Spring 2013

Tuning Out the Pain

'Guided imagery' can help patients relax in the chair

By Jacqueline Mitchell

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Illustration: Marc Rosenthal

If you’ve gotten lost in a book or found yourself “in the zone” at the gym, you’ve been in a kind of hypnotic trance, so focused on the task at hand that time passes unnoticed. Dentists can take advantage of that state of mind to help their patients manage orofacial pain, says Teresa Sienkiewicz, a physical therapist who uses clinical hypnosis to manage her patients’ pain and stress.

A simple technique known as guided imagery is one way health-care providers can “manipulate patients’ experiences and alter their perceptions,” said Sienkiewicz, who spoke at Tufts School of Dental Medicine last fall as part of a speaker series hosted by the Craniofacial Pain Center. Practitioners might ask patients to imagine physically pushing away the pain or visualize it swirling down a bathtub drain.

With guided imagery, patients who can easily reach a deep trance state can “set their pain to zero,” said Sienkiewicz, who specializes in the treatment of facial pain and headaches. But even for the control freaks among us—those who are generally less susceptible to hypnosis and are capable of only shallow trances—hypnosis can still help modulate pain.

She recommends using these techniques in conjunction with other pain-management strategies, including medication and cognitive behavioral therapy. Anyone can become certified in hypnosis, and some training sessions are specifically designed for health-care professionals. The techniques can also help patients manage their fear of going to the dentist and help improve compliance. “As with any discipline,” says Sienkiewicz, “the real learning happens when working with patients.”

Sienkiewicz cited peer-reviewed research, published in 2009 in the European Journal of Pain, which found that hypnosis can help patients manage the pain associated with fibromyalgia. Though it’s not known exactly how it works, the same study found that hypnosis induces measurable physical changes in the thalamus, prefrontal cortex and insular cortex, all regions of the brain associated with emotions, suggesting that hypnosis reduces pain by altering those brain structures.

Ironically, it can be tough to assess the effects of hypnosis in a controlled study. Any kind of caring attention from a health-care provider seems to have a positive effect on pain management and patient compliance with follow-up care, Sienkiewicz said. It turns out that good chairside manner can be as powerful as the power of suggestion.

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