International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS AND PAIN 263
PAIN, STRESS AND THE IMMUNE SYSTEM
According to Melzack 1993), pain is a major stressor in human life and produces
the classic physiological responses of all stressors. However, different pain stimuli
or situations produce different perceived levels of stress, depending on the extent to
which they are interpreted as life-threatening, so that physiological responses show
great variability. There is convincing evidence on the damaging effects of painstress
on the immune response, as described and evaluated by Liebeskind and
others at the 1993 Padua Conference. A large body of evidence shows that stress
suppresses immune function generally, suggesting that severe, prolonged pain can
have serious, health-threatening consequences. Because it occurs more often in
older people who are more likely to have severe postoperative and other kinds of
pain, pain can no longer be brushed aside as `well, it's just pain; it can't kill you'.
Most data describe the physiological effects of acute pain. We know much less
about the physiological effects of chronic pain. On the other hand, the effects of
chronic pain on psychological health are well known. Chronic pain produces
depression, anxiety and fear. These adverse psychological consequences affect the
person, the family, and, because of the great costs of medical and social care, all of
society.
To treat chronic pain, which has such devastating psychological and social effects, we
must use all the techniques at our disposal, but we often fail to do so, producing the
tragedy of needless pain. Melzack, 1990)
CAN PHYSICAL EFFECTS OF HYPNOTIC ANALGESIA BE
DEMONSTRATED?
As reviewed in the ®rst part of this chapter, a number of investigations have
overwhelmingly supported the effectiveness of hypnosis in providing pain relief.
This has been demonstrated for many types of pain experience, and even in patients
with low hypnotizability ratings.
Spiegel, Bierre & Rooteberg. 1989) found a well-de®ned physiological effect of
hypnosis on pain control. They determined that the amplitude of neurophysiological
responses of hypnotized subjects given pain-blocking imagery was signi®cantly
reduced in comparison to that of non-hypnotized subjects. Based on this phenomenon
they propose that there is, in fact, a de®nable neurophysiological basis for
pain blockage via hypnosis.
There appears to be no real evidence of a relationship between hypnosis and the
endorphinsÐnatural brain opiates or morphine-like substances. A study in 1975 by
Goldstein & Hilgard showed that hypnotic analgesia was not reversed by naloxone,
a drug which reverses the analgesic effects of morphine in a dose which is effective
in reducing the placebo response. On the other hand placebo response in pain