Hypnotherapy for Chronic Pain: What Modern Pain Science Tells Us About Pain
One of the earliest enquiries I received when I first started practising hypnotherapy, nearly 20 years ago, was from somebody with back pain.
They asked me a very straightforward question: did I specialise in back pain?
I don't think I answered quite as confidently as I would today. I was a new practitioner, and although I already understood that as hypnotherapists we weren't treating a particular body part, I certainly didn't have the depth of knowledge about pain that I've developed over the years since.
It's an enquiry I've thought about occasionally because pain is a particularly interesting area for hypnotherapists. Someone may experience their pain very clearly in their back, knee, shoulder or elsewhere, but understanding pain involves looking at far more than the part of the body where it hurts.
Of course, the body matters. Pain can be associated with injury, inflammation, disease, nerve damage and many other physical processes which require appropriate medical assessment and treatment.
But pain isn't simply a direct measure of what's happening in the tissues.
It's an experience involving the nervous system and brain, influenced by many different factors.
And once we begin looking at pain in that way, it changes how we think about hypnotherapy for chronic pain too.
Pain Isn't Simply a Message From the Body
We often talk about pain as though it works in a very straightforward way.
Something happens in the body. A pain signal travels to the brain. The brain receives it. We experience pain.
Contemporary pain science gives us a considerably more complex picture.
The International Association for the Study of Pain defines pain as:
"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
An important part of understanding that definition is recognising the distinction between pain and nociception.
Nociception refers to the nervous system's processing of potentially harmful stimuli. It isn't the same thing as pain.
We don't have pain receptors sending pain itself from our backs, knees or shoulders to the brain. The nervous system receives information from the body, and the experience of pain emerges through a complex process involving the brain and nervous system.
That's one reason why the relationship between tissue damage and pain isn't always straightforward.
Someone can have significant tissue damage and experience surprisingly little pain.
Someone else can experience severe pain when investigations don't reveal tissue damage that adequately explains the intensity or persistence of what they're experiencing.
Neither person's pain is less real.
Acute Pain and Chronic Pain Aren't Necessarily the Same Problem
Pain is extraordinarily useful.
If you put your hand on something dangerously hot, pain encourages you to move it.
If you injure an ankle, pain may encourage you to protect it while healing takes place.
In situations like these, pain serves an important protective function.
But chronic pain can become considerably more complicated.
Chronic pain is generally defined as pain that persists or recurs for longer than three months. In some chronic pain conditions, the relationship between ongoing pain and continuing tissue damage can become much less straightforward.
An original injury may have healed while pain persists.
The nervous system can become increasingly sensitive.
Movements or activities that have become associated with pain may begin to produce protective responses more readily.
Attention, expectation, previous experience, emotional state and context can all potentially influence what somebody experiences.
None of this means chronic pain is imaginary.
It means pain isn't simply a damage detector.
Pain as Protection
One of the useful ways we can think about pain is as a protective experience.
Our nervous system is constantly processing information about what's happening inside and outside the body.
When something is interpreted as sufficiently threatening, pain may form part of the protective response.
Most of the time, that's incredibly useful.
But protective systems can become overprotective.
The smoke-alarm analogy is often used in pain education. A smoke alarm is designed to alert us to danger, but an increasingly sensitive alarm might eventually respond to burnt toast or steam from the shower.
The alarm is genuinely sounding.
What has changed is its relationship with the level of danger.
Like any analogy, this has its limitations. Human pain is vastly more complicated than a smoke alarm.
But it helps illustrate an important principle:
The amount of pain somebody experiences doesn't necessarily tell us how much tissue damage is occurring.
That can be particularly important for somebody who has come to interpret every increase in pain as evidence that they are causing themselves further harm.
Where Does Nociplastic Pain Fit In?
Another important development in pain science has been the recognition of nociplastic pain.
Traditionally, pain was largely discussed in terms of nociceptive pain, associated with actual or threatened tissue damage, and neuropathic pain, associated with a lesion or disease of the somatosensory nervous system.
But those categories didn't adequately describe every chronic pain experience.
The International Association for the Study of Pain now also recognises nociplastic pain: pain arising from altered nociception where there isn't clear evidence of actual or threatened tissue damage activating peripheral nociceptors, or evidence of disease or a lesion of the somatosensory system, that would explain the pain.
The concept can be particularly relevant when thinking about some persistent and widespread pain conditions.
And again, it doesn't mean that pain is psychological or somehow less real.
It recognises that changes in the way pain-related information is processed can themselves become important.
Why Attention Matters in Chronic Pain
Pain is exceptionally good at capturing our attention.
There's an obvious reason for that.
If the nervous system is trying to alert us to something potentially threatening, being able to ignore it completely wouldn't necessarily be very useful.
But when pain becomes chronic, attention can become increasingly organised around monitoring the body.
Is it worse today?
What happens if I bend?
What's that sensation?
Will walking make it worse?
Am I going to trigger another flare-up?
The more important and threatening something becomes, the more likely we are to notice it.
And the more closely we monitor something, the more information we're likely to detect.
This can become part of a cycle involving pain, attention, anticipation and threat.
And this is one of the areas where hypnosis becomes particularly interesting.
Hypnotherapy for Chronic Pain: Where Might Hypnosis Fit?
Hypnosis involves attention, expectation, perception and experience.
All of these are relevant to pain.
That means hypnotherapy for chronic pain can involve far more than simply helping somebody relax or asking them to imagine turning down the intensity of their pain.
We might work with how attention is directed.
We might explore expectations around pain.
We might help somebody develop different ways of responding to sensations.
Where appropriate, we might work with fear surrounding particular movements or activities.
We can use hypnosis to explore changes in the perceived intensity, location, temperature or quality of sensations.
We can develop experiences associated with comfort and safety.
And we can help someone practise moving their attention more flexibly rather than having it repeatedly captured by pain.
Importantly, the goal doesn't always have to be making pain disappear.
For somebody living with chronic pain, meaningful therapeutic change might include sleeping better, feeling less frightened of their body, becoming more active, reducing distress or being able to engage more fully with things that matter to them.
What Does the Research Say About Hypnosis for Chronic Pain?
Hypnosis and pain have been researched for many years, and there is a substantial literature exploring the use of hypnosis for both acute and chronic pain.
As always, though, we need to be careful with simple statements that hypnosis either "works" or "doesn't work".
Studies involve different types of pain, different populations, different hypnotic approaches and different comparison conditions.
A 2024 systematic review and meta-analysis examining hypnosis used alongside other interventions for clinical pain included 70 studies and more than 6,000 participants in its meta-analyses.
For chronic pain, adding hypnosis to usual care produced a small additional reduction in pain intensity.
Interestingly, the review also identified potentially promising findings when hypnosis was combined with pain education, although the authors highlighted uncertainty within the evidence.
A 2025 systematic review and meta-analysis of randomised controlled trials examining medical hypnosis for acute and chronic pain also found evidence of potential benefit, although results varied according to the type of pain and intervention being studied.
So there is good reason to consider hypnosis as part of pain management.
But the evidence doesn't support presenting hypnosis as a universal solution for chronic pain, and it certainly doesn't mean that appropriate medical assessment or multidisciplinary care can be replaced.
Understanding Pain Can Be Part of Therapy
One of the things I think is particularly valuable when working with chronic pain is helping clients develop a more accurate understanding of what pain actually is.
That doesn't mean giving somebody a neuroscience lecture during their hypnotherapy session.
But what somebody believes about their pain can matter.
Consider the difference between:
"My back hurts, so I must be damaging my back."
and:
"My back hurts. I need to pay attention to that, but the amount of pain I'm experiencing doesn't necessarily tell me how much damage is occurring."
Those beliefs can potentially lead to very different responses.
If pain is interpreted automatically as damage, somebody may become increasingly frightened of movement, avoid more activities and monitor their body more closely for evidence that something is getting worse.
Of course, nobody should simply be encouraged to ignore unexplained pain. Appropriate medical investigation is essential, and hypnotherapists need to remain firmly within their professional scope.
But once somebody has been appropriately assessed, understanding that pain and tissue damage don't always correspond neatly can open up different possibilities.
Chronic Pain Isn't "All in the Mind"
This is important.
When we explain that the brain and nervous system are central to the experience of pain, there's a danger that clients hear something very different:
"They're saying there's nothing physically wrong with me."
Or worse:
"They're saying I'm imagining it."
That isn't what contemporary pain science tells us.
Pain is real.
The fact that psychological and contextual factors can influence pain doesn't make it psychological in origin.
Similarly, recognising the role of the nervous system doesn't mean assuming there is no continuing physical contribution to someone's pain.
Chronic pain includes many different conditions, mechanisms and individual experiences.
Our role as hypnotherapists isn't to diagnose the cause of somebody's pain.
But we do need enough understanding of pain science to avoid reinforcing outdated or unhelpful ideas about what pain means.
Moving Beyond the Pain Dial
Hypnosis for pain has traditionally included a lot of approaches based around changing the sensation itself.
Turn down a dial.
Move a lever.
Change a colour.
Imagine anaesthetic spreading through an area.
Make the sensation warmer, cooler, smaller or more distant.
There's nothing inherently wrong with these approaches. Some clients find them extremely useful.
But they represent only one part of what we might do.
If pain is influenced by attention, expectation, threat, previous experience, learning and context, our therapeutic possibilities become much wider.
For one person, sensory modulation may be exactly what's needed.
For another, the important work might involve fear around movement.
Someone else may benefit from developing greater flexibility in where they place their attention.
Another person might need to experience their body as something other than a constant source of threat.
And sometimes the most important change isn't a dramatic reduction in a pain score.
It might be going for a walk again.
Sleeping through the night.
Returning to a hobby.
Feeling more confident about movement.
Or having more of a life alongside the pain.
Nearly 20 Years Later
That early enquiry about back pain has stayed with me, partly because it's such a simple example of how much there is to understand when somebody comes to us looking for hypnotherapy for chronic pain.
Nearly 20 years later, I'd certainly answer that caller with more confidence.
Not because I've become a specialist in backs.
But because I've spent many more years understanding people, hypnosis and the complexity of pain.
Where somebody experiences pain is obviously important, but it tells us only part of the story.
We also need to understand how long the pain has been present, what medical assessment they've received, what they've been told about it, what they believe is happening, what they fear, what they've stopped doing and, importantly, what they would like to be able to do.
Because as hypnotherapists, we're not treating a back, knee or shoulder.
We're working with a person who is experiencing pain.
Contemporary pain science gives us an increasingly sophisticated understanding of that experience. Pain can be influenced by biological, psychological and social factors. Attention, expectation, learning, threat and context can all matter.
For hypnotherapists, understanding that complexity gives us far more to work with than simply asking somebody to turn down a pain dial.
And it gives us a much more useful way of thinking about what hypnotherapy for chronic pain can offer.
References
International Association for the Study of Pain (IASP). IASP Terminology: Pain and nociplastic pain definitions.
Raja, S. N., Carr, D. B., Cohen, M., et al. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976–1982.
Stanton, T. R., et al. (2024). Adjunctive use of hypnosis for clinical pain: A systematic review and meta-analysis. Pain.
Yerzhan, A., Ayazbekova, A., Lavage, D. R., & Chelly, J. E. (2025). The use of medical hypnosis to prevent and treat acute and chronic pain: A systematic review and meta-analysis. Journal of Clinical Medicine, 14(13), 4661.
Comments