A meta-analysis examines treatments like meditation and cognitive behavioral therapy as alternatives for alleviating pain that is typically treated with opioids.
The more we learn about opioids, the clearer it becomes that there’s no simple solution to the opioid crisis and the cycle of dependency and misuse that has already impacted millions of Americans.
It’s especially difficult given how effective opioids are at pain management, particularly the kind of acute, short-term pain associated with cancer treatment or surgical or injury recovery.
Researchers are actively seeking alternatives to opioids when it comes to pain management—and a meta-study tracking the efficacy of mind-body therapies for treating pain that was previously managed with opioids indicates that some MBTs could act as effective pain management treatments, as well as tools for helping reduce opioid use and dependency.
The survey examined 60 studies looking at the effectiveness of “psychologically oriented MBTs,” including meditation, hypnosis, guided imagery, relaxation, cognitive behavioral therapy, and therapeutic suggestion, at pain management and/or opioid use outcomes.
The overview found a moderately significant association between MBTs and pain reduction and a smaller significant association between MBTs and reduction of opioid doses, as well as some relationship between MBTs and the treatment of opioid misuse and cravings.
Meditation was found to have the strongest correlation with pain reduction. The five meditation-related studies reviewed all showed participants experiencing some level of pain relief from the therapeutic treatment.
Four of the five studies also found meditation and mindfulness resulted in “opioid-related outcomes,” including decrease in opioid dosage, decreased cessation time, and dips in opioid misuse and cravings.
Hypnosis and CBT were also associated with positive opioid-related outcomes, with 12 of 23 hypnosis studies and four of the seven CBT studies reviewed showing “significant therapeutic effects” on opioid use.
Eric Garland, the study’s lead author, said his background in social work led him to a better understanding of the relationship between MBTs and pain, as well as the one between MBTs and opioids. “I’m a licensed clinical social worker,” Garland told VICE. “I’ve used mind-body therapies both for the treatment of chronic pain as well as the treatment of addictive behaviors.”
He said opioid misuse, pain, and MBTs all have one major factor in common: the brain. “Mind-body therapies make a lot of sense for the treatment of pain since all pain is in the brain.
If you use a technique that changes the way the brain functions, that changes the way the brain interprets signals from the body and therefore it will affect the experience of pain, as well as the person’s emotional reaction to pain.”
Since long-term opioid use can lead to brain changes like opioid tolerance and a loss of the ability to self-regulate opioid usage, MBTs can play a dual role for someone already using prescription drugs to manage their pain, Garland said.
“[MBTs] are all about teaching people a way to regain some of that control over the function of the brain and so therefore it can be useful not only for reducing the pain and helping the patient manage the pain, but also helping them gain better control over their opioid use itself.”
Does this mean people with opioid use disorder or who are living with pain from other medical procedures can ditch the Oxycontin and just fire up a ‘Yoga with Adrienne’ video? Of course not.
Research has shown that mindfulness and opioids don’t operate on the same parts of the brain, for starters, which means MBTs are a better side-by-side treatment than a ready-made substitute for medication.
The 60 studies surveyed included a total of 6404 participants who were already taking opioids, which averages out to around 100 people per study—a sample group too small to base conclusive solutions on.
Authors were careful to note that different MBTs were applied to different types of pain, with meditation studies tending to target chronic pain while hypnosis, relaxation, therapeutic suggestion and guided imagery treatments were more likely to be applied to acute pain.
Garland also said in the future, he hopes more research will focus on the relationship between MBTs and opioid use, rather than just the relationship between MBTs and pain.
By: Katie Way
Medical Hypnotherapy can be a powerful method to treat various mental health conditions. By creating a calm and controlled environment, it allows patients to focus on their deepest disruptions.
What is hypnosis treatment?
Medical hypnotherapy works through its ability to remove all distraction from the mind of the patient, and speak clearly and directly about personal habits that need their attention. It is often used to help change the behaviors of the patient, but does not rely on manipulation, coercion or compulsion to achieve a positive outcome.
Misconceptions about hypnosis treatment are commonplace, but its real utility as a treatment option comes from its clean approach (no drugs or chemicals are used) and its success in de-cluttering the mind of stresses and disruptions, thereby allowing the patient to focus completely on the task at hand.
Many patients benefit from hypnosis for anxiety and depression, while others use it to break free from phobias, eating disorders, burnout, or learned behaviors such as smoking. Sexual dysfunction and pain management are among the other frequent areas of focus for which hypnosis treatment can be useful.
Medical hypnotherapy is often used in conjunction with cognitive behavioral therapy – a treatment combination which has proven to be particularly effective in achieving improved patient health.
How does medical hypnotherapy work?
Medical hypnotherapy allows the patient to imagine in detail a source of anxiety while in a controlled setting. The patient is then encouraged to enter a state of deep 
relaxation, rather than allowing the anxiety to grow. This paired activity helps the brain to associate the potential anxiety trigger together with a calmer state of mind, allowing the brain to begin building new and healthier pathways of behavior and emotional response.
At the same time, the hypnotherapist provides calming suggestions for the patient under hypnosis, in an effort to show him or her a path toward healthier living. Included in these messages is an invitation to view the world in a more positive light, by embracing a generous outlook toward the surrounding environment.
During each hypnotherapy session, the patient remains awake and lucid, and in full control of every decision regarding whether or not to act upon the suggestions made by the hypnotherapist. The duration of treatment varies according to the condition being treated, as well as the mental state of the patient.
The treatment process
Hypnosis treatment begins in earnest when the hypnotherapist helps the patient achieve a trance-like state, in which external distractions are removed and the voice of the hypnotherapist is placed at the center of the patient’s consciousness.
Once in this state, the patient is encouraged to explore inner thoughts and feelings, which he or she is able to see with the type of rare clarity that is commonly associated with meditation. This newfound concentration lets patients use all of their inner resources to contemplate the issues that otherwise trouble them – whether alcohol, cigarettes or other drugs; traumatic events; or conditions which ordinarily cause stress for the patient.
The hypnotherapist acts as a guide for the patient during this period of exploration, suggesting a calm and observational approach to each distressing phenomenon, rather than an instinctive emotional reaction. After a period of contemplation, including mental encounters with the provocative stimuli, the hypnotherapist encourages the patient to enter a state of deep relaxation.
Through each successive treatment, the patient learns to cope with the reality of the thing feared, or the object of obsession – and then observe it from a detached space, before moving past it and into a state of tranquility. The lesson of detachment and balance becomes a learned skill, empowering the patient to deal with stressors in a healthier way in everyday life.
Key benefits of hypnosis for anxiety and depression
Hypnosis has a broad range of applications, due to its general ability to improve the power of concentration and suggestion. Common benefits of medical hypnotherapy include:
• Increased ability to focus on stressful objects and ideas while remaining emotionally balanced
• Increased ability to detach from obsessive behaviors and habits, including smoking
• Increased tolerance for pain under certain conditions
• A more positively oriented worldview
• Renewed feelings of self-control
• Reduced feelings of depression or anxiety, and recovery from burnout
By creating new conditions for personal empowerment, hypnosis gives patients the internal tools needed to overcome the unhelpful group of emotions and behaviors that caused them to seek treatment.
How successful is hypnosis treatment?
Natural human variability means that some people are more open to suggestibility and hypnosis than others. In general, however, it is effective to use hypnosis for anxiety and depression as part of a larger course of treatment.
In particular, studies show that cognitive behavioral therapy (CBT) provides an effective complement to hypnosis treatment for conditions such as acute stress disorder.
A more general meta-analysis reveals widespread improvement in many areas due to the combination of hypnosis with CBT. The study also found sustained improvements after measuring patient outcomes long after the period of treatment had ended.
Though it does not promise a complete cure in all cases, it is clear that hypnosis, with its ability to clear away the noise of day-to-day life during therapy sessions, can have a significant, positive, and long-lasting effect on behavior modification.
If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional.
By: Chris Jansen
Doctors and researchers at MD Anderson are exploring hypnosedation to manage pain and anxiety during certain breast cancer surgeries.
When Beverly Levinson’s doctor noticed two unusual spots on her dense breasts, she was sent to The University of Texas MD Anderson Cancer Center for a lumpectomy—a surgical procedure to remove abnormal or cancerous tissue along with a small portion of the surrounding healthy tissue.
Levinson, 64, wasn’t as concerned about the surgery as she was about undergoing general anesthesia. She had received general anesthesia for previous surgeries, but because of her temporomandibular joint (TMJ) disorder, she suffered severe jaw pain from opening her mouth wide enough for the breathing tube to be inserted down her throat.
Luckily, an unconventional solution presented itself to Levinson. Her surgeon approached her about an ongoing clinical trial that would allow her to avoid general anesthesia by using hypnosis. Levinson, who had been hypnotized for jaw pain years ago, immediately jumped at the opportunity.
“In my eyes, I had nothing to lose,” Levinson said. “I could try something new or I could go the old-fashioned way. I’m the middle child. I always try new things. That’s my personality.”
Led by Lorenzo Cohen, Ph.D., director of the Integrative Medicine Program at MD Anderson, the ongoing clinical trial aims to determine whether or not a method of deep relaxation, called hypnosedation, is safe and effective for patients with stage 0/1 breast cancer who are undergoing lumpectomies with or without sentinel lymph node dissections.
The study, still in its pilot phase, will examine 50 patients who are randomly selected to receive either general anesthesia or a combination of local anesthesia and hypnosedation before and during surgery.
In both cases, a patient has an intravenous line placed in her arm and an anesthesiologist is present to administer a cocktail of drugs used to put her under.
For patients receiving hypnosis, the anesthesiologist monitors their vitals, calculates the appropriate dose of local anesthetic medication, administers medication for pain and nausea and stands by to convert to general anesthesia if the patient experiences any discomfort.
“Over the past couple of decades there is a very solid evidence base that incorporating hypnosis during invasive conscious sedation medical procedures reduces anxiety, helps to control pain, decreases recovery time, and helps lower medical costs,” Cohen said.
General anesthesia is still the standard approach at MD Anderson, even for smaller surgeries, such as lumpectomies. But the drugs used for general anesthesia can potentially weaken the body’s immune system and slow the recovery process, Cohen said.
Cancer patients, in particular, cannot afford to have their immune systems compromised. Cohen and his team want to find out if hypnosedation would be a viable replacement for general anesthesia during smaller, less invasive surgeries.
The practice of hypnosis, in one form or another, has been around for centuries. But it wasn’t until the mid-19th century that it came to be defined as a kind of “nervous sleep” that could alleviate anxiety or pain during medical procedures.
In the 1840s, Scottish neurosurgeon James Braid developed a technique of deep relaxation and visual fixation to guide patients into a trance and help alleviate their pain.
He coined the term “hypnosis” and defined it as “the induction of a habit of abstraction or mental concentration, in which … the powers of the mind are so much engrossed with a single idea or train of thought, as … to render the individual unconscious of, or indifferently conscious to, all other ideas, impressions, or trains of thought.”
Although hypnosis is often associated with parlor tricks and stage magicians, the practice itself has been used clinically to address several conditions, including smoking, anxiety and overeating.
For Levinson, it was a great option. A week before surgery, Levinson met with Rosalinda Engle, a mind-body specialist at MD Anderson Cancer Center who would perform the hypnosedation, in a small conference room in the hospital.
“Do you have a place where you feel really comfortable and at ease?” Engle asked Levinson in her soothing, mellifluous voice. “It could be your grandmother’s house.
It could be a vacation you’ve enjoyed, a vacation spot. It could be anywhere, any place in nature. Close your eyes and call that up.”
As Levinson focused on the task, Engle continued to offer instruction.
“Breathe in deeply. Experience your breath from the tip of your nose. Feel as your breath moves through your body. Imagine breathing into the palm of your hands. Now exhale. Breathe out through your fingers, the soles of your feet, your toes. Relax.”
Slowly but surely, Engle lulled Levinson into a state of deep relaxation.
“I felt very, very safe,” Levinson said, when it was over. “It was like [going] into someone’s house where they’re baking a cake. It smells good, and they welcome you in. You just have a warm feeling.”
Engle guided Levinson through what to expect on the day of the surgery. The room would be sterile, with five or six people at hand. The lights would be bright. Engle would sit beside her throughout the procedure to keep her calm and relaxed.
“My sole job is to sit at the head of the bed and focus on the patient,” Engle said. “Any changes to breathing patterns [or] facial muscles will alert me that I need to check in. Periodically, I’ll ask the patient, ‘How’s your comfort level?’”
On the day of the surgery, doctors injected local anesthetics— lidocaine and bupivacaine—to numb Levinson’s right breast and made a 1-inch incision to remove some of the tissue.
As promised, Engle sat next to Levinson for the duration of the surgery, helping her maintain a state of deep relaxation.
“I didn’t feel anything,” Levinson said. “You’re in a calm state. You’re in a safe state of mind. You’re being reassured. It was great.”
Throughout the surgery, Levinson recalled feeling pressure on her breast as the surgeon operated, but said it didn’t hurt any worse than getting a filling at the dentist.
Less than an hour after her surgery was complete, Levinson was out of bed, dressed and walking around. She skirted the unpleasant side effects of general anesthesia, recovered faster and didn’t require any post-operative painkillers.
For hypnosedation to work, Engle said, the patient must be receptive to it.
“All hypnosis is self-hypnosis,” Engle said. “You’ll go as deep into this trance state as you are willing to allow yourself to go.”
Engle points to shifts in attention and consciousness that people commonly experience throughout the day. Ordinary moments—such as zoning out while driving or becoming so engrossed in a conversation that you’re able to block out surrounding noise—are examples of how the mind can tune out distractions.
“Pointing out these everyday shifts and our capacity for absorption is important to let the patients know they are in control and driving this experience,” Engle said. “They can train themselves to be as relaxed and calm as possible.
They can guide themselves. They can walk through this experience with surgery and take it throughout the treatment process, the whole continuum of cancer care.”
While general anesthesia is very safe for most people, it can have unpleasant side effects. The most common are temporary nausea and vomiting, dry mouth, a sore throat and grogginess.
Older patients who receive general anesthesia are more likely to experience longer-term cognitive and memory impairments, a condition called post-operative cognitive dysfunction (POCD) that can last anywhere from a few days to a few months. Those with a history of POCD have a higher risk of experiencing the condition again with repeated anesthetic.
“[Hypnosedation] is a nice alternative,” said Elizabeth Rebello, M.D., associate professor in the department of anesthesiology and perioperative medicine at MD Anderson. “The patient doesn’t require an extended period of time in the recovery room. They’re able to go on with the rest of their life.”
According to Cohen, more than 34 clinical trials and numerous papers published in scientific journals have shown that hypnosedation works. But he says there is still some doubt among his colleagues.
“Although a physician may think, ‘I don’t believe in hypnosis,’ that is a scientifically unsound statement. Science is not about personal belief. It’s about evidence,” Cohen said.
“Your religious practices are part of a belief system. Science is evidence-based. Unfortunately, there are some people who approach science from a belief perspective, as well, and they’re wrong.”
Most surgeons were initially reluctant to participate in the clinical trial, said Dalliah M. Black, M.D., a breast surgical oncologist at MD Anderson.
Because the standard approach at MD Anderson is to use general anesthesia for surgeries large and small, most surgeons are accustomed to having their patient sleep throughout every procedure.
“Surgeon interest was very slow up front, but I would offer them to come in to watch my cases,” Black said. “Many colleagues have been so surprised.”
Using hypnosedation, patients like Levinson can gain some semblance of control during an otherwise stressful experience.
“It’s amazing how complex we are as humans and how complex the mind is. A lot of times, it’s mind over matter,” Black said. “Hypnosedation is a way we’ve applied mind over matter to a situation in the operating room for a specific population of the patients here.
That mental fortitude and the strength that we have, that has to be carried through and has better outcomes if we use that path throughout our cancer care.”
No matter how effective the clinical trial shows hypnosedation to be for surgeries, Rebello stressed that hypnosedation will not become a new standard approach for pain management.
“I think there’s a concern that this is going to replace general anesthesia. It is not going to replace general anesthesia,” Rebello said. “But for a certain niche of patients, there are certainly some benefits that could exist and we need to find out if that is, indeed, the case.
By: Shanley Pierce
This study assesses the effect of hypnosis for insomnia with school-age children, ranging from ages 7-17, dealing with stressors and medical conditions.
In an effort to evaluate the reduction of emotional and physical disturbances in patients scheduled for breast biopsy, this study compared audio-recorded hypnosis with background music vs. music without hypnosis. It also included a control group.
