E-ISSN: 2458-9101
Utilizing Principles of Clinical Hypnosis for an Effective Communication with Patients in Managing Chronic Pain
Dr Anand Chandrasegaran, Manjit Singh
Sleep and Hypnosis: A Journal of Clinical Neuroscience and Psychopathology 2019; Online Ahead of Print
This report is an undertaking to illustrate the application of hypnosis in the initial patient doctor consultation to build better patient rapport. An effective communication in consultation leads to better rapport with the patient for a comprehensive chronic pain management. This case involves a young patient who presented with worsening body ache and insomnia. She sought consultations and treatment from 6 doctors. She was not satisfied with these consultations. All investigations showed negative clinical findings with same diagnosis from all doctors. She was seen in the author’s pain clinic, for chronic pain management. Hypnotic principles were used to manage the consultations and as therapeutic option for her problems. In the initial consultation, the author used Rogerian approach in-cooperating hypnosis in establishing empathy with the patient. This was followed by formal hypnotic intervention as a therapeutic intervention. Patient’s expectation was met and solved her initial presenting medical problem, which the patient was not able to achieve with previous consultations with 6 different doctors. Better management of patient’s presenting complain should take into account the perceptions and interactions of patients and physicians. Physicians need to empathize, listen, elicit patients' beliefs and expectations, and offer a range of treatments, including cognitive and behavioural therapies, tailored to individual needs. In this strategy, communication could be improved by applying basic principles of hypnotherapy. Doctor’s dominance in relation to the patient-professional communication need to be reexamined.
Keywords: Effective communications, clinical hypnosis, chronic pain management
Bartlett, E. E., Grayson, M., Barker, R., Levine, D. M., Golden, A., & Libber, S. (1984). The effects of physician communications skills on patient satisfaction - recall, and adherence. Journal of Chronic Diseases, 37(9-10), 755-764. doi:Doi 10.1016/0021-9681(84)90044-4

Bikker, A. P., Mercer, S. W., & Reilly, D. (2005). A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow homoeopathic hospital. Journal of Alternative and Complementary Medicine, 11(4), 591-600. doi:DOI 10.1089/acm.2005.11.591

Bingel, U. (2014). Avoiding nocebo effects to optimize treatment outcome. Jama-Journal of the American Medical Association, 312(7), 693-694. doi:10.1001/jama.2014.8342

Brugel, S., Postma-Nilsenova, M., & Tates, K. (2015). The link between perception of clinical empathy and nonverbal behavior: The effect of a doctor’s gaze and body orientation. Patient Education and Counseling, 98(10), 1260-1265. doi:10.1016/j.pec.2015.08.007

Castel, A., Salvat, M., Sala, J., & Rull, M. (2009). Cognitive-behavioural group treatment with hypnosis: a randomized pilot trail in fibromyalgia. Contemporary Hypnosis, 26(1), 48-59.

Dyas, J. V., Apekey, T. A., Tilling, M., Orner, R., Middleton, H., & Siriwardena, A. N. (2010). Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. British Journal of General Practice, 60(574). doi:10.3399/bjgp10X484183

Hansen, E., & Bejenke, C. (2010). Negative and positive suggestions in anaesthesia - Improved communication with anxious surgical patients. Anaesthesist, 59(3), 199-+. doi:10.1007/s00101-010-1679-9

Hartland, J. (1971). Further observations on the use of “ego-strengthening” techniques. American Journal of Clinical Hypnosis, 14(1), 1-8.

Hauser, W., Hansen, E., & Enck, P. (2012). Nocebo phenomena in medicine their relevance in everyday clinical practice. Deutsches Arzteblatt International, 109(26), 459-U426. doi:10.3238/arztebl.2012.0459

Kirschenbaum, H., & Jourdan, A. (2005). The current status of Carl Rogers and the person-centered approach. Psychotherapy, 42(1), 37-51. doi:10.1037/0033-3204.42.1.37

Lamberg, L. (1999). Chronic pain linked with poor sleep; Exploration of causes and treatment. Jama-Journal of the American Medical Association, 281(8), 691-692. doi:DOI 10.1001/jama.281.8.691

Lang, E. V., Benotsch, E. G., Fick, L. J., Lutgendorf, S., Berbaum, M. L., Berbaum, K. S., . . . Spiegel, D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet, 355(9214), 1486-1490. doi:Doi 10.1016/S0140-6736(00)02162-0

Lang, E. V., Berbaum, K. S., Faintuch, S., Hatsiopoulou, O., Halsey, N., Li, X. Y., . . . Baum, J. (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: A prospective randomized trial with women undergoing large core breast biopsy. Pain, 126(1-3), 155-164. doi:10.1016/j.pain.2006.06.035

Lang, E. V., Berbaum, K. S., Pauker, S. G., Faintuch, S., Salazar, G. M., Lutgendorf, S., . . . Spiegel, D. (2008). Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: When being nice does not suffice. Journal of Vascular and Interventional Radiology, 19(6), 897-905. doi:10.1016/j.jvir.2008.01.027

Liossi, C., & Hatira, P. (1999). Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. International Journal of Clinical and Experimental Hypnosis, 47(2), 104-116. doi:Doi 10.1080/00207149908410025

Lipkin, M., Quill, T. E., & Napodano, R. J. (1984). The medical interview - a core curriculum for residencies in internal medicine. Annals of Internal Medicine, 100(2), 277-284. doi:10.7326/0003-4819-100-2-277

Peter, B. (2015). Hypnosis. In J. D. Wright (Ed.), International Encyclopedia of the Social & Behavioral Sciences (2nd Edition ed., pp. 458-464). Oxford: Elsevier.

Roter, D. L. (1977). Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education Monographs, 5(4), 281-315.

Seemann, M., Zech, N., Graf, B. M., & Hansen, E. (2015). The premedication visit--suggestions for a patient-friendly design. Anasthesiol Intensivmed Notfallmed Schmerzther, 50(2), 142-146. doi:10.1055/s-0040-100082

Turner, J. A., & Chapman, C. R. (1982). Psychological interventions for chronic pain - a critical-review .2. operant-conditioning, hypnosis, and cognitive-behavioral therapy. Pain, 12(1), 23-46. doi:Doi 10.1016/0304-3959(82)90168-3

Wright, L. (1977). Conceptualizing and defining psychosomatic disorders. American Psychologist, 32(8), 625-628.