Hypnotic analgesia: 1. somatosensory event-related potential changes to noxious stimuli and 2. transfer learning to reduce chronic low back pain

Abstract

Fifteen adults with chronic low back pain (M = 4 years), age 18 to 43 years (M = 29 years), participated. All but one were moderately to highly hypnotizable (M = 7.87; modified 11-point Stanford Hypnotic Susceptibility Scale, Form C [Weitzenhoffer & Hilgard, 1962]), and significantly reduced pain perception following hypnotic analgesia instructions during cold-pressor pain training. In Part 1, somatosensory event-related potential correlates of noxious electrical stimulation were evaluated during attend and hypnotic analgesia (HA) conditions at anterior frontal (Fp1, Fp2), midfrontal (F3, F4), central (C3, C4), and parietal (P3, P4) regions. During HA, hypothesized inhibitory processing was evidenced by enhanced N140 in the anterior frontal region and by a prestimulus positive-ongoing contingent cortical potential at Fp1 only. During HA, decreased spatiotemporal perception was evidenced by reduced amplitudes of P200 (bilateral midfrontal and central, and left parietal) and P300 (right midfrontal and central). HA led to highly significant mean reductions in perceived sensory pain and distress. HA is an active process that requires inhibitory effort, dissociated from conscious awareness, where the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. In Part 2, the authors document the development of self-efficacy through the successful transfer by participants of newly learned skills of experimental pain reduction to reduction of their own chronic pain. Over three experimental sessions, participants reported chronic pain reduction, increased psychological well-being, and increased sleep quality. The development of "neurosignatures of pain" can influence subsequent pain experiences (Coderre, Katz, Vaccarino, & Melzack, 1993; Melzack, 1993) and may be expanded in size and easily reactivated (Flor & Birbaumer, 1994; Melzack, 1991, 1993). Therefore, hypnosis and other psychological interventions need to be introduced early as adjuncts in medical treatments for onset pain before the development of chronic pain.

Understanding the multidimensional mechanisms of hypnotic analgesia

“…More recently, Crawford (1994) and Crawford, Knebel, Kaplan and Vendemia (1998) targeted attentional mechanisms, hypothesizing that these involve the frontal and limbic areas of the brain, in line with Gruzelier and Warren (1993) who suggested that inhibitory functions of the frontal lobe and limbic systems may contribute to peripheral nervous system effects of hypnosis in general, not solely pain modulation effects.…”

“…Extensive experimental work that substantiates involvement of the frontal and limbic areas of the brain has been done by Crawford and colleagues (Crawford et al, 1993a;Crawford, 1994;Crawford et al,1998). These authors have related inhibitory patterns of brain activity, including theta rhythm in the EEG, to the disattention resulting from suggestions for hypnotic analgesia (not to be confused with distraction).…”

“…Consequently, hypnotic analgesia can be seen as an active process that requires inhibitory effort, dissociated from conscious awareness, where the anterior frontal cortex participates with a supervisory, attentional control system in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities (Crawford et al, 1998).…”

Psychogenic pain: a study using multidimensional scaling

“…Hypnosis has also been linked to theoretical accounts of pain and its origins. Crawford, Knebel, Kaplan and Vendemia (1998), for example, have identified a link between high hypnotic suggestibility and chronic pain. Wickramasekera, Pope and Kolm (1996) and Wickramasekera (1998) cite high or low hypnotic susceptibility in conjunction with high social desirability scores as a risk factor for chronic pain within his high-risk model of threat perception.…”

Hypnosis for Chronic Pain Management

“…The use of hypnosis in the treatment of pain as well as for other medical and psychological conditions is an old practice that mainly consists on techniques designed to develop a state of mental ease and absorption that heighten responsiveness to suggestions oriented to produce changes in subjective experience [16][17][18][19][20][21][22][23][24][25][26].…”