Hypnosis/ pain relief - Support?

[kev]

Looking for some thoughts. I teach HS Biology/Anatomy. I incorporate a variety of activities throughout my courses that I use as a means of including "scientific thinking" in addition to the basic content covered in each class.

One activitiy that I use in Anatomy deals with Alternative Medicine. In short, students select a from of alternative medicine, research it and report on it to the class - what is it, how does it "work", what are the benefits.

I then provide students with some handouts on comparing "pseudo-science" to "real" science. The appeals to emotion, the anecdotal evidence, no controlled testing, static nature of knowledge etc. etc. We then go back and they are to attempt to locate any ACTUAL research which would substantiate any of the MEDICAL claims made by the alternative medicine. Not claims of "it made me feel better" but, actual medical benefits - what did it cure? etc. By and large, they find that there simply is nothing out there. Their assignment is to either find a true, scientific study that suggests there are real benefits - conducted by reputable people in a scientific manner in a way that could be reproduced by others. Or, they need to write an essay that examines how the alternative medicine they researched utilizes many of the elements of pseudoscience in order to promote itself, and examine the possibilities that there may actually be no evidence what-so-ever for the claims of benefit.

The best student in my class has been on to my tricks for quite some time in regard to how I present my classes with an assignment, "teaching them one thing" only to "unteach it later." So, he is usually trying to stay one step ahead of me. He selected Hypnosis as his topic and pursued it from the perspective of pain relief. He found some interesting ideas, and I like that he approached it from the angle he did. Some of the primary support he has found is linked to a University of Iowa study that suggested hypnosis does lessen pain, and it utilized MRI of brain activity to show differences in hypnotized patients.

What do you think? Does he have some level of support for this application of hypnosis? I have done a lot of looking and have not found anything to the contrary. I realize it is one example, but am curious as to other's thoughts.

I can't post links yet, but if you google "Iowa hypnosis pain research" it comes up pretty readily.

Thanks

 

[blutoski]

Pain relief does have the challenge of measurement. How does it differ from anecdotal reporting?

Even the objective metrics I've seen (such as range of motion, measured in inches or degrees of joint bending) rely on the patient's personal decision to say 'when'.

So: you have to decide whether pain reporting in general falls into the category of anecdotal evidence.

Secondly: These studies are clearly not blinded, because the patient and investigators know who's who. That is also problematic.

Thirdly: The study in question is conflating two claims:
a) that hypnosis can reduce pain while under hypnosis

vs

b) that hypnosis therapy sessions can reduce pain the rest of the time


Another problem: what a small sample size! Where are the stats? What was the p-value? ie: was this statistically significant? If not... we have an anecdotal report, basically.

Another problem: I find it difficult to believe that all 12 volunteers were successfully or uniformly hypnotized. The ability to be hypnotized is actually quite rare... something like one in twenty people. This experimental premise in particular is very suspicious.

 

[Jeff Corey]

Patterson,D.R. & Jensen, M.P. (2003) Hypnosis and clinical pain. Psychological Bulletin, 129, 495-521.
I was able to google the title and get the whole article. Those pesky methodological problems are discussed.

 

[JoeTheJuggler]

Those pesky methodological problems are discussed.

Yep--the worst, I think, being the same issue as with acupuncture, how can you do a placebo? In acupuncture they did fake needles (that feel the same as real ones) or someone purposely placing the needles in the wrong spot, but then you've lost your double blind (the person administering the sham treatment knows it's sham and can inadvertently communicate the expectation).

With hypnosis, you could have someone administer "fake" hypnosis. Aside from the issues just mentioned, there's also the problem that whatever hypnosis is, a "fake" but credible version of it might be doing exactly the same thing.

These difficulties arise, I think, from the lack of a clear theoretical definition of what hypnosis is.

 

[JoeTheJuggler]

Another problem: I find it difficult to believe that all 12 volunteers were successfully or uniformly hypnotized. The ability to be hypnotized is actually quite rare... something like one in twenty people. This experimental premise in particular is very suspicious.

This problem can be huge. It can be a complete misrepresentation of the effect. If, for instance the 12 were cherry-picked out of a pool of for example 64 subjects, the conclusions are meaningless.

Also, some of the studies look at the effects of hypnosis on high-hypnotis]zable vs. low-hypnotizable groups. So pretty much, you do some sort of screening to select the people upon whom hypnosis seems to have an effect, and then you run a study to see if hypnosis differently affects that group. Again, a completely meaningless experimental design--dishonest too if the reporting doesn't go into the screening step.

Imagine dividing your class into tall people vs. short people (people above or below some specific height) as your screening step. The one thing you certainly cannot do with any significance is to then compare the average heights in the two groups.

 

[kev]

Is there any relavance to the assertion that the brain imaging showed different activity levels in various areas of the brain? I guess that was a portion of what he was looking at that I thought (if anything) held the greatest promise of at least a plausible attempt to "measure" pain, and any affect hypnosis might have on it.

Also, as mentioned - the nature of "what hypnosis is" causes problems with experimental setups. I guess I view that as a little differently than deliberately evading the use of research to examine validity. Are there "levels" of acceptance in regard to the medical value of various "treatments." For instance, it is accepted and proven that antibiotics kill bacteria. On the other end of the spectrum there are obviously complete shams that evade any type of attempt to be subjected to actual testing. Is something like "the use of hypnosis to control pain" an example of something that would fall in between - perhaps having some use, although as of yet, there are not adequate means of testing and proving what that may or may not be?

 

[polkablues]

The ability to be hypnotized is actually quite rare... something like one in twenty people.

Do you have any sourcing for that figure?

 

[Blu]

Is there any relavance to the assertion that the brain imaging showed different activity levels in various areas of the brain?

I would have thought so. Our brain activity varies all the time. The procedure to induce hypnosis causes the person to enter a relaxed state of mind whilst being guided by the hypnotizer, and the constant focus by the "client" on the guidance being given acts, in a similar way to meditation, as a focal point to prevent falling deeper into relaxation and thus sleep. The guidance can then be used to focus on various "issues" for the client which will cause different activity in different parts of the brain. If the focus relates to an emotional memory then the relevant part of the brain will show activity; if the focus is on a currently felt pain then that part of the brain will show activity. I don't know how "pain relief" works through hypnosis, but it could be that the combination of focus on the specific issue area and the guidance to relax that are of the brain, cause relief. As for post hypnotic suggestion, I'm clueless, so I'm gonna have to go off and do some of my own research.

For instance, it is accepted and proven that antibiotics kill bacteria. On the other end of the spectrum there are obviously complete shams that evade any type of attempt to be subjected to actual testing.

Well that applies in all fields, whether alternative therapies or supposed "medical science". How many medications are proven safe only to be taken off the shelves a year later or whatever because of side effects.
I wouldn't say that it's proven that antibiotics kill bacteria. The viruses are managing to mutate and become immune to antibiotics in recent years causing a need to develop new ones to combat those. Yes, antibiotics can be effective, but not always. I certainly wouldn't assume that they can kill bacteria, but just that they may kill it.

Blu

 

[JoeTheJuggler]

Is there any relavance to the assertion that the brain imaging showed different activity levels in various areas of the brain? I guess that was a portion of what he was looking at that I thought (if anything) held the greatest promise of at least a plausible attempt to "measure" pain, and any affect hypnosis might have on it.

I'm not clear on what they were doing with the brain imaging. Were they looking for a difference to correlate with being hypnotized? Or were they using the brain image as some sort of way to measure the sensation of of pain?

To your bigger issue: it's a hairy problem testing something when no one can say what that something is. Is it simply the same thing as a profoundly relaxed state? How can you design a test to tease out the effects of something when we're not sure what that something is?

As you can probably tell, I'm very skeptical of hypnosis. My thinking is if its proponents can ever say exactly what it is, and then come up with some rigorous test design, I'd be happy to accept it. Unless or until that happens, it's "unproven" at best.

Think how rigorously we need to be with drug testing (double blind, placebo controlled studies for safety and efficacy). We really want be as sure as we can that we're testing just the treatment we intend to be testing and not something else. Maybe just teaching a comparison about what it takes for alternative therapies to be accepted compared to what we demand of a real drug would be a nice way to approach it with your class.

 

[kev]

Think how rigorously we need to be with drug testing (double blind, placebo controlled studies for safety and efficacy). We really want be as sure as we can that we're testing just the treatment we intend to be testing and not something else. Maybe just teaching a comparison about what it takes for alternative therapies to be accepted compared to what we demand of a real drug would be a nice way to approach it with your class.

Thanks for the input. This is a major portion of what we discuss in regard to alternative medicine - it simply does not undergo (nor is it required to undergo) the same scrutiny as "true" drugs and treatments.

And, for most of what the kids research, it is so easy to see the massive problems with many of the topics they choose. When we look at characteristics of pseudoscience and unsubstantiated claims, the examples just jump out and they connnect with it very easily. However, in this case, many of the problems with the "research" are not as clear to an average person or a high school student. Distinguising between the nuances of experimentation and what constitutes accurate measure, what constitutes faulty design - it can get pretty tricky.

I want to promote a questioning nature in my students, but I also don't want them at the other extreme of simply dismissing things off hand, either. So, I am just looking for the best way to examine the issue that this student has found. Basically, I am having him use some of the given links and examine a combination of ideas in regard to hypnosis - in what ways is it promoted as some pseudosciences are, in what ways does it attempt to be tested as a legitimate treatment, and ultimately, what are some of the limitations in trying to conclusively test it, and its effects.

Thanks for the help to all who responded.

 

[blutoski]

Do you have any sourcing for that figure?

Nah. Just off the top of my head. My impression from personal experience is that nobody can be hypnotized. ie: my wife is a psychiatrist and her coworkers who were keen early in their practices have pretty much given up on hypnosis. My friends who were looking forward to hypnotism in their personal lives for reasons ranging from entertainment to weight-loss feel they have wasted their money.

Basically, I have met one person who says she was hypnotized, and other people who were there at the time say, "I don't know what she's talking about."

When I reviewed internet resources, I found few credible studies about this.

I really think it's iatrogenic.

 

[JoeTheJuggler]

Also, let's not leave off the guilt (or should I say suspicion) by association.

Even if there is a kernel of something real and valuable in hypnosis, that bit has been far outweighed by its horribly damaging applications: regression and so called recovered memories (leading to the ruin of many perfectly innocent lives), its use in past life regression (the Bridey Murphy hoax), its use in creating alien abduction stories (especially when the client may have had some imminently treatable condition like depression or an eating disorder), and so on.

Not exactly a nice history.

 

[kev]

Also, let's not leave off the guilt (or should I say suspicion) by association.

Even if there is a kernel of something real and valuable in hypnosis, that bit has been far outweighed by its horribly damaging applications: regression and so called recovered memories (leading to the ruin of many perfectly innocent lives), its use in past life regression (the Bridey Murphy hoax), its use in creating alien abduction stories (especially when the client may have had some imminently treatable condition like depression or an eating disorder), and so on.

Not exactly a nice history.

Agreed - I did make a specific point of providing these types of examples and their obvious links to misuse. There are many, many examples of its very blatant flaws.