Hypnosis frequently contributes to anxiety reduction but this effect can be distinguished from pain reduction. Anxiety is strongly associated with pain but separate from it; a person in acute pain will often be anxious whereas chronic pain is usually associated with depression. Benzodiazepine drugs have been shown to reduce pain by relieving anxiety but they do not affect the pain threshold or the physical sensation of pain. Pain tolerance is something beyond sensory pain and suffering so that, in some cases, hypnosis substitutes for a tranquillizer rather than acting as an analgesic.
Hypnotherapy is often ineffective with pain of a psychological nature, particularly when pain is seen to be a depressive equivalent. Masked depression is one of the conditions where hypnosis should be avoided unless the hypnotist is able to deal properly with depression, using medication and psychotherapy. This situation should be suspected if the patient gives a history of sleep disorder, fatigue, lack of interest in sexuality or in general, or inability to work—or a tendency to stay in bed. This is particularly so if the patient functioned effectively previously; such patients can respond dramatically to antidepressant therapy. Hypnosis may be used after the depression is controlled.
Methods of treatment need to be adapted to the individual's hypnotic ability. They depend on that patient's interests, capabilities and levels of motivation. Even non-hypnotizable subjects may benefit from the therapy aspects of the treatment rather than the hypnosis itself.
Hypnotic pain reduction procedures are equally applicable to many painful conditions where the pain occurs in short episodes, as in most dental procedures, as well as in childbirth and surgery, where the pain is longer but with a known endpoint. It is even useful when pain is protracted for days or weeks, as in burns patients and in cancer cases.
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