Chronic pain affects an estimated 86 million American adults to some degree. Here you'll find the latest pain management information including. Chronic pain relief is a bit like major weight loss: It takes time, effort and often multiple methods to get noticeable results. Pain, like excess. When you're managing pain, like after surgery, it can be challenging to balance the risks and benefits of all pain treatment options, such as over-the-counter.
Relief Finding Pain
There are ways to provide adequate pain control with less opioid risk. Balancing the risks and benefits of opioids can be challenging. A multimodal pain management plan can include multiple medications and techniques, including opioid, non-opioid prescription or OTCs , and topical medications, as well as nonpharmacologic therapies.
Download this planner Keep multimodal analgesia reminders on hand when creating pain management plans with your patients. There are ways to address those concerns and still provide effective pain relief. Numerous studies support the efficacy of OTC analgesics for a variety of acute and chronic pain states. When you recommend an OTC analgesic as part of a patient's pain management plan, remind them to:.
Follow your recommendation exactly. Patients may stop their analgesic regimen if they feel their pain is under control. Encourage them to follow your dosing directions to stay ahead of their pain. Explain that eliminating pain completely may not be achievable and work together to create realistic, meaningful goals that can help patients get back to normal functioning.
Keep you informed on their progress. Use OTC pain medicine safely. Provide handouts with OTC analgesic dosage and frequency. Ask your patients about their pain management preferences. Another consistent finding is that general hypnotizability i. This has led to speculations that hypnotizability might explain the variability in response to hypnotic treatments of chronic pain. The weak associations with clinical pain and the fact that the majority of patients show at least some benefits of hypnotic treatment Montgomery et al.
Clinicians in our hypnosis clinical trials anecdotally noted that the overwhelming majority of participants reported high levels of treatment satisfaction whether or not they experienced clinically meaningful pain relief. Moreover, we also found that a large proportion of patients—including many who did not report clinically meaningful decreases in average or characteristic pain with treatment— reported at follow-up that they continued to practice the self-hypnosis skills taught Jensen, Barber, Romano, Hanley, et al.
To help understand what appeared to be an anomalous finding, we contacted a cohort of patients who received self-hypnosis training to determine their reasons for continued use of self-hypnosis skills despite an apparent lack of benefit on average daily pain intensity. Consistent with what the study clinicians reported, almost all of the study participants reported high levels of treatment satisfaction Jensen et al. In addition, the great majority of those who continued to practice self-hypnosis reported that they experienced temporary pain relief when they listened to audio recordings of the treatment sessions or practiced self-hypnosis on their own without the recordings.
In short, we have found that hypnosis treatment has two potential effects on chronic pain. First, as described above, the treatment can result in substantial reductions in average pain intensity that is maintained for up to 12 months in some—but not all—patients. We interpret this finding as support for the hypothesis that hypnosis treatment can result in sustained changes in how the brain processes sensory information in subgroups of patients larger or smaller subsets, depending on the specific pain condition studied.
However, for greater numbers of patients, hypnosis treatment teaches self-management skills that patients can and most do continue to use regularly and that can result in temporary pain relief. We also asked our sample to describe the positive and negative effects of hypnosis, and of the 40 different effects elicited, only three were negative Jensen et al.
Non-pain-related beneficial treatment effects included improved positive affect, relaxation, and increased energy. These non-pain-related benefits were reported despite the fact that the hypnotic intervention was script driven and focused exclusively on pain management.
They also reflect another important finding in the pain literature: As we discuss in greater detail below, the use of hypnosis to improve quality of life in people with chronic pain often involves focusing on outcome variables other than just pain relief. The key findings from the hypnosis clinical trials reviewed above have three important implications for maximizing the benefits of hypnotic pain treatment.
Specifically, they indicate that clinicians should a include suggestions for both immediate and long-term pain relief, b include suggestions for benefits in addition to pain reduction, and c use the knowledge about the multiple benefits of hypnosis to enhance treatment outcome expectancies. Given the evidence that hypnotic analgesia treatment can result in both a long-term pain relief and b learning skills that produce immediate but shorter lasting i.
They should also provide suggestions, such as the following, that can facilitate the regular use and practice of self-hypnosis:. And when you practice self-hypnosis, your mind can easily enter this state of comfort, and the comfort will stay with you for minutes and hours … the more you practice, the easier and more automatic this will be … and the longer the beneficial effects will last.
Given the established beneficial effects of hypnosis on other outcome domains, hypnotic suggestions for addressing additional pain-related issues should also be included in the hypnotic treatment Jensen, ; Patterson, In chronic pain, there are almost always associated symptoms that deserve attention.
For such patients, hypnotic suggestions can be provided for an increased ability to fall asleep, to return to sleep if they awaken, and to feel rested in the morning Jensen, Effective chronic pain treatments also often target increased activity and adaptive coping responses.
Patients who are involved in physical therapy or who are maintaining a regular exercise program can be given suggestions that they will feel confident in their ability to engage in and maintain exercise.
Those who experience fatigue might be given suggestions such as being able to draw on an inner strength and experience reserves of energy when needed and appropriate Jensen, It is also important to remember that people with chronic pain often suffer from clinically significant depression and anxiety Patterson, , and mood states can be addressed by hypnosis Alladin, ; Yapko, Hypnosis can also include suggestions for improving activity levels, adaptive coping responses, adaptive pain-related cognitions, and sleep quality Jensen, Thus, clinicians should take full advantage of all potential hypnotic effects to help patients achieve a number of treatment goals; suggestions should rarely, if ever, focus exclusively on pain reduction.
It is clear, based on research findings, that not all patients with chronic pain are going to experience pain relief with hypnosis. This brings up the question of how expectations for treatment can be enhanced, given that outcome expectancy is an important factor that can enhance any clinical intervention.
Because of our finding that the great majority of the participants in our clinical trials report some benefits through learning hypnosis, even when those benefits do not necessarily include pain relief, we now tell patients something along the lines of the following to enhance outcome expectancies without giving unrealistic expectations:. Many patients find that they experience meaningful reductions in their pain that maintain for a year or more after treatment.
Others report that they use the skills they learn to experience pain relief for a few hours at a time when they use self-hypnosis for just a minute or two.
Even when the treatment does not result in significant pain relief, almost everyone reports some benefit, such as improved sleep, an increased sense of overall calmness and well-being, or reduced stress. To date, the primary imaging techniques used to study the neurophysiological effects of hypnosis include positron emission tomography PET; cortical metabolic activity , functional magnetic resonance imaging fMRI; changes in blood flow in the brain and spinal cord , and electroencephalography EEG; cortical electrical activity.
The cortical areas most often activated during pain are the thalamus, anterior cingulate cortex ACC , insular cortex, primary and secondary sensory cortices, and prefrontal cortex. The relative contribution of each of these areas to the experience of pain varies as a function of the nature of the pain stimuli Apkarian et al. Some of the earliest research on the cortical effects of hypnotic analgesia was reported by D.
Spiegel and colleagues , and this body of research has gained substantial momentum over the last decade Abrahamsen et al. Each of the brain areas involved in pain processing has been shown to respond to hypnosis in more than one study: Moreover, hypnosis has also been shown to influence the processing of aversive stimulation at the level of the spinal cord see review by Jensen, Thus, hypnotic analgesia appears to influence different areas of the nervous system that are involved in the processing of pain rather than having a single, unilateral mechanism.
In a hallmark study, Rainville and colleagues demonstrated that hypnotic suggestions for reduced pain unpleasantness influenced activity in the corresponding area of the brain expected ACC but not in other brain areas, including the sensory cortex. Subsequently, this research group demonstrated that hypnotic suggestions for less pain intensity influenced activity in the primary sensory cortex but did not influence activity in the ACC Hofbauer et al. Together, these studies indicate that hypnotic suggestions can be targeted to specific effects in brain activity.
Thus, not only the hypnotic induction but the content of the specific hypnotic suggestions is of critical importance to the benefits derived from hypnosis. Cortical neurons fire at different frequencies, and the speed at which they fire is associated with different brain states. Thus, the neurophysiological processes associated with pain perception appear to be related not only to the site of activity but also to general activity levels that likely transcend specific areas of functions.
Therefore, hypnotic analgesia may influence pain both by altering activity in specific areas and by facilitating shifts in general brain states. The fMRI results for the noxious stimulation condition were consistent with those of many other fMRI pain studies, showing activation in the thalamus, ACC, secondary sensory cortex, insula, and prefrontal cortex as well as, in this case, activity in the cerebellum and parietal cortex.
Moreover, the pattern of brain activity during the hypnotic pain condition was similar to that observed during the noxious stimulation condition, with overlap of activity in the ACC, insula, prefrontal cortex, and parietal cortex. However, the intensity of this activity in the stimulation condition tended to be stronger than that in the hypnotic pain condition, and activation of the primary sensory cortex occurred only in the hypnotic pain condition.
In the imagined pain condition, there was some but much less than either of the other two conditions activation in the ACC, insula, and secondary sensory cortex. The findings add support to the aforementioned notion that hypnotic suggestions are localized to specific areas of the brain but also add important support for the conclusion that such effects involve more than a process of simple imagination.
The key findings from the studies on the effects of hypnotic analgesia on neurophysiological processes discussed above have two important clinical implications. First, to maximize efficacy, hypnotic treatment should target multiple specific pain domains. Second, clinicians should take full advantage of the calming effects of hypnosis on brain activity and processes. We have already discussed the importance of providing suggestions to improve outcomes other than just pain relief sleep quality, well-being, activity level, etc.
This same principle applies when treatment targets pain relief, because pain is a multidimensional construct with sensory, affective, and evaluative components. Each of these domains can be influenced by hypnotic suggestions. It follows that clinicians using hypnosis for pain management should target their suggestions to the different brain areas that process pain. In fact, clinicians will likely be more effective if they are guided by knowledge of the specific brain areas that are linked to pain Jensen, Current thinking in pain physiology suggests that hypnotic suggestions should target several of these domains rather than any one of them Jensen, ; Patterson, The hypnotic induction itself— even before any suggestions are made for pain relief— results in a shift of brain activity in a direction consistent with that of someone experiencing pain relief.
Hypnosis is certainly not necessarily the only technique that can be used to shift brain states. Many meditation strategies have also has been shown to result in shifts in EEG bandwidth activity consistent with those that follow hypnosis i. Certainly, relaxation training and guided imagery often contain elements that look very much like a hypnotic induction, and hypnosis often includes suggestions for relaxation and use of imagery.
However, clinical hypnosis usually involves suggestions not only for perceptual changes but also for other clinical benefits Jensen, ; Patterson, , while these other techniques tend to focus on just a single outcome e. Understanding that it is often difficult to distinguish among hypnosis, relaxation training, and guided imagery in a clinical situation, we would argue that hypnosis allows clinicians to target a much larger variety of outcomes i.
We have cited the important finding that hypnosis has larger effects on pain than does simple imagination Derbyshire et al. The implication is that hypnosis is more powerful than simple imagery; however, it is important to acknowledge the potential beneficial impact of imagery in changing perceptual processes. For many patients, including imagery for pain reduction can be a powerful component of the hypnotic intervention. Many patients will benefit from the inclusion of imagery as long as it does not bring up unpleasant or irritating memories.
However, clinicians should realize that not all patients enjoy imagery or find visual processing easy and that a variety of other components of hypnosis should also be typically included e. Our understanding of hypnotic analgesia has increased substantially in the past two decades. Based on the findings from the clinical trials and neurophysiological studies cited in this article, we can conclude that hypnosis and hypnotic analgesia have specific effects beyond those attributable solely to placebos.
Yet, as we discussed in our introduction, there remains a lack of consensus on what hypnosis is, and there are significant unanswered questions regarding the mechanisms and best clinical use of this approach to pain management. We conclude this article with a brief discussion of four of these critical questions: We cannot address possible mechanisms of hypnotic analgesia without at least introducing some of the different theoretical perspectives of hypnosis.
During much of the latter part of the 20th century, a substantial amount of effort was put into arguing the relative merits of two primary theoretical models of hypnosis: However, despite significant debate and decades of research, neither perspective has been universally adopted by experts in the field.
In the last decade, there has been a growing call to view hypnosis from multiple perspectives e. Some preliminary work to develop more integrative models has also been published e. Despite the fact that the field is beginning to move beyond these two narrow and conflicting notions of hypnosis, it is still useful to understand the original models, because each will likely contribute important ideas to an overarching biopsychosocial model of hypnotic analgesia.
The perceived effortlessness is thought to be associated with a shift in the control of responses from higher executive functions evaluative and more effortful responding to those cognitive subsystems that have a direct influence on the behavioral responses without the usual layer of judgment or critical screening. In short, dissociation theories hypothesize that hypnosis involves a qualitative shift in the nature of cognitive processes.
Dissociation models of hypnosis are also consistent with the views of a number of researchers studying the brain processes associated with hypnotic analgesia. Rainville and Price , for example, argued that hypnosis creates a shift from an active to a passive form of attention and noted that these attentional shifts are associated with a reduction in the monitoring of control and the censoring of experience.
Because dissociation theories hypothesize a qualitative shift in neurophysiological states during hypnosis, these models are often referred to as state models of hypnosis. As mentioned above, hypnotizability is a trait-like capability that remains highly stable across decades Morgan et al. State theorists have argued that hypnotizability is a genetically loaded characteristic that helps predict which subjects are more likely to respond to suggestions.
Researchers who espouse sociocognitive models of hypnosis argue that the concept of an altered state is not needed to understand or explain hypnosis. Rather, they maintain that hypnosis is best explained by the same sociopsychological factors that explain all behaviors whether or not they involve hypnosis: In support of this line of reasoning, Montgomery and colleagues have shown that measures of outcome expectancies partially mediate the benefits of hypnotic analgesia. We can envision at least two directions that such theories might take in understanding hypnotic analgesia.
First, it is possible that state and nonstate theories explain different components of hypnotic analgesia; each model may ultimately prove to be most useful with different subsets of patients. For example, patients who score high on tests of hypnotizability may respond better to hypnotic analgesia interventions based on a state approach e.
Alternatively, some investigators have hypothesized that hypnotizability is not a trait that lies on a single continuum but rather that there may be different types of hypnotic responding. Barber proposed three basic types of hypnotic responders: To the extent that people can be reliably classified into different types of responders, hypnotic interventions might be developed that could best match each individual, ultimately resulting in more positive outcomes for more people.
Research examining these questions would be very useful. Which potential mechanisms of hypnosis might be considered in the development of a more complete model? Research suggests that the effects of hypnotic analgesia are not mediated by endogenous opioids J. We have discussed how hypnotic suggestions can affect specific areas of the brain that process pain depending on the wording of the hypnotic suggestions.
One important next step is to investigate how hypnosis allows subjects to better access and impact those areas of the brain. We speculate that subjects experiencing hypnosis suspend critical monitoring and judgment and, as a result, have more direct access to and influence over critical areas of the central nervous system. This process may be enhanced by any number of factors: Neurophysiological research provides preliminary support for these ideas in that individuals who score high on tests of hypnotizability highs clearly process information differently from those who score low on hypnotizability tests lows and that many of the differences in processing are associated with those frontal areas of the brain associated with executive control Jensen et al.
These authors reviewed 18 studies in which cognitive-behavioral psychotherapy was provided in a hypnotic context and compared with the same therapy without hypnosis. Mention every medicine you take. The medicines you are currently taking may affect which pain reliever your healthcare professional recommends. Get started by downloading an easy-to-use personal Pain Management Planner before your next appointment.
You are here Home. Get Pain Relief Safely. Agency Producer Contact Name: Managing pain is all about finding the right balance Create a personalized plan to effectively relieve your pain. Download this planner Work with your healthcare professional to find the pain relief therapies that will work best for you.
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A tool to help your patients find the best combination of pain relief therapy, including OTC solutions, drug-free methods, and non-opioid pain relief that's right for. After surgery for my broken tibia, I realized that there were only four points on the pain scale that really mattered to me. MCH patient becomes first child in the world to use nitrous oxide at home to relieve pain. Last April, eight-year-old Evan Prescott trained for.