A CASE STUDY: By Danielle Aitken RN.RM.
HYPNOTHERAPY IN THE SUCCESSFUL TREATMENT OF INTRACTABLE PAIN.
Clinical Hypnotherapist & Counsellor
Tutor & Clinical Supervisor
My client whom I shall refer to as Peter, has given me permission to share this information
Background information :
Post viral syndrome ( see below ) and Guillain-Barre Syndrome ( see below)have both been implicated with the Polyneuropathy ( see below) and the acute pain that this client had experienced since its onset, which began on 10th October 2016. The symptoms were attributed to a post viral illness that was contracted during a holiday in Cairns in the preceding 4 days prior to him returning home. On arrival back home my client was quite unwell and began to experience his first symptoms which were treated conservatively. As the symptoms escalated so did the medical interventions and investigations, but with little effect.
Peter, who is legally blind and was experiencing reduced mobility due to extreme pain, was assisted by a carer in order to attend the sessions. He stated to me that he did not consider his vision impairment a problem. He had been vision impaired for 40 years and told me that “he was a coper”, “he was adaptable” and “he was happy to do change”. These beliefs were noted and utilized in his hypnosis sessions. I also noted the degree of resilience he obviously possessed to cope with his life challenges so seamlessly and I utilized this strength and ability in his hypnosis sessions.
Session One 04/06/19
In the first meeting Peter presented in severe pain that he described as a” fire storm’ most of the time , ‘nerve firing’, ‘intense’, ‘shock like pains all day every day’, and as well as this he would experience several times a day what he called “bone shattering pains” and he never knew when they would strike. He described his usual and constant level of pain as 8-10/10. The “bone shatterers” that would come any time of the day or night, were rated by Peter as an 11/10.
He was living in desperation. The Sensory Polyneuropathy that he was constantly experiencing affected the whole surface area of his body, including his scalp, face, arms and legs. He had residual weakness in his hands. He had experienced planter fasciitis, feet tingling, hand tingling, tingling up his arms and legs worsening over time such that there were times that he could not walk at all. His bowel and bladder were also affected. The pain he experienced in his left leg was often so severe at 11/10, that he had asked his Doctor on more than one occasion to amputate his leg so he could have some relief. He described his pain as insurmountable. He had residual weakness persisting in both his hands. He was in the habit of chewing the inside of his mouth and he was suffering from anxiety and related comfort eating which was also becoming an issue of its own. He stated he ate “rubbish” often.
By the time he arrived at my clinic he had seen many doctors including;
- A regional pain specialist in 2018 : “Offering him no treatment options” according to Peter
- A Prof of Neurology who formally diagnosed him with Sensory Motor Neuropathy
- A specialist Anaesthetist from a Persistent Pain Clinic – connected to a Holistic Centre providing a Multi-disciplinary team approach.
- A local GP who supervised the day to day monitoring and medication maintenance.
At the time of our first visit Peter had tried multiple drug regimens all to no avail and he confessed he was at the end of his tether. He presented to my rooms stating that he had tried to get into a different pain clinic, and had been told the wait was nine months. He candidly stated “ If things continue like this he would not be here in nine months”
He was currently taking;
- Morphine patches 15ug
- Targin 20/10
- Duloxetine 30mg day and 60 mg at night.
Peter had experienced hypnotherapy before and described the outcome as “Iffy”
He admitted he was sceptical about the success of what we were about to undertake but he was prepared to be open minded.
Therapy session one we briefly discussed the following, which would be further discussed in subsequent sessions.
- What his preferred outcome was to be: I.e. His life in the absence of the current problem.
- How to challenge negative repetitive thoughts. CBT / Reinforced during Hypnosis
- Neuroplasticity and the brains ability to create change / function and rewire.
- He requested that we work on “rewiring his brain” to experience and respond in new ways
- Fight flight response with regard to the Mind body connection stressing the importance of not referring to the pain, which his SC mind understood all too well , but rather referring to it as discomfort.
- The importance of getting him out of stress mode and how to achieve that utilizing breath work and mindfulness
Hypnosis I used a longer hypnotic muscle relaxation as an induction, to help Peter experience a different state than the one he had been living in for so long. I did not mention pain; instead I directed his SC mind to go looking for the areas of comfort he was currently experiencing. As he gave visible signs of relaxation, I utilized what I was observing, continuously directing his attention towards relaxed mind and body.
Post session observations : He noted he was not aware of the “discomfort” during the session.
- Peter was taught breath techniques to connect to sympathetic nervous system ( the opposite to stress mode) and instructed when to use them.
- I gave Peter a 7 minute muscle relaxation recording to practice at least daily / or more often as required. At the completion of this relaxation recording, I instructed him to sit and to imagine his preferred outcome and step right into it for that moment and pretend he had already achieved it. (Hypnotic future pace)
- Peter was also instructed to be very aware of his thoughts challenging Negative Autonomic Thoughts or faulty beliefs.
- I gave Peter a recording demonstrating a pattern interrupt technique and instructed him to use it anytime his mind or thoughts were dwelling on the things he could not control or overly focusing on the discomfort. He was instructed to use the technique, taking a long slow breath focusing on the exhalation and relax right in to it, and then refocusing his attention on any areas of comfort he could find within his body.
Note : This put Peter in control and he was able to observe the immediate impact of his thoughts on his physical body.
Session Two 11/6/19
What had changed? Each session began with this question, and this is important as it builds an expectation that change was expected.
Peter walked through the door with a smile on his face proudly declaring that “I’ve had a good week” He had been doing his breathing exercises, the 7 minute muscle relaxation daily, and using the pattern Interrupt often. He stated that he had not had a single “bone shatterer” in a whole week. He felt calmer; He had managed to baby sit his Grandson and was able to play with him.
He was able to do mild exercise; 1 hour of ironing and his anxiety now felt like a tummy upset.
Overall he was more active and feeling positive about his observable changes.
He also stated that he had not used the word pain once since his previous session and this had also been noticed and commented on by his partner.
Therapy session 2
We again discussed the powerful mind body connection and the potential of his thoughts.
We acknowledged his progress and reinforced the principals behind what he was observing . We further discussed the principals of neuroplasticity and the potential to create change effectively rewiring his brain for increased calm and comfort.
Hypnosis session 2
I utilized a hypnotic, long slow muscle relaxation induction with suggestions of mind body connection, including suggestions about the power of his thoughts to create immediate change in his physical and emotional body. All positive changes he had observed were reinforced and stacked to build an expectation for further noticeable change.
Homework session 2
Continued as above and further instructions to specifically notice what was changing.
Session 3 18/06/19
What had changed :
He stated he had experienced “13 great days.”
He said he had “stopped eating rubbish”
“Pattern Interrupt was working very well”.
Between sessions he, with the assistance and approval of his Doctor, had stopped the use of his Morphine patch. He was accepting of the withdrawal symptoms he was experiencing and said they would be lessened or gone after a week/ He could cope with them.
He said “he was getting better in so many ways”
“He was sleeping better”
He said he felt “his brain was functioning differently”
He recognised he was going through an adjustment period where he said he was “re-learning to relax and release surface tension and to relax his jaw.”
Hypnosis session 3: Was directed towards relaxation, comfort, and his ability to be adaptable, happy to embrace change and we explored the idea that he was no longer just coping, he was designing and creating a new life.
Homework : As above
Session 4 2/7/19
What had changed:
He was now weaning of Duloxetine with the approval and supervision of his doctor, however his blood pressure had gone up, so this weaning process was modified.
He stated “Anxiety was a bit of an issue”
He had experienced a “mega Blow out” i.e. full body pain on the previous Saturday
Sunday he was fine again
Discussion session 4: Was directed toward the possibility that after Saturday he had begun to doubt his ability to maintain his outcomes. We again discussed the brain and its amazing ability to respond to every thought immediately chemically and physically, and the fact he had simply triggered an old response. I stressed the importance of maintaining his positive mindset and as I did, utilizing waking hypnosis, I deliberately moved the focus from what had gone wrong to all the amazing things he had already achieved
Hypnosis session 4: I used Peter’s description of his discomfort and his description of his comfort in somatic body work within the next hypnotic session.
Pain : was experienced as Black and heavy
Calm : was experienced as Blue / He also had a beautiful memory he connected to calm. We again focused on the calm in his body and mind as we utilized his meaningful color to assist in releasing / fading / breathing out any heavy dark areas and replacing them with beautiful blue while allowing his mind to go to his calming memory.
I also utilized a metaphor about riding a bike. I related it to what you can’t do until you believe you can, and when you believe you can you then do it easily and effortlessly.
Homework : As above with and continuing focus and monitoring of his negative or self-limiting thoughts
Session 5 9/7/19
What had changed:
He had had no further explosive pains: I.e. bone shatterers’ which were the “insurmountable pains” that he previously had been having several times a day.
He was walking more, His mood was better
Discomfort was better now only “back ground noise 4-5/10” according to Peter.
Pattern interrupt was still working well
He was still bothered by anxiety and he was worried about that.
Hypnosis session 5 : A lengthy progressive muscle relaxation, followed suggestions about mindfulness and being here and now not back in the past which no longer exists or out in the future imagining things that haven’t happened , and probably won’t, and how much more comforting it is to be here and now in the present moment.
All sessions reinforced his progress and allowed him to look back to see how far he had come and included a future pace to remind him where he was going.
Homework session 5 : Continued as above : daily breath work, mindfulness and 7 min muscle meditation also particularly being aware of his thoughts and feelings and challenging any negative / faulty beliefs utilizing CBT.
We were always working on the principle that what you focus your attention on you strengthen.
Session 6 : 16/ 07/10
What had changed.
Peter presented saying he was “really really well’
He had no “bone shatterers” and his back ground discomfort was “now at a manageable 2-3/10”
He was back to walking.
He was continuing to do his breath work and homework.
He had been “sleeping 5.5- 6.5” hours a night ( previously 2.5 )
“It was easier to get up in the morning”.
His BP was now under control and he was no longer on Duloxetine
He had not eaten ice-cream in 4 weeks and stated “no comfort food was required”
He was “feeling emotionally better”
His “anxiety was under control”; he stated he could “nip it in the bud” by using his pattern breaker.
Peter was now planning a trip to Monkey Mia in Western Australia, which had previously been completely out of the question. Nil further appointments were scheduled at that time.
1/10/19 Peter returned to my clinic after coming home from a successful trip to Western Australia. He stated “his mobility was dramatically improved”. He stated happily he was “walking regularly, and once again had a bounce in his step.” He said he “was in good health and had not chewed the inside of his mouth in some time.”
He was losing weight with exercise and was no longer comfort eating.
His weight was now 88 kg down from 93kg when he first attended my clinic.
He was continuing to do his homework: 7 minute relaxation each week and Pattern interrupt when required. He was meditating during the day and using controlled breathing as needed.
He was now sleeping 8 hours at night and was feeling good.
He described his background discomfort as “manageable 2-3/10” and he had not experienced any “bone shatterers”
He was now on a threshold dose of Oxycontin 20mg (previously on 80mg with little effect ) and he stated he wanted to continue hypnosis with a view to getting off this completely.
It is important to note the following :
- At no point during hypnosis did I ever mention the word PAIN .
- At no point did I ever tell Peter “I” could relieve his Pain. I continued to emphasise that research and evidence clearly indicates that his thoughts and his mind could influence the functioning of his body in powerful ways, which I would help facilitate through hypnosis and cognitive therapy.
- All medications were reduced under medical supervision and at no point did I ever encourage him to reduce or stop any medication.
- Peter was VERY motivated to achieve change and from my observations with so many clients this is essential in order to achieve this level of success.
What Peter’s ongoing care Specialist Doctor had to say:
His Specialist Anaesthetist from the Persistent Pain Clinic was astonished at Peter’s “remarkable recovery” stating according to Peter that “people don’t recover like this from Guillain-Barre Syndrome” and has since written a letter regarding Peter’s recovery to Peter’s local GP who had directed the supervised the reduction of all Peter’s pain medications.
What Peter had to say:
“As my symptoms escalated so did the medical interventions with little effect for 2.5 years until I started with Hypnotherapy with structured relaxation and CBT counselling for positive reinforcement. The strategy or goal was to reduce and hopefully eliminate acute pain and achieve freedom from drugs especially anti-convulsent and opioid treatments that were not working.”
“I was quite sceptical about what we could achieve, but I remained open minded.”
“Up until I started Hypnotherapy, my pain levels were commonly 8-10 / 10 and worse at night; often 11 / 10.”
“Sleep, even with drugs, eluded me with as little as 2.5 hours of restful sleep a night.” “Now I get 8 hours and 10 minutes according to my Fitbit activity monitor.” J
“My mobility and general presentation has improved dramatically since starting Hypnotherapy only a few short months ago and the 6 sessions to date.”
“I am happy for you to use the above in context as testimonial and case study”
Glossary of terms
“Post Viral Syndrome also known as Post viral fatigue or Chronic fatigue syndrome (CFS) is a condition that causes extreme tiredness. People with CFS have debilitating fatigue that lasts for six months or longer. They also have many other symptoms. Some of these are pain in the joints and muscles, headache, and sore throat. CFS does not have a known cause, but appears to result from a combination of factors”. https://medical-dictionary.thefreedictionary.com/Post-Viral+Syndrome
Guillain-Barre Syndrome: “A rare disorder in which your body’s immune system attacks your nerves. Weakness and tingling in your extremities are usually the first symptoms. These sensations can quickly spread, eventually paralysing your whole body. In its most severe form Guillain-Barre syndrome is a medical emergency. Most people with the condition must be hospitalized to receive treatment”. “The exact cause of Guillain-Barre syndrome is unknown. But it is often preceded by an infection” “There’s no known cure for Guillain-Barre syndrome” https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-causes/syc-20362793
Polyneuropathy : “A disorder that involves damage to multiple peripheral nerve fibres.” “Classic presentation is a symmetric distal burning or loss of sensation.” https://www.amboss.com/us/knowledge/Polyneuropathy
Drugs used to treat this client’s condition prior to hypnotherapy:
Anticonvulsants : Used to help relieve the pain caused by damaged nerves.
- Lyrica – Pre Gabapentin (large dosages used)
Often First line treatment for pain due to nerve damage.
- Neurontin – Gabapentin ( Titrated doses used with nil effect )
Used to treat neuropathic pain.
Antidepressants : Used to assist pain management
- Endep: – A tricyclic antidepressant : Nil effect
- Duloxetine – A serotonin-norepinephrine reuptake inhibitor (SNRI)
Often used to treat pain. This was very effective in changing the nature of the pain from acute burning to acute stinging that was more tolerable but took 6 weeks to become effective.
Clint states: “This was the only positive medication that actually did anything useful.”
Pain medications: Typical approach’s taken
- Morphine – 50-100mg Sustained Release tab.
- Morphine – 15ug Patch
- Oxycontin – Oxycodone Sustained Release – heavy doses 80 mg
- Targin – combo of oxycodone and naloxone as high as 60/30 mg
- Palexia – Tapentadol : An opioid (narcotic) pain reliever.
Dose up to as 400mg daily.
- Tramadol – A narcotic-like pain reliever: Dose up to 400mg daily.
Drugs taken as required:
- Endone : Narcotic analgesic
- Zopicone 7.5 mg: A non-benzodiazepine hypnotic agent used in the treatment of insomnia