SCI Forum Reports

Relaxation and Hypnosis for SCI Pain

October 11, 2005—“As everyone in this room probably knows, pain is a problem for many people with SCI,” said Katherine Raichle, PhD, a psychologist and postdoctoral fellow in the UW Department of Rehabilitation Medicine. Over and over, studies reveal high rates of pain in the SCI population, and for many the pain is severe and disabling.

“Pain in SCI can occur above, at or below the level of injury and can have different causes,” Raichle continued. “We used to believe that you couldn’t experience pain below the level of injury, similar to how we once believed people with amputations couldn’t feel phantom limb pain. We know now that’s not true.”

“A common kind of pain in SCI is neuropathic pain, which is caused by damage to the central nervous system (brain or spinal cord) or peripheral nervous system (legs and arms). Neuropathic pain is often difficult to treat effectively.”

Persons with SCI also experience other kinds of pain, such as musculoskeletal pain from overuse injuries due to years of wheelchair propulsion and/or the use of other assistive devices. Regardless of the cause, pain that lasts longer than three months is considered chronic pain. This contrasts with acute pain, which goes away after healing takes place.

It’s very important to treat chronic pain, Raichle said, because it can negatively affect many areas of people’s lives, contribute to depression and stress, and cause functional limitations above and beyond the impact of the SCI itself. “If we treat pain effectively, we can have a huge impact on quality of life.”

“Significant pain problems in SCI don’t tend to go away on their own over time,” she went on. “Often people try many different types of medications, and there does not yet appear to be a treatment that tends to help everybody.” For this reason, researchers at the UW and elsewhere are looking for new treatments and new approaches.

Raichle and her colleague Travis Osborne, PhD, are working on a number of studies at the UW looking at non-medication-based treatments for pain in persons with chronic illnesses and injuries. One of these is a study investigating the effectiveness of relaxation treatments for SCI pain that involve hypnotic components.

What is (and isn’t) hypnosis?

“Hypnosis has a lengthy history of use within the medical field, especially for pain,” Osborne said. “It’s interesting because when most people think of hypnosis they don’t usually think of treatment but of something from the entertainment industry. As a result, people often think hypnosis is something that is used to make people do embarrassing things.” Osborne reviewed some common myths about hypnosis.

Common myths

Hypnosis is like being asleep. False. Stage hypnosis looks like sleep, but sleep is a state in which you’re actually unconscious and unaware of what’s going on around you. A hypnotic state is in fact a state in which your mind is quite active and your attention is focused and absorbed in a particular image or series of suggestions, and you’re completely conscious. “If you’re asleep, it’s not hypnosis,” Osborne said.
You don’t remember what happens during hypnosis. False. Because they are awake and conscious during hypnosis, most people have a fairly good memory of what happens to them in a hypnotic state. But this can vary depending on how deeply relaxed a person is during hypnosis. “If you don’t remember everything that happens,” Osborne said, “it may be because you’re focusing on one thing in particular and not paying attention to anything else.”
During hypnosis, the therapist controls you,and you are giving up your free will. False. In the treatment setting the role of the therapist is to act as a facilitator or guide to help you achieve this state. The patient is the one who’s doing the focusing. While in a relaxed state, people tend to respond only to suggestions that are consistent with their personal values.
You are passive during hypnosis. False. You cannot be hypnotized against your will. Entering into a hypnotic or very relaxed state requires the individual to be a very active participant, to actively focus his or her attention.
You can be hypnotized without your consent. False. Again, you are directing where your attention is going. No one else can force you to do that.
You can remain stuck in a hypnotized state. False. Although you may feel groggy or take a while to become alert after hypnosis—like waking from a nap—you cannot become stuck in this state.

What is hypnosis?

According to Joseph Barber, PhD, a psychologist who specializes in hypnotherapy and hypnosis research, and who trained Raichle and Osborne, hypnosis is “an altered condition or state of consciousness characterized by marked increased receptivity to suggestion, the capacity for modification of perception and memory, and the potential for systematic control of a variety of usually involuntary physiological functions (such as glandular activity, vasomotor activity, etc.).” 1 The actual mechanisms behind how it works, however, are not fully understood.

In a hypnotic state, a person becomes increasingly absorbed in one thing. Raichle noted that this is actually a very common, natural process. “We all experience hypnotic states to some degree in our everyday lives, times when we are so absorbed in something that we are unaware of what’s going on around us.” In these trance-like states we do things “on autopilot”—without attending to what we are doing, tuning out all other awareness. Raichle admitted this often happens on her drive home if she’s been listening to an absorbing radio program. “I literally can’t remember how I got home.”

How easily a person can be hypnotized depends somewhat on one’s ability to focus his or her attention and become absorbed in his or her experiences. “It’s a skill,” Raichle said, “and as with all skills, some people are naturally better at it than others. Practicing can improve your skill.” Other variables, such as rapport between the therapist and the client, can also have an effect on the experience.

In treatment sessions, the therapist uses suggestions to help the individual achieve a hypnotic state and attain a desired outcome, such as reduced pain or anxiety. “We try different types of suggestions to see what works with each person,” Raichle said, such as prompting the person to imagine the pain is diminishing or changing in some way that might make it more tolerable.

Research on hypnosis for pain

Most of the clinical trials on hypnosis so far have focused on acute pain caused by tissue damage (such as burns or surgery), painful medical procedures, or childbirth. “These are all acutely painful situations with a clear beginning and clear end,” Raichle noted. “Hypnosis has clearly been shown to be helpful in these studies.” In several controlled studies (studies that compare treatments by randomly assigning patients to receive different types of treatment), hypnosis was found to be more effective than no treatment or standard care and as or more effective than other non-medication forms of treatment such as relaxation or cognitive-behavioral therapy. 2

Unlike acute pain, chronic pain persists well after healing is complete. In the controlled studies that have been conducted that have focused on chronic pain , “hypnosis was generally superior to a variety of control conditions (e.g., no treatment, standard care) and comparable to other viable treatments (e.g., relaxation training, autogenic training),” Raichle reported. It is important to note that these studies focused on chronic pain associated with conditions other than SCI (i.e., cancer, fibromyalgia, headaches, back pain) 2 . More controlled trials are needed for a variety of chronic pain conditions, including chronic pain related to SCI.

UWMC Research Study

Raichle and Osborne are part of a research group at the UW’s Department of Rehabilitation Medicine conducting a 5-year NIH-funded clinical trial of relaxation treatments for SCI pain. The study, conducted by Mark Jensen, PhD, is currently in its 4 th year and is accepting new participants.

Study participants are randomly assigned to one of two treatment conditions, both of which include hypnotic and relaxation components. One method uses verbal suggestions for relaxation and the other incorporates biofeedback for relaxation training. The study objective is to see if either or both are effective in managing or reducing SCI pain. Participants receive free treatments and payment for completing interviews associated with the study. Sessions can be conducted at the UW Medical Center or the subject’s home, depending on how far from the medical center an individual lives.

To be eligible for the study, subjects must be 18 or older and injured for at least 6 months, and have ongoing pain that interferes with daily life. Participation takes place over 12 months and includes the following phases:

Screening phase—telephone screening interview and in-person consent session.
Baseline phase—medical exam; 8 weeks of daily pain ratings.
Treatment phase—ten treatment sessions typically spaced over 3-5 weeks, though the treatment schedule varies from person to person depending on scheduling needs
Follow-up—in-depth interviews at 3, 6, 9, and 12 months; brief interviews on alternate months.

“The study focuses on skill development so people can continue to use the skills after the treatment sessions,” Osborne said. “We provide people with audiotapes of the sessions so they can practice on their own. Like any other skill, the more people practice these methods for pain management, the more benefits they typically experience.”

For information about this study, call 206-616-9058 or 800-377-9707 or email painstdy@u.washington.edu.

References

Barber, J. (1996). Hypnosis and suggestion in the treatment of pain: A clinical guide. New York : W W Norton & Company.
Patterson, D. R. & Jensen, M. P. (2003). Hypnosis and clinical pain. Psychological Bulletin, 129, 495-521.