Part one
By Marianne CHARVET, Silvia MIRANDA and Alicia RENOU.
Introduction
In France, for a long time, the medical profession has defined, mistakenly, a pain which lasts as an insignificant, banalized disorder, or even an “imaginary or psychiatric illness” (Grisart et Berquin, 2017). We had to wait for the modification of cultural, philosophical and religious representations in our society in order to eradicate these evils and develop new therapeutics, molecules and substances. However, all these attempts were undermined by increased resistance to treatment amongst patients (Grisart et Berquin, 2017).
Today, this pain grows continuously and the population keeps getting older, so the relief of chronic pain remains more than ever a major public health issue (SFETD, 2015). Indeed, according to the INSERM, the difficulties related to chronic pain affect currently 20 millions of French or about 30% of the general population in the country (2016).
In order to improve the knowledge about care quality, many researchers have begun to defend the benefits of non-drug methods in the treatment of chronic pain. In this article, we have chosen to focus on hypnosis because its curative effects have been little known in public opinion.
Definitions
Chronic pain
To understand the expression “chronic pain”, we can take the definition given by the International Association for the Study of Pain, where it is defined as « an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage » (2012). This subjective experience is characterized as chronic when it exceeds six months. More precisely, according to the HAS, we talk about chronicity when there is a permanence of the painful symptoms or a recurrence of the latter (Haute Autorité de la Santé, 2008). Thus, we understand that consequences of chronic pain can impair the physical, psychological, family, social and economic well-being of patients (Association québécoise de la douleur chronique, 2009).
Chronic pains can be found in the MPD (Manual of Psychiatric Disorders) under the name of “somatic symptomatic disorder” (SSD) and are presented as « somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms. To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for 6 months) » (APA, 2013). In conclusion, these disorders may seem very limiting for patients in their daily management.
Pain can have several etiologies. First of all, we found neuropathic pains when the central or peripheral nervous system is damaged, and it sends false messages to the brain. Then, there are nociceptive or inflammatory pains which are manifested by sending to the brain a severe, persistent and excessive pain stimulus from the injured tissue. In this case there is a significant stimulation of the peripheral pain receptors. Finally, we can include the mixed pains that combine both of the above (Stinson and Montgomery, 2011). As a result, chronic pain requires a multifactorial approach for both assessment, diagnosis and treatment.
It is therefore in a context of unbearable suffering for patients that hypnosis, associated with more traditional treatments, can be very useful.
Hypnosis
Hypnosis is a modified state of consciousness, allowing us to access our unconscious. Unlike what most people think, hypnosis cannot be compared to a state of sleep. Indeed, the patient on hypnotic trance is fully aware of what is going on around him.
The purpose of the hypnosis’ set of techniques is to mobilize internal resources barely exploited by the patient, but also to reactivate traumatic processes so that we may try to solve it and modify their consequences on life. To put it in a nutshell, this techniques consist in emitting hypnotic inductions in order to relax and bring comfort but also to induce a change in behavior or perception (Elkins, Jensen and Patterson, 2006). When it comes to pain, these inductions consist of specific suggestions that have the benefit of modifying the way that pain is perceived or experienced (Patterson and Jensen, 2003).
Hypnosis benefits
In 2000, a study conducted by Lynn, Kirsch, Barabasz, Cardeña, and Patterson, have shown that hypnotic state can diminish pain, by focusing directly on the unconscious memory of the painful experience. Authors have defined this concept by the term “hypno-analgesia”.
At the same time, Montgomery, Duhamel, and Redd (2000) conduct a meta-analysis of eighteen studies, gathering 933 participants. According to them, hypnosis causes moderate to severe analgesic effect in 75% of the cases, relieving clinical or experimental (induced) pain.
A previous meta-analysis, conducted by Kirsch, Montgomery and Sapirstein in 1995, compares the cognitive-behavioral therapy effectiveness with and without hypnosis on patients with varied disorders (obesity, insomnia, anxiety, pain and hypertension). They found that patients’ state improvement is 70% less important in CBT without hypnosis. Moreover, hypnosis effects seem to last more when this technic is associated with CBT, in particular obesity, since patients kept losing weight long after treatments (Kirsch, Montgomery and Sapirstein, 1995 cited by Lynn, Kirsch, Barabasz, Cardeña, and Patterson, 2000)
Besides, in 2003, Dr Patterson and the psychologist Mark Jensen believe that hypnosis is also an efficient way to reduce the use of painkillers or sedation, side effects like nausea and vomiting, or the duration of hospital stay. Some patients are able to reduce pain or its intensity by practicing self-hypnosis. The goal of this method is to handle for patients their own pain outside therapy sessions and throughout their lives. Thanks to hypnosis, they get back some control over their bodies and emotions, they are not only focusing on their pain and are able to enjoy their life better.
To illustrate our comments, we can describe the model used in Jensen and Patterson’s study, in 2006. It consists in telling hypnotic inductions to the patient while he has to focus on an object or on the therapist’s voice. This step implies preliminary suggestions that modify progressively the patient’s perception and lead him to a relaxation state. Then, the therapist brings up suggestions to change the patient’s experience of pain. In order to do that, he can draw the patient’s attention to painless sensations or induce a pleasant numbness. The phase of hypnotic suggestions last about twenty minutes. Authors define hypnotic treatment as therapy with hypnosis exceeding eight sessions. Finally, therapy ends with the learning of self-hypnosis techniques that the patient can repeat at home.
In 2007, a second study of Elkins, Jensen and Patterson explores multiple works showing effectiveness of hypnosis in contrast with neurofeedback techniques (a scientific technique that involves modifying and regulating brain activity by placing electrodes on the skull. It allows to know the activity and send the information back to the brain). The authors mention an identical effectiveness of hypnosis techniques than cognitive-behavioral techniques on pain perception. Moreover, hypnosis seems to be more efficient in relieving pain than relaxation alone, and increase CBT effectiveness afterwards.
