BY ROBERT RAKOWCZYK, Resident, Family Medicine, University of Texas Medical Branch, Galveston
With the opioid abuse and overdose epidemic now on the national radar, many of us are wondering what we can do to help swing the pendulum of pain control back to a reasonable, middle-of-theroad approach. Maybe drug manufacturers will develop the perfect painkiller, but my gut says it’s not going to pan out they way we might hope. It may be time that we look into using different kinds of therapeutic tools. I recently participated in a medical hypnosis training workshop hosted by the American Society for Clinical Hypnosis (ASCH), and I was amazed by the potential of this often-ridiculed technique for treating pain and a vast array of other conditions. My first personal exposure to hypnosis, like many people, was through watching a stage hypnotist perform a comedy show, and walked away with mixed feelings. This is an unfortunate reality about how hypnotism is perceived in our society, and I fear that the public perception of it will continue to hinder its use as a medical therapy for a long time. In medical school, I encountered it again, this time during a lecture on irritable bowel syndrome. Medical hypnosis was listed as one of the most effective treatments for it! I’m pretty sure almost nobody paid attention to that fact, as it was not likely to appear on Step 1, and it didn’t come up during a case discussion of IBS a week later. A 2014 meta-analysis1 gave it a summary rating of “may be a useful and safe therapeutic option for refractory IBS in short term,” which is certainly less glowing than the recommendation it received in that med school lecture, but certainly worth a try for a notoriously difficult-to-treat condition. One of the problems for that meta-analysis appears to be the fact that two of the four RCTs considered it unethical to not allow the control group to receive hypnotherapy for a full year while awaiting long-term study results.
As someone who thinks of himself as openminded but grounded in scientific thinking, I decided to check out hypnosis firsthand. It takes a much smaller leap of faith to believe in hypnosis in 2018 compared to fifty years ago, as we have a much greater evidence base and knowledge of neuroscience to make sense of it now. The biggest obstacle today is getting past our notion of hypnosis as a form of entertainment, and start looking into what it can do as a medical therapy.
Smoking cessation and weight loss are some of the more widely-known applications, and pain management is the one that piqued my interest. After a 4-day workshop, I was given the tools to be able to apply this on my own. In fact, that first Monday after the workshop, I was able to use it with a patient suffering from panic attacks. I haven’t received any feedback from her yet regarding long-term effect, but she did relax quite a bit in clinic. In late January, I was able to give a demonstration for some coresidents, helping a colleague bring down acute muscle spasm pain in his back from a 7 to a 2. Despite my confidence that it would work, it was still surprising and baffling to me when it did. It’s probably a carry-over from years of bias and skepticism in my training.
An appealing aspect of this type of therapy is the unique human connection that takes place. You have to establish rapport, earn the person’s trust, craft a suggestion that will resonate with them on a subconscious level (using some personal knowledge of them), and then make adjustments as you go through the process to maximize the experience for them. The end goal is to give the tool to the patient so that they can use it for themselves whenever they need it. Using it on their own is not dramatically different than doing it with a hypnotherapist because of the fact that all of hypnosis is, in the end, self-hypnosis anyways. The hypnotherapist simply facilitates and teaches the process. It’s up to the individual patient to actually carry it out.
If you were to ask me how hypnosis works, my opinion for now is that we are intentionally inducing a placebo effect. I have some deepseated philosophical problems with the usual idea of a subconscious mind, so my personal view is definitely not the standard one. I’ll dive into that a little more next time, along with some details about the process of a medical hypnosis session and what conditions might be most amenable to its use.
1. Lee HH, et al. The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Journal of Neurogastroenterology and Motility. 2014;20(2):152-162.