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ERICKSONIAN APPROACHES TO PAIN MANAGEMENT

Jeffrey K. Zeig, Ph.D., jeff@erickson-foundation.org

The Milton H. Erickson Foundation, www.erickson-foundation.org

Communication Can Alter Lived Experience

My introduction to Hypnosis

The Treatment of Pain

Hypnosis and Hypnotherapy without Trance

Three primary hypnotic techniques for working with pain:

Dissociation, Distraction, and Modification

These processes can, and should be affected during assessment

The Assessment of Pain

Pain is a multifaceted experience: Physiology and Psycho-Social-Contextual

• Pain must be properly assessed in order for it to be treated effectively. Traditionally

clinicians often focus on the organic causes

• Ericksonian assessment: Evaluative procedures in and of themselves effect pain control.

• Pain is a communication, not just a symptom: Elements of Communication

• Scaling.

• The communication process

Five Areas of Assessment

1. What Does the Pain Mean to the Patient?

Subjective aspects of the pain: Is it:

• Threatening pain, like angina;

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• The intractable pain of cancer; or

• Spasms of pain, such as those experienced during labor.

Asking about the meaning of the pain subtly encourages the patient to “dissociate” from the

experienced pain.

2. Detailed Description

By procuring a detailed description of the pain, the therapist can effect experiential division

in the gestalt of pain, thereby modifying the experience.

The “Farrah Fawcett Principle.”

Ask about:

size

shape

texture

thickness

weight, etc

3. Analogies

“What is the pain like?”

“What does the pain remind you of?”

Analogies allow the patient to change the category of thinking about the experience of pain.

If the pain were a color, what color would it be?

If the pain were a plant, what kind of a plant would it be?

If the pain were a tool, what kind of a tool would it be?

If the pain were a vessel to contain water, what kind of a vessel would it be?

Metaphoric redefining/reframing methods.

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Pain is like an alarm. It serves a productive function, but, once the alarm goes off, you no

longer needs the warning.

4. Expectations and Motivation

Incorporate positive expectations and motivations into the backbone of the treatment plan.

5. Listen for “Key Words” and Metaphors

Changing symptom words into solution words: Redefining

Aspects of Pain

Another assessment device involves understanding the aspects of pain. Pain is malleable.

Learned Aspects

Cultural Aspects

Temporal Aspects

Pain is composed of experienced pain, remembered pain, and anticipated pain.

Splits: Pain and Suffering

Pain consists of both physical sensations and emotional suffering.

Other Splits

Harmful and harmless pain

Needed and unneeded pain.

Contextual and Relational Aspects

Pain is a Process, not a Thing

Pain as a Habit/as an Identity

Five Principles of Working with Pain

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1. You do not need an all comprehensive trance.

2. Set the patient on a train of activity that modifies the experience of pain as the patient

carries it out.

3. Patients have resources that make pain control possible.

4. Pain is a process, not a thing.

5. Reinforcement is often indicated.

Techniques

Seven techniques that are used both traditional and Ericksonian practitioners:

1. Glove Anesthesia

2. Hypnotic Phenomena

3. Displacement

If a patient can have phantom pain, the patient can have phantom pleasure.

If a patient can displace negatively, he or she can displace positively.

4. Modification

Utilize particular strengths and associations of the patient.

If the patient is a musician, perhaps the pain could change in tempo.

A student can learn something from the pain.

5. Confusion

Word plays and ambiguities to help patients with pain.

6. Interspersal Technique

Deliver messages on the social and psychological levels simultaneously.

7. Amplification and Deviation

The therapist can work to increase the experience of pain rather than diminish it.

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8. Self-Hypnosis/Make personalized tapes

9. Work from the Periphery I

An Erickson Case Example

Erickson: “I don’t mind the pain. What I don’t like is the alternative.”

Case of Kathy

Lady and the Tiger: Reference experiences

Conclusions

Pain control is very much a matter of faith. There are three kinds of faith. Faith that:

1. You can utilize the experiences that patients bring

2. Patients have within them resources that make pain control possible.

3. If you had the problem you could modify it

References

Erickson, M.H. (1966). The interspersal hypnotic technique for symptom correction and pain

control. The American Journal of Clinical Hypnosis, 8, 198-209.

Erickson, M.H. (1980a). The collected papers of Milton H. Erickson on hypnosis, Volumes I - IV.

E.L. Rossi (Ed.). New York: Irvington.

Erickson, M.H. (1980b). An introduction to the study and application of hypnosis for pain control.

In E.L. Rossi (Ed.), The collected papers of Milton H. Erickson on hypnosis, Volume IV, (pp. 237-

245). New York: Irvington.

Erickson, M.H. (1980c). A teaching seminar with Milton H. Erickson. J.K. Zeig (Ed.). New York:

Brunner/Mazel.

Hilgard, E. R. & Hilgard, J. (1983). Hypnosis in the relief of pain. (Revised Edition). Los Altos,

CA: William Kaufman.

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Thompson, K. (1982). The curiosity of Milton H. Erickson, M.D. In J. K. Zeig (Ed.), Ericksonian

approaches to hypnosis and psychotherapy (pp. 413-421). New York: Brunner/Mazel.

Zeig, J.K. (1988) An Ericksonian phenomenological approach to therapeutic hypnotic induction and

symptom utilization. In J.K. Zeig & S.R. Lankton (Eds.), Developing Ericksonian therapy. New

York: Brunner/Mazel.