Removing pain and anxiety without medication
Niamh Flynn discusses the application of hypnosis in the world of dentistry
How much easier would your work be if your patients were relaxed and calm during a consultation? How much time and money could you save if your patients were in a positive frame of mind pre and post surgery? How about being able to use an analgesic technique with some patients without the use of narcotics?
If this all sounds a little too far-fetched then it may be because you have not yet considered hypnosis. This age- old treatment has been used for centuries as a substitute for anaesthesia and as a method of reducing anxiety and helping patients to recover faster from operations.
Placebo and hypnosis are examples of top-down regulation in the treatment of pain. The mechanisms by which they operate are different, however. Thanks to studies which used naloxone to reverse hypnotic analgesia and placebo analgesia it was discovered that, while naloxone is effective in reversing the latter, it is not effective in reversing hypnotic analgesia.
Subsequently, researchers have concluded that hypnosis does not work on the opioid system. Further investigations have revealed that the suggestions given in hypnosis can be up to three times more powerful in alleviating discomfort of back pain for example, than those given in the waking state (Nusbaum et al. 2011).
Nonetheless, both hypnosis and placebo are useful adjuncts in any practice. The way in which words are framed and the choice of words used can have a significant impact on how patients respond to treatment and how well they recover from procedures.
The biopsychosocial model of pain is now widely accepted but the practical application in dentistry is still in its infancy. Pharmaceutical sedation is certainly effective in providing immediate pain relief for many and, while hypnosis is certainly not a panacea for all ills, it is effective in alleviating dental anxiety and can help in reducing the amount of pharmacological sedation and analgesic medication required by patients (Facco, Zanette and Casiglia 2014).
Hypnosis is about words and understanding, how words and non-verbal communication can have an influence. A few simple strategies can make life easier for dentists and patients alike. It can increase positive expectations, reduce pain catastrophising and eliminate bruxism. It can even help control an exaggerated gag reflex. One case study reported by Ramazani et al. (2016), described how a 34-year-old male referred for root canal treatment of a molar tooth had not been able to avail of dental treatment for nine years due to a severe gag reflex. A combination of simple hypnotic tools, which included eye fixation, progressive relaxation and guided imagery were effective in reducing the gag reflex to a normal level, thus permitting the necessary dental treatments.
For those who value a serene, tranquil atmosphere in their practice, hypnosis can endow patients with a greater sense of control and a calm approach to treatment. For those unfamiliar with hypnosis in a therapeutic setting, there are no adverse side effects with hypnosis and basic skills can be learned in a matter of days.
Hypnosis is safe and the person being hypnotised will hear everything that is said and is in complete control all of the time. They will not say anything they do not want to say nor will someone accept suggestions that they do not want to accept. It is a very relaxing state and one which we naturally go in and out of every day. Highway hypnosis is an example of the trance state. If you have ever gone on a long journey and cannot remember driving through a specific town or village but you know you must have, the chances are you were in trance. It is a state of heightened awareness where you were driving on ‘autopilot’ and if a person ran out in front of you while you were driving in that state you would instinctively put your foot on the brake without even having to think about it. It is an automatic response.
There are two levels where hypnosis can be useful in the dental arena – in communication between dentist and patient during consultation and at a more comprehensive level prior to treatment where issues such as bruxism, anxiety and fear are addressed.
Dentists can arm themselves with a persuasive arsenal in the form of perfectly timed words and specific phrases which can instantly relax the patient so that procedures go as smoothly and easily as possible for everyone. These phrases are something that anyone with or without hypnotic know-how can learn relatively quickly.
Additionally, the usefulness of these persuasive strategies can extend far beyond the treatment chair to follow up calls and bringing in new business.
For patients with severe anxiety, an experienced hypnotherapist can eliminate dental fears and anxieties by using age regression and suggestion-type work in as few as four or five sessions. The hypnotherapist will guide the individual into the trance state and discover the root cause of the fears. Once the emotions attached to the memories are examined, reviewed and edited, a new perspective is gained and the fear eliminated.
If you would like to learn more about how persuasive language can calm your patients, a three-day course ‘Hypnosis for Pain Management for Health Professionals’ is running at The Galway Clinic on the 4, 5 and 6 of November. There are 18 NMBI CEUs available on successful completion of the course. More details at www.bodywatch.com or call Niamh at 00 353 (0)91 720 145 for information.
About the author
Niamh Flynn is a sports psychologist based at the Galway Clinic, a private hospital in the west of Ireland. She has a masters in sports medicine (MMEDSCI) from the University of Sheffield, a masters in business administration (MBA) from Michael Smurfit Business School UCD, a bachelor of arts in psychology (BA), a diploma in hypnotherapy and psychotherapy (DHP) and is a certified instructor with the National Guild of Hypnotists (NGH). Her PhD research involved a randomised controlled trial which designed and implemented an online hypnotherapy programme for migraine sufferers.
The results showed a 60 per cent drop in pain catastrophising and a 48 per cent drop in headache disability over a 10-week period.
Facco, E., Zanette, G., & Casiglia, E. (2014). The role of hypnotherapy in dentistry. SAAD Digest. January. 30, 3-6.
Nusbaum, F., Redouté, J., Le Bars, D., Volckmann, P., Simon, F., Hannoun, S.,
et al. (2011). Chronic low-back pain modulation is enhanced by hypnotic
analgesic suggestion by recruiting an emotional network: A PET imaging study. International Journal of Clinical and Experimental Hypnosis, 59(1), 27-44.
Ramazani, M., Zarenejad, N., Parirokh, M. & Zahedpasha, S. (2016). How can hypnodontics manage severe gag reflex for root canal therapy? A case report. Iranian Endodontic Journal. 11(2), 146-149.