OVERVIEW OF PAIN.

There have been a number of researches that suggest that people’s responses to placebo or “dummy” pain relief varies according to their way of thinking.

In one experiment, a group of 40 pain-free volunteers took part in an experiment using an artificial pain stimulus, and were led to expect reduced pain after the application of a cream which was actually a placebo.

24 of the volunteers initially received a moderately painful heat stimulus to both arms. The placebo cream was then applied to the skin, but they were led to believe that the cream on one of their arms may be a local anesthetic.

After the application of the cream, the intensity of the heat stimulus was turned down on one arm without informing the volunteer. Subsequently the intensity was returned to its previous level, but – in contrast to the 16 people in the control group – 67% of the treatment group continued to perceive the heat as less painful.⁽¹⁾

Eric Robins, M.D., tells us about his meeting with John Sarno, MD who is a professor of physical medicine at NYU, and sees the worst chronic pain patients in the world.  Most have had severe pain (neck, back, shoulder, buttocks) for 10 to 30 yrs; most have had multiple epidural injections, one or more surgeries, and years of physical therapy.  They all had terrible mechanisms of action (like a forklift truck falling on them or a 747 jet rolling over them), and all their x-rays look like the “Elephant Man”, so they seemingly have a good reason for their pain.

With this cohort of patients, he has a 70% cure rate (with regard to both pain and function), and an additional 15% of his patients are much improved (i.e., 40 – 80% better). And he has had these results with about 12,000 patients. (Dr Robbins advises that the numbers quoted about success rates were based on a direct communication he had with Sarno in 1/06.

Sarno looked at the literature and noticed that if you take 100 middle-aged people with NO back pain and does an MRI scan, 65% have a slipped disc or spinal stenosis, and NO pain (New England Journal of Medicine article 1994).

Sarno felt that many of us grow up in families and learn, at a certain (unconscious) level, that it’s not okay to feel or express our anger or anxiety.  As these emotions start to come up in our body, our unconscious makes a decision, “It’s not okay or safe to be feeling these things.”  Then, Sarno says, the unconscious mind will cause the muscles to clamp down and tighten to cause a pain to take our minds off of what we are angry or anxious about. Sometimes this pain/process can last decades.  Sarnos showed his patients the X-rays and advised that what is causing your pain is chronic tension and spasm of the muscles.   He had them journal or enroll in group therapy sessions, or engage in psychotherapy.  He says that about 20% of his patients weren’t consciously aware of what they were angry or anxious about, and needed to work with a therapist to get in touch with some repressed or unconscious material.⁽²⁾

The Brain is capable of creating changes in pain depending on what it sees.  In a study of ten right-handed patients with chronic pain and dysfunction through tests that changed the look of the hand, researchers have found they could increase or decrease the pain and swelling in patients moving their symptomatic limbs.

While the patients’ pain was always worse after movement than before, the pain worsened dependent on what people saw.  A possible philosophical explanation comes from the notion that protective responses are activated according to the brain’s implicit perception of danger level. ⁽³⁾

People with unrelenting pain don’t only suffer from the non-stop sensation of throbbing pain. They also have trouble sleeping, are often depressed, anxious and even have difficulty making simple decisions.

Researchers found that in a healthy brain all the regions exist in a state of equilibrium. When one region is active, the others quiet down. But in people with chronic pain, a front region of the cortex mostly associated with emotion never shuts up. The areas that are affected fail to deactivate when they should.  They are stuck on full throttle, wearing out neurons and altering their connections to each other.  It could be that the brain damages itself by being in this long term activated state.

This is the first demonstration of brain disturbances in chronic pain patients not directly related to the sensation of pain.

Using functional magnetic resonance imaging (fMRI) to scan the brains of people with chronic low back pain and a group of pain-free volunteers showed while both groups were tracking a moving bar on a computer screen, although the pain sufferers performed the task well it was at the expense of using their brain differently than the pain-free group.

When certain parts of the cortex were activated in the pain-free group, some others were deactivated, maintaining a cooperative equilibrium between the regions. This equilibrium also is known as the resting state network of the brain. In the chronic pain group, however, one of the nodes of this network did not quiet down as it did in the pain-free subjects. ⁽⁴⁾

This is supported by a Northwestern University research that has found a key source of chronic pain appears to be an old memory trace that essentially gets stuck in the prefrontal cortex, the site of emotion and learning. The brain seems to remember the injury as if it were fresh and can’t forget it.

Scientists have always tried to understand pain from the viewpoint of sensation.  To control it, they tried to stop the sensory input to the brain. What this study was saying, is that there’s a cognitive memory and emotional component in the brain that seems abnormal.  Chronic pain is not caused by a single mechanism. Sensory abnormalities in people with chronic pain probably drive this memory abnormality. ⁽⁵⁾

But what about natural therapies and hypnosis?

A systematic analysis combining 51 clinical studies, the Cochrane of Evidence-Based Healthcare found that patients exposed to music rate their pain as less intense and even use lower doses of painkillers.

On a zero to 10 scale, patients reported an average .5 drop in their pain due to music. “It’s not a huge amount, but that’s an average and for some people, it will be more, and for some it will be less.” The review found that it didn’t matter if patients chose their own music or were prescribed certain music.  Since music has no side effects, there’s no risk to trying it. ⁽⁶⁾

The Greek scholar Hippocrates treated sprains, joint pains and inflammation by cooling the skin, and traditional Chinese remedies used mint oil to the same end. Scientists have discovered that cooling chemicals which have the same properties as mint oil have a dramatic pain-killing effect when applied in small doses to the skin. Unlike conventional pain killers, these compounds are likely to have minimal toxic side-effects, especially because they are applied externally to the skin. This should mean they are ideal for chronic pain patients for whom conventional pain killers often do not work. ⁽⁷⁾

Some of the Energy Psychology methods have shown significant reductions in pain.  EFT in a number of studies has shown the emotional connection to the otherwise physical injury that the client perceives is at the root of the pain.  Dealing with the emotion, has released the pain. ⁽⁸⁾

Researchers have used functional magnetic resonance imaging (fMRI) to find out if hypnosis alters brain activity in a way that might explain pain reduction.  The researchers found that volunteers under hypnosis experienced significant pain reduction in response to painful heat. They also had a distinctly different pattern of brain activity compared to when they were not hypnotized and experienced the painful heat. The changes in brain activity suggest that hypnosis somehow blocks the pain signal from getting to the parts of the brain that perceive pain.

Hypnosis was successful in reducing pain perception for all 12 participants used in this study. Hypnotized volunteers reported either no pain or significantly reduced pain (less than 3 on the 0-10 pain scale) in response to the painful heat.

Under hypnosis, fMRI showed that brain activity was reduced in areas of the pain network, including the primary sensory cortex, which is responsible for pain perception. ⁽⁹⁾

Neuroplastician, Vilayamur Subramanian Ramachandran, born in Madras, India is an M.D., a specialist in neurology with a Ph.D. in psychology, Center for Brain and Cognition at the University of California.  He solved the centuries-old mystery of phantom limbs and the chronic pain they engender.  Phantom limb pain is prevalent in 95 percent of amputees.  Through the use of a large square box with a mirror standing inside it, he solved the centuries-old mystery of phantom limbs and the chronic pain they engendered.  The mirror image of the good limb being reflected in the mirror fooled the brain into thinking that this was the phantom limb moving and through a few weeks of using this technique, the pain was released by the brain. fMRI brain scans show that as these patients improve, the motor maps for their phantoms increase, the map shrinkage that accompanies amputation is reversed and sensory and motor maps normalize. ⁽¹⁰⁾

There are techniques that might be used in hypnotherapy.  Some of these are shown below:

Hypnotic imagery provides a potentially powerful means of altering pain experience and is widely used in pain management.  One such image might be to ask the client in hypnosis to create an image of a ‘dial’ or ‘thermometer’ to represent their current experience of pain. It is then possible to suggest that they use these to ‘turn the pain down’ (or sometimes to turn it up and then down to emphasize their own control).

The client can be asked to describe an image of their pain.  They may imagine their pain as a fire.  When the client is asked to imagine what sort of image might be used to extinguish the fire, they might see that as using a water hose.  The more this image was used, the smaller the fire became until it was just embers.

Glove anesthesia can be a helpful technique wherein the practitioner is able to create a feeling of numbness in the hand and then pass that numbness into certain parts of the body experiencing the pain in an effort to reduce or eliminate the pain.

The hypnotherapist may suggest that the client focus on other activities or tasks, and that change of focus will diminish any feeling of discomfort. In fact, the mere use of the word discomfort during a hypnotic session versus the use of the word pain can radically reduce any sensation of pain. Many clients achieve excellent results, and they can be taught to practice self-hypnosis for pain relief to gain personal control of their situation.

The hypnosis pain treatment approach can also be used to program the brain to release endorphins, which can induce a state of light anaesthesia, which is referred to as analgesia. This state can also be used to assist women to experience natural childbirth without the use of drugs that may harm the infant. It also helps to provide natural arthritis pain relief in long-term sufferers.

Hypnotherapy can also be used to induce a state of complete anaesthesia in a percentage of the population. This is referred to in medical literature as hypnoanaesthesia. In days before general anaesthesia became widely available to patients, many surgeons performed major surgery under hypnoanaesthesia.

Can hypnosis release the full throttle effect in the front region of the cortex to deactivate the sensation of pain?

Can we use imagery such as the ‘mirror box’ to fool the brain and so release pain not only in phantom limbs but in other areas of pain?

I suggest that these are areas worth exploring.

Bruni Brewin JP

www.bbbenefits.com.au

Bibliography:

⁽¹⁾University of Manchester (2006, December 23). Pain Relief Effectiveness Down To Mind-set?. ScienceDaily. Retrieved April 11, 2010, from http://www.sciencedaily.com/releases/2006/12/061222092853.htm

⁽²⁾ Eric Robins, MD explains how a chronic pain expert links pain and unresolved emotions,  http://www.emofree.com/Pain-management/pain-sarno-eric.htm

⁽³⁾Cell Press (2008, November 26).  Pain Is In The Eye Of The Beholder. ScienceDaily. Retrieved November 28, 2008, from http://www.sciencedaily.com/releases/2008/11/081125146110.htm

⁽⁴⁾ Northwestern University (2008, February 6). Chronic Pain Harms The Brain. ScienceDaily. Retrieved February 6, 2008, from http://www.sciencedaily.com­ /releases/2008/02/080205171755.htm

⁽⁵⁾Northwestern University (2007, June 5). Newly Identified drug Relives Suffering. ScienceDaily. http://www.sciencedaily.com/releases/2007/06/070604123715.htm

⁽⁶⁾ Good, M (2006, June). Music for Pain. Archives http://www.sciencentral.com/articles/view.php3?article_id=218392834

⁽⁷⁾ University of Edinburgh (2006, August 22). ‘Mint’ Pain Killer Takes Leaf Out Of Ancient Medical Texts. ScienceDaily. Retrieved April 11, 2010

⁽⁸⁾Emotional Freedom Technique website to view these: http://www.emofree.com

⁽⁹⁾ Schulz-Stubner, S (first author), (2005, March 14).Functional magnetic resonance imaging shows that hypnosis eases pain, from Medical Research News, http://www.news-medical.net/print_article.asp?id=8400

⁽¹⁰⁾Doidge N, (2007) The Brain That Changes Itself, ISBN 978-1-921215-82-7