, tired, beat, guilty, hopeless, helpless. (flat affect)
•Anxiety/Fear – shaky, nervous, worried, scared, afraid, “it will hurt”, “butterflies inside”, (anxious focus on pain, usually not articulated, but evident in pain behavior).
•The cause of the pain
•Meaning of the pain (reduce anxiety)
•Everything that should be done medically has been done (there is no surgical cure)
•What to expect from medication (control; cognitive functioning)
•How might other approaches help?
•Hurt engendered through physical movement: therapy/conditioning/exercise will not cause harm
•Explaining Central Sensitization/Nociplastic Pain
•Hand repeatedly burned reacting to warmth
Changing Pain Affect by Accessing Positive Emotions
(Positive State Dependent Learning, Rossi, 1986)
•“Discover their patterns of Happiness”
•Milton Erickson (Joe, Tomato Plants)
•“zone” –sports, performing or creative arts
•Loving memories (e.g. grandchildren)
•“Your brain is working correctly” (not all in your head)
•Pain activates the fight or flight/ alarm reaction in response to threat
•This increases the sensory sensitivity of the brain
•(“Turns the dial up on the receiver in the brain”)
•You want to dial it down – activate the parasympathetic/relaxation response
•Deeper, slower breathing
•Clearing/quieting/refocusing the mind
•Often takes the edge off the pain; more so reduces emotional reactions to pain anger/irritability, depression/sadness, anxiety/fear
•“last nerve feeling”
Breathe - tense - yawn
• Relaxed Breathing
• Clenching & release
• better Breathing practice - belly breathing
• Yawning is good!
•“Dialing Down the nervous system” – sensory effective Mindspace - HP
•Acctivation of HP - distance form sensory/feelings
•EEG – measures brain states
•Pain associated with more neurons firing relatively fast (beta frequencies) and less neurons firing at slower (alpha frequencies)
•Hypnotic suggestion for pain relief results in a decrease in beta frequencies with an increase in relative alpha activity
•PET and fMRI measures locations of brain activation
•Intensity and quality – sensory cortices
•Unpleasantness/bothersomeness – ACC
•Comfort and physical integrity – Insula
•Reduced threat and negative implication – amygdala and prefrontal cortex
•Screen out discomfort – spinothalamic tract
• Jensen & Patterson, 2014, pp. 7-9
•“To maximize efficacy, hypnotic treatment should target multiple specific pain domains. Second, clinician should take full advantage of the calming effect of hypnosis on brain activity and processes”
•Jensen and Patterson, 2014, p.9
•Hypnotic induction, like meditation and relaxation techniques, can have in and of itself analgesic effects.
•Additionally, hypnotic suggestion can target a large range of changes
•Hypnosis: “A focused experience of attentional absorption that invites people to respond experientially on multiple levels to amplify and utilize their personal experiences in a goal directed fashion”
•(Yapko, Trancework, p.7)
Auditory - focused attention - deeply focusing on a relaxed state.
Attentional Absorprtion - sensory - somatic - wealth of expereince of life - right at your fingertips - a lifetime of knowledge, skills& resournces to get in touch with;
• The process of knowing by sensory sensation -
•Focus on hands with fingers lightly touching
•Exhale fully, take in a deep breath and close your eyes to increase your focus on your fingertips
•Begin to move your hands in “whatever rhythm feels right for you”
•Continue to focus on your fingertips as your hands move “in whatever rhythm feels right to you”
•“You’ll begin to notice a phenomenon in which your hands seem to get larger and larger in your mind, as everything else seems to fade away”(focused absorption, dissociation)
•“Increase principle” – “what you focus on increases in awareness while what you are not focused on fades away”
•Yapko: “The first lesson of hypnosis: what you focus on you amplify in your awareness”
•“Your hands will increasingly move on their own in whatever rhythm feels right to you, without you having to think about or make them move” (ideomotor movement)
•“and you have many experiences of your hands moving automatically without you thinking about them”
•Brushing your teeth, writing your name, steering your car
•“Your brain knows what rhythmic pattern of kinesthetic input it wants, what feels best, just like you know what music you are in the mood for”
•Calm/soothing; Upbeat/dance, Inspirational/Spiritual, Oldies
•“In this way, creating a feedback loop that transforms (trance forms) excess nerve energy (generated by anxiety/pain) into a calming, soothing input”
resources retrieval - you know so much, do so much - so well...
•Sensorimotor learning – hands moving automatically, musical instrument, keyboard
•Enjoyable sensory experiences – feeling your hands in the sand/water
•Competence/Mastery – “handling things easily”, “the feeling of the ball on your fingers, knowing it will go in before it leaves your hand”
•Flow/In the Zone – (“moving effortlessly, confidently, without thinking”)
•“We are focusing on your hands, not only because they are rich in sensory nerves, but you have a wealth of life experience at your fingertips.”
•“You can get in touch with what will be most helpful to you now”
•“Sensing what you need”
•“You can reach within yourself for what will best help you handle things”
•Positive emotional experiences – “the feeling of a child’s hand in yours”; “getting in touch with what you feel appreciation/gratitude for”
•Coping – “getting a handle on things”, “getting a grip”, “knowing you can handle this”
•Future Pacing – “seeing your life back in your own hands”
Post Hypnotic Suggestion - PHS
•“The more you practice this, the more strongly you will feel a sense of (calm, comfort, control, confidence) flow through you whenever you put your fingers together and move in whatever rhythm is right for you”
•“With practice you will eventually feel this by simply putting your fingers together and moving your hands, not needing to close your eyes”
The CORE principle:
•Utilizing the sensitivity of the finger tips
•Skedung, L., Arvidsson, M., Chung, J. Y., Stafford,C.M., Berglund, B. & Rutland, M.W. (2013). Feeling Small: Exploring the Tactile Perception Limits. Nature: Science Reports, 3: 2617.
•Utilizing the high degree of representation of the hands in the somatosensory cortex
Checking sources & induction 2 -
•Generating counter stimulation
•TENS, Spinal Cord Stimulator
•Longe SE, Wise R, Bantick S, Lloyd D, Johansen-Berg H,McGlone F, Tracey I. (2001). Counter-stimulatory effects on pain perception and processing are significantly altered by attention: an fMRI study. Neuroreport:12(9):2021-5
•Generating a different pattern of stimulation moment to moment, activating the orienting response to novel stimuli
•Lange F, Seer C, Finke M, Dengler R, Kopp B, (2015), Dual routes to cortical orienting responses: Novelty detection and uncertainty reduction. Biol Psychol. 2015 Feb;105:66-71
Checking sources & induction 3 -
•Utilization/Redirection of psychomotor agitation primed by the fight or flight reaction to pain/stress
•Generating and utilizing the relaxing quality of rhythmic sensation
•Self stimulation of infants/developmentally disabled
•Self soothing techniques of dialectical behavior therapy
•Experiential memory – rocking in a rocking chair, swinging on a swing, swaying in a hammock
•“When coherence is increased in a system that is coupled to other systems, it can pull the other systems into increased synchronization and more efficient function. For example, frequency pulling and entrainment can easily be seen between the heart, respiratory, and blood-pressure rhythms, as well as between very low-frequency brain rhythms, craniosacral rhythms, and electrical potential measured across the skin.”
• McCraty, R & Childre, D. (2010). Coherence: Bridging Personal, Social, and Global Health. Alternative Therapies. 16 (4), 10-24.
•“As coherence tends to naturally emerge with the activation of heartfelt, positive emotions such as appreciation, compassion, care, and love, it suggests that such feelings increase the coherence and harmony in our energetic systems which are the primary drivers of our physiological systems. This increased coherence and alignment in turn facilitate the body’s natural regenerative processes”
•McCraty and Childers, 2010
•Sensitivity of the fingers
•Representation of the hands in the somatosensory cortex
•Fight or Flight Reaction/Psychomotor agitation
•Distracting/analgesic effect of counter stimulation
•Brain’s orienting response to novelty
•Soothing quality of rhythmic movement
•Sense memories associated with the hands
•Positive emotions/skills/competencies associated with the hands (encoded experiential learning and experience)
•Pain is a complex subjective experience involving multiple areas of the brain and multiple aspects of prior and current human experience
•There are significant individual differences in sensitivity to and reactivity to pain
•The experience of pain can be influenced by expectations, attention, arousal, affect (emotions), cognitions, and behaviors
•Chronic pain different than acute pain (central sensitization/nociplastic)
•Affective/emotional aspects of pain generally more important than the sensory
•We can influence the affective experience through the language used and the evocation of positive experiential memories (Ericksonian interspersal and utilization)
•The importance of normalizing mind/body techniques
•Hypnotically informed relaxation/breathing technique of therapeutic benefit to most individuals regardless of hypnotic responsiveness
•The relaxation/breathing technique can be used diagnostically to assess responsiveness (rather than an hypnotic suggestibility scale) and suggest what to utilize to individually tailor further treatment
•Analgesic suggestions may not play a primary role in beneficial outcomes of hypnosis at the beginning of chronic pain management
•Ericksonian utilization can be used on multiple levels for pain management/coping.
•Pain and hypnosis research and clinical experiences guides us to shift from traditional hypnosis approaches that focus on anesthesia/ analgesia through direct suggestion to an approach that initially assists a higher percentage of people and subsequently individualizes treatment