Treating Chronic Pain with Hypnotherapy and EFT

by Patricia Worby
Patricia is based in Southampton, England

The background

Hypnotherapy, despite its recent popularity, suffers from some misunderstanding with the general public. Firstly, as one of the ‘psychotherapies’ many people tend to think that it is only used for mental health issues/dysfunctions with all the stigma that can entail. Secondly, it is not really considered effective in dealing with physical problems, even though its evidence base is actually stronger in physical manifestations such as skin problems (eczema, psoriasis), insomnia and pain relief(i). Most people tend to automatically think of it as something for smoking cessation and weight loss (hence the phenomenal rise of techniques such as the HypnoGastric Band). However, this is unfortunate as, in fact, hypnotherapy is an incredible self-development tool, both for helping achieve general life goals (banishing poor self-esteem issues for instance) and in achieving full health and wellbeing. Given there are so many life issues that are affected by stress and anxiety (aspects of mental health), including chronic pain syndromes, there is a great need for something to alleviate this gigantic burden on the health service.(ii)

The mind-body

The old mind-body split (popularised by Rene Descartes in the 17th century and very much still influencing medical practice today) has been shown by current neuroscience to be a defunct and erroneous duality – the mind and body are one. Our modern understanding shows that the gut, for instance, possesses many of the neurotransmitter receptors that the brain does and other organs, including the gut, are able to manufacture these chemicals so that the idea of brain-body communication being one way is now outmoded. With the discovery of neuropeptides in the 1980’s it was found that two-way communication is the norm – your gut knows when you are happy and sad, in love or stressed. Although it has long been accepted that some conditions are ‘psychosomatic’ in origin (ignoring the negative connotations of that word), we have only recently begun to piece together the puzzle that is the mindbody (the term first coined by molecular biologist Dr Candace Pert(iii) and subsequently developed by Dr. Bruce Lipton(iv)).

It is not a new idea that some physical conditions are affected by stress levels (and thus, indirectly, by emotions). For example stomach ulcers which were commonly diagnosed in the 1960’s/70’s and Irritable Bowel Syndrome (IBS), currently, are generally accepted as diseases with a high correlation to chronic adrenal stress(v). But what of conditions like back pain, and frozen shoulder which have a much more musculoskeletal manifestation. How could these be related to emotions?

Recent work by such doctors as Dr John Sarno(vi) have highlighted how even these common conditions can respond to a primarily psychotherapeutic treatment. In his clinic and in his writings, Dr Sarno has developed his theory that many instances of these conditions (once other causation has been ruled out) originate in the unconscious mind. His theory, developed alongside psychotherapists, is that it is the body’s way of distracting the conscious process from feeling unacceptable emotion.

For instance say you are a middle aged woman who suddenly has to look after elderly parents. You love them unconditionally (hopefully!) and honestly and sincerely dedicate your time to caring for them. You do not consciously resent the work as these people raised you without complaint and you feel it is what anyone would expect when you reach old age. You then develop unexplained shoulder pain which slowly gets worse. Your doctors are mystified as there is no organic reason for the pain. Another example could be a man who takes on a job which he hates because he feels he must earn the money to support his family and this offers better security. He develops a bad back which starts mildly but begins to get disabling, but scans offer no clues other than a mild herniation of a disk. He is offered surgery but although successful in alleviating the herniation makes no difference to the pain. These two scenarios are both examples of what Dr John Sarno calls Tension Myositic Syndrome or TMS. For our purposes this means a psychosomatically driven condition affecting the muscles. Fibromyalgia and Chronic Fatigue are other examples.

How do they develop? The theory is that the unconscious mind (this is a ‘working model’ of process rather than a defined area of the brain) harbours very childlike emotions and your longterm memory. Freud called it the id, modern psychotherapy refers to it as the Child. In this part of your mind are the unreconstructed emotions of childhood – envy, anger, resentment which come out as negative thoughts and feelings. They are not very acceptable to the conscious (adult) mind and so they are repressed via the conscious part of the mind the so-called ‘critical factor’. So, that they don’t become conscious the mind creates a practical diversion which is the pain. As long as the person is focussed on the pain or disability they do not have to think about the unacceptable emotions they are harbouring.

I am aware that this sounds implausible. It is not something that is recognised in current medical science. But experience has shown me time and time again that this effect is truly real. As a budding holistic/hypnotherapist I have come across many clients whose pain seems intractable but finding the cause proves impossible. In an early case study of someone with muscle pain, I found that when using EFT to calm the person before treatment the pain suddenly moved! This flouts all the traditional views of pain being a specific response to damage in a particular part of the body. It certainly astounded me. Since that time I have repeated this with many clients and have found invariably that the pain reduces and/or moves position. This made me start to research the physiology of pain signals and how the messages are constructed.

Physiology of pain

Sensory nerves in your tissues pick up signals from the environment; tension of muscles, cold/heat, air pressure, etc and transmit impulses along the nerve fibres which travel to the brain to be interpreted. There is a great deal that can intervene in this passage – notice for instance that the brain is able to override the pain signal if necessary. Have you ever had a minor injury that you didn’t notice till you looked at it and then it became painful? What about children who often interpret pain as ticklishness? This happens a lot when I am treating youngsters with musculo-skeletal problems using various bodywork techniques (massage, passive stretching, etc). Pain is a subjective phenomenon – it can be switched on and off, or decreased in level by psychological means.

Pain in chronic disease – the case of fibromyalgia

Two years ago I first came across my first case of a client with fibromyalgia. I discovered that it is characterised by intense muscular/joint pain in specific points in the body – the trigger points (similar to but not the same as trigger points in massage therapy). These points tend to be the same in all patients although the severity will vary. There is also severe weakness and fatigue and patients may be unable to work or live normal lives because of their condition.

Fibromyalgia is treated in conventional (allopathic) medicine by symptom suppression. Thus patients often end up on high dose painkillers (morphine derivatives), anti-spasmodics (for the characteristic involuntary jerking of muscles), sleeping tablets to counteract the insomnia (disturbed sleeping patterns of late night alertness and difficulty getting up due to adrenal dysregulation) as well as anti-depressants and blood-pressure tablets in some cases. Patients become a repository for pharmaceuticals and this stresses their livers even more and may have many side effects including those that cause more of the same symptoms they are intended to cure (e.g. fatigue).

Fibromyalgia shares many of the same features as Chronic Fatigue Syndrome (CFS); in naturopathic terms it is simply the same dis-ease expressing itself in a different way. Conventional treatment views them as separate diseases with ‘treatment’ that is focussed on pharmacological symptom suppression and management. Thus, patients end up prescribed many drugs without a clear diagnosis or understanding of what is going on (fibromyalgia is a descriptive term – it means ‘pain in the muscles’ – rather than explanatory). This is very demoralising and disempowering and leads to further internalisation of blame (‘I’m a shirker, if only I had enough will-power I could overcome it’, etc) which further exacerbates the problem. In addition, there is still no accepted aetiology for the disease although conventional medicine views it as ‘incurable’ and progressive(vii). Thus for people with this diagnosis there is a depressing prognosis and often nowhere to turn for relief.

However there is light at the end of the tunnel. New research being propounded by various alternative/integrated practitioners(viii) shows there to be very clear predisposing factors including;

• childhood trauma (usually then triggered in adulthood by accident, bereavement, etc)
• dental amalgam exposure (either by having fillings or working in the dental profession) – mercury is highly toxic and constant exposure is a cumulative toxic burden
• microbial and viral infection (caused and exacerbated by a leaky gut which affects immunity)
• certain personality characteristics of diligence and perfectionism. It affects far more women than men (at a ratio of about 9 to 1 – testosterone appears to be protective by preventing Adrenal fatigue(ix)).

Despite its emotional connections it is a real physical condition – unfortunately the term psychosomatic has been hugely misrepresented as being ‘all in the mind’ – this is not what it means. It means it has its origins in the subconscious part of the brain which then affects the somatic (body) part of the mindbody. It’s basic causes are:

• Mitochondrial function is severely impaired (mitochondria are the energy producing units in the cell)
• hormonal disregulation (particularly adrenal and thyroid), leading to fatigue and all the other symptoms of dizziness, poor stamina, water retention, etc.
• sympathetic nervous system overstimulation which controls the automatic body functions of blood pressure, sweating, etc and prepares us for ‘fight or flight’. In short, the body is on perpetual alert but without any resources to back it up. People are thus left ‘tired by wired’.

Here, then we have the potential for mind-body intervention. By blocking the nervous system stimulation we can intervene in that process and help the body calm the system. This is where EFT appears to be helpful in that by the tapping of certain points on the meridians we can stimulate the amygdala (part of the reptilian emotional brain that lies deep beneath the cerebral cortex) to break the link between a particular thought and its accompanying emotion. So, if by tapping and simultaneously focussing on the pain you add the vital ingredient of ‘acceptance’ even though I have this pain in my shoulders I deeply and completely accept myself’ (the so-called ‘set-up phrase’) you re-wire the brain in subtle and still not understood ways that may involve the limbic system(x).

My first experiments with this on myself and others showed me the power of such interventions to reduce or restructure the pain. Sometimes it move around the body or change form – with my fibromyalgia clients for instance a stabbing pain became tingling, or would become massive jerking. Clearly something psychosomatic was at work.

Hypnotherapy in the alleviation of chronic pain

This led me to investigate whether further more structured psychological interventions might be helpful. As I was studying for a hypnotherapy diploma at the time it occurred to me to use one of my regular fibromyalgia clients as a case study.

Diane(xi) had had the condition for nearly 10 years although the last 5 have been the worst. This phase was triggered by the last in a series of car accidents which she had had and which resulted in terrible trauma. She was treated for the physical trauma with physiotherapy and painkillers but nobody seemed to think she might need counselling of any sort despite the fact that she inadvertently caused the death of the other driver (who was at fault incidentally). Being by nature a ‘coper’ and despite a very dysfunctional childhood of physical and sexual abuse her family managed to successfully inculcate her with a ‘never complain’ attitude and a skill in burying feelings or standing up for herself. She went on to deny her natural abilities in writing to become a medical secretary – a job she hated- because she felt she wasn’t ‘good enough’ to become the natural teacher that she was. This is ‘fish out of water’ characteristic is also common to many fibro sufferers.

So Fibro sufferers generally ‘put up and shut up’, often denying their own needs in order to ‘be good’. They also overwork, pushing beyond their own natural limits, so, when chronic illness does come it may strike them down just when they were at their most productive. There were early warning signs but they were ignored until collapse is inevitable.

I decided to explore these issues in hypnotherapy as the medium of hypnosis is able to disconnect the critical mind in order to facilitate focussing on the unconscious process where the emotions of the initiating experiences reside. In 5 sessions with Diane we uncovered many of the erroneous and downright dangerous beliefs she had about herself and her role in her past. She realised that she still harboured a lot of guilt about the abuse, she still blamed herself despite knowing she was too young to be responsible for what happened. People often know logically that events were not their fault but the unconscious still holds these beliefs as it has not updated the programme from our childhood selves. Therefore being able to release these feelings in hypnotherapy has profound benefits for the self.

I took Diane back to her childhood with regression to which she responded almost immediately becoming childlike in voice and language. I made sure she was dissociated from the experience( i.e. was viewing herself having the experience so as not to retraumatise her) but it was clear that she was able to reconnect with her younger self. With my help we gave that younger self some suggestions about what was happening and that the responsibility (ie. not blame which is a negative and pointless emotion) lay with the adult in the scenario who transgressed boundaries and shattered her trust. Once she truly understood this she was released from the guilt and other associated negative feelings she had had (subconsciously) all her life.

When brought out of hypnosis her experience of the pain was much reduced and lasted between sessions. With subsequent sessions we have looked at different experiences and worked on other issues as they came up including working in the ‘here and now’ with Cognitive behavioural therapy (CBT). I am not tied to any one psychological approach but seek to explore the client’s perspective depending on their needs and characteristics. As a holistic therapist I have also supported with nutritional and adrenal/thyroid support and occasional physical therapy/Reiki when needed. To date we have achieved much relief and new purpose with Diane hoping to finally start her new business from home – a long-held dream.

Other uses in chronic pain e.g. back pain

My other research in nutrition and naturopathy has led me to determine the common factors in much chronic disease;

• Nutritional deficiency/gut dysbiosis (imbalance of flora)
• Toxicity
• Emotional dysfunction

By looking at each of these in turn (with help from other practitioners in a team-based approach) the client can be liberated from their illness.
Thus I have come to the opinion that it doesn’t really matter if your diagnosis is Fibro, Frozen shoulder, Scleroderma, Lupus, IBS – you see the same factors over and over which can be treated with a holistic approach using these common underpinnings. I find that limiting your approach to one modality is probably not best for the client with chronic disease – the disease itself is multifactorial so why shouldn’t the solution be?

With issues of a more traditional nature like back pain, I am encouraged by theories such as those expounded by Dr Sarno(xii) and Dr Sarah Key(xiii)who stress self-empowerment and a self-help approach to treatment. Thus hypnotherapy is a key part of this mix as it approaches the psychological component swiftly and painlessly. EFT is helpful as a first-aid measure and self-empowerment technique – I enjoy giving clients the ability to learn this and treat themselves. I believe this is a profound sea-change in the way chronic disease is looked at and offers hope for many with these debilitating and otherwise ‘incurable’ illness. I hope as a hypnotherapist specialising in pain and chronic illness (including depression) I will offer an alternative to a life on pain-killing medication. As such I am now embarking on a Practitioner diploma in specialist Fibromyalgia/CFS training with the Chrysalis Effect which is a company set up by former sufferers of these conditions. I hope this proven protocol which incorporates Wellbeing Coaching (a form of life coaching focussed on health and wellness) will add further insight into my approaches.

References
i) Lynn, S. J., Kirsch, I., Barabasz, A., Cardeña, E., & Patterson, D. (2000). Hypnosis as an empirically supported clinical intervention: The state of the evidence and a look to the future. International Journal of Clinical and Experimental Hypnosis, Vol. 48, pp. 235-255
ii) The British Pain Society, The Costs of Pain FAQ http://www.britishpainsociety.org/media_faq.htm
iii) Dr Candace Pert. Molecules of Emotion.
iv) Dr Bruce Lipton. The Biology of Belief.
v) James L Wilson Adrenal Stress; The 21st century stress syndrome.
vi) Dr John Sarno, The Mind Body Connection 1999
vii) NHS Choices website http://www.nhs.uk/Conditions/Fibromyalgia/Pages/Treatment.aspx
viii) Alison Adams, The Natural Recovery plan 2010
ix) Anti aging research Laboratories http://www.antiagingresearch.com/adrenal_exhaustion_symptoms.shtml
x) Jay A Goldstein. Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Related Neural Network: Neurological Basis of … networks in health & illness. 1996
xii) Dr John Sarno, Healing Back Pain: The Mind-body Connection 2010
xiii) Dr Sarah Key, The Back Pain Sufferers Bible 2000