Introduction
Case History of Mr. X
Hypnosis
Practice and Repetition
Summary
Introduction
Now, more than ever, concerned physicians are beginning
to ask about and understand the role of non-drug therapies to assist patients
with headache. These therapies, alone or in combination with medications,
can significantly impact headache treatment.
This pleases me. As a family physician and clinical hypnotist
with 30 years experience in the field, I applaud this trend. Certainly,
a capable and compassionate physician will struggle to assist his or her
patient to find headache relief by whatever methods; complimentary, traditional,
or both. Much can be gained if we look at hypnosis as a helpful tool in
the battle for headache relief.
Training your brain
As our understanding of how the brain works and which
compounds (or
neurotransmitters) control
our pain response expands, we begin to suspect that relaxation therapies,
including hypnosis, may alter in a positive and fundamental way our brain
chemistry such that pain relief is more likely. An interesting study was
performed with patients who learned relaxation skills. The researchers
checked the subjects’ monoamine oxidase levels—since
monoamine oxidase is what metabolizes serotonin,
a pain relief chemical, and found changes in those levels consistent with
what you would expect with preventive drug therapy. The study suggests
that it is not just a matter of feeling relaxed that’s important, but actually
learning via these relaxation therapies to turn on and off certain pain
pathways in the nervous system by changing monoamine oxidase levels and,
consequently, serotonin levels.
In this article, I would like to introduce you to hypnosis
and self-hypnosis as a modality of pain relief for patients who suffer
from headache. Hypnosis is fun, effective, relaxing, and has no side effects.
What is this thing they call hypnosis? No, Virginia, it
is NOT clucking like a chicken, barking like a dog or being “put under,”
helpless and at the control of the master. Rather, for most people most
of the time, it is a focused state of attention or harmony. It is easily
achieved by visiting a professional skilled in hypnosis. This pleasant
state has two fascinating and useful properties:
1) It is profoundly relaxing.
In our stressful lives what person would not enjoy a few minutes of deep
relaxation in the middle of the day from hell!
2) The mind becomes open to positive
and therapeutic suggestions. Only suggestions given with
your permission and for your own benefit are accepted. No one can be
forced or coerced into doing something they do not wish to do.
Hence, when I help patients use hypnosis for headache
and stress, I offer them headache-specific suggestions as well as relaxation
and stress reduction instructions. I find this process fun and creative.
I get to know my patient not just as Mr. Jones with a headache, but also
as a real person in a stressful situation. This stressor in combination
with his or her biological predisposition to headache is creating more
pain.
Case
History of Mr. X
Let’s take a look at a case history and see how it all
fits together. Mr. X, a hard-driving chief financial officer of a high-tech
company is known as the “firing man,” and is responsible for downsizing
a company whose expenses exceed its revenues, and whose market share is
declining. His neurologist has referred him to me for help with his chronic
daily headache that has not responded well to numerous medications. His
executive decisions in the short run will result in layoffs and suffering
for many. However, with his expertise, talent, intelligence, and hard work,
he may “turn the company around” and in the long run, his efforts will
benefit far more people than those who will suffer in the short term. He
is not well liked by his coworkers and worries a lot about his health and
finances.
He is a pleasant man, but rather intense and self confident
to the point of arrogance. At this time, he is willing to consider non-drug
therapies to diminish the pain and discomfort of his daily headaches.
Motivation
As I got to know him, I developed for him the three elements
essential to our success. First, in order to benefit from the therapy he
must be motivated. He must be motivated to want to use hypnosis for his
purposes, not mine, and motivated to put aside ten minutes each day to
develop via hypnosis relaxation sufficient to impact on the pain chemicals
in his brain.
Rapport
Second, I established with him a positive and supportive
rapport. Trust is an essential element of the hypnotic process. For this
gentleman who is used to firing people and always being in control in a
“one up, one down” situation, I must simply be his assistant. Without this
rapport, hypnosis will not be effective.
Hypnotizability
Third, I made sure he had sufficient hypnotizability.
Most of us can experience hypnosis without difficulty. Maybe only about
ten percent of us will not be able to enjoy the hypnotic process. I have
little to worry about with this patient. Most high-functioning individuals
in our society have good hypnotic skills, as hypnotizability is associated
with creativity, intelligence, and imagination.
Hypnosis
After a brief explanation of hypnosis and after gaining
his permission, Mr. X was hypnotized to enjoy some deep relaxation. Of
course, like many patients he had expected to be “put under” as he had
seen on the stage. Prior to his hypnosis, he was informed that this would
not happen and that he could maintain whatever level of awareness that
he desired. Regardless of the depth of his experience, his relaxation and
his ability to accept therapeutic suggestions would please him.
With this mixture of motivation, trust, and hypnotizability,
I was not at all surprised that Mr. X achieved some initial success at
relaxation using hypnosis and self-hypnosis. Contrary to what some might
expect, I do not use a gold watch or have my patients stare at a fixed
point or command people to relax. Rather, I use my voice and music to develop
a relaxation situation that guides a patient via a series of permissive
and open-ended suggestions into a hypnotic state.
Mr. X was pleased and agreed to return for further sessions.
Not surprisingly, he canceled most of them because he was too busy at work!
Nonetheless, he was very positive about the hypnosis that we did. He reported
that the relaxation lessened the pain from his headaches.
Practice
and Repetition
It is a principal of hypnosis that all suggestions require
reinforcement. Additionally, practice and repetition are required to develop
these skills so they can produce both a biologically medicated pain relief
(via altered brain chemicals) and a psychological harmony that helps the
patient deal more easily with daily stress.
As with most of my patients, I asked Mr. X to set aside
ten minutes daily (preferably at work and without interruption) to listen
to a CD that I created for him to recapture the relaxed feeling and increased
suggestibility that he experienced in my office. With some practice on
his part, I was confident that these daily and pleasant practice sessions
would reinforce positive suggestions relating to his particular headache
and attitude toward work.
Results have been very satisfactory so far. Mr. X has
not returned for further work. When last I inquired, he reported an improvement
in the severity of his daily headache. Once again, he said he had little
time for therapy, but he was enjoying the ten minute practice sessions
via his personalized CD.
This particular case history illustrates the value of
using non-drug therapies to assist in pain control. Human beings are complex
creatures who may have many different triggers for headache. Some of these
triggers are stress and psychologically mediated. By dealing effectively
with these triggers we may assist in pain control with fewer or no drugs.
Summary
Hypnosis is effective and fun and provides a powerful
complimentary or stand-alone therapy to those who suffer from headache.
Stress reduction and relaxation techniques have an important role to play
in the treatment in one of the more vexing problems physicians face in
practice, the patient with headache. A recent paper titled “New Treatment
Options in Migraine” by neurologists Drs. Brandes, Edvinson, Marcus, and
Rapoport rates relaxation therapies as “effective” as a non-drug therapy
for migraine.
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