Neurophysiology of pain and hypnosis for chronic pain

Abstract

In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available. KEYWORDSHypnosis, Hypnotic analgesia, Chronic pain, Neurophysiology, Hypnotic suggestions Chronic pain, defined as pain lasting longer than 6 months [1], is a complex experience that requires multifaceted approaches for both evaluation and treatment [1,2]. Chronic pain is considered to have an underlying biological basis, for which medications and physical treatments are commonly prescribed. Medical approaches for pain relief and management include pharmacological and surgical interventions as well as physical therapy. While nonsteroidal antiinflammatory drugs are commonly used to treat mild pain from inflammation, opioid analgesics are the mainstay of pharmacologic treatment of moderate to severe pain [2][3][4][5][6]. However, prolonged use of opioids may result in opioid tolerance and opioid-induced hyperalgesia, which is an increased sensitivity to pain. These problems, coupled with unpleasant medication side effects, may lead to discontinuation of treatment [7]. Depending on the patient's condition and cause of pain, surgery is typically considered for the treatment of chronic pain when it is deemed medically necessary or after other treatments have failed. These include intrathecal drug delivery [8], spinal cord stimulation [9], radiofrequency ablation [10], and chemical sympathectomy [11]. One concern is that even though surgical procedures can provide pain relief, they also may permanently damage the person's ability to perceive other sensations, such as light touch and temperature changes, and can cause different pain problems to occur.Medical approaches for pain reduction are only one element of an interdisciplinary approach, since gains in physical and social functioning are important goals as well [12]. Psychosocial and neuropsychological models of chronic pain show that pain treatment cannot focus solely on the sensation of pain itself (e.g., pain intensity) but must also consider the affective (e.g., emotional suffering), cognitive (e.g., beliefs about pain) and behavioral (e.g., inactivity) responses which also impact the overall experience of pain [13][14][15]. This idea has been further supported by research ev...

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