International Handbook of Clinical Hypnosis - E-Lib FK UWKS

264 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
control has been shown to work by making the brain produce its own endogenous
opioids Portenoy, 1994).
In 1995 Kiernan, Dane, Philips & Price published the results of a study of
hypnotic pain control. Gracely 1995), commenting in an editorial in the same issue
of the journal Pain, suggests `by temporarily removing the second burden of
relying on a subjective response, Kiernan et al. have also relieved the ®rst burden
of at least the validity, if not the uniqueness, of hypnotic analgesia'.
Kiernan and his team claim to have shown that the hypnotic procedure
signi®cantly attenuates a physiological measure, the nociceptive re¯ex elicited by
electrical stimulation of the sural nerve. They used both the nociceptive re¯ex and
separate verbal measures of the intensity and unpleasantness components of pain
sensation to infer a triple, hierarchical pain-control system that is activated at all
levels by their hypnotic procedure. They found that hypnosis activated all three
systems. The percentage reduction in sensory intensity of about 30% was greater
than the 20% reduction in the nociceptive re¯ex, suggesting that the additional
10% was provided by supraspinal inhibition. Similarly, the 40% reduction in
unpleasantness ratings suggested that the 10% increase over the reduction in
sensory ratings was provided by a reduction in the amount of unpleasantness
associated with a speci®c sensory magnitude. Kiernan concludes his paper by
stating the results of this study demonstrate the multiple mechanisms of pain
reduction by hypnotic suggestions, and suggests, such mechanisms may also
participate in other psychologically mediated forms of pain reduction.
FLEXIBILITY IN THE HYPNOTIC MANAGEMENT OF PAIN
Hypnosis frequently contributes to anxiety reduction but this effect can be distinguished
from pain reduction. Anxiety is strongly associated with pain but separate
from it; a person in acute pain will often be anxious whereas chronic pain is usually
associated with depression. Benzodiazepine drugs have been shown to reduce pain
by relieving anxiety but they do not affect the pain threshold or the physical
sensation of pain. Pain tolerance is something beyond sensory pain and suffering so
that, in some cases, hypnosis substitutes for a tranquillizer rather than acting as an
analgesic.
Hypnotherapy is often ineffective with pain of a psychological nature, particularly
when pain is seen to be a depressive equivalent. Masked depression is one
of the conditions where hypnosis should be avoided unless the hypnotist is able to
deal properly with depression, using medication and psychotherapy. This situation
should be suspected if the patient gives a history of sleep disorder, fatigue, lack of
interest in sexuality or in general, or inability to workÐor a tendency to stay in
bed. This is particularly so if the patient functioned effectively previously; such
patients can respond dramatically to antidepressant therapy. Hypnosis may be used
after the depression is controlled.