Hypnosis or the Power of Suggestion

Which works best to reduce pain?

Healthy people under hypnosis who are given the suggestion of heat pain (even though they do not receive any stimulus) show changes in their brain activity using functional magnetic resonance imaging (fMRI).¹

These changes are consistent with what would be expected for people experiencing pain. However, do people need to be hypnotized for the suggestion to produce pain, or in the case of fibromyalgia, relieve pain? Stuart W. G. Derbyshire, Ph.D., and his colleagues at the University of Birmingham in England, attempted to answer this question using fMRI in a group of patients with fibromyalgia.²

Only patients who were able to increase or decrease their pain by visualizing a “pain dial” in an experimental setting were included in the study. Researchers selected these volunteers because they were more likely able to respond to hypnosis and suggestion using the same pain-altering technique. Fibromyalgia patients who used distraction or other techniques to reduce pain were excluded.

To image changes in brain activity, all subjects had to be in the fMRI scanner during the sessions. After a few practice sessions, verbal suggestions were replaced by non-verbal signals in the form of a simple sequence of taps to the patient’s left foot (one tap to dial the pain down as close to zero as possible, two taps to bring the pain to mid-range, and three taps to dial it up to the maximum pain of 10).

Seven fibromyalgia patients in the hypnosis group were evaluated under hypnosis with the suggestion for controlling their pain dial. Six patients were given only the suggestions without any hypnosis (the suggestion-only group). After each session of low, medium, and high pain suggestion states, patients were asked to rate their pain on a scale of 0 to 10, and how hypnotized they felt on a 0-10 scale (zero being not at all hypnotized). Each patient also rated how much control they felt in the hypnosis group and the suggestion-only group on a 0-10 scale (zero being no control).

Based solely on patient pain ratings:

• hypnosis alone had no effect,
• suggestion-alone was significantly effective for altering the person’s pain, and,
• hypnosis plus suggestion was the most effective.

Is there something about hypnosis that makes it easier for patients to incorporate the suggestion of turning the pain dial up or down? “That was one of the puzzles of the study,” says Derbyshire. “Going in, we expected a fairly good difference from the hypnosis, but we found that behaviorally (i.e., the patient’s pain ratings) the hypnotic induction made very little difference. This is in line with arguments that suggestion is independent of any hypnotic induction.”

Unlike each patient’s high and low pain ratings, significant changes in brain activity were visible on the fMRI for all conditions, including the hypnosis-only situation. Still, hypnosis plus suggestion produced the greatest changes in key brain centers responsible for processing pain. Derbyshire believes that there may be something happening in the brain that cannot be detected by a simple pain rating scale.

“One possibility,” says Derbyshire, “is that the pain was moving more in general after hypnosis, but the peak shifts remained the same. Patients reported the peaks (high and low pain from 0-10) because that is what we asked them to do. I’m not sure that the induction provides for more relaxation or a better ‘focus’ but that is consistent with what we found. More studies are needed to determine this.” It should also be added that patients felt more in control of their pain when hypnotized.

Do the results of this study mean that you can just suggest to yourself that your pain is less to ease your discomfort? “Positive self-talk might be helpful,” says Derbyshire, but he cautions against interpreting his study in such simplistic terms.

“The hypnotic suggestion technique is very good for acute pain control in highly regular environments, such as a dentist’s chair. There is no reason why that cannot be adapted to the more messy, outside world but, in reality, life is not lived under controlled dental or laboratory conditions.”

“I would not want to overstate what we did. We chose people who could bring to mind a dial controlling their pain and then asked them to move the dial up and down, allowing their pain to move with the dial. That’s really it and there is no reason why one has to use a dial. Sean Mackey, M.D., Ph.D., at Stanford does a similar trick using a fireplace, whereby as the fire is dulled the pain goes with it. And there is no reason why a patient can’t stop when their pain gets really bad, drag up the dial, and dial their pain down. No reason except life can’t always be stopped like that and, once the effort of dialing down the pain is relinquished, the pain comes back, which is probably demoralizing.”

Positive self-talk and being optimistic is bound to be helpful, but Derbyshire is being realistic about fibromyalgia patients being able to mentally tune down their pain. “Fibromyalgia is a tough illness, and it won’t yield to suggestion on an everyday basis. If it was that easy, you could argue that anything that helps is a good thing. Of course, our study was fundamentally based upon the premise that pain can be controlled under some circumstances. But it is a heck of a reach from there to suggestions of everyday control in the messy, real-world setting.”

Mindfulness techniques that involve positive suggestion may plausibly help with your pain and are certainly worth a try. However, keep your expectations realistic. Derbyshire says these techniques he used were simple to learn and should not require a therapist to learn them, although this could be useful. Check the self-help section of your local library or bookstore for assistance.

1. Derbyshire SWG, et al. Neurology 23:392-401, 2004.

2. Derbyshire SWG, et al. Eur J Pain [Epub ahead of print] 2008.