Chronic pain, a persistent and pervasive health issue affecting millions globally, demands a multifaceted approach that extends beyond conventional pharmacological solutions. In the United Kingdom, chronic pain takes a toll on a significant portion of the population, affecting roughly one‑third to one‑half of its inhabitants.
Classifying the pain we feel
The National Institute for Health and Care Excellence (NICE) guidelines classify chronic pain as either primary or secondary pain. Secondary pain is the pain that is related to a diagnosed condition such as osteoarthritis, rheumatoid arthritis, ulcerative colitis, or endometriosis.
Chronic primary pain has no clear underlying condition or the pain (or its impact) appears to be out of proportion to any observable injury or disease. ICD-11 gives examples of chronic primary pain, including fibromyalgia (chronic widespread pain), complex regional pain syndrome, chronic primary headache and orofacial pain, chronic primary visceral pain and chronic primary musculoskeletal pain. The prevalence of chronic primary pain is unknown, but is estimated to be between 1% and 6% in England.
The NICE guidelines for chronic pain make recommendations about the management of the two different types of pain, including a recent change which guides medical professionals towards offering non-pharmacological management options.
Research indicates that nearly two-thirds of individuals reporting chronic pain in 2019 continued to experience it a year later. This blog delves into the intricate landscape of chronic pain, exploring the medical facts surrounding its persistence and the evolving strategies in pain management, with a special focus on the role of hypnotherapy.
Understanding the Scope of Chronic Pain
The NIH Pain Consortium emphasises the importance of recognising pain as both a broad public health concern and a set of individual circumstances, urging an individualised and whole-person approach to pain management. This approach acknowledges the unique nature of pain experiences, shaped by social and physical environments, genetic makeup, and the condition causing the pain.
Recent research efforts have unveiled promising insights into the neural mechanisms of chronic pain. Clinical trials, using advanced technologies such as neuroimaging, have identified brain regions associated with pain perception and severity. These breakthroughs signify a collaborative effort to bridge gaps between basic research, clinical trials, and implementation science.
Pain Education and Collaborative Care
A holistic approach to pain management necessitates collaboration between healthcare providers and patients. Pain education equips individuals with the knowledge to comprehend the underlying causes of pain, treatment options, and coping mechanisms. Regular updates in pain education empower patients to adapt their pain management strategies in line with evolving options.
Technological innovations, including virtual reality and wearable devices, are emerging as alternative modalities for pain management. Virtual reality provides immersive distractions from pain, while wearable devices and smartphone apps enable individuals to track pain levels and medication effectiveness. Many of the techniques embraced by VR and wearable devices have their roots in hypnotherapy and other somatic practices. Hypnotherapy has demonstrated efficacy in conditions ranging from chronic pelvic pain to headaches.
The Emerging Role of Hypnotherapy in Pain Management
Conducted by trained professionals, a hypnosis session induces a trance-like state of heightened inner concentration, employing suggestions tailored to enhance emotional or physical well-being. The effectiveness of hypnosis in alleviating pain has long been acknowledged, yet the underlying mechanisms triggering its efficacy remain speculative.
As mentioned previously, research has identified two key brain areas involved in pain processing during hypnosis – the anterior cingulate cortex and the somatosensory cortices. Studies have demonstrated that hypnotic suggestions addressing the “unpleasantness” of pain induce changes in the anterior cingulate cortex, while those targeting the intensity of pain lead to alterations in the somatosensory cortices. This supports the idea that hypnosis modifies pain perception by influencing activities in brain regions linked to pain processing.
The reverse experiment, inducing pain through hypnotic suggestion, further corroborates this phenomenon. Brain scans of participants subjected to hypnotically suggested pain mirrored the patterns seen in those experiencing real pain. The unique neurological response seen under hypnosis reinforces the argument that hypnosis has a tangible impact on how the brain processes pain.
Individual susceptibility to hypnosis, often termed “hypnotisability,” is influenced by a complex interplay of biological, psychological, and socio-environmental factors. Medium-to-high suggestibility individuals experience substantial pain reduction, ranging from 29-42%, while their low-suggestibility counterparts exhibit more modest benefits at around 17%.
Data from research conducted back in 1965 support the position that hypnotic suggestibility roughly conforms to a bell-shaped distribution in the population, with fewer people falling at the extremes and most people in the middle. This means that hypnosis emerges as a potentially powerful tool in pain management with the ability to support the majority of individuals.
Beyond its pain-relieving properties, hypnosis demonstrates promise in reducing the reliance on painkiller medications and relieving mental distress associated with surgeries and medical procedures. Its application extends to multidisciplinary long-term pain management strategies.
However, the ability to hypnotically induce pain raises questions about unintended consequences, emphasising how important it is for improved regulation of current practices. While reviews of the safety of clinical hypnosis have shown no evidence of ill effects, the level of professionalism among hypnotherapists is a crucial factor. The need for rigorous training and adherence to professional standards is paramount, as hypnosis, when conducted by inadequately trained individuals, may pose unknown risks.
In essence, hypnosis stands as a valuable adjunct in pain management, provided it is administered by qualified clinicians trained to navigate the intricacies of specific pain profiles. Acknowledging pain’s multifaceted nature, health professionals must adopt a holistic approach, integrating hypnosis into comprehensive treatment plans for meaningful and clinically significant changes. The path to establishing hypnosis as a reputable therapeutic approach entails stringent regulation and a deep understanding of its nuanced application in the diverse landscape of pain management.
As Pain Awareness Month ends, it’s important that we keep searching for holistic solutions to these complex issues. To find a hypnotherapist near you who has been trained to a high standard and who upholds a code of conduct for professional practice, you can visit the National Council for Hypnotherapy’s Therapist Finder.