Introduction to HypnoAnesthesia

by Ron Eslinger, CAPT, USN, RETIRED, RN, CRNA, APN, MA, BCH, CMI

Introduction

Hypnosis is a fascinating domain of clinical research and practice that involves the study of how ordinary people like you and me can accomplish extraordinary things by using our minds. The way we use our minds in hypnosis involves learning to focus our mind on mental images, thoughts, and ideas that can influence our body’s responses in some very specific and special ways.

There’s a great deal of flexibility in what the mind experiences, including perceptions about the body that we in health care professions have learned through the study of hypnosis. We have learned that people can become so deeply absorbed in their daily life experiences that they can permit their body to be more comfortable, even when there are reasons that perhaps they shouldn’t be. Even when there is an injury or disease that causes discomfort, the ability to use the mind to make the body comfortable is the foundation for what is called hypnotic analgesia or hypnotic anesthesia. It represents the most sophisticated use of hypnosis and it is what hypnosis for pain management is all about.

Teaching and helping individuals to eventually master hypnotically based skills associated with creating comfort within themselves, is the main purpose of the hypnotist. As I discuss hypnotic analgesia and the experience of hypnosis, it is important that you understand what hypnosis is about. Hypnotic analgesia is using hypnosis to reduce or diminish bodily sensations. Hypnotic anesthesia refers to the total elimination of sensations and pain.

Hypnotic analgesia is typically one of the hypnotic phenomena that people react to with the most uncertainty and disbelief. When considering a person is in pain from a physical cause like a disease or injury, people wonder and are skeptical that mind-body medicine can make a difference? Many people even go a step further with a misconception that if you’re in pain, and it is reduced by hypnosis then it must have been in your head in the first place. The meaning being that there wasn’t actually any pain to begin with. I have had many patients say to me, “I don’t know why I was sent to you my pain is not in my head.”

Nothing is further from the truth. In fact, hypnosis has been used as the sole anesthetic in major surgical procedures from the 1800’s to the present. The incision and physical effects are obviously quite real; therefore, the pain is not just in the head, but at the surgical site also. However, there is not pain until it gets to the brain. That is why surgery with hypnosis is a very powerful and dramatic application of the same principles and skills that one can experience through hetero-hypnosis (hypnosis directed by some one else) or self-hypnosis (self directed hypnosis). Hypnosis actually takes the hurt out of pain.

As dramatic and remarkable as surgery is with hypnosis as the anesthetic, you should be aware that it involves the every day routine uses of hypnosis. You can probably remember a time when at the end of the day you discovered a bruise or cut that you were totally unaware of at the time it occurred. In such an experience your mind is distracted from noticing the injury.

The essence of hypnosis for pain management is to facilitate analgesia. With hypnosis you can give yourself control over your discomfort rather than letting the pain control you. Control your thought to control your pain.

Using hypnosis as an adjunct to medicine to relieve pain is important for the following reasons.

• The opportunity for greater self-control and greater personal responsibility for their own level of well-being.

• Letting go of the feeling of helplessness

• Limit the degree of suffering

• Help get back to work and decrease financial burden

• Hold the family together

• Decrease the number of pain related suicides

The ability to experience hypnosis is a natural thing that exists within each of us, which means that we have the ability to reduce the use of medications or even eliminate them all together. Unlike medications, hypnosis has no side effects nor is it addictive. Discomfort is reduced to different degrees in different people and the result is obtained safely and naturally.

Hypnosis permits a higher level of functioning, enhances the healing process while remaining active. Progress is greatly influenced by the expectations of wellness for a positive outcome. It advances the experience of comfort and lessens anxiety and fear, which are very important factors in facilitating recovery or at least in minimizing decline.

You may or may not have experienced hypnosis in the past. However, if you have experienced hypnosis then you know that it is nothing more than focus and concentration in a way of setting aside all the demands and pressures of everyday life so that you can spend a little bit of time with yourself in a way that is easy and comfortable.

If you experienced hypnosis in the past you know that it is a truly enjoyable experience, relaxing experience that feels good. But more importantly, hypnosis opens the doors to new ideas and perspectives on mind/body techniques for health and wellness.

Hypnosis Review

Hypnosis in one form or another has been used throughout the millennium from ancient witch doctors to modern day physicians. Hypnosis is an excellent adjunct to anesthesia. Many operating room nurses and nurse anesthetists use simple hypnotic techniques. They do not realize it is hypnosis but they know that the way they talk to their patients makes a major difference in the patient’s outcome. They know their suggestions are effective because there is confirmation from the Post Anesthesia Care Unit (PACU) staff. The results are less nausea, less vomiting and less pain.

“Ouch! Pain Cost Employers $80 Billion Annually”

Summarized from a Reuters Health/ABC News Story, August 21, 2002

Employers spend eighty billion dollars a year because of employees with pain. Employers also pay large insurance premiums for employee regular medical care. Consider that seventy-five percent of the conditions that people see their family physician for would cure itself with in two weeks. Therefore the amount of money that could be saved by decreasing physician visits by seventy-five is phenomenal. Zig Ziggler, a noted motivational speaker, said, “Most people after they see their doctor for medication will get better in about a week. However, if they don’t go to the doctor it might take as long as seven days to get better.” Amazing, isn’t it? Yet insurance companies just keep paying for treatment and health care costs keep rising. Yet, insurance companies still refuse to pay for the much less expensive preventive health and wellness education and training.

As stated earlier, hypnosis is nothing more than focused concentration that is defined by some as an altered state of consciousness which allows us to be more accepting of suggestions. It is a state that is said to raise awareness by as much as 200 percent, which is focused inward to the subconscious mind. This concentrated focus enhances the ability of the subconscious mind to accept and to positively respond to suggestions. It is often thought that the subconscious mind is located in the brain. Not so according to Candace Pert, a biochemical researcher from George Town University in Washington D.C., who says the subconscious mind is made of every cell in the body. Stating that every cell in the body has its own consciousness and includes over 6,000 receptor sites on the surface of the cell with memory units with in the cell. Each soft tissue cell divides into a daughter cell and becomes a new cell every three months and the mother cell dies off. Skeleton cells go through the process of division and dieing every six months. Each cell’s receptor sites and memories are influenced by the chemical responses we create by our thoughts, which will be discussed in greater detail later.

In 1958, hypnosis was endorsed by the American Medical Association (AMA) as a legitimate tool in health care. In 1955 by the British Medical Society and in 1956 the Pope stated that hypnosis should be used like any medicine would be used.

Because in hypnosis most people have their eyes closed and are very relaxed they look like they’re asleep James Braid coined the word hypnosis derived from the word Hypnos after the Greek God of sleep.

Figure 1: What hypnosis is – is not

The Challenge of Pain Management

The challenge of pain management starts by abandoning the belief that chronic pain is a type of acute pain. Chronic pain is pain that has lasted for at least six months and has not purpose. Therefore, the management of chronic pain is different than for acute pain. Acute pain is relieved with traditional medications and when there is no longer a need for the pain it does not return. On the other hand chronic pain may receive relief, but the pain keeps returning and so more and more medication is needed and in many cases there is no relief. Because of the chemical message received a wide dynamic range of neurons may physiologically change, as in the same manner there is adverse physiology from unrelieved pain. This has lead to physicians specializing in pain management.

Pain management clinics are popping up across the country because of the inability for most physicians to deal with the number of pain patients flooding their office and their ability to offer only limited treatment composed mostly of addicting medications. The techniques used in pain management clinics are very expensive. Unfortunately, many pain management clinics do not incorporate the mind/body connection. The reasons are that they do not know the techniques and because insurance rarely pays for complementary or alternative medicine. These clinics measure their success rate by patient having a 50% improvement in pain relief. Adding hypnosis to pain management greatly increases the success rate.

More than 50 million Americans are partially or fully disabled by chronic pain

• 4 in 10 with moderate to severe pain do not have adequate relief

• 26 million have frequent or persistent back pain

• One American in six has painful arthritis

• Such pain contributes to impaired ambulation, sleep disturbance and depression

Four in ten Americans with moderate to severe pain do not have adequate relief. One American in six has painful Arthritis. Twenty-six million Americans have frequent or persistent back pain, which is inadequately treated by most physicians. Dr. Ronald Seigel, Psy.D., in his book Back Sense discusses how most physicians treat pain exactly the opposite way it should be treated. Inadequate treatment of pain led the Joint Commission for Accreditation of Health Care Organizations (JCAHO) to set the 2000 standard for pain management and assessment to deal with the major changes in life pain creates economically, emotionally and in family dynamics.

Thoughts become things

Every time we have a thought, we create a new neuron within the brain. Therefore, if we dwell on pain we create pain responding neurons. The more pain responding neurons we create the more pain we have. Or we can think: “I’m getting more comfortable. I feel better now.” And we create neurons and connect them for comfort. So the cliché, use it or lose it can be applied here. If you don’t keep rebuilding them, they go away. The neurons disconnect and atrophy; just like a muscle can atrophies when not used. Think about it, which would you rather lose, the pain or the comfort? Only you control your thoughts, so the decisions belongs to the one with the pain.

Unrelieved pain develops the same physiology as stress. These include; irritability, high blood pressure, increased pulse rate, and a slew of other body changing problems.

Pain is Multifactorial

Pain is physical, psychological, sociological, and spiritual.

Pain is physical in that it hurts and creates physiological changes in the body. Some of these changes are related to the body’s stress response which produces adrenalin, cortisol and activates the immune system. Pain also decreases one’s ability to work or play due to the physical discomfort..

Pain is psychological. It affects how we think of ourselves as a complete person. One does not feel like an asset to himself, family or to society as a hold. It is difficult for Patients who are accustomed to medications to accept a psychological treatment. It is common to hear; “Well I don’t know why they sent me to you. This ain’t in my head.”. However since pain is only an electrical impulse until it gets to the brain in actuality it is in the head. There are over 3,000 different chemicals in the body that are responsive to our thoughts. Among these are endorphins, melatonins, and seratonins. By helping a person change their thoughts they can effect the stimulation and production of these chemical hormones that can lessen pain.

Pain is sociological because it involves not just the person with the pain but also the surrounding environment. The person with pain does not feel like socializing. Uncomfortable in attending children’s school activities, or have marital relations. You have probably heard the saying: “If mamma ain’t happy, nobody’s happy.” Pain affects the immediate and extended family.

Pain can be spiritual as was shown in a double-blind study using prayer using prayer groups that prayed for people who did not know they were being prayed. There was a significant positive effect for the group being prayed for. The Sylvan Mind Control group reported such studies in the 70s and it has taken over 30 years to reach mainstream thinking. The movie What the Bleep. . . do we know anyway discusses quantum physics and the connectedness of everything.

There are those who think physicians see only the pain and not the whole patient. In many cases they are right, however if one is able to look beyond the sensory aspect of pain into the emotional suffering that pain causes they can see that pain represents many things in the pain sufferer’s life. These may be physical limitations, economic ruin, broken families. Chronic pain can destroy a person’s life. However, the true pain horror is the fear of not getting relief from medications or procedures. Many feel they are helpless and have no control over their life when they have chronic pain. Unfortunately physicians do not know how to handle chronic pain either.

Chronic pain is defined pain lasting for six months or more that serves absolutely no functional purpose. Yet it limits function and quality of life in different ways for different people. Some use it as an excuse for not having to hold a job, while others may see it as a punishment. There are numerous ways that people to respond to their pain, regardless one thing is constant and that is that pain changes the quality of their lives. Hypnosis is proven to reduce pain and therefore improve function and quality of life.

Importance of Controlling Pain

The underlying purpose for controlling pain is to preserve hope and decrease suffering. The normal procedure is to start with medications either over the counter or by prescription; later progressing to pain clinics for epidural steroids, trigger-point injections, or T-Electrical Nerve Stimulation (TENS) units in order to relieve suffering. Unfortunately most physicians don’t but should instruct their patients change their self-talk by dropping the following words from their vocabulary: if, maybe, hope, cant, won’t and later. Pain patients should also let go of past events, negative words. It is time to train patients how to change their thinking about themselves and their pain.

Preventing debilitation will allow for muscle exercise and strengthening, aid the heart, and ventilation of the lungs leading to oxygenation of the cells. Suggestions to improve treatment compliance by follow their doctor’s orders is very important. Any changes in medication are between them and their doctor. It is very scary to learn the percentage of patients that do not pick up their prescriptions and the one that do who never take them.

Pain the 5th Vital Sign

The JCAHO 2000 pain standard is known as the 5th Vital Sign is written to greatly encourage the use of non-pharmacological treatments because of the number of addictions and abuse of narcotics among chronic pain patients. The NIH also has the evidence-based research on the effects of hypnosis and relaxation techniques in the successful treatment of chronic pain.

One can be relaxed without being in hypnosis and hypnosis can occur with out being relaxed; however, most people easily enter hypnosis when relaxed. Some examples of a hypnotic state are driving to work and not remembering passing buildings or intersections or watching TV and being unaware when some one enters the room. These are critical times because the thoughts or daydreams that accompany these times are more open to suggestion.

We enter highway hypnosis while all the time the billboards on the side of the road are imprinting subliminal messages into the subconscious mind. Advertisement agencies have understood for years the power and success of subliminal suggestions. Examples are: Things go better with ____. I would walk a mile for a ________. Double your pleasure, double your fun with ______. Think of which commercials you remember and why. Today’s commercials may not even tell you the name of the products. You’re looking at it subliminally. Then they’ll have this little thing at the bottom that tells you what the product is.

Hypnosis in managing pain

Hypnosis, as evidenced by its multi-centennial history-it’s been around forever and ever. In proper perspective, hypnosis may not only relieve pain but may also help to maintain the dignity and the well being of the patient without dependence on large quantities of medication.

It appears that the majority of chronic pain patients sleep better once they learn the use of self-hypnosis. This is important in that it takes six hours of sleep for sleep to be restorative sleep. Six hours for your body to restore itself from all of the rigors of the day before. Therefore, there are a many benefits in improving the quality and quantity of sleep for chronic pain patients. The body can restore and heal while decreasing the amount of pain and the over all quality of life.

Interpreting Pain

When we experience acute pain as when we touch something hot we jerk it away. That’s our warning system. It tells us if you hold on to that too long you’re going to get burned. If you hold on it too long you become very consciously aware of the burn, but now unconsciously, subconsciously there’s lots going on in your brain because it’s got to send out platelet. It’s got to get the immune system activated. It’s got to redirect more blood flow to that area. It’s got to start all these things. It’s got to get the immune system down there. It’s doing all these things to protect you because it hasn’t determined yet how bad your injury is.

So you get the injury. It sends it up to the brain. The brain takes that electrical impulse-that’s all it is now. It’s nothing more than an electrical impulse. When it gets to the brain it turns into a hormone, a neurotransmitter. And at that point then the cells start talking to each other and your brain starts trying to make up what we can do. So the beauty of hypnosis is, and other non-pharmacological ways, is we can interrupt it.

One of the things that I can do with people, especially with phantom limb pain or peripheral pain is so easy because you just have them to turn off the pain. You can put a switch right in the spinal canal at the dorsal horn ganglion to turn off or turn down the pain. You can also have them pretend they are in the control room in their mind. There are lots of creative ways that one can do imaginary which the body responds to.

So what we want to do is to put a block–. It’s the same thing we do when we put in an axillary block. Same thing we do when we put in a spinal block. We’re blocking that impulse from getting to the brain. That’s one of the reasons now we found out what? If we go ahead and infiltrate some medication, Morphine or Fentenyl or something before making incisions and stuff, we have a lot less problem with pain afterward.

Now Ron’s theory is-one of the reasons that I saw all this chronic pain-is when we use our halogenated agents and when we use narcotics and versed that the brain loses its ability to understand exactly how it’s supposed to deal with the pain. It doesn’t know what it’s supposed to do, so it sends back the wrong message. It gets interpreted wrong. It’s not now sending out its own endorphins. It’s not doing the things it’s supposed to do because it doesn’t understand that message because we’ve interfered with it getting there.

So therefore, by pre-dosing either with an injection or using a regional technique along with our general anesthesia, we make a big difference in the pain threshold and the pain complaints of patients after surgery.

So what we can talk about here is-and that’s why I just said if the brain doesn’t understand that signal-then we can come back and using psychological techniques, hypnosis being one of those, to retrain the brain on how to respond because the Limbic System knows how to do that.

Two Aspects of Pain

Now there are two aspects of this pain that we have to deal with. One is sensory and it’s discriminative. It occurs when neural processes converge so the person can quickly pinpoint the location, intensity, and duration of the painful stimulus. That’s acute pain. We reach out, we touch it, and we turn it loose if we’re smart.

We’ve seen people walk across hot coals and not get, because mentally they’ve turned it off-that electrical impulse-from getting to the brain. You turn it off in your brain. There is no pain until it gets to the brain. That’s the one thing you have to keep in mind.

The motivational-affective aspect refers to the emotional response that makes pain personal and unique for every one. That’s why some women with no problem can go through natural childbirth and feel nothing, while others just the thought about, “Oh I think I may be having a contraction” sends them into oblivion or the same thing with some people who have to go in for dental work. Some need anesthesia. Some don’t. Or you just hurt your hand or you get a broken arm. Some people respond in different ways than other people. We all have different amounts of neurotransmitters.

In conclusion, hypnosis allows us to direct our thoughts and our thoughts determine create biochemical and physiological responses in our bodies. That is why hypnosis is one of the best ways of creating pain relief and unlocking the reason for individual chronic pain.

References:

Barber, Joseph, Hypnosis and Suggestion in the Treatment of Pain, W. W. Norton & Company, 1996

Crasilneck, Harold A. , Ph.D. and Hall, James A. , M.D., Clinical Hypnosis: Principles and Applications, New York: Grune and Stratton, 1975.

Yapko, Michael D. Trancework, An Introduction to the Practice of Clinical Hypnosis. New York, Brunner-Routledge, 2003.

Copeland, Rachel, How to Hypnotize Yourself and Others, New York: Harper and Row, 1982.

Hilgard, Ernest R. and Josephine R. Hilgard, Hypnosis in the Relief of Pain, Brunner/Mazel, Inc. 1994

Copyright © 2006 Ron Eslinger