Hypnosis - An option for Chronic Pain

With advances in science, we have learned many things on how our brains experience pain.  We have learned that our brains do not have a "pain center".  Our brains are more like a "pain matrix" because multiple areas of our brain become active when we experience pain.  We have also learned that input from outside of the brain can and often does play a role in how we experience pain.


Science can now observe the direct effects hypnosis has on brain activity and how this can also affect the areas and structures within the pain matrix of our brain.


The pain matrix includes the sensory cortex (the area of the brain that is active when we feel sensations); the anterior cingulate cortex (the area involved with processing information about how pain makes us feel); the insula (the area that beomes active when something is perceived to be wrong with the body); and the prefrontal cortex (the area of the brain that is likely involved in the meaning we give to our sensations and experience).


These areas of the brain can also influence each other.  So when we think that our pain may indicate something is broken or breaking (prefrontal cortex), the pain can increase in intensity (sensory cortex) or can worry us more (cingulate cortex).  This influence allows a new understanding about our brains and can also explain how the same level of stimulation can be felt differently by different people.  It also explains how hypnosis can also effect our experience of pain.


Controlled clinical trials have shown that hypnosis is consistently "more effective" than no treatment and is either "more effective" or "as effective" as other effective pain treatements, proving that hypnosis has more than just a placebo effect.


Hypnosis in itself is not complicated.  It is simply defined as an induction followed by a suggestion or a set of suggestions.  The induction focuses ones attention on a voice, a point of light, or a mark on a wall.  This focused attention or awareness has been shown to make people more receptive to suggestions that can change their experience.  In dealing with chronic pain the induction is usually followed by suggestions to feel pain sensations differently, to be less bothered by these pain sensations, to think differently about pain, to be better able to ignore pain, or some combination of the above suggestions. 


The hypnosis session usually ends with the suggestion that provided relief during the session will last beyond the session.  Hypnosis is not receommended as a sole therapy for the treatment of chronic pain due to its complexity, but can work as part of a comprehensive pain treatment program.


I have used hypnosis and positive visualization as part of my pain treatment program.  I have found it to be successful in helping me sleep and to relax me while I am using the chi machine. 

Reference:  "Hypnosis for Chronic Pain Management: New Evidence for an Old Treatmet" by Mark P Jensen, PhD

Electrical Stimulation of Nerves for Chronic Pain

Transcutaneous Electrical Nerve Stimulation (TENS) or Spinal Cord Stimulators (SCS) for Chronic Pain

What is it:  It is the application of  mild electrical current to the nerve fibers using electrodes, either internally (Spinal Cord Stimulator) or externally (TENS Unit).  This stimulation is characterized by current, pulse width, and changes in frequency.  The rationale to use electical nerve stimulation is based on the gate theory.  The gate theory proposes that pain perception depends on the balance of large and small diameter nerve fiber acticivty and that an increase in large nerve fiber activity can potentially "close the gate" to inofrmation going to the brain from small pain fibers.  When the gate is closed, the tramission of pain signals to the brain is blocked.

How effective is it?

There are conflicting reports on the effectiveness of  TENS and SCS.  Some doctors say both methods can be effective and some doctors feel that both methods can be ineffective.  Some doctors tend to feel that implanting the stimulator (Spinal Cord Stimulator) is more effective then using the external stimulators (TENS).  Wall & Sweet changed their opinion of application reporting that electrical nerve stimulation provided succesful relief of chronic pain directly through the skin alleviating the need for surgically implanted devices.  I just recently read an aricle that stated the reverse. 

I did seem to find one consensus of opinion that most all doctors seem to agree on is that you should do a trial stimulator before the surgically implanted one.  Doctors feel that you should only get a surgically implanted stimulator, if the trial stimulator reduces your pain by 50%.

I have found through talking with individuals, that some have found both forms beneficial, TENS and SCS.   For myself, external electric nerve stimulation has had a positive effect on my chronic pain. I chose not to do a surgical implant since I agree with Wall & Sweet, external is as effective as internal.  You will have to draw your own conclusions.  For more information on the risks and benefits of Spinal Cord Stimulators.

References:  "Electrical Stimulation Therapy" by Jeffrey Larson, PT, ATC;

"Effectiveness of Transcutaneous Electrical Nerve Stimulation for Treatment of Hyperalgesia and Pain" Josimari M. DeSantana, PT, PhD, Deirdre M. Walsh, PT, PhD, Carol Vance, PT, MSc, Barbara A. Rakel, RN, PhD, and Kathleen A. Sluka, PT, PhD

"Spinal Cord Stimulation in Patients with Chronic Reflex Sympathetic Dystrophy", Marius A. Kemler, M.D., Gerard A.M. Barendse, M.D., Maarten van Kleef, M.D., Ph.D., Henrica C.W. de Vet, Ph.D., Coen P.M. Rijks, P.T., Carina A. Furnée, Ph.D., and Frans A.J.M. van den Wildenberg, M.D., Ph.D.

Scientists Discover New Treatment for Chronic Pain

ScienceDaily (Feb. 7, 2010) — Scientists at the University of Liverpool have discovered that treating the immune system of patients with Complex Regional Pain Syndrome (CPRS) leads to a significant reduction in pain.  Read the full article at http://www.sciencedaily.com/releases/2010/02/100201171417.htm.  I found it interesting.