Low back pain and hypnosis

Townsend Letter for Doctors and Patients,  Oct, 2006  by Robert A. Anderson

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Fifteen adults, age 18-43, with chronic low back pain (mean duration four years) were found to be moderately/highly hypnotizable based on the modified 11-point Stanford Hypnotic Susceptibility Scale. Somatosensory, event-related, potential correlates of noxious electrical stimulation were evaluated during control and hypnotic analgesia conditions at anterior frontal, midfrontal, central, and parietal regions. Significant brain inhibitory processing was evidenced in different brain locations (p<.05-p<.001) compared to the control condition. Hypnotic analgesia led to highly significant mean reductions in perceived sensory pain and distress (p<.001). Participants were then shown to develop self-efficacy through the successful transfer of newly learned skills of experimental pain reduction to reduction of their own chronic pain; within three sessions, they reported chronic pain reduction, increased psychological well-being, and increased sleep quality. In 60% of the patients, the pain was totally gone, and in 80%, the distress was totally gone by the end of the third session. Hypnotic analgesia is a proactive process that requires inhibitory effort, dissociated from conscious awareness, in which the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. The development of "neurosignatures of pain" can influence subsequent pain experiences and may be expanded in size and easily reactivated.

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Crawford HJ, et al. Hypnotic analgesia: 1. Somatosensory event-related potential changes to noxious stimuli and 2. Transfer learning to reduce chronic low back pain. Int J Clin Exp Hypn. 1998 Jan; 46(1):92-132.

Comment: The last comment by the authors speaks for the early introduction of hypnosis or other psychological interventions before the development of chronic pain patterns becomes fixed. The effect of hypnosis is here shown to quickly result from central changes in the brain that occurred under active treatment but not in controls. The teaching of quality courses in hypnosis, suggestion, imagery, and relaxation techniques remains a rarity in schools of medicine, despite the enormous effects those techniques have on outcomes in the evidence-based research that we try to present here.

COPYRIGHT 2006 The Townsend Letter Group
COPYRIGHT 2006 Gale Group