If you’re looking for a noninvasive, nonmedicinal way to manage the pain that comes along with a chronic condition such as rheumatoid arthritis, or RA, hypnosis is probably the last thing on your mind.

That’s not surprising, considering popular culture has given hypnosis something of a bad rap. We’ve all seen movies or TV shows where a doctor swings a watch in front of his unsuspecting victim’s face, tells her she’s “getting very sleepy,” then forces her to flap her arms and cluck like a chicken.

Forget all that, say today’s practitioners, who are using hypnosis to give patients fighting chronic pain an additional weapon in their arsenal.

Just Relax

Jeffrey B. Feldman, PhD, an assistant professor of neuropsychology at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., became interested in hypnosis during his internship at New York Univerity in the 1970s. The practice has come a long way from its authoritarian “you will listen to my words, you will hear every word I say, it will go right to your unconscious, you will do every thing I say” roots, he says.

Hypnosis isn’t about convincing patients they don’t feel pain, Feldman says, it’s about helping them manage the fear and anxiety they feel related to that pain.

“Hypnosis redirects your attention; redirects the perceptual focus of sensation,” says Feldman, who uses hypnosis to treat chronic pain patients at Wake Forest’s Center for Worker Health. “It may first relax or quiet your nervous system so you’re not as reactive to the pain.

In fact, a hypnosis session, which usually lasts 10-20 minutes, is likely to start out by having the patient relax by focusing on his breathing. Then the hypnotist will ask him to imagine a pleasant place, and describe it in detail.

“I’m refocusing them from something that’s going to trigger negative emotions to something that’s going to activate positive emotions, such as being at the beach,” Feldman says. “The analogy I sometimes use is we can turn the dial down on the volume of the TV, but we can also change the channel so you can shift from what might be an unpleasant here and now to someplace you might enjoy being.”

In other words, if your mind is off to the beach, and you’re imagining the warmth of the sun, the cool of the breeze, the sand at your feet, you’ll be less focused on your pain – and ready for the indirect suggestion on how to react to pain in the future.

That suggestion might sound something like this, Feldman says: “You will continue to feel this same sensation of pain, but you’ll be much less distressed about it, much calmer, much more at ease, not worried about it.”

Practice Makes Perfect

Hypnosis isn’t a one-shot treatment. It can be part of regular psychotherapy sessions, or delivered in a clinical setting. The goal is to teach patients the technique so they can use it on their own when pain strikes.

“All hypnosis is self-hypnosis,” says Janet Wootton, RN, nurse clinician for the pain clinic at Duke Children’s Hospital and Health Center, in Durham, NC. Though formally trained in hypnosis for several years, Wootton says she’s practiced the relaxation techniques it centers on far longer than that – as has anyone who’s ever spoken quietly, calmly and rhythmically in an effort to soothe a hurting or frightened child.

Wootton likens the process to guiding patients into a daydream. Because the kids she works with are more active in their daydreaming than adults, creating an escape for them may be less about relaxing at the beach than doing something they love like playing on the playground or kicking a soccer ball downfield.

“When something is hurting, it’s nice to be able to do something immediately,” Wootton says, “not wait until Mom gets there with the pills or wait an hour until the pill starts to take effect. You’re giving them something to help them take control. Stress comes from not being able to control everything – or anything. When you make patients feel they’re active participants in their health, it grows from there.”

She works with her patients to create a tape they can play to lead themselves into the hypnotic process. Feldman prefers his mostly adult patients to come up with their own script and not rely on a tape – or his voice – to activate the process when pain strikes and they need it.

“What I usually say is you need to practice it. It’s an acquired skill – some people develop it more easily than others,” Feldman says. “When you’re in a lot of pain, it’s hard to do. I tell people to practice when they’re in a relatively low degree of pain to get into the habit of doing it when they’re in what I call the yellow zone, pain-wise.”

Demonstrated Results

If there’s any downside to hypnosis, Feldman says, it’s only that some patients are more responsive to hypnosis than others.

Guy Montgomery, PhD, director of the Integrative Behavioral Medicine program at The Mount Sinai Medical Center in New York, agrees.

“People respond differently,” he says, “just as people perceive pain differently. Like most things in the world, how people respond falls on a curve. Some people have no hypnotic susceptibility; a few people have super susceptibility. Most patients fall right in the middle.”

Ironically, how suggestible a patient is under hypnosis is often inversely proportional to how suggestible they are when not hypnotized, Feldman says.

Montgomery, who works primarily with cancer patients, has been intrigued by hypnosis since his graduate school days. In 2007 the Journal of the National Cancer Institute published a study he conducted showing that breast cancer patients who received a 15 minute hypnosis session prior to an outpatient procedure felt less discomfort afterward. They also needed less pain medication, which resulted in a savings of more than $700 per individual.

In Montgomery’s mind, that makes hypnosis a winning proposition for patients and healthcare facilities alike. “It works and it saves money and it’s easy to do,” he says. “So let’s do it.”