Oakes and Oakes
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Oakes and Oakes Consulting |
Deep Muscle Relaxation For Pain Management FOR MORE INFORMATION: Telephone: 404.627.2004 Fax: 404.506.9067 Email: marilyn@oakes.org -or- marilynoakes@yahoo.com
Marilyn T. Oakes Certified Rehabilitation Counselor Licensed Professional Counselor Certified Pain Practitioner P.O. Box 672275 Atlanta, Georgia 30006 DEEP MUSCLE RELAXATION (aka
HYPNOTHERAPY) is widely used in pain
clinics in the industrialized western world
(U.S., Europe, Australia and New Zealand).
DMR goes by several names, including
relaxation therapy, self-hypnosis, autogenic
training, hypnosis, and hypnotherapy. DMR
can be employed as a therapeutic method
during either individual or group therapy.
Patients usually require three to six sessions
to become sufficiently skilled to work
independently and patients may supplement
therapist sessions with tapes or CDs. Group
health insurances often reimburse therapy
sessions, including CPT codes 90880
(medical hypnotherapy), 90806 (individual
therapy) or 90853 (group therapy). IMPORTANT POINTS: ● DMR IS NOT magic, witchcraft, or a sideshow trick. ● DMR WILL NOT subjugate a patient’s will, cure a broken arm, or make anyone rich, thin, smoke-free, or famous in one treatment. ● DMR IS A deeply relaxed waking state of highly focused attention, where alterations can occur in sensations, perceptions, and awareness. How does DMR work? When falling asleep,
people pass through a five-minute phase
between sleeping and waking where they are
still partially aware of their surroundings but
focused inward. They may hear things around
them but feel they cannot move. In an
emergency, they really can move, but an
emergency jars them out of their drowsing
phase and into full waking consciousness. Once
asleep, they pass into an unconscious state, no
longer aware of surroundings. The deeply
relaxed state, also called trance or hypnotic
state, expands this drowsy phase between
sleeping and waking. While in this drowsy
state, the brain is more open to therapeutic
suggestions. This deeply relaxed state also
creates perceptions of peaceful tranquility.
How is DMR done? Person sits in a chair and
gets comfortably relaxed. By talking, a clinician
systematically guides a person into a deep state
of relaxation and internal focus, which increases
control, soothes feelings and alters brain wave
function. Patients generally require about 20
minutes to become deeply relaxed. Once the
person is sufficiently relaxed, the clinician may
continue giving relaxation suggestions, or may
give pain relief messages for 20 - 30 minutes. In
individual sessions, the suggestions are tailored
to the person’s particular problems or concerns,
and patients learn to do this for themselves. The
last 10 minutes of therapeutic sessions are spent
bringing the person back and giving post-session instructions to maintain the suggestions. Does relaxation training have a scientific
basis? Yes. Researchers are still identifying the
exact mechanisms but evidence of its impact on
brain function have been measured via PET
scanners, fMRI and other testing from
neuroscience laboratories. The area of interest
seems to be the midcingulate area A’ in the
brain. This region seems to serve as a
switching station that modulates or influences
sensory, affective, cognitive, and behavioral
areas.
How does it work to control pain? After the
person reaches a deeply relaxed state of
internal focus, a clinician gives suggestions to
increase pain control, soothe physical feelings
of distress and improve self-care. Individual
sessions are tailored to specific pain
problems.
Does it work for everyone? No. About 80%
of patients respond during the first session
and most people can learn the exercises. An
experienced hypnotherapist can tell from the
first session who can benefit. The capacity to
benefit seems to be in-born and physiological.
A small study (12 patients) showed that
electrocortical (brain waves) differences can
be identified in EEG and evoked potentials,
depending on individual hypnotic
susceptibility. Psychophysiological studies
have shown that hypnotic analgesia interacts
with pain processes in the central nervous
system. Particular brain waves (cortical late
somatosensory evoked potentials) can be
reduced, which reflects pain reduction. Some
evidence suggests that pain transmission
systems in the spinal cord may become
involved. PET scanners demonstrate that
hypnotherapy appears to influence sensory,
affective, cognitive and behavioral aspects of
nociception, compared to the resting state.
Other research has shown that hypnosis seems
to blunt the pain signal in the motor cortex.
The exact mechanisms are as yet unknown. Does DMR (hypnotherapy) help with stress,
sleep disturbance and other factors
influencing pain management? Yes. Most
pain patients sleep poorly and deep muscle
relaxation improves sleep patterns without
drugs. A growing body of research shows the
beneficial physiological effects of
hypnotherapy. DMR reduces muscle tension,
increases coping skills and somewhat alters
pain perception at the level of brain function.
Once learned, the pain patient can relax on
cue, using a code word or phrase. Stress is a
known factor that increases pain perception.
Stress-sensitive patients can redirect their
focus instead of experiencing increased pain. But.... if I turn my mind over to the control
of the therapist, she might make me cluck
like a chicken and hop on one leg, right?
No. The patient retains control at all times.
Quite literally, if the patient decides not to go
deep or not to relax, period, the therapist can
do nothing. Deep relaxation (trance) is a more
suggestible state, so people must be careful
whom they choose to give them suggestions,
but the patient is in control and cannot be
compelled to do anything against their will or
values. The TV and movie portrayals of
people who are completely controlled by
another person and unwillingly do silly or
destructive things are Hollywood
entertainment.
What kinds of conditions benefit from
DMR? Research studies have shown benefits
for such diverse conditions as insomnia,
fibromyalgia, chronic pain syndrome, tension
headaches, migraine, breast cancer pain, bone
marrow pain, burn pain and phantom limb pain.
Most pain syndromes respond to relaxation
training. The most crucial variable is individual
patient response, not type of pain syndrome.
The National Institutes of Health recognizes
relaxation therapy as an effective treatment for
chronic pain and insomnia. MARILYN T. OAKES is a rehabilitation counselor in Atlanta, Georgia. She attended the University of Kentucky and graduated from Peabody College at Vanderbilt University and the University of Alabama-Birmingham. She has worked with pain patients more than 25 years and served on pain team at the University of Alabama - Birmingham Pain Center. She is presently a member of the Center for Spine Care at Shepherd Pain Team and the Northside Hospital Multidisciplinary Pain Management Team. In 1998, she became a pain patient herself, and uses her experiences to help patients. She is a Licensed Professional Counselor, National Certified Counselor, Certified Rehabilitation Counselor, Certified Pain Practitioner (Fellow of the American Academy of Pain Management), and Certified Rational Hypnotherapist. She is presently the only CRC/LPC in Georgia with dual certification in pain management.
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