Experimental (Price & Barber, 1987) and neuroimaging studies (Rainville, Carrier, Hofbauer, Bushnell, & Duncan, 1999), suggest that it is the affective dimension of pain as processed in the anterior cingulate cortex (ACC) that is most associated with suffering and autonomic arousal. Conversely, pain related emotions (Rainville, Bao, & Chretien, 2005) and expectations (Koyama, McHaffie, Laurenti, & Coghill, 2005) modulate pain perception and associated pain affect. This paper presents both the scientific background and the general clinical steps involved in a practical hypnotic approach that uses emotion specific wording and the elicitation of prior positive experience to intervene at both the affective and sensory dimensions of pain. Such an approach enables patients to therapeutically use hypnosis to reduce their subjective distress even if they are not able to greatly reduce the sensation of pain. The utilization of positive state dependent learning (Rossi, 1986), following the advice of Milton Erickson to "discover their patterns of happiness" (Parsons-Fein, 2005) is emphasized.

Am J Clin Hypn. 2009 Jan;51(3):235-54. Feldman JB. Wake Forest University School of Medicine, USA. jfeldman@wfubmc.edu