First Chronic Pain Client

[angelo246]

Hello everyone. I am a new hypnotherapist and had my first chronic pain client today. This client has been suffering form multiple back surgeries and the pain associated with them for 4 1/2 years. The induction and anesthesia went well, I had the pain down to 0% while he was reclined (he can't sit for more than 5-10 minutes, or lie down for more than 10-15) He was under for 40 minutes when he thought it was only 5. The pain came back when he went to get up, then subsided as he stood. (but he left the office with some pain) My question is, is it common for the the client to experience pain upon arisal? I gave post hypnotic suggestions for him to re-enter deep relaxation, as well as sleeping soundly. I guess I'm nervous because I felt a tremendous amount of responsibility to the client, to myself as a professional, and to the craft as well. I feel as though I had a successful session in as far as achieving a subnombulistic state, total numbness, etc, but I was concerned to see him struggle to get up. Any suggestions on how I can approach my next session (if any) with this particular problem? Thank you all very much.

[Simple Guy]

Angelo,

Nice to see your first post here. (I've met Angelo and am glad to see
that he is now an active participant.) Pain can be a useful
signal to people. Perhaps the pain came back to the client because
he had been reclined for 40 minutes and you mention that "he can't
sit for more than 5-10 minutes." Possibly, the recurrence of the pain
was to provide notice that remaining in the reclined position for 40
minutes is physically not for him because of structural/neurological
effects of the surgeries. So, when this client comes back, you
may want to have him vary his positioning or the time that he is
reclined to maximize comfort for him. His "struggle to get up," by
the way, may very well be a physical limitation of his back condition,
more so than an expression of pain. It's important that people
experience discomfort when it is medically helpful; disconnecting
this ability is equivalent to removing batteries from a smoke detector
(not at all suggesting that you've done so). I appreciate your
conscientiousness and look forward to your continuing participation
with us.

[angelo246]

Thanks SimpleGuy. I've done minor pain control before, shoulder, toes etc, but nothing this severe. I guess I was concerned for his wellbeing and hoping that I "did it right". I made sure that if any changes occur that he immediately become aware of them. He did experience change from the moment he stood up. He wasn't able to feel or wiggle his toes on his right foot for a long time. He actually stood there wiggling them almost in disbelief. I made sure I congratulated him and wished him a pleasant night's sleep. I sincerely appreciate your reply. I haven't felt this kind of anxiety about a client's wellbeing before. My wife (a PsyD) assures me this is common in the field. :) Thanks again for your reply.

[Terry (existing)]

To remove pain completely as not only dangerous but also leaves a vacuum. Always suggest to the client that they will feel some slight discomfort until such time as the physical problems have been solved and removed. By doing this you leave no vacuum, make sure that the client doesn;t recline or otherwise damage their chances of recovery during treatement for the intitial problem...

[EC]

angelo246,

In my experience, Terry gave you excellent advice about "filling the vacuum", which I also believe is essential. Fill it with "something" acceptable (like feeling pressure), otherwise his anticipation of pain will likely bring it on.

Additionally, chronic pain relief is somewhat of a learning process for the client. Will probably help to keep working for depth and when you have it, teach him how to get there at will.

Sounds like you did a great job !
EC

[BarBrian]

I'm not a hypnotist so I hope this isn't insulting.....

I have read that chronic pain has a three-pronged affect on us. Firstly it involves the memory of all the previous pain up to now. Secondly, it is the actual current pain and lastly it is the anticipation of future pain. I learned from Aikido that the past and the future are merely phantoms in our mind. All that really exists is the present and if we simply deal with each "now" as it occurs, we will be much more comfortable in our selves. Perhaps having your patient may have a better perception of his pain if he is not clinging on to the past and the future events. Somebody once said, " a man who suffers before it is necessary, suffers more than it is necessary".

Brian.

[EC]

BarBrian,

Not insulting at all. I believe you are absolutely correct. Accounting for the effect of the past and future, and bringing attention to the desired result in the present is exactly what we are doing by providing a new expectation.

EC

[Simple Guy]

BarBrian's post and EC's response are nicely on target. :)

[skip]

This is exactly the method Erickson used in the 30's and 40's to help with chronic pain.

Wonder if Erickson studued Akido? :)

skip

[Simple Guy]

Skip,

I know he studied rowing, as a youngster. Never did hear of him doing
physical stuff in a dojo. Maybe Aikido's founder, Ueshiba, was a
patient or student of Dr. Erickson. ;)

[EC]

While he rowed as a youngster, he was probably contemplating "mental" Akido which he came to be quite efficient at :) EC

[BarBrian]

It wouldn't surprise me if the Sensei had known about Erickson's efforts. But have a look at this interesting site from a guy in Japan who draws the parallels between Aikido and NLP:

http://www.seishindo.org/aikido_nlp.html

Sorry, I should clarify that I did not learn about the concepts of chronic pain in readings about Aikido. Just the part about learning to deal only with what is in the present, and living in the here and now.

Thanks,
Brian.

[angelo246]

I want to thank all of you very much. I sincerely appreciate all your advice. I was deeply concerned for this individual (and still am). I made sure that if there were any changes to his condition (especially since it is his lower spine) that he would quickly become aware of them, that he were to stop what he was doing and pay attention to his needs, and that he contact his doctor right away. And yes I do believe that the pain is memory or what has become the status quo, and that there is definitley fear that it will get worse AND the fear that his life will never be "normal" again. I also think that there is a deeper emotion element to this person's pain. I think that my during next session, I will work within his present limitations as Simply Guy stated, and at the very least allow him to start sleeping more, and begin healing. He is on meds and undergoing accupuncture for his pain. I am in contact with his doctor (who refered him to me) and can only hope that there are positive changes for him. Thanks again.