There are two types of pain 1) Acute pain – if you fall and your attention is pulled towards where you feel pain to alert you to the injury and 2) Chronic pain – which can occur after an injury has healed, or through some illness such as Fibromyalgia or shingles.
It was French philosopher Descartes who originally came up with the idea that pain is a simple reflexive response to injury. The larger the injury the more pain a person experiences. We know this is not necessarily true, as we now know about endorphins and neurotransmitters, which can play their part in masking the pain until the person is “out of danger”.
Melzack and Wall, first put the gate control theory of pain, forward back in 1965. Their research found that there is activity in both the peripheral and central nervous systems which influences our experience of pain, so instead of the brain being the part of the system that just receives the information, it was discovered there are multiple networks contributing.
The nerve fibres that transmit physical damage are called C fibres – which do not contain myelin, and A-delta fibres – which do have a myelin sheath, and A-beta associated with touch.
When we injure ourselves the messages are transmitted along the fibres, but pain is not experienced until certain networks in the brain become activated. The messages come from the injured part of the body, but there is also activity going from the brain to the injury. The area of the brain controlling this is called the periaqueductal gray or PAG, it receives electrical input from the insula, the anterior congulate cortex and the sensory cortex – all areas know to process pain signals – and also to produce analgesia.
The Anterior Cingulate Cortex lies between the brain’s two hemispheres, it does a lot of the processing work and research has found that it relates to the emotional component of pain. The Insula is responsible for a number of physical conditions such as whether we feel hungry, thirsty, itchy or in pain. If this part perceives it’s threatened it rings the alarm bells.
The Prefrontal cortex evaluates the meaning of pain and how to respond. When our PFC is more active we feel less pain, because it sends messages to the PAG to close the gate.
Now we have sorted out which part of the brain does what, how does that relate to hypnosis?
Pain is very much influenced by our psychological state and it has to consider ideas such as meaning of pain, if a person accepts the pain or whether they are fighting it. When people catastrophise about pain – “My pain is stopping me from what I want to do” they also experience more anxiety, distress, depression, helplessness and hopelessness – and more pain.
Belief systems come into play – recent research into paracetamol has shown it’s about as effective as a sugar pill, so placebo plays a large part it overcoming pain. Accepting pain and being able to move on with managing the pain is key in coping. Many Arthritis sufferers for example were found to think that all pain meant physical damage was being done, and so guard them from further pain. This often results in a person adapting a stance, which puts too much pressure on another joint – by limping – or stops them from exercising.
During hypnosis, we find the brain functioning in a slightly different way. Dissociation allows certain parts of consciousness to split from one another, so we can block out noise so we can concentrate on one thing (my father often does this when engrossed in a television programme and can’t hear what my mother is saying – well that’s his excuse!) Or we can change what we feel and even numb parts of our body if necessary.
There is also evidence that stress decreases our pain threshold – think about how long someone can hold their hand under iced water, then relax them and visualise somewhere warm, and the length of time their hand can rest in the bucket increases. Hypnotic suggestions can influence the chemical, inflammatory and other physiologic processes at the site of injury and alter responses of the nociceptors.
One’s imagination is powerful, if you think about eating certain foods, you might just find your mouth watering – think how powerful TV adverts have on our minds, telling us to enjoy ice cream even when we’ve just eaten a large meal and nothing more could pass your lips! Research has also found that hypnotic analgesia can influence the nervous system activity on the spinal cord.
When using hypnotherapy to ease or change perception of pain I work very much with the individual. For some people lying in a boat on a lake may seem one person’s idea of heaven, yet to someone with a fear of water will think it’s hell. I often ask questions like “What’s your favourite beach?” so I can get them to focus on relaxing on said beach as a super quick way of them going into trance. However, on some occasions I have been told they don’t like beaches – How about a garden, or lying in your bath, or wherever you have felt deeply relaxed in the past.
Pain can be perceived as sharp, red in colour, or dull dark grey, heavy and like a rock, a black ball with spikes coming out of it/ We utilise these ideas of how pain is perceived to change that into something more suitable. Cool blue ointment rubbing out the red sharp pain for example. We can help visualise their limbs growing longer and more flexible so their idea of where their elbow is becomes confused and so the person stops perceiving pain there.
Pain can often interrupt sleep, so hypnotherapy can help change sleep patterns too by focusing the attention elsewhere as they drift off to sleep. Hypnosis was used as an analgesia years before the chemical sort came along. It’s still used widely in France for example and in dentistry in the UK. I use it to numb my arm when having blood taken or having injections, or any dental work done.
If you are experiencing long term pain then why not make arrangements to visit our pain clinic in Beaumont Street in Oxford on a Thursday morning to discuss your choices. Acupuncture is available too, as well as information on foods that promote inflammation and things you can do to help.