In order to utilize hypnosis for pain relief, one needs to look upon pain in a most analytical fashion. Pain is a subjective experience, and it is perhaps the most significant factor in causing people to seek medical aid. Treatment of pain as usually viewed by both physician and patient is primarily a matter of elimination or abolition of the sensation. Yet pain in itself may be serving certain useful purposes to the individual. It constitutes a warning, a persistent warning of the need for help. It brings about physical restriction of activity, thus frequently benefiting the sufferer. It instigates physiological changes of a healing character in the body. Hence, pain is not just an undesirable sensation to be abolished, but rather an experience to be so handled that the sufferer benefits. This may be done in a variety of ways, but there is a tendency to overlook the wealth of psycho-neurophysiological significances pain has for the patient. Pain is a complex, a construct composed of a great diversity of subjective interpretative and experiential values for the patient.

The hypnotic procedures in handling pain are numerous in character. The first of these, most commonly practiced but frequently not genuinely applicable is the use of direct hypnotic suggestion for total abolition of pain.

With a certain limited number of patients, this is a most effective procedure. But too often it fails, serving to discourage the patient and to prevent further use of [tag-tec]hypnosis[/tag-tec] in his treatment. Also, its effects, while they may be good, are sometimes too limited in duration, and this may limit the effectiveness of the permissive indirect hypnotic abolition of pain. This is often much more effective, and although essentially similar in character to direct suggestion, it is worded and offered in a fashion much more conducive of patient receptiveness and responsiveness.

Another procedure for hypnotic control of pain is the utilization of amnesia. In everyday life we see the forgetting of pain whenever more threatening or absorbing experiences secure the attention of the sufferer. An example is the instance of the mother enduring extreme pain, seeing her infant seriously injured, and forgetting her own pain in the anxious fears about her child. Then of quite opposite psychological character is the forgetting of painful arthritis, headache, or toothache while watching an all-absorbing suspenseful drama on a cinema screen. But amnesia in relationship to pain can be applied hypnotically in a great variety of ways. Thus one may employ partial, selective, or complete amnesias in relationship to selected subjective qualities and attributes of sensation in the pain complex as described by the patient as well as to the total pain experience.

The fourth hypnotic procedure is the employment of hypnotic analgesia, which may be partial, complete, or selective. Thus, one may add to the patient´s pain experience a certain feeling of numbness without a loss of tactile or pressure sensations. The entire pain experience then becomes modified and different and gives the patient a sense of relief and satisfaction, even if the analgesia is not complete. The sensory modifications introduced into the patient´s subjective experience by such sensations as numbness, an increase of warmth and heaviness, relaxation, etc., serve to intensify the [tag-tec]hypnotic[/tag-tec] analgesia to an increasingly more complete degree.

Hypnotic anesthesia is the fifth method of hypnosis pain relief. This is often difficult and may sometimes be accomplished directly, but is more often best accomplished indirectly by the building of psychological and emotional situations that are contradictory to the experience of the pain and which serve to establish an anesthetic reaction to be continued by posthypnotic suggestion.

The sixth hypnotic procedure useful in hypnosis pain relief concerns the matter of suggestion to effect the hypnotic replacement or substitution of sensations. For example, one cancer patient suffering intolerable, intractable pain responded most remarkably to the suggestion of an intolerable, incredibly annoying itch on the sole of her foot. Her body weakness occasioned by the carcinomatosis and hence inability to scratch the itch rendered this psychogenic pruritis all-absorbing of her attention. Then hypnotically, there were systematically induced feelings of warmth, of coolness, of heaviness and of numbness for various parts of her body where she suffered pain. And the final measure was the suggestion of an endurable but highly unpleasant and annoying minor burningitching sensation at the site of her mastectomy. This procedure of replacement substitution sufficed for the last six months of the patient´s life. The itch of the sole of her foot gradually disappeared, but the annoying burning-itching at the site of her mastectomy persisted.

Hypnotic displacement of pain is the seventh procedure. This is the employment of a suggested displacement of the pain from one area of the body to another. This can be well illustrated by the instance of a man dying from prostatic metastatic carcinomatosis and suffering from intractable pain, particularly abdominal pain, in both the states of drug narcosis and deep [tag-ice]hypnosis[/tag-ice]. He was medically trained and understood the concept of referred and displaced pain. In the hypnotic trance he readily accepted the idea that, while the intractable pain in his abdomen was the pain that would actually destroy him, he could readily understand that equal pain in his left hand could be entirely endurable, since in that location it would not have its threatening significances. He accepted the idea of referral of his abdominal pain to his left hand, and thus remained free of body pain and became accustomed to the severe pain in his left hand, which he projected carefully. This hand pain did not interfere in any way with his full contact with his family during the remaining three months of his life. It was disclosed that the displaced pain to the left hand often gradually diminished, but the pain would become increased upon incautious inquiry.

This possibility of displacement of pain also permits a displacement of various attributes of the pain that cannot otherwise be controlled. By this measure these otherwise
uncontrollable attributes become greatly diminished. Thus the total complex of pain becomes greatly modified and made more amenable to hypnotic intervention. Hypnotic dissociation can be employed for pain control, and the usual, most effective methods are those of time and body disorientation. The patient with pain intractable to both drugs and hypnosis can be hypnotically reoriented in time to the earlier stages of his illness, when the pain was of minor consideration. And the disorientation of that time characteristic of the pain can be allowed to remain as a posthypnotic continuation through the waking state. Thus the patient still has his intractable pain, but it has been rendered into a minor consideration, as it had been in its original stages. One may sometimes successfully reorient the patient with intractable pain to a previous time predating his illness and, by posthypnotic suggestion, effect a restoring of the normal sensations existing before his illness. However, although intractable pain often prevents this as a total result, pleasant feelings predating his illness may be projected into the present to nullify some of the subjective qualities of his pain complex. Sometimes this effects a major reduction in pain.

The next hypnotic procedure for hypnosis pain relief, which is very similar to replacement or substitution of sensations, is hypnotic reinterpretation of pain experience. By this is meant reinterpreting for the patient in hypnosis of a dragging, gnawing, heavy pain as a feeling of weakness, of profound inertia, and then as relaxation with the warmth and comfort that accompanies muscular relaxation. Stabbing, lancinating, and biting pains may sometimes be reinterpreted as sudden startle reactions, disturbing in character but momentary and not painful. Throbbing, nagging, grinding pain has been successfully reinterpreted as the unpleasant but not distressing experience of the rolling sensations of a boat during the storm, or even as the throbbing that one so often experiences from a minor cut on the fingertip and of a no greater distressing character. Full awareness of how the patient experiences pain is requisite for an adequate hypnotic reinterpretation of his pain sensation.

Hypnotic time distortion, first described by Cooper and then later developed by Cooper and Erickson (1959) is often a most useful hypnotic measure in hypnosis pain relief. An excellent example is that of the patient with intractable attacks of lancinating pain which occurred approximately every 20 to 30 minutes, night and day, and which lasted from five to 10 minutes. Between the attacks the patient´s frame of mind was essentially one of fearful dread of the next attack. By employing hypnosis and teaching him time distortion, it was possible to employ, as is usually the case in every pain patient, a combination of several of the measures being described here. In the trance state the subject was taught to develop an amnesia for all past attacks of pain. He was then taught time distortion so that he could experience the five- to 10-minute pain episodes in 10 to 20 seconds. He was given posthypnotic suggestions to the effect that each attack would come as a complete surprise to him, that when the attack occurred, he would develop a trance state of 10 to 20 seconds´ duration, experience all of the pain attack, and then come out of the trance with no awareness that he had been in a trance or that he had experienced pain. Thus the patient, in talking to his family, would suddenly and obviously go into the trance state with a scream of pain, and perhaps 10 seconds later come out of the trance state, look confused for a moment, and then continue his interrupted sentence.

The eleventh hypnotic procedure is that of offering hypnotic suggestions effecting a diminution of pain, but not a removal, when it has become apparent that the patient is not going to be fully responsive. This diminution is usually brought about best by suggesting to the [tag-tec]hypnotized[/tag-tec] patient that his pain is going to diminish imperceptibly hour after hour without his awareness that it is diminished until perhaps several days have passed. He will then become aware of a definite diminution either of all pain or of special pain qualities. By suggesting that the diminution occur imperceptibly the patient cannot refuse the hypnotic suggestion. His state of emotional hopefulness, despite his emotional despair, leads him to anticipate that in a few days there may be some diminution, particularly that there may be even a marked diminution of certain of the special attributes of his pain experience. This in itself serves as an autosuggestion to the patient. In certain instances, however, he is told that the diminution will be to a very minor degree. One can emphasize this by utilizing the ploy that a one percent diminution of his pain would not be noticeable, nor would a 2 percent, nor a 3 percent, nor a 4 percent, nor a 5 percent diminution, but that such an amount would nevertheless be a diminution. One can continue the ploy by stating that a 5 percent diminution the first day and an additional 2 percent the next day still would not be perceptible. And if on the third day there occurred a 3 percent diminution, this, too, would be imperceptible. But it would total a 10 percent diminution of the original pain. This same series of suggestions can be continued to a reduction of pain to 80 percent of its original intensity, then to 70 percent, 50 percent, 40 percent, and sometimes even down to 10 percent. In this way the patient may be led progressively into an ever-greater control of his pain. However, in all hypnotic procedures for hypnosis pain relief one bears in mind the greater feasibility and acceptability to the patient of indirect as compared with direct hypnotic suggestions, and the need to approach the problem by indirect and permissive measures and by the employment of a combination of various of the methodological procedures described above.