Chronic pain continues to be one of the most challenging health problems that exists. Sadly, the suffering from chronic pain often flummoxes the medical community and leads to people feeling ignored or overlooked by health professionals. A significant reason for this disconnection between the medical community and people with chronic pain can be explained by recent advances in the science of pain perception.

We now better understand that when people experience chronic pain long enough, the experience of suffering becomes imprinted in their brain. Through the phenomenon of neuroplasticity, people become conditioned to experience suffering in their pain years after trauma, wounds, or illness are long gone. Often, people with chronic pain, and I certainly can count myself among them, seek medical cures for their suffering when the best option is to manage symptoms rather than try to make them disappear.

Hypnosis can create dramatic changes for pain from acute sources, such as dentistry, labor and delivery, and medical procedures. When pain is short-lived and predictable, hypnosis can work wonders. It has proven remarkable in this respect for two hundred years. The problem is when such profound effects are applied to chronic pain. Hypnosis can no more make most forms of chronic pain disappear than can most medical interventions; chronic pain is notoriously refractory to medical interventions.

Hypnosis has been recently shown to show promise in chronic pain management, but it requires a dramatically different model of treatment as well as commitment from patients. Hypnosis can help manage chronic pain, but it can almost never cure it. My collaboration in NIH-funded research with Mark Jensen, Ph.D., has led to two models for using hypnosis to manage chronic pain. The first involves teaching people self-hypnosis to reduce their pain signals. This usually involves a minimum of four sessions of treatment, and more often eight. Patients are taught how to go into a deeply relaxed state with hypnosis, usually through counting downward and using progressive relaxation through the body. We then have patients go to imagery of their most positive, relaxing place. Once in this “place,” patients are taught a variety of techniques to reduce their pain. These might involve (as very rough examples) turning down their pain with an imaginary dial, locking their pain in an imaginary box, imagining a control center in the brain that can monitor pain, or using comforting imagery (lying in a cool mountain stream).

In this self-hypnosis approach, we have found that hypnosis is particularly effective when combined with interventions that modify negative cognitions about pain. Patients are taught to identify and change unhelpful, automatic thoughts that they have about their pain (e.g., “This will never go away”, “This is the beginning of the end”, “I can’t stand this”). They are taught to replace these unhelpful thoughts with more realistic ones (e.g., “This feels really bad, but it will not last forever”). This cognitive approach is a standard in psychological pain management, and we teach patients to use hypnosis to identify, amplify, and reinforce more adaptive thoughts.

The second approach that we use for hypnosis for chronic pain management involves using hypnosis to inform psychotherapy. My colleague M. Elena Mendoza, Ph.D., and I have recently developed an eight-module approach to using hypnosis and meditation to manage chronic pain. We begin with a biopsychosocial assessment of pain, which includes looking at the biological, psychological, and social factors that keep chronic pain in place. We teach patients that chronic pain often makes them stop moving, and this can be one of the worst possible things they can do. We further educate them about the role of dysfunctional cognitions in their pain experience as discussed above. We teach them how to meditate, as we now know that mindfulness is one of the most powerful approaches to managing pain. Very importantly, patients are taught that chronic pain often goes hand in hand with depression, anxiety, grief, and PTSD; addressing these psychological issues often reduces pain and suffering. Finally, patients are taught to improve their sleep, which is almost always disrupted by chronic pain. Hypnosis is used in this model to reduce pain signals, but it is mainly used to reduce all these other factors. This approach usually requires at least eight sessions of psychotherapy.

People who think that hypnosis can cure their chronic pain will often be sadly disappointed. Be careful of “hypnotherapists” who claim to be able to cure your pain. Managing chronic pain requires discipline and persistence in most cases, and it would be disingenuous as a health professional to claim otherwise. Two promising applications of hypnosis include teaching patients self-hypnosis (often with meditation) to make the pain more tolerable over time. The other approach involves using hypnosis to inform psychotherapy, and multiple factors are usually involved in chronic pain. Either way, with chronic pain, it is usually best to pursue management rather than a cure.