the first installment

I wonder how much I can post!
Introduction
Mrs. E suffered from terminal breast cancer that had metastasized into the bone of her right arm and hand. She described the pain in her arm as “terrible,” and reported that on most days the pain forced her to take codeine every three to four hours, and it was then only effective in taking off the edge. Her constant pain was a perpetual reminder of her terminal illness. Left in this state, Mrs. E was unable to truly live during what she knew to be her last months of life. She was depressed and unable to enjoy even the simple things that had previously filled her life, like her family and friends, reading, or relaxing at the beach.
Mrs. E was referred to Dr. Ernest Hilgard for therapy involving hypnosis. Once induced into a state of hypnosis using imagery related to her positive experiences at the ocean, she was able to use the suggested analgesic technique to completely remove the pain in her arm. Before being instructed to wake from hypnosis, Mrs. E was told that she would retain a mild discomfort in her right arm—just enough to serve as a warning not to overdo any activity. In addition, she was instructed that she would retain the freeing and pleasant feelings associated with her idyllic time at the beach.
For the remainder of that day, she reported not needing any more codeine; in fact, after this point, an overall reduction in usage of pain medication continued. As treatment continued, Mrs. E was also taught a suggestion technique that helped her sleep through the night. Although Mrs. E eventually passed away, her therapy not only helped to reduce the pain in her arm, it greatly improved her overall quality of life.
Dr. Ernest Hilgard (1975) writes about Mrs. E:
At the time of the first contact, Mrs. E was clearly depressed not only by her pain but also by anxiety over the implications of her illness. Anxiety and pain are inextricably woven together in the problems faced by such a patient; at times the anxiety can be more severe than the pain of the disease itself…The patient was seen a total of seven times during a month. On each occasion, suggestions of relaxation and comfort of mind were stressed: how valuable it was to be able to exert more control over a part of her life, over the pain, and over the insomnia. Judging from the patient’s statements, from her cheerfulness, and from a positive shift in the tests of her mood at the laboratory, her mental state had improved markedly. She spent less time thinking of herself, and instead spent more time reading and enjoying the company of family members and friends.
Hilgard and Hilgard (1975) discussed the use of hypnosis in the clinical setting and the promise of experimental research. They write, “Our hope is that because we have preserved scientific integrity and caution, members of the medical and psychological profession…will find a considered statement of the role of hypnosis in relation to pain” (viii-ix). Our culture demands empirical evidence. Therefore, considering the 30-year-old contributions from researchers such as Hilgard, I wonder why it is that the general populous remains only familiar, by and large, with the sensational use of hypnosis as an entertaining novelty.
Stories and rumors surrounding the practice of hypnosis commonly induce curiosity and skepticism, but I have heard of observed hypnosis as a viable option for clinical therapy. My previous exposure to the practice of “hypnotherapy” was limited to neon signs advertising “licensed” hypnotherapists who worked in the same seedy buildings as the local Tarot card reader. Skepticism about hypnosis may be inherent to any sort of study peering into the depths of our mind. The secret of our cognition is the heart of all that is transcendent and mysterious in our universe. Throughout the course of history, the study of the mind has often left us more dazzled. The more we search for the very threads that tie our existence together, the more tangled we find the knot to be. Although complexity may be married to the essence of existence, the core of human nature can never cease in its attempts to explore and understand.
This never-ending puzzle, whereby an increase in complexity evokes more curiosity, which in turn uncovers more complexity, may seem antithetical toward reaching any sort of answers. It is foolish to ignore complexity in an attempt to achieve parsimony, yet it is just as disastrous to refuse grounding in perspective by wallowing in an overwhelming web of detail and intricacy. The problem of pain is no exception to this epistemic conundrum. On one hand, the nature of pain is extremely complicated. In any given painful experience, even if the cause of pain can be determined, the pain cannot be considered as an isolated event. The experience and implications of even simplest of all painful experiences, imagine a paper cut for instance, is affected by the surrounding circumstances. The function of pain is widely known to be of survival value. Pain is therefore necessarily…painful—it relentlessly grabs all of our attention with an unwavering grip and will not let us rest without relief. It is no wonder that psychological intervention may be necessary for treating patients who are chronically impaired by this mechanism designed for survival. Skidmore (2004) writes, “It has been my experience that pain chronicity—the longer a patient has to struggle with pain—increases the likelihood that a patient may require psychological services to assist with emotional distress and relationship problems, and/or readjustment to work and life goals.” As we have seen with Mrs. E, the pain served as a woeful reminder of her cancer and fueled her depression. Yet it is this extremely overwhelming tangled mess of comorbid physical and psychological issues around pain control that begs for answers, cures, and relief. If we stop our attempts to untie the knot of pain, we tie the noose on hope.
It is from this frame of reference that I set out to explore the empirical efficacy of hypnotherapy, specifically in the context of the treatment of chronic pain. It did not take long to discover that it has indeed met with a fair amount of success within the clinical disciplines. In reference to the previous work of Crasilneck & Hall, Robinson, Crasilneck and Garofalo (2006) write, “hypnosis is a frequently misunderstood technique that has been shown to be safe and effective in addressing a number of physical and psychosocial disorders, including acute pain, chronic pain, smoking cessation, and obesity” (2006). In a clinical study of 30 patients with disabilities, it was found after 10 sessions of hypnotherapy, through the duration of a post-treatment window, the reduction of pain severity was mild to moderate in over half of the patients (Jensen, Hanley and Engel, 2005). In a more recent study reviewing the effects of hypnotherapy, Jensen, McArthur, & Barber did not find a distinct, common effect, but reported that patients experienced “a variety of both symptom-related and nonsymptom-related benefits…including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress” (2006).
Empirically based acceptance of hypnosis as a clinically proven method of managing pain remains in its relative infancy. After citing the work of Higard and Hilgard from 1975, Patterson and Jensen write, “relatively few randomized clinical studies on hypnotic analgesia have been published, and the extant reviews of this literature, although making important contributions to the understanding of hypnotic analgesia are limited (2003).” In answer to this disappointingly limited body of clinical literature, the researchers proceed to carry out the task of thoroughly and critically examining the few randomized clinical studies that do address the question of efficacy of hypnotic analgesia in both chronic and acute pain arenas. The researchers found hypnosis to be beneficial in reducing pain for patients in both acute and chronic pain conditions. These results are also confirmed by Hawkins (2001). However, while hypnosis was found to be significantly more analgesic than other psychological treatments (such as relaxation techniques and biofeedback) with acute pain, this was not the case for chronic pain (2003).
By no means is hypnosis a miracle cure for pain; its effectiveness is in fact variable from person to person—likely due at least in part to factors such as hypnotic susceptibility and the degree to which a patient predicts the success of the treatment (Patterson & Jenson, 2003). However, there is no doubt that hypnotherapy has proved beneficial in reducing pain for chronic sufferers to at least some extent.
Endless research could be performed in an attempt to pin down a profile for the predicted efficacy of hypnotherapy for patients of varying hypnotic susceptibility indices and degrees of experienced chronic pain, etc. However, since I am satisfied with evidence for the value attributed to hypnosis, I would rather narrow the scope of my research to exploring how hypnosis is effective. Perhaps I am just the glib product of Aristotelian causality, but I cannot help asking what portion of our brain might be responsible for the alleviatory effects of hypnosis on chronic pain. It seems plausible that a neurological mechanism be at hand that would allow a patient in a trance state to interrupt, or at least affect, the pain signal. After all, the perception of pain only exists in one’s mind. Might we capitalize on the ability to trick the mind into stopping this perception? As discussed earlier, relief is not obviously this simple, but I want to better understand why.