So much of our work here at the hypnosis office is about empowering people just like you and me to use these incredibly powerful and intricate machines we call our minds. We help people to move away from the thinking that they are at the mercy of their automatic behaviors, and teach them to harness the ability to program their minds to work for them instead.

This week I’d like to share with you a story  that aired this morning on Morning Edition from NPR. This is an excellent example of how we integrate the signals in our brain to create a habitual response, and how we can use simple and easy-to-learn techniques to interrupt those signals and experience less pain.

How The Brain Shapes Pain And Links Ouch With Emotion

Heard on Morning Edition May 20, 2019

By Jon Hamilton

When Sterling Witt was a teenager in Missouri, he was diagnosed with scoliosis. Before long, the curvature of his spine started causing chronic pain.

It was "this low-grade kind of menacing pain that ran through my spine and mostly my lower back and my upper right shoulder blade and then even into my neck a little bit," Witt says.

The pain was bad. But the feeling of helplessness it produced in him was even worse.

"I felt like I was being attacked by this invisible enemy," Witt says. "It was nothing that I asked for, and I didn't even know how to battle it."

So he channeled his frustration into music and art that depicted his pain. It was "a way I could express myself," he says. "It was liberating."

Witt's experience is typical of how an unpleasant sensation can become something much more complicated, scientists say.

"At its core, pain is just something that hurts or makes you say ouch," says Karen Davis, a senior scientist at the Krembil Brain Institute in Toronto. "Everything else is the outcome of the pain, how it then impacts your emotions, your feelings, your behaviors."

The ouch part of pain begins when something — heat, certain chemicals or a mechanical force — activates special nerve endings called nociceptors.

"Once they are activated, they trigger a whole cascade of events with kind of a representation of that signal going through your nerves and into your spinal cord and then all the way up to your brain," Davis says.

And that's when things get really complex.

Pain signals interact with many different brain areas, including those involved in physical sensation, thinking and emotion.

"There's quite a pattern of activity that permeates through the brain that leads to all the complexities of what we feel associated with that initial hurt," Davis says.

All that processing can have benefits, she says, like sometimes allowing us to ignore pain signals.

Say you're playing hockey and you just got slammed into the boards, Davis says. "If you're concentrating on that, you're not going to be able to keep skating. So you need to be able to tune out the pain and deal with it later."

Witt learned that he could tune out pain when he immersed himself in composing songs or painting.

"When I'm making art and music, I feel less pain," says Witt, who is 40 now and makes his living as an artist and musician in the Kansas City area. "While I'm doing those things I'm so distracted from my pain that it's almost like I don't have it."

But as a younger man, Witt still struggled with the emotional fallout from his back pain. He was depressed and felt like a social outcast.

Why does the brain link pain with emotions?

One of the scientists trying to answer that question is Robyn Crook, a biologist and brain researcher at San Francisco State University.

Crook studies the evolution of pain, and her lab compares the pain system found in mammals with its counterpart in squids and octopuses.

The most obvious evolutionary reason for pain, she says, is to prevent or minimize damage to the body. Touch a hot stove and pain tells you to move your hand away. Fast.

But evolution didn't stop there, Crook says.

"In some animals with more complex brains there's also an emotional or a suffering component to the experience," she says.

In dogs, for example, pain appears to cause emotional distress much the same way it does in people. And there must be a reason for that, Crook says.

One possibility, she says, involves memory.

"Having that emotional component linked to the sensory experience really is a great enhancer of memory," she says. "And so humans, for example, can remember a single painful experience sometimes for their entire lives."

So they never touch that hot stove again.

And there may be another reason that people and other highly social animals have brains that connect pain and emotion, Crook says.

"Experiencing pain yourself produces empathy for other group members or other family members that are in pain," she says. As a result, if one of them is injured "you will offer help to them because of the empathetic response or the emotional response to pain."

That response has obvious benefits for animals that live in groups, Crook says. But an octopus is a solitary animal with no obvious need for empathy. So Crook's lab is trying to figure out whether pain has the same links to emotion in these marine animals.

For people, the link between pain and emotion is a good thing. But sometimes it can also be destructive, says Beth Darnall, a psychologist at Stanford University.

"Mental health disorders amplify pain," she says. "They engage regions of the brain that associate with pain processing. And they can also facilitate rumination and fearful focus on the pain."

And when pain doesn't go away, Darnall says, it can cause disabling changes in the brain.

"Pain is really a danger signal," she says. "But once pain becomes chronic, once it's ongoing, these pain signals no longer serve a useful purpose."

Over time, these signals can lead to problems like depression, anxiety and stress.

That's what happened to Witt in his teens and 20s. His pain led to negative thoughts and depression, which made the pain even worse.

But it's often possible to break that cycle, Darnall says, by learning techniques that help pain patients gain some control of the way their brain is processing pain signals.

For example, she has a system for teaching pain patients how to slow their breathing and relax their muscles.

"This state of relaxation is an antidote to the hard-wired pain responses that are automatically triggered by the experience of pain," she says.

For some patients, techniques like these can provide an alternative to pain drugs, including opioids. And for pain patients who rely on medications, she says, psychological therapies can often help the drugs work better.

But patients are rarely offered psychological treatments for pain, Darnall says.

"We have overemphasized pain as being a biomedical phenomenon that requires a biomedical intervention," she says.

Witt, the artist and musician, agrees. He has lived with back pain for more than two decades.

But he doesn't create songs or paintings about pain anymore. And he chooses not to take pain medication.

Instead, Witt says he stretches and exercises, watches his diet and works hard at staying optimistic.

"I'm actually not convinced that I have to live with this for the rest of my life," he says. "I very well may. But at the same time I live in that state of mind all the time that there's hope."

You can listen to the program on NPR here:

https://www.npr.org/sections/health-shots/2019/05/20/724136568/how-the-brain-shapes-pain-and-links-ouch-with-emotion#

The Impact of Pain

In 2016, the Institute of Medicine estimated that up to one-third of the US population lives with ongoing pain. Chronic pain, the main cause of disability, is more prevalent than diabetes or heart disease. It costs the US economy up to $630 billion every year in health care and lost productivity, and lowers the quality of too many lives. Although precise numbers are hard to come by, National Institute of Health spending breakdowns show that the agency committed just over $500 million in 2017 to broad pain research. Finding better ways of treating pain is surely worth a greater investment.

Consider this crucial question: what is the first treatment you should give a person for chronic pain, or even many acute injuries? Most clinicians now agree that the answer should not be opioids. Fewer recognize that the question is not which pill to use instead, but what system of interventions, including medication, and monitoring to implement.

Too often, pain is treated as a purely physical problem. It is a biopsychosocial condition. Psychological treatments can be combined with medication to equip people with the tools to better control their pain experience. Psychological therapies, such as hypnosis, EFT, and others, can also lower risks such as addiction, because the emphasis is on engaging patients in managing their daily actions to help themselves to feel better in the long run, rather than relying solely on passive medications. And despite this, a common medical practice is to recommend such psychosocial strategies for pain only after all medications have failed.

The Role of Hypnosis

Hypnosis is a complementary therapy that works well with traditional medical care. Clinical research has provided a large amount of evidence that hypnosis is a recommended first-line treatment for many types of pain. The integrative use of hypnosis provides pain relief, stress management, relief from depression and anxiety, and provides the client with a sense of real control over their bodies.

Hypnosis, when used for the treatment of chronic pain,  generally involves a hypnotic induction with suggestions for relaxation and comfort. Posthypnotic suggestions are usually given that the client will experience reduced pain. These suggestions can continue to be effective long after the session, and can be integrated so that the client can quickly and easily create a state of comfort using an anchor, such as a finger press or a deep breath.

Effective hypnosis treatment of chronic pain also often involves teaching the client self-hypnosis or providing recordings of hypnosis sessions that can be used to reduce pain on a daily basis outside the sessions. In our experience, many clients experience an immediate reduction in pain severity following hypnosis treatment, whereas others can obtain reduction in pain with repeated  hypnosis sessions or by practicing self-hypnosis.

Clinical studies on the effectiveness of hypnosis in pain management can be found here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/

If you have questions about using hypnosis as a part of improving your health, or maintaining your healthy lifestyle, send us an email or give us a call. We are happy to talk with patients and healthcare providers about the benefits of hypnosis.⬛

Pain is a part of life. It sounds a little wrong, but in reality people experience pain all the time. It is a normal and important signal that your body uses to communicate. We have a saying in our office,

“Pain is mandatory. Suffering is not!”

Last weekend we hosted a Meetup here at GMH. It was the first of an eight part series discussing some of the founding principles of hypnosis. Charles Tebbetts, a hypnotist and instructor in the 1970’s, wrote out his observations in the “Rules of the Mind”, eight rules that define how the subconscious mind interacts with you and the outside world.

At the Meetup, we discussed the first rule. “Every thought causes a physical reaction.”

According to Tebbetts, your thoughts can affect all of the functions of your body. For example, Worry thoughts trigger changes in the stomach that in time can lead to ulcers. Anger thoughts stimulate your adrenal glands and the increased adrenaline in the blood stream causes many body changes. Anxiety and Fear thoughts affect your pulse rate.

Ideas that have strong emotional content almost always reach the subconscious mind, because it is the feeling mind. Once accepted, these ideas continue to produce the same body reactions over and over again. In order to eliminate or change these chronic negative bodily reactions we must reach the subconscious mind and change the idea responsible for the reaction. This is easily done with hypnosis and autosuggestion.

Think about how you have noticed this rule in action in your life, whether it was thinking about a happy moment from your past and feeling those happy feelings again, or recalling a sad event and wiping away some tears, and even thinking about a situation that makes you anxious and feeling your chest tighten up and your heart speed up.

There is a fundamental connection between our minds and our bodies. We are essentially machines run by computers. The computers, our brain, sends signals to the machine, our bodies, telling it what to do. We think of this relationship most often in terms of physical events, such as touching something sharp or hot and pulling our hand away. By noticing the effect that our thoughts have on our physical reactions, we open up the door for new and more efficient ways of reducing unpleasant feelings, like chronic pain.

During our discussion, the topic of pain came up more than a few times, probably since pain is a universal experience. We talked about how our thoughts affect our experience of pain, and if we can use our thoughts to decrease the amount of pain we feel. The answer is a definite “YES!”

Pain Is Mandatory...

Pain is a part of life. It sounds like a cliche, but in reality, pain is an important signal that your body uses to alert you of harm happening to your body. Pain tells us that something is wrong and we need to stop whatever we are doing and address it.

Here is what happens when you prick your finger on something sharp.

You prick your finger on something sharp. This causes tissue damage, which is registered by microscopic pain receptors (nociceptors) in your skin. Each pain receptor forms one end of a nerve cell. The other end is connected to the spinal cord by a long nerve fiber or axon. When the pain receptor is activated, it sends an electrical signal up the nerve fiber.

The nerve fiber is bundled together with many others to form a peripheral nerve. The electrical signal passes up the nerve cell within the peripheral nerve to reach the spinal cord in the back.

Within the spinal cord, the electrical signals are transmitted from one neuron to another across synapses (junctions, or tiny gaps, between two nerve cells) using chemical messengers called neurotransmitters. The signals are then passed up the spinal cord to the brain.

In the brain, the signals pass to the thalamus. This is a sorting station that relays the signals to different parts of the brain. Signals are sent to the somatosensory cortex (responsible for physical sensation), the frontal cortex (in charge of thinking), and the limbic system (linked to emotions).

The end result is that you feel a sensation of pain in your finger, think ‘Ouch!’, and react emotionally to the pain by feeling scared or alarmed, annoyed, irritated, or something else.

However, even before you were consciously aware of the injury, you probably jerked your hand away. In sudden strong pain like pricking your finger, a reflex response occurs within the spinal cord. Motor neurons (responsible for movement of muscles) are activated and the muscles of your arm contract, moving your hand away from the sharp object. This occurs in a fraction of a second before the signal has been relayed to the brain. So you have pulled your finger away before even becoming aware of the pain.

Types of Pain

Pain is classified into several types depending on what causes it, how long it lasts, how it feels, and where (and how) it occurs. The description above is an example of acute pain.

Nociceptive pain

Nociceptive pain is caused by any injury to body tissues. For example, a cut, burn or broken bone are all classified as nociceptive pain. Pain after surgery and cancer pain are other forms of nociceptive pain. This type of pain can be aching, sharp or throbbing. Nociceptive pain can be constant or intermittent and may be worsened by movement or by coughing, depending on where the pain is located.

Neuropathic pain

Neuropathic pain is caused by problems or abnormalities in the system that signals and interprets pain. The problem may be in the nerves, spinal cord, or brain.

Neuropathic pain is felt as a burning, tingling, shooting or electric sensation. One example of neuropathic pain is associated with shingles, a skin condition caused by the varicella zoster virus. The virus triggers inflammation of the nerves that can set off a constant deep aching, tingling, or burning sensation that can persist for months after the shingles rash has disappeared.

People with neuropathic pain may feel pain from stimuli that are not normally painful, such as a light touch or cold temperatures. They can also be more sensitive than normal to stimuli that are usually painful. For example, bedclothes touching the affected area could feel painful, and a pin prick could feel excessively sharp.

Psychogenic pain

This type of pain is caused or worsened by psychological factors. Often the pain has a physical cause, but the degree of pain and disability are out of proportion to what would be experienced by most people with a similar problem or injury. This does not mean that the pain is not real, even if a physical cause cannot be found. Any kind of pain can be complicated by psychological factors.

Acute pain

This is short-lived pain warning the body that damage is occurring. It is a symptom of injury or disease, and tends to disappear as the injury or disease resolves.

Chronic pain

Chronic pain, or persistent pain, can be caused by ongoing tissue damage. One example of this is arthritis. However, in some cases there is no physical cause for the pain, or the pain continues to persist long after the injury has healed. Chronic pain can be a disorder all by itself, rather than being a symptom of a separate injury or disease process.

There are a few ways that can contribute to pain becoming chronic.

• Pain receptors and neurons along the pain pathway may become hypersensitive and activate too easily.

• Connections between the neurons in the pathway can be altered, changing the pain signal.

• The brain or spinal cord may intensify, or fail to turn down the pain signals.

• Pain receptors that are normally silent (dormant) can become activated by inflammation, creating an increase in pain.

• After an injury, nerves may regrow but they may not function correctly.

Chronic pain can persist for months or even years after an initial injury and can be difficult to treat. People with chronic pain may experience sleeplessness, anxiety and depression, all of which can make the problem worse.

Pain Is Mandatory…    Suffering is Optional!

We already know that pain protects us in an important way. It lets us know when we are hurt, and prevents us from getting more hurt. Imagine how terrible it would be if, instead of pulling your hand off a hot stove quickly, you kept it there for a little while longer. The damage to your hand would be more severe.

When pain becomes chronic, when it goes on longer than we need it to in order to alert us of danger, then it becomes suffering. Chronic pain affects over half of all Americans. That is over 163 million people suffering with pain that persists beyond any injury or disease. Pain that has no real purpose.

Typically, people who suffer with chronic pain are treated with medications and physical therapy. And all too often these treatments are ineffective. When pain treatments are not effective, people become frustrated, which makes them more susceptible to pain. And when the pain isn’t managed, people lose their quality of life.

There are many theories of how the pain experience can be changed. One of the most popular and comprehensive is called the Gate Control Theory of Pain.

As you can imagine, there are several points in the pain pathway where the signal for pain can be modified. One of these points in the spinal cord is a ‘gate’ mechanism that  either lets the pain signal through or blocks it from going any further. The gate control theory of pain was introduced by Ronald Melzack and Patrick Wall in 1965.

When we feel pain, such as when we touch a hot stove, sensory receptors in our skin send a message through the nerve fibers to the spinal cord and brainstem and then onto the brain where the sensation of pain is registered. There, the information is processed and the pain is perceived.

The gate theory says that as these pain messages come into the spinal cord, before they even get to the brain, they can be amplified, turned down or even blocked out. We all remember stories of how people injured on the battlefield or in sports games don’t feel any pain from their injuries until afterwards. This has to do with the brain being busy doing other things and shutting the gate until it can pay attention to the pain messages.

An example of this would be when a child falls over and hurts her knee. If she rubs her knee, the signal from that sensation temporarily blocks the pain signal travelling from the injured knee to the brain.

Severe pain quickly gets your attention and usually produces a stronger physical response than mild pain. The location of your pain can also affect how you perceive it. For example, pain coming from the head is harder to ignore than pain coming from somewhere else in the body.

The gate control theory helps explain how the brain influences your experience of pain. But it also opens up the concept that thought can affect how we feel. Since each of our thoughts creates a physical response, it is possible to use our own thoughts to modify the path that our pain signals follow, lowering the intensity and even the frequency of chronic pain.

Charles Tebbetts believed that the mind could make you sick or keep you well. For example, he believed that a person could easily produce a headache just by imagining one. He also demonstrated the ultimate benefit of self-hypnosis when a stroke totally paralyzed him and left him unable to talk. Through self-hypnosis, he recovered and continued to teach hypnotherapy for many years afterward.

Not only can we use our imaginations to think of a safe and comfortable space to “distract” ourselves when we are experiencing pain, we can also create permanent changes in the way our brain recognizes and reacts to chronic pain.

The Role of Hypnosis

Pain contributes to many problems in our lives. Physicians and patients both constantly search for pain relief methods, sometimes missing out on treating other contributing factors such as anxiety and depression.

Hypnosis is one of the most effective and under-utilized tools for helping patients manage chronic pain. The results of hypnosis are immediate, there are no harmful side effects, and the patient is in control of when and where they use it. Hypnosis should be one of the very first treatment options made available to anyone suffering from chronic pain, offering an individual control over pain, emotions and ultimately, their recovery.

You may ask, why hypnosis? Hypnosis is a mind-body therapy that can harness the mind’s ability to influence the body’s physiological and neurological activity. So if a patient is able to change the mind and change the thought, they can change how the brain is wired - which in turn changes their body’s response.

In the 2009 article, “Hypnotherapy for the Management of Chronic Pain” Gary Elkins, Mark P. Jensen, and David R. Patterson look at the effectiveness of using hypnosis as pain management.

This article reviews controlled trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than non-hypnotic interventions such as attention, physical therapy, and education.

The article goes on to describe that the focus of hypnosis in the treatment of chronic pain also often involves teaching the patient self-hypnosis or providing recordings of hypnosis sessions that can be used to reduce pain on a daily basis outside the sessions. “In our experience, some patients experience an immediate reduction in pain severity following hypnosis treatment, whereas others can obtain reduction in pain with repeated practice of self-hypnosis or hypnosis sessions.”

You can read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/

Since the publication of this article, several other studies have been conducted that continue to support the effectiveness of hypnosis in the management of many types of chronic pain, including fibromyalgia, cancer, burns, arthritis, sickle cell disease, back pain, headaches, and more.

But Wait, There’s More…

Not only is hypnosis a powerful and effective way to manage pain, it is also a powerful and effective way to manage the psychological factors that contribute to the experience of pain. Hypnosis is used to reduce stress, eliminate anxiety, decrease anger and fear, ease depression, and create an overall sense of calm and well-being. We know that stress, anger, fear, anxiety and depression can increase the amount of pain we experience. By managing these psychological contributors to pain, we can better manage our experience of pain, heal faster, and improve your quality of life.∎

The Pain Experience

Pain is a part of life. It sounds like a cliche, but in reality, people experience pain all the time.  When the pain becomes strong enough to interfere with life, we go to our doctors.  During the ten minutes that the doctor has to address your pain, it is very likely that they will write you a prescription for pain medications and order physical therapy.

To give an example of how big the problem of pain really is, we can look at one specific type of pain. An alarming twenty-six million patients report frequent or persistent back pain. Unfortunately, most physicians’ methods for treating back pain, including surgery, are unsuccessful, either because they fail to address the underlying causes of pain, or because they ignore the psychological component that accompanies all pain. And, as we have seen all too often, the result of improperly treating pain is the prescribing of stronger and stronger opioids.

Whatever the reason, when pain is not adequately addressed, and an individual is left dependent on opioid pain medications to function, there will likely come a point in time when there are no more prescription opiates available, and the person must either choose to suffer with the pain, or to self-medicate with other, more harmful substances.

The Backstory

The number of pain patients continues to rise across the country. Most physicians treat pain by prescribing nonsteroidal anti-inflammatory drug (NSAID) or addicting medications simply because that is all they know. The number of pain management clinics across the country indicates how big a business pain has become. Unfortunately, most pain treatments fail to incorporate the mind-body connection when dealing with pain, or even identify a psychological component within their treatment of pain.

In 2000, such reports led the Joint Commission for Accreditation of Healthcare Organization (Joint Commission) to set new standards for pain assessment. This standard for evaluating pain became known as “the 5th Vital Sign”. 

Even though the Joint Commission did not create the slogan, the Joint Commission did create the standard for a pain scale. Every patient was to be asked “What is your pain on a scale of 0-10, if 0 equals no pain and 10 the worst pain you have ever experienced?” The reason behind the pain measurement standard was the Joint Commission’s studies showing patients were being under-medicated for pain.

In 2016 Joint Commission started taking heat for the number of patients addicted to opioids. The Joint Commission stated it did not create “the 5th Vital Sign”. But they did create the standard for monitoring the pain levels of every patient, and their good intentions do not release the Joint Commission from the responsibility of the effects of that standard.

The Effects of Pain

The prevalence of pain has a tremendous impact on business. Half of the American population lives with chronic or recurrent pain, and that pain costs businesses in a big way.

In a study by the American Academy of Pain Medicine, 13% of the total American workforce experienced a loss of productive time during a two-week period due to common pain conditions such as headaches, back pain, and arthritis. Overall, workers lost more than 4.5 hours of productive time per week due to a pain condition.

The cost of lost productivity due to pain is estimated to be more than $95 billion per year.

There are also hidden costs that chronic pain causes as well. In fact, 17% of people change their jobs due to pain. Replacing and training new employees is one of the larger costs associated with human resources. With more than 100 million adults experiencing chronic pain in the United States, that adds up to a lot of people switching jobs and a lot of money being spent to train their replacements.

Treating the Cause

Pain contributes to many problems within our lives. Physicians and patients constantly search for pain relief, sometimes missing other contributing factors such as anxiety and depression. As a society, we need to look for positive solutions to these problems.

Hypnosis is one such solution. Hypnosis is one of the most effective and under-utilized tools for helping patients deal with chronic pain. The results are immediate, there are no harmful effects, and the patient is in control of when and where they use it. Hypnosis should be one of the very first treatment options made available to anyone suffering from chronic pain, offering an individual control over pain, emotions and ultimately, their recovery.

You may ask, why hypnosis? Hypnosis is a mind-body therapy that can harness the mind’s ability to influence the body’s physiological and neurological activity. So if a patient is able to change the mind and change the thought, they can change how the brain is wired - which in turn changes their body’s response.

Hypnosis can change the stress response by stimulating anti-stress hormones. By controlling the stress response, one can improve healing. It is a simple methodology that has been around for centuries, and it works.

While I never say hypnosis will take all of the pain away, patients do experience a greater reduction in pain with hypnosis in comparison to treatment in traditional pain clinics.

Now What?

If you are one of the thousands of Americans who live with chronic pain, or if you know someone who is, talk to your health care providers about all the alternatives to medications. Ask about physical therapy, hypnosis, yoga, and massage. Try these therapies out on your own.

Try to remember that, even though they are the medical professionals, your physician works for you, and if they aren’t working for you, you can find another one who does.

Despite all of the national attention being given to the Opioid Crisis, we will never solve the problem without giving serious consideration to how we treat pain in the first place.⧫

About the Author: Karen Gray is a Registered Nurse, Certified Hypnotist, and Director of Green Mountain Hypnosis. For more information on how hypnosis is used to manage pain and improve quality of life, email karengray@greenmountainhypnosis.com, or call (802) 566-0464.