How Does Dr. Elvira Lang Use Hypnosis for Pain Management in an Ethical Way? Neuroethics Canada

Video Transcript:

With that preamble it is my pleasure to welcome Dr. Elvira Lang to launch into her presentation for us and to welcome her virtually to Vancouver and Whistler, BC and all of us from our remote locations… and for all of you joining us from Elvira’s network.

Well thank you very much it is an incredible pleasure and also honor to be here today with you, because, as Dr. Illes said, we go back a very long time and she was the inspiration to get me into this whole topic of using hypnotic tools to help patients through procedures. I’m an interventional radiologist so I was more on the end of inflicting pain on individuals than actually treating it in the beginning. But you have these patients with these big fearful eyes looking at you and that’s how we evolved the program surrounding it. And Dr. Illes introduced me to Dr. David Spiegel at Stanford at the time who taught me a lot about hypnotic techniques. And then over the next twenty/twenty-five years we proceeded further on elaborating more of how we can make that into the very best tools patients can get. And in more recent years I have become more interested in this interaction between providers and patients. Or actually how two people interact, how their emotions are rubbing of onto each other and how this will be determining their entire interaction. So, I’m going to do a little screen share here.

Now it’s really not about dangling watches or people influencing people to do things they don’t want to do like walking around and clucking like a chicken, what one might have seen in a movie. And the traditional teaching is that all hypnosis is self-hypnosis, that we cannot make someone do something they would not want to do either in general or at that specific moment. Kind of like getting absorbed in a book or a movie or surfing on the web, and if you don’t like the content anymore, you’re still at liberty to close the book turn or off the movie. But then there’s the power of words, and spoken to oneself or says to others, and sometimes the intentions of those words are not necessarily going to produce the outcomes that one might desire. On top of it, patients are in a highly suggestable state, so whatever you tell them…. They will take it pretty much as a hypnotic suggestion. Or look at times like now. I mean we have COVID, people are afraid of getting infected, they may be, they have sick persons in their environment, they’re afraid other people will get it, people’s jobs are at risk.

So, we have this perfect storm of people being in an anxious mode whether it’s about their health, their future what they will do and that’s where one becomes very suggestible in general and obviously also when it comes to pain management. On top of it fewer and fewer people dare to go to the doctor nowadays because you don’t want to expose yourself to any germs. And put the opioid crisis on top of it and getting any prescription id not an easy feat.

So, I thought to share some pointers on how to help yourself or others in an ethical fashion. I thought I’d just put that out as a little question to ask yourself where you can reflect about it or bring some things on the chat function. If you were across from this person, what would you say? I mean what are the words you would pick? And you may even want to formulate in your mind what would you say in a very realistic situation?

Because words do matter particularly in these very first seconds of an interaction, the way you will phrase that to find out what the person has or to soother their distress. Now you may not have picked any of those but what we very commonly hear in clinic are things like, “are you in pain?”, “how bad is your pain?”. Or you may be consoling, “things are not that desperate”, “the worst is nearly done”, “it’s all not that bad”, or “I feel your pain”. We always explain that no you never do that; pain is very subjective. This is one thing where you cannot be in someone else’s shoes. And, if you look at what we call negative suggestions, that is what is most ingrained in a culture and in the belief systems of people. It is the one thing that is the hardest to change.

And so we actually had to do a trial in clinic where we looked at what to patients say when, let’s say, they want to put an IV in. Or when they do a procedure and there’s some potentially painful stimulus. And we encountered one clinical team that was entirely convinced that if you say it’s going to hurt only a little or it’s not that bad, patients are going to feel better. One nurse even said, “oh I like to describe it in real terrible terms because then patients feel better and think I did a great job in having it not hurt that much.” So we went through the effort and looked through 159 tapes of procedures to check what did people say (they could say whatever they wanted) but we noted did they use any of these negative suggestions even if proceeded by “a little” or “ it’s not that bad”. And on a scale of 0 to 10, 0 no pain at all and 10 worst possible, we found that actually the warning of such a stimulus and using these words significantly increased the pain