Hypnosis and physiotherapy

Abstract

Summary Hypnotherapy is now a validated evidence-based science, demonstrated on brain imaging, especially thanks to modern techniques of medical imaging. Imaging studies further enabled the hypnotic state to be described as a specific state of consciousness, differentiating it from other states of consciousness. This state of consciousness is primarily characterized by a state of mental permeability or suggestibility, showing an increased ability to produce desirable changes in motivation, habits, lifestyle, health, perception and behavior as well as modifying physical sensation. Its usefulness is interesting for physiotherapists since hypnosis has higher levels of evidence than many other conventional tools used in physiotherapy. The basic techniques of hypnosis are: the interview which seeks to put the patient at ease, eliminating all preconceived misconceptions about hypnosis and creating treatment expectations that are as positive as possible; suggestion which is the most powerful technique in hypnosis: direct suggestion, indirect suggestion, post-hypnotic suggestion, and self-suggestion; induction which is the process of transition from the usual waking state to the hypnotic state; visualization which consists in a virtual experience of a specific event proposed by the therapist. It is often used by physiotherapists in traumatologic, rheumatologic and neurologic rehabilitation, where efficacy is improved by hypnosis. Hypnosis affects the subconscious, which is the center of emotions, habits and automatisms. The subconscious transmits commands to the unconscious mind, which in return translates these emotions into somatic feelings and reactions. In parallel, the neurophysiology of hypnotic suggestion is currently well-defined, as is the brain permeability associated with increased regional cerebral blood flow in the attentional system of the brain. Furthermore, positive expectation and labeling of “hypnosis” seem to have remarkable effects on the efficacy of the procedure. Clinical randomized controlled studies have shown efficacy on pain in general, tension headache and migraine, temporomandibular pain, chronic low back pain, osteoarthritis and bone and joint pain, fibromyalgia, regional pain syndrome, phantom limb pain, sports rehabilitation, irritable bowl syndrome, stress and anxiety, and many other pathologies. Hypnosis is a powerful and very useful tool in everyday physiotherapy. Level of evidence NA.