This book is a very welcome and thorough account of hypnosis and suggestion in the treatment of pain. During the past four decades, hypnosis has become much better understood due to the extensive laboratory and clinical research. While much about hypnosis still remains to be explored and understood, there is a need to more accurately describe the practical applications of hypnosis and imagination. Clinicians who care for patients in pain have benefited greatly from theoretical work that has advanced our knowledge about hypnosis. At the same time, some of the most important questions in this field have been studied by clinicians, who are concerned primarily with practical applications.
This book brings together experimental and clinical knowledge regarding the treatment of these very real problems. Clinicians who read this book will appreciate the detail and thoroughness with which practical clinical questions are explored. At the same time, experimentalists will develop a deeper understanding of the world of those who treat pain.
The literature on psychological factors involved in the treatment of pain is a rich one, but it has been incomplete. There is an unfortunate abundance of exaggerated claims for the efficacy of various psychological methods in treating pain. There are few serious and careful reports of methods that integrate a compassionate exploration of pain problems with the rigorous approach required by the scientific method. This book is a significant contribution to the field, a valuable resource to clinicians and experimentalists alike.
Over the years, Josephine Hilgard and I, along with others in the Stanford Hypnosis Laboratory, observed the wide variability of experimental subjects’ experience. This variability helped us realize, with guidance from clinical colleagues, the importance of bringing a flexible approach into the experimental setting. We benefited greatly from this clinical point of view in our design and execution of laboratory studies on pain. A great source of rich detail in these experimental studies was the clinical interviews that Josephine and her associates conducted to explore the experience of both the subject and experimenter. From our work with experimental subjects we learned some valuable lessons that we hoped would be applicable in the clinic. After all, the primary purpose of this experimental work was to benefit actual patients in pain. The first major test of our ability to integrate experimental and clinical methods was the investigation of pain in children with cancer, conducted by Josephine and her colleague, Sam LeBaron. This investigation confirmed that, as we expected, the complexities of clinical work were far greater than we had ever seen in the laboratory. Fortunately, this research also demonstrated the relevance of scientific method in clinical inquiry. The present volume is a demonstration of the genius and creative spirit of many clinicians and their work that has continued in this same manner.
Clinicians who attempt to relieve the suffering of patients in pain know far more about it than the experimental researcher can learn in the laboratory. But in order to truly study the clinical phenomenon and be able to communicate it requires an integration of clinical skill and experimental method. Reading through these chapters, I am deeply gratified to see that Joseph Barber and his colleagues have brought together a fine integration of clinical and experimental methods in approaching the treatment of pain.
Clinicians who wish to know how to treat a specific kind of pain problem with hypnosis or suggestion have had few sound, comprehensive resources. With the publication of this volume, at last the clinician has access to a variety of specific methods accompanied by thoughtful case discussions. This volume is especially valuable for the attention paid to very wide-ranging pain problems.
These cases include preparation for painful medical procedures, pain associated with dentistry, burns, cancer, common pain syndromes such as headache or arthritis, the pain of children, and the pain of the elderly. In short, this book encompasses the pain problems likely to be faced by most clinicians. The reader will also find interest in the unusual and helpful discussion of the occasional failure of treatment and subsequent attempts to understand what went wrong.
In Section I, Barber creates a context for the book by introducing the theoretical position that underlies this work. While the introductory chapter on hypnotic analgesia was thorough and clear, I was particularly intrigued by the discussion of hypnotic responsiveness and clinical outcome. This complex question of the clinical relevance of hypnotic responsiveness has needed further discussion and elaboration. I am particularly pleased that this book on hypnotic treatment includes the very relevant chapter by Bonica and Loeser on the medical evaluation of the patient. Price’s chapter is particularly noteworthy for its clear discussion of the importance of neurophysiological experiments pertinent to this domain, as well as for the author’s very interesting theoretical contribution.
The chapters in Sections II and III explore and discuss a wide range of pain syndromes and patients in pain. Previous discussions in the literature have tended either to be limited to theoretical concerns or make clinical claims that are not borne out in practice. I particularly appreciate the carefully reasoned clinical discussions found in these chapters. It has been suggested for some time that the pain of burns can be significantly improved with hypnotic treatment. Patterson’s chapter further convinces us of the value of this treatment. Finally, let me take this opportunity to remark on the special satisfaction I feel when I read the chapter on children in pain by my young colleagues, LeBaron and Zeltzer, who have contributed a fine example of clinical treatment based on empirical research. It was a particular pleasure for Josephine and me to observe the important contributions made by them over the years.
There are some clinicians whose writing suggests that their methods are so effective that all their patients are cured. Yet common experience tells us this cannot be so. In the Afterword, Barber and LeBaron give us a rare and compassionate view of the clinician’s thinking when he or she is confronted with patients who do not improve with treatment. I am confident that this chapter will afford an opportunity for other clinicians to discuss their experiences of treatment complications and failure.
Experienced scientists, clinicians, and students will find much of value within these pages. I am pleased to have this opportunity to participate in this excellent book.
ERNEST R. HILGARD, PH.D.
Stanford, California
December, 1995