A temporomandibular disorder (or TMD) is a term used to describe chronic and or acute inflammation of the temporomandibular joint with sufferers reporting significant pain in and around the jaw, radiating pain across the shoulders and neck as well as also commonly reporting associated headaches, earaches and facial pain. Typically 5-7% of the population suffers from some form TMD which includes bruxism.
There are a number of different approaches in treating the condition and hypnotherapy is often said to be one of them. Since TMD in many cases is an unconscious sleep state action (teeth grinding), many report that traditional means of treatment simply do not work because a conscious awareness of the action is a prerequisite to treatment. Hypnosis is often seen as a possible option because it targets the unconscious driver behind the bruxism not requiring a conscious state of awareness to be of some benefit. Researchers from the University of Hawaii and the Tripler Regional Medical Center looked at the effectiveness of medical hypnosis in treating the pain symptoms of TMD to find out whether hypnotherapy could be a more mainstream approach to treat it.
28 patients were recruited for the study who at the onset, had not responded to more traditional means of treatment. The patient’s age ranged from 20 to 52 years with a mean age of 33. Of the original 28 patients, 23 patients were included in the final results of the study. Those 23 participants had at least 3 to 6 sessions of hypnosis treatment. The 5 not included in the study were classified as drop outs. Hypnosis treatment involved standard hypnotic treatment protocols including relaxation techniques, inductions, guided imagery, taught self hypnosis, convincers and post hypnotic suggestions. The patients were asked to fill out a relevant pain questionnaire four times – during a period on a wait list, immediately before treatment, post treatment, and finally, at a 6 month mark follow up.
71% of the patients reported improvement in daily functioning immediately after treatment and at the 6 month mark, this figure improved further to 80.45%. It should also be noted that patients exhibited far less wear and tear on their respective splints. The patients overall reported a significant reduction in pain frequency, duration, and intensity of pain post treatment. This study provides some promise to the argument that hypnosis and hypnotherapy can help alleviate the pain associated with TMD including bruxism and teeth grinding. Future studies should include a control group to provide a more evidentiary basis for this argument.
Simon E & Lewis D: Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:54-63.
May 23, 2011
Researchers from the University of Washington compared the effect of self hypnosis training and biofeedback relaxation based training on pain levels in sufferers of spinal cord injury (Jensen M, et al., 2009). 37 adults were included in the study that all had spinal cord injury and high levels of associated chronic pain. Participants were either assigned to 10 sessions of self hypnosis training or EMG biofeedback relaxation training. Participants in both groups reported significant reductions in pain levels including intensity, however, those assigned to the self hypnosis training group reported greater decreases in their respective pain scores. These reductions in pain levels were consistent at the three month follow up. Future studies should include a control group with no intervention to provide a more accurate picture on the significance of both treatments. However, as with many hypnosis and pain studies that go before this one, hypnosis is shown once again to help those that suffer from high levels of chronic pain.
Ian Wickramasekera II: Effects of self-hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal cord injury American Journal of Clinical Hypnosis. Bloomingdale Oct 2009. 52:2; 158
May 16, 2011
Hypnosis is now an accepted treatment method for pain alleviation. Nurses have a special opportunity to reduce the patient’s apprehension about upcoming tests and surgeries. Hypnosis is an effective tool for those patients who agree to undergo the process. The goal is not to replace medication, but to augment the pain relief afforded by medication. The nurse can perform hypnosis, under supervision, to decrease pain, thereby lowering the anxiety that creates an increased perception of pain.
This article examines empirical data on the use of hypnosis for pain management. The many medications for pain may have side effects when used by some patients. Some are not only addictive, but may result in unpleasant side effects. Hypnotherapy is non-addictive and has no negative side effects. National Institutes of Health (NIH) Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia, concluded that hypnosis has a moderate effect on pain and is possibly advantageous on a long-term basis.
The use of hypnosis is contraindicated as treatment for those who are psychotic or suffering from other conditions that render them incapable of understanding what is real and what is not (Eliopoulos, 1999). Clinicians can offer hypnosis as an alternative to medication. Some patients will ask for it specifically, and others will ask for a substitute for medication without naming hypnosis. The nurse can explain how the hypnotic trance is brought about, and what it will do for the patient. For example, the feeling of pain can be altered. In other words, the pain remains the same, but the patient does not perceive the pain in the same way. His focus is on something other than awareness of pain. Another feeling can replace the perception in the patient’s thoughts or he can achieve amnesia of the pain itself.
Candidates for hypnosis are those who find that medication provides minimal relief and maximum side effects. They are looking for a replacement that will not negatively affect their ability to think clearly. The nurse, or other health-care worker can do a pre-hypnosis interview to find out what activities bring pleasant thoughts to the patient. She can then provide a clear explanation of the process of hypnosis and the desired goal. Any words relating to pain should be avoided during the hypnosis session. Even skeptical patients find hypnosis to be beneficial in reducing the pain they feel.
The general sequence of events leading to sessions of hypnosis are:
• Pain assessment
• Patient assessment
• Educating the patient
• Conducting the actual session
Hypnosis was found to reduce pain, provide relaxation and do so without negative side effects. A nurse is close by when a patient prepares for a procedure that causes anxiety and pain. Visualization of a pleasant place or situation can displace the anxiety and reduce the apprehension that may intensify the perception of pain.
Pain is a major health-care concern. In 1995, partial or full disability affected more than 50 million Americans (Foley, 1995, Genuis, 1995) as the result of chronic pain. Additionally, 26 million people in the US have back pain and 50% of surgical patients feel their post-surgery pain relief is inadequate. Pain affects more than 50% of psychiatric patients as well.
Researchers and members of the medical community have evaluated the use of hypnosis as a treatment for pain. The culmination of these evaluations is the endorsement of hypnosis as a viable treatment option when used for pain relief. These conclusions are based on self-reports by the patients who utilized it.
Researchers will continue to compile examples favoring hypnosis for pain alleviation as a valid method, both in conjunction with medication or alone. Nurses, physicians, psychotherapists and other health care workers can be trained in the application in medical settings. This education is the next important step towards facilitating the management of acute and chronic pain in the patient population through the competent application of hypnotherapy.
Eliopoulos, C. (1999). Complementary and alternative therapies in longterm care. Primary Care Practice, 3, 194-203.
Foley, K.M. (1995). Pain, physician-assisted dying and euthanasia. Pain Forum, 4, 163-178.
Genuis, M.L. (1995). The use of hypnosis in helping cancer patients control anxiety, pain, and emesis. A review of recent empirical studies. American Journal of Clinical Hypnosis, 37, 316- 325.
Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. (1996). Journal of the American Medical Association, 276, 313-318.
March 2, 2011