PAINWeek News                        Thursday, Sept 6, 2012

Outside the Box: Reviewing Non-Pharmacologic Pain Relief
Expanding the scope of your practice to incorporate hypnosis and other non-pharmacologic therapies and modalities can provide a multitude of benefits for your patients.Yesterday morning at PAINWeek 2012, Daniel F. Cleary, an internationally recognized pain relief and hypnosis instructor, and Michael B. Ellner, CHt, MSH, an internationally prominent self-hypnosis educator, led a discussion on incorporating evidence-based self-care modalities and other forms of non-pharmacologic pain relief into practice.

Cleary began the presentation by telling the audience that the language used in pain management needs to be changed. Much of the discussion centered on the mental aspect of chronic pain, and the presenters advised that changing the terms and lingo associated with this area of medicine is an excellent place to start in terms of helping patients cope with their conditions.

Cleary said that he chooses to use the term “pain relief” rather than “pain management;” he asked the audience “Would you prefer management or relief [when treating your pain]?”. He also mentioned that when he speaks to his clients, he is careful to refer to patients’ pain as signals. “You can modify signals but if it is ‘pain’ than it is part of who you are,” he said.

If anyone knows about pain it’s Cleary. In 1978 he was partially paralyzed as the result of a motorcycle accident. In addition to the partial paralyzation, Cleary also suffered Brachial Plexus Avulsion, which in his case causes a burning, crushing sensation throughout his arm and hand. For about five years after the accident, Cleary was unable to sleep normally, and it wasn’t until he turned to hypnosis that he was able to sleep more regularly. After discovering the healing powers of hypnosis, Cleary began dedicating his life to developing techniques and approached for patients with chronic pain. For providers, it is important to understand that every chronic pain patient’s situation is unique and treatment “by the book” isn’t always the solution. This is when non-pharmacologic options can enable patients to get relief that they otherwise cannot.

In addition to discussing the need to change the terms associated with pain management, Cleary repeatedly stressed throughout his presentation that clinicians and patients alike must always remember that patients are not a diagnosis. Chronic pain patients can often allow their condition to become their identity. This can become problematic for a number of reasons and can often lead to depression.

For the provider, it is also important to understand that every chronic pain patient’s situation is unique and treatment “by the book” isn’t always the solution. This is when non-pharmacologic options can enable patients to get relief that they otherwise cannot. “There is evidence that people living with chronic pain can be responsive to a wide range of non-pharmacologic approaches,” said Ellner. “Medical hypnotists, acupuncturists, and massage therapists can be a very nice fit for pain management and practices. These modalities are evidence based for a wide range of pain relief and are both complimentary and complementary to pain management centers and practices.”

Hypnosis (or hypnotherapy) has been studied and in some cases proven to be beneficial for a number of conditions, such as state anxiety (ie, before medical procedures or surgeries), headaches, smoking cessation, pain control, hot flashes in breast cancer survivors, and irritable bowel syndrome. “The doctor-patient relationship is one of the most powerful hypnotic relationships that exist,” said Ellner. “If a doctor says that something could be helpful, that alone can create a placebo effect.

Both Ellner and Cleary stressed the importance of providers and others involved in the management of chronic pain patients “getting a little more personal with patients” in order to help divert focus away from pain signals. When they treat clients they begin by asking them about their grandchildren or television shows or anything that will get them talking about something that they are interested in. Cleary also makes a habit of asking his clients to focus on their breathing so that they subconsciously fixate on it and not their pain.

Non-pharmacologic pain relief is a topic that is gaining more attention from patients, providers, and researchers. According to a 2010 survey released by AARP and the National Center for Complementary and Alternative Medicine, 73% of respondents who utilized complementary and alternative medicine did so to help reduce pain or treat a painful conditions. Perhaps more importantly, 47% of respected academic medical centers are members of the Consortium of Academic Health Centers for Integrative Medicine. As a new era of truly personalized medicine continues to evolve, expect non-pharmacologic pain interventions and therapies to continue to develop.

By Sean Johnson

Michael Ellner, CHT, MSH