Hypnosis shown to ease pain, but not all patients respond

Repeat after me: I am lying on a tropical beach. I am not undergoing surgery. I am lying on a tropical beach. I am not undergoing surgery.

Using hypnosis as a form of anesthesia is not a new idea, but lately it seems to be gaining currency. A pair of small Belgian studies published earlier this year reported that breast and thyroid cancer patients whose surgeries involved a combination of hypnosis and local anesthesia required fewer medications, recovered faster and spent less time in the hospital. The French Society of Anesthesiologists last year created a division in their group dedicated to the study of clinical hypnosis.

Can hypnosis really block pain? Should it be practiced in the operating room? We asked Tony Yaksh, professor of anesthesiology and pharmacology at the UCSD School of Medicine and director of the UCSD Anesthesiology Research Lab, to talk about altered states of consciousness and the science of pain.

Q: Is pain purely a neurological phenomenon? In other words, if the brain is unaware of signals sent from injured tissues, does pain actually exist?

A: If you injure tissue (which occurs in surgery) or cause it to become inflamed (as in arthritis), a message is generated and encoded in sensory nerves and sent through the spinal cord to the brain. The brain decodes the message and we become aware of this sensation. Just like when we key the letters P-A-I-N into a computer search engine and the search engine provides associated words and concepts, so it is that the brain provides us with myriad conscious correlates to describe this sensation, such as unpleasant, aversive and more. These produce behaviors that make us want to escape the sensation: Put down the hot coffee cup or move your foot to avoid a thorn. These conscious events are strong and have overpowering emotional content, such as dread, suffering and anxiety. The consequences are as real as any sensory experience can be.

This component of the pain experience is very much dependent upon the information that brain receives. If we block that transmission (as with a local anesthetic) or change the way it is encoded (as with an agent like morphine), then the conscious experience of pain is diminished.

But pain can be real without physical injury. That’s evident in cases of post-traumatic stress disorder where individuals have experienced enormous sensory overload – the sights, sounds, odors, noises of war, for example – without actually being injured themselves. Profound experiences can impact how the brain functions; later stimuli can trigger painful perceptions. Traditional analgesics are of little use. There’s no physical injury or inflammation to block, but the pain is just as real.

Q: Do you think it’s possible for a person to consciously block out severe pain?

A: There are many reported examples of individuals exposed to an intense emotional experience who may not notice the physical injuries that others could not ignore. Professional athletes in the heat of competition or wounded soldiers in the middle of a battle are common examples. It’s a variable phenomenon. One can sometimes cope with the pain, but that’s not the same as blocking it out. You need only watch a football game and players’ reaction to an injury like a severely sprained ankle. A player might continue to play, but he’s not blocking the pain.


