International Handbook of Clinical Hypnosis - E-Lib FK UWKS

254 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
future fear give way to the frightening awareness that a painful injury or condition
may have a permanent effect. Despair and despondency develop as the suffering
remains partially unrelieved, and activities become restricted. The seductiveness of
seeking, demanding, and receiving help from signi®cant others, including doctors
and family, the mildly pleasant and/or euphoric effects of medication, or the
sedation and induced sleep which avoids pain, can produce a reinforcement
contingency for which the pain is a suf®cient, and eventually a necessary precursor.
Feelings of helplessness lead to depression, guilt, and internalized anger concerning
perceived loss of bodily parts or functions, and diminished self-control. Gradually,
a time-protracted pattern is established involving helplessness and depression
which reinforces pain behavior Fordyce, 1976; Sternbach, 1968). Pain is sometimes
positively reinforced by its pleasant consequences, and sometimes negative
consequences are avoided by continued pain. Good things happen only when the
patient has pain: `My low back pain allows me to watch the Sunday football game
instead of mowing the lawn'). Alternatively, pain is that which prevents bad things
from happening: `When I have my migraines, I can avoid my spouse's advances';
`My unmanageable children go outside and play when I hurt'). Hypnotic strategies
need to be developed which will not initially threaten the secondary gain issues that
typically exist with the chronic pain patient. Hypnotic intervention based on
anxiety reduction will only frustrate the patient and the therapist, and will usually
be unsuccessful. While using hypnosis for pain control it is necessary to address
simultaneously the depression and secondary gain as psychotherapeutic issues.
HYPNOSIS AND CHRONIC PAIN MANAGEMENT: USEFUL
CLINICAL STRATEGIES
The typical chronic pain patient will be taking several medications, and will have
been treated unsuccessfully by several specialists before considering hypnosis.
These may have included neurologists and neuro)surgeons `when in doubt, cut it
out'), manipulative procedures by orthopedic and chiropractic specialists `when in
doubt, pound it out'), physical therapists `when in doubt, walk it out'), mental
health professionals `when in doubt, talk it out'), and extensive pharmacological
intervention `when in doubt, medicate'). For these patients, the demand, `hypnotize
me and get rid of my pain', is often an invitation to failure. When the burden of
cure is abrogated to the implicit magic of the technique, any initial attempt to use
hypnosis at best would be unsuccessful, and at worst, would precipitate an early
termination of the therapeutic encounter. Most pain patients have been unable to
accept their current reduced functionality, and angrily demand to be helped `return
to the way I used to be'. The typical chronic pain patient is angry, depressed, pastoriented,
feels abused by the medico-legal system and insists that he/she has lost
control of life. These are all relevant therapeutic issues. It is critical that the
therapist accepts the pain as `real', and not merely in the patient's head.