While how it works is not fully understood, hypnosis shows potential for being part of a multi-pronged pain management approach.
Pain relief involving hypnosis remains mysterious but can no longer be called a myth. Pain, after all, is a composite experience produced by various parts of the central nervous system, not simply the result of tissue damage.
Psychological techniques and interventions that modify activity in the brain and spinal cord can alter pain perception.
During a clinical hypnosis session, a trained professional brings about a trance-like state of heightened inner concentration and then helps the patient via suggestions geared towards better emotional or physical well-being.
Scientists have long known that hypnosis is effective in alleviating pain, but speculation rages as to why it works. Two areas of the brain appear to be involved in processing pain: the anterior cingulate cortex and the somatosensory cortices.
One study showed hypnotic suggestions addressing the ‘unpleasantness’ of pain elicited changes in the anterior cingulate cortex but not the somatosensory cortices. Meanwhile, suggestions targeting the intensity of pain elicited changes in the cortices but not in the cortex.
This is evidence that hypnosis alters pain perception by changing activities in brain areas associated with pain processing.
Another way to prove this is by doing it in reverse: inducing pain with hypnotic suggestion.
In this study, researchers compared brain scans of participants who were subjected to mild pain via a heating pad on their hand, hypnotically suggested pain, or were just asked to imagine pain while not under hypnosis.
Not only did the participants report experiencing pain when it was suggested under hypnosis, the scans showed their brains lit up in a similar way to those with real pain. The scientists did not see such patterns when they asked participants to simply imagine pain.
Another study found that good pain relief from hypnosis can be achieved when directly suggesting numbness. For example, “You cannot feel pain because the glove you are wearing prevents you from feeling it.”
Some people are more susceptible to hypnosis than others. An individual’s level of ‘hypnotisability’ is influenced by biological, psychological and socio-environmental factors and can vary from situation to situation.
Medium to high suggestibility individuals were estimated to experience 29 to 42 percent reductions in pain while low suggestibility individuals had minimal benefits at around a 17 percent reduction.
With more than 80 percent of the general population being in the medium to high hypnotic suggestibility range, hypnosis is potentially very useful.
On top of reducing pain, hypnosis can reduce the amount of painkiller medications and mental distress associated with surgery and medical procedures. Multidisciplinary long-term pain management is another important application of hypnosis.
The fact that pain can be hypnotically induced means the risk it could be caused unintentionally should be investigated. This also highlights the need to improve the regulation of current practices.
One review of the safety of clinical hypnosis found no evidence of ill effects in individuals treated with hypnosis. But the level of professionalism of the hypnotists was presumed to be high in these studies.
Whether hypnosis can be effective and safe when done by individuals with minimal professional training remains to be seen.
Like all clinical interventions, hypnosis to relieve pain should be done by legitimate clinicians who have been professionally trained to manage a given condition. Having training in hypnosis alone does not qualify someone to manage pain.
This is because the treatment and techniques are not inherently meaningful, rather it is people’s ability to properly employ them that matters more. Pain relief will not occur by simply performing hypnosis, similar to how we should not expect patients to be up and about just after surgery.
Pain, as a complicated phenomenon, should not be approached with a single-mode solution. Hypnosis could be implemented alongside a complete treatment plan by trained professionals for clinically meaningful changes to occur, and regulation will be required if hypnosis is to become a reputable therapeutic approach.
Lee Ji Kwan is a practising clinical psychologist and teaches at Monash University Malaysia. He declares no conflict of interest.