Hypno-analgesia

Overview

Hypno-analgesia refers to the use of hypnosis for pain reduction or elimination in medical settings. This practice has a long history: in 1829, Jules Cloquet performed a mastectomy under hypnosis in Paris, and James Esdaile performed over 300 surgical procedures under hypnosis in India in the 1840s. With the advent of chemical anesthesia, hypno-analgesia was marginalized before experiencing a spectacular revival from the 1990s.

The modern pioneer is Dr. Marie-Élisabeth Faymonville of the CHU de Liège (Belgium), who developed hypnosedation — a combination of hypnosis and light local sedation — allowing major surgical procedures (thyroidectomies, breast surgeries, plastic surgeries) with the patient awake and serene. Over 10,000 patients have been operated on using this technique with remarkable results: fewer complications, faster recovery, less post-operative medication.

Core Principles

• Descending pain modulation: hypnosis activates descending inhibitory pathways in the brainstem, reducing the pain signal before it reaches the cortex
• Affective component modification: neuroimaging shows hypnosis modifies anterior cingulate cortex activity (emotional pain processing) without necessarily modifying somatosensory cortex activity (pure sensation)
• Hypnotic dissociation: the patient mentally "absents" themselves from the surgical situation while remaining physiologically stable
• Attentional focusing: attention is diverted from pain toward a pleasant experience (happy memory, vacation spot)
• Comfort suggestions: continuous suggestions of well-being, warmth, safety, maintaining a state of deep serenity

Main Indications

• Surgery under hypnosedation (thyroidectomy, breast surgery, plastic surgery)
• Dental care (replacing or complementing local anesthesia)
• Endoscopies and colonoscopies
• Catheter placement and punctures
• Burn dressings
• MRI and anxiety-inducing examinations
• Painful procedures in pediatrics
• Chronic pain (fibromyalgia, back pain, migraines)
• Oncology support (chemotherapy, radiotherapy)

Session Structure

In a surgical context (operating room hypnosedation):

1. Pre-operative consultation: meeting with the anesthesiologist-hypnotherapist, assessing hypnotic receptivity, choosing the "safe place" (pleasant memory the patient will experience during the procedure)
2. Operating room induction (10 min): patient is settled, medical monitoring in place. The hypnotherapist begins induction through visual fixation and progressive relaxation, then guides the patient to their safe place
3. Trance maintenance during surgery (variable duration): the hypnotherapist maintains continuous dialogue with the patient, guiding them through their pleasant experience. Meanwhile, the surgeon operates with minimal local anesthesia. The patient feels no pain
4. Specific suggestions: during the procedure, suggestions for rapid healing, post-operative comfort, and accelerated recovery are given
5. Awakening and reorientation: at the end of surgery, the patient is gently brought back to waking state, often surprised the operation is already over

Variations

Conversational hypno-analgesia is used in emergency rooms and routine care: without formal induction, the caregiver uses hypnotic communication techniques (distraction, reframing, positive suggestions) during painful procedures. Virtual reality hypnosis combines VR headsets with hypnotic suggestions for total immersion. In pediatrics, the "Magic Gloves" program uses play and imagination to induce natural hand anesthesia in children before venipuncture.

Contraindications

• Non-consenting patient or hypnosis-phobic
• Procedure requiring absolute immobility impossible to maintain under hypnosis
• Severe unstabilized psychiatric disorder
• Deafness or communication disorder preventing verbal guidance
• Local anesthetic allergy (hypno-analgesia alone may be insufficient for some surgeries)