Learning the Fundamentals of Clinical Hypnosis for Pain Control

Chronic persistent pain is a pervasive problem that physicians and dentists see frequently in their practices (Rickard, Strahan, et al., 2023; Eimer & Freeman, 1998; Eimer & Hunter, 2020). Unfortunately, these health professionals rarely have the training, educational background, or time to address the complex psychological needs of these patients. People with chronic persistent pain syndromes frequently struggle with anxiety, depression, anger, trauma, substance abuse, and problematic relationships with others. The U.S. Department of Health and Human Services has highlighted the pivotal role that psychology plays in the field of pain management and proposed a comprehensive set of core competencies. To date, Pain Psychology is an emerging sub-specialty in clinical psychology (Wandner, Prasad, et al., 2019).

Research has shown that pain patients who habitually predict the worst possible outcomes or view their situation as unbearable or insurmountable have the most difficult time adjusting to their pain. This type of thinking pattern has been termed “catastrophizing” and it has been associated with unnecessary suffering and unfavorable pain treatment outcomes (Edwards, Smith, et al., 2006). CBT has been demonstrated as effective in reducing “catastrophizing” and improving adjustment to chronic pain (Ehde, Dillworth & Turner, 2014; Eimer, 1989). Clinical hypnosis has been shown to make CBT more effective (Alladin & Alibhai, 2007; Eimer & Freeman, 1998).

With appropriate training, psychologists can learn to employ evidence-based psychological pain treatment tools such as Clinical Hypnosis and Cognitive Behavioral Therapy (CBT) to assist chronic pain patients in developing coping strategies, changing pain-related thoughts and behaviors, and alleviating emotional and physical distress.

When I earned ABPP board certification in Behavioral and Cognitive Psychology in 1997, I had been employing hypnosis as a tool in my practice of CBT for a decade. Given that I dealt with the challenge of chronic pain in my own life, and that I also specialized in Pain Psychology, I experienced personally and professionally the power of Cognitive- Behavioral Hypnotherapy for creating pain relief (Eimer, 1988, 1989; Eimer & Freeman, 1998; Zarren & Eimer, 2002).

Pain May Be Mandatory, but Suffering Is Optional

The Society of Psychological Hypnosis (Division 30) of the American Psychological Association, defines hypnosis as: “A state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion.” Hypnosis is the oldest effective drug-free remedy for relieving chronic pain because it leverages the power of focused attention, relaxation, and suggestion to influence the perception and experience of pain (Chaves & Dworkin, 1997; Eimer, 2000). Here’s why it can be particularly effective:

• With the induction of a deeply relaxed and focused state, hypnosis can shift attention away from pain sensations and reduce their perceived intensity. Studies show that under hypnosis, activity can decrease in brain regions associated with pain processing, resulting in reduced awareness of pain and discomfort (Dillworth, Mendoza, & Jensen, 2012). 
• Anxiety and stress amplify the sensation of pain and hypnosis can help to reduce anxiety and stress.
• Hypnosis helps patients gain a sense of control over their pain by employing mental strategies, such as visualization and dissociation, to manage their discomfort.
• Hypnosis enhances suggestibility so that therapeutic suggestions, such as imagining pain melting away or the pain sensations transforming into numbness, can reduce the pain experience.
• Research indicates that patients who use hypnosis for pain management frequently report a reduced need for pain medications (Rosenbloom, Slepian, et al., 2024).
• The effectiveness of hypnosis may also come partly from the placebo effect because when a patient believes in the treatment, the patient will expect it to work. This then modulates the patient’s perceptions of the pain (Kirsch, 1999).

In summary, when effectively and appropriately administered, hypnosis directly influences the three major dimensions of the pain experience – the brain’s sensory-perceptual, cognitive-evaluative, and emotional processing of pain (Melzack & Wall, 1970). This makes hypnosis an optimal modality for empowering individuals in managing their pain, reducing their stress and anxiety, and promoting their self-efficacy.

Hypnosis is an Evidence-Based Pain Treatment Tool

Research has shown that hypnosis is an effective tool for treating both acute and chronic pain. See reviews and meta-analyses by Jones et al. (2024), Langlois, Perrochon, et al., (2022), Milling, Valentine,  et al., (2021), Thompson, Terhune, et al., (2019), Jensen & Patterson (2014), and Elkins, Jensen, & Patterson (2007). However, its effectiveness was seen to be influenced by several variables.

A meta-analysis conducted by Thompson et al., (2019) found that the analgesic effects of hypnosis for all pain outcomes were strongly influenced by (1) hypnotic suggestibility and (2) the use of direct analgesic suggestion. While researchers such as Spiegel and Spiegel (2004) consider “hypnotizability”, to be a “fixed trait”, it is modifiable to a degree clinically if certain conditions are met (Eimer, 2008; Eimer and Hunter, 2020; Ewin & Eimer, 2006; Zarren & Eimer, 2002). Specifically, malleability of hypnotic suggestibility is determined by the clinical context, which must include good rapport, the clinician’s skillful use of language, the patient’s motivation, and effectively dealing with the patient’s fears of hypnosis (Eimer, 2024). Moreover, the efficacy of “direct analgesic suggestions” is determined by the clinician’s hypnotic language expertise. To deliver effective direct analgesic suggestions, the clinician must competently assess the patient, prepare the patient for hypnosis, choose and competently administer an appropriate hypnotic induction, formulate an appropriate individualized treatment strategy, and deliver precise suggestions before, during and after the trance (Eimer, 2024).

When a person is relaxed, they cannot be in pain on a conscious level (Zarren & Eimer, 2002). Thus, we teach pain patients to use self-hypnosis to achieve mental and physical relaxation to facilitate the patient’s ability to tolerate pain sensations and emotional distress. Hypnotic techniques promote the patient’s controlled use of imagination, dissociation and distraction in a therapeutically constructive way. This helps patients to filter the hurt out of their pain and suffer less (Spiegel & Spiegel, 2004).

Appropriate Training is Mandatory

Ethically, clinicians should limit their use of clinical hypnosis to problems within their scope of practice (Eimer, 2012). Clinical hypnosis is an effective pain treatment tool when utilized by a clinician who understands the complex biopsychosocial factors that maintain unremitting pain and who is competent in using hypnosis.

Effective training and supervised practice are necessary to prepare a practitioner to evaluate pain patients, formulate pain control hypnosis treatment plans, effectively induce hypnosis, and competently administer pain treatment strategies. Toward this end, I developed my Pain Control Hypnosis Practitioner Training programs to enable psychologists and other health care professionals to become part of the solution to the widespread problem of inadequately treated chronic pain (Eimer, 2024). 

In our APA approved 2-day intensive continuing education program on Pain Control Hypnosis, we teach psychologists and other health professionals to help pain patients “tame pain” and to understand why this is preferable to “fighting” pain. Clinicians who attend our training learn how chronic pain develops, principles of hypnotic analgesia, how to evaluate the array of pain coping strategies patients employ, effective rapport-enhancing ways to obtain informed consent, methods of inducing the hypnotic state, principles of suggestion, techniques for transforming pain perceptions, how to construct and teach an individualized self-hypnosis exercise, and the ethical and risk management concerns attendant to using hypnosis for pain management (Eimer, 2012). 

After completing this training, psychologists will be able to choose an appropriate pain control hypnosis induction, formulate an effective pain treatment strategy, construct powerful post-hypnotic suggestions, teach self-hypnosis for portable pain control, and minimize the risks of inadvertent negative consequences. Additionally, psychologists who complete the two-day course of study earn 16 continuing education credit hours, which are recognized by the APA and most state psychology licensing boards. In sum, psychologists who complete the training will feel confident about using hypnosis to create immediate pain relief, and be able to demonstrate convincingly to a pained person the power of hypnosis to change their pain experience. 

There are also several reputable professional hypnosis associations that sponsor clinical hypnosis training and list certified clinical hypnosis instructors, such as myself, on their websites. Two such organizations are the International Medical and Dental Hypnosis Association and the American Society of Clinical Hypnosis.