Saturday, 11 June 2011

Closing the Gate on Pain

Closing the Gate on PainIn 1965, Psychologist Ronald Melzack and Neurobiologist Patrick Wall proposed a new theory on how pain is perceived. I first learnt about this theory while attending an NHS-run pain management programme and again later during my Hypnotherapy training at The Clifton Practice. This theory was the catalyst that led to my recovery from chronic pain and as such I feel it is the most important piece of information that I can relay to my clients. It also actively demonstrates that changing the way one mentally perceives pain can actually change (decrease) the experience of pain on a physiological level.(1)

Melzack and Wall’s Gate Control Theory of Pain suggested that when there is damage to the body, be it a cut or burn, fracture or sprain, messages carrying information about the injury travel up to the brain along two separate sets of nerve fibers; small nerve fibers (pain receptors) and large nerve fibers (“normal” receptors).(2)

The large fibers transmit messages about sensations such as joint movement, heat, cold, touch, etc. while the smaller fibers carry pain signals. The large fibers are faster transmitters of messages compared to the small fibers therefore messages being transmitted by the large fibers arrive at the spinal cord before those being transmitted by the small fibers.

According to Melzack, “Pain messages flowing along peripheral nerves to the spinal cord on their way to the brain encounter ‘nerve gates’ that can inhibit (close) or facilitate (open) the incoming nerve impulses.” (3) It’s the balance between the messages flowing along the small fibers (pain) and the messages flowing along the large fibers (pressure) that determines whether this gate opens and pain is perceived or the gate closes blocking the pain signals from reaching the brain.(4) The nerve or pain gate opens when there are more messages being transmitted along the smaller fibers and the pain gate closes when there are more messages being transmitted along the larger fibers.

In addition to these ascending nerve pathways which transmit messages up to the brain, there are also descending pathways which transmit messages down from the brain. These messages are what causes your hand to pull away from something that is causing you pain and they also depress the reactions from the autonomic nervous system such as increased heart rate and blood pressure which would have been triggered as a result of the pain. More importantly the descending messages cause a release of natural pain-relieving opiate-like neurotransmitters such as endorphins, dynorphins and enkephalins which closes the gate and also blocks the release of neurotransmitters which are responsible for increasing pain such as Substance P.(4)

Melzacks model suggested that “psychological factors such as past experience, attention, and emotion influence pain response and perception by acting on the gate control system”.(3) People who suffer with chronic pain often note that their pain is worse when they are feeling stressed or having a bad day!

When people suffer from chronic pain they often withdraw from activities, such as socialising, going out, exercising, housework, going to work etc., based on the idea that it will minimise the pain. But what actually happens is the opposite! It’s quite ironic really how we stop doing all the things that actually could help keep that pain gate closed.

Things that cause the "gate" to open and therefore making the pain worse include stress, tension, anxiety, worry, depression and negative thoughts; focusing on your pain; boredom; and lack of activity and exercise.

Things that help close the "gate" on pain include relaxation; feeling happy and thinking positively; socialising, taking an interest in life and doing things you enjoy; being active and exercising regularly even if it is only light exercise or walking; and counter-stimulation such as massage, acupuncture, heat/cold, and TENS.

Knowing about the Gate Control Theory of Pain made me realise that I had a choice; I could either continue living my life as I had been where the pain was in control or I could take positive steps to help close the gate on pain for good. That is when I decided to try hypnotherapy to help reduce my stress and anxiety levels, stop the negative thoughts about my pain, and help me realise what I wanted from life rather than just “not being in pain”!

More information on how Hypnotherapy can help you manage chronic pain

Check out my Bristol Hypnotherapy website to find out more about Hypnotherapy and where I practice.

(1) Dalton, Ph.D., Erik. The Pain Game Part Two, Massage & Bodywork Magazine (2006)
(2) Freudenrich, Ph.D., Craig. How Pain Works, (2007)
(3) Melzack, T., Wall, P. D., Pain Mechanisms: A New Theory, Science 150 (1965): 971.
(4) Koman, K. The Science of Hurt, Harvard Magazine, (2005)

Dalton, Ph.D., Erik. The Pain Game Part One, Massage & Bodywork Magazine (2006)
Jackson, M. Pain and Its Mysteries, Adapted from Pain the Fifth Vital Sign (2002)

Thursday, 9 June 2011

Hypnotherapy in the News

This week there have been two news reports about Hypnotherapy.

The two stories were both publicised on Monday 6th June 2011 – the major story referred to a stage hypnotist who faked a fall during his act, apparently knocking himself unconscious, to test whether hypnotised subjects would remain in trance or wake up naturally if the hypnotist became incapacitated.

The Association for Solution Focused Hypnotherapists (AfSFH) wishes to reassure the public that hypnotic ‘trance’ is a perfectly natural state, and that should anything befall the hypnosis practitioner, their subject would ‘wake up’ in their own time anyway.

Association Trustee and Company Secretary, Nicola Griffiths, explains,
‘We all drift in and out of the ‘trance’ state many times a day – concentrating so hard on a report or spreadsheet at work that you are oblivious to your colleagues’ banter, becoming so engrossed in a book or TV programme that you are unaware that your partner has been trying to attract your attention, or being so involved in an activity, even ironing, that you lose track of time.

The only difference between this state and being hypnotised is that the practitioner guides you into the state in order to engage your full attention. You cannot be made to do anything against your will and should anything untoward happen to your practitioner then you would simply wake up naturally.’

The second story concerned the news that the Royal Society of Medicine is seeking to make hypnosis more widely used within the NHS. It is already used in a range of areas, but the Society would like it to be much more commonplace, such that it is simply another tool at the medical profession’s disposal.

The story discussed the use of hypnosis to help with anxiety, depression, chronic pain and disease. The National Institute for Health and Clinical Excellence (NICE), who are responsible for providing national guidance on promoting good health and preventing and treating ill health, already advise GPs to refer patients suffering with Irritable Bowel Syndrome for psychological interventions (CBT, Hypnotherapy or Psychotherapy) if they have not responded to pharmacological treatments.

Myself and the AfSFH welcomes the news that the Royal Society is recommending the use of hypnosis by more medical professionals but are concerned that an interview on Radio 4’s Today programme may have given the impression that unless a therapist is medically trained they are somehow ‘strange’ with ‘questionable qualifications’.

Whilst there is no doubt that the quality of training varies across the Hypnotherapy field, there are a number of highly credible training schools whose courses have been externally accredited and are nationally recognised. To put it into context, the Hypnotherapy Practitioner Diploma (HPD), which is considered to be the ‘gold standard’ in Hypnotherapy training, has been recognised by the Open University to be the equivalent of 45 points at Undergraduate Level 1 (FHEQ Level 4).

I would encourage any member of the public seeking the services of a Hypnotherapist to ensure that they are registered with a professional body. This will mean the therapist is properly trained, insured and adheres to a professional code of conduct.

As a qualified Hypnotherapist, I have undergone extensive training with one of the leading Hypnotherapy Schools in the Country, The Clifton Practice in Bristol, and obtained the HPD qualification. My training is also enhanced by ongoing Continuing Professional Development (CPD) and regular Supervision. I am a member of the AfSFH.

I offer Hypnotherapy at The Harbourside Practice in Bristol. To find out more about hypnotherapy or to book an initial consultation please get in touch. Check out my Bristol Hypnotherapy website.

Below you can find the original News stories:

BBC Health (Video) - NHS should offer hypnosis as standard says new report
BBC Radio 4 (Audio) - Hypnosis 'is more than a placebo'

For more information on how hypnotherapy can help with various medical conditions:
Irritable Bowel Syndrome
Pain Management