Hypnotherapy can be effective, drug-free therapeutic tool
In the midst of a growing opioid crisis, a new book provides an alternative to dealing with chronic pain
Growing up, Dr. Jeffrey Ennis was into boxing, wrestling, martial arts and gymnastics. But at 16, he dislocated his knee playing soccer, marking the start of a lifelong struggle with chronic pain.
For Ennis, now 63, medication never worked as well as he’d like it to. One thing that has helped is hypnotherapy, a set of techniques used to induce hypnosis in a person whereby the individual focuses on their internal state, making it easier to control pain. Although hypnosis has been controversial, studies show it can be an effective therapeutic tool.
For the last three decades, Ennis has used self-hypnosis every day, reducing his pain by about 30 per cent for an hour. When the pain returns full-force, he simply does it again.
As the medical director of the Ennis Centre for Pain Management, a bustling clinic in Hamilton he started more than 20 years ago, Ennis teaches self-hypnosis to patients grappling with a range of conditions. They include fibromyalgia, back disorders and pain from trauma such as car accidents or workplace injuries.
He’s one of the only doctors in the region teaching self-hypnosis and says it’s a poorly understood practice, which is why it isn’t part of the mainstream medical community.
“Anyone can do it and everyone can benefit, some more than others,” says Ennis, a psychiatrist and specialist on managing chronic non-cancer pain. “I’m in an outlying group and get less benefit than most people will. And I’m quite happy with what I get because I have yet to take a pill that does better.”
In his recently published book Hypnotherapy for Pain Control: A Safe and Non-Addictive Way to Relieve Chronic Pain, Ennis talks about his personal struggles, the problem with relying on pills such as opioids, the science behind hypnosis and a step-by-step guide on self-hypnosis.
The Star recently spoke with Ennis, who’s also assistant clinical professor in the department of psychiatry and behavioural neurosciences at McMaster University and a staff physician at Hamilton Health Sciences in the department of physical medicine and rehabilitation.
After dislocating your knee, you suffered more joint dislocations and at 25 were diagnosed with Ehlers-Danlos Syndrome, a connective tissue disorder affecting the stability of joints. At 35, you were struck with Guillain-Barré syndrome, causing paralysis of the peripheral nervous system and have experienced multiple episodes. How has living with chronic pain influenced your work as a pain specialist?
Misery likes company. It’s one of the few places where I could take something that is miserable and do something constructive with it. I’ve never had a patient say, “How would you know?” Because I do.
When people think of hypnosis, they think of the stage hypnotist. So, how is it used to control pain?
Stage hypnosis is not clinical hypnosis . . . Clinical hypnosis is putting a person into a trance-like state, which makes them turn more inward. If I get someone into a good trance, they don’t hear the traffic outside or the clock ticking in the room. They’re more internally focused. In that state, people are able to take advantage of skills they didn’t otherwise recognize they had — one is to control their pain more effectively.
How do they do that?
They’re accessing a part of the brain that allows them to, by intention, push down the pain . . . At its most basic, even if it helps a person relax a bit, they’re relaxing muscles and that will make the pain less. Someone who’s a little better at self-hypnosis can actually stop it.
How long does it take to do selfhypnosis and what does it look like? For instance, can someone do this at work while sitting at their desk?
As a newbie, you may be at your desk and have your eyes closed for a bit. You need about five to 10 minutes — if you’re good at it. If not, it will take you longer. You have to practise.
Each of us are different . . . The better you get at it, the more you’ll get out of it.
And the longer you do it, the quicker it takes.
I don’t look like I’m doing anything. I don’t have to do a formal trance. I can do this standing, walking. It didn’t start this way.
It took me a year until I got into my first trance-like state.
And a five-to-10-minute investment of time buys someone how much time of pain relief?
Each person is different. For me, it’s an hour, sometimes two. One fellow I talk about (in the book) gets three to four hours of no pain and he has dropped his use of narcotics way down because of this.
You’re not anti-medicine and aren’t suggesting folks toss out their medications. Rather, you want them to think of hypnosis as another tool in the therapeutic tool box.
It’s a tool when other things aren’t working as well as you’d like. The data is very clear that, for the most part, opioids really don’t work so great . . . I do prescribe opioids. I’m a very conservative user of them. I think people have to be willing to develop other skills.
The biggest problem in North America is that we teach people to be passive. The easiest thing you can do is take a pill — and the easiest thing for a doctor to do is prescribe one. Everybody is quite happy if a pill works. The problem in chronic pain is there is nothing on the table that works great. If it did, I’d be taking it.
Have you seen patients use hypnosis to reduce their pain and their reliance on opioid medications?
Yes. One fellow was a long-distance runner who developed rheumatoid arthritis, so his joints are basically crumbling. He was put on opioids and got up to a high dose, near 400 milligrams a day, and they weren’t doing what he wanted. I taught him selfhypnosis and he was a natural. He found that when he did it, he could get 100-per-cent pain reduction . . . Right now, he’s taking a low dose of opioid, probably below 50 mg. He’s a great example of what’s possible . . . On the other side of it is me: It took me a year to learn self-hypnosis. But I went from 90 mg of morphine down to 10 mg and I used these skills to help me do it.
(In May, Canada updated opioid-prescribing guidelines for chronic non-cancer pain. The upper limit used to be 200 mg per day, now it’s 50 to 90 mg.)
You’re one of the only doctors teaching self-hypnosis. Given that nearly 30 per cent of people live with chronic pain, why do you think other doctors resist hypnotherapy?
It’s useful. There’s no harm. And there’s data to support its use. From a science and medical point of view, there’s every reason to say, “Let’s consider it.”
But why not? Because no one is trained to do it. And my guess is that when you say hypnosis, people think of the guy on the stage, with a watch and the person clucking like a chicken.