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American Journal of Clinical

Hypnosis
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Hypnosis in the Control of Chronic

Low Back Pain
a
Harold B. Crasilneck Ph.D.
a
University of Texas Southwestern Medical School , USA
Published online: 22 Sep 2011.

To cite this article: Harold B. Crasilneck Ph.D. (1979) Hypnosis in the Control of
Chronic Low Back Pain, American Journal of Clinical Hypnosis, 22:2, 71-78, DOI:
10.1080/00029157.1979.10403201

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 THE AMERICAN JOURNAL OF CLINICAL Hypnosis
Volume 22, Number 2, October 1979
Printedin U.S.A.

Hypnosis in the Control of Chronic

Low Back Pain 1

HAROLD B. CRASILNECK, Ph.D.

University a/Texas Southwestern Medical School
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Twenty-nine patients were referred because of low back pain. Five were
excluded on psychological grounds because they were highly masochistic, ex-
tremely depressed, or manifested a low frustration tolerance. Of the 24 in the
treatment group, 18 of the patients had surgery two or more times, and six one
time. In each case low back pain returned within three to six months after
surgery. Twenty of the patients were addicted to or excessively dependent on
medications including acetaminophen, secobarbital, codeine phosphate,
oxycodone hydrochloride, and morphine sulphate. Common factors among the
patients included (I) consistent pain which was primarily organic in origin, (2)
analgesic dependence, (3) insomnia, (4) reactive depression, (5) excessive in-
terpersonal dependence, and (6) a fear of becoming a lifelong "backache crip-
pie." Twenty patients responded positively; four patients failed to respond to
the repeated hypnotic induction techniques and were considered failures. Six-
teen reported an average of 80% relief during the first four sessions, and all 20
patients reported an average of 70% relief (based on verbal estimates by pa-
tients) by the sixth session. Fifteen voluntarily discontinued medication by the
third week of therapy, and the rest were withdrawn by their physicians during
the ensuing four weeks. Most patients were seen daily the first week, three times
the second week, twice the third week, and thereafter as necessary. The mean
number of out-patient sessions was 31 over an average of nine months. All
patients were taught self-hypnosis. None of the individuals retained their addic-
tion, and only occasionally did they require analgesics. Patients were seen by
their referring physicians as needed during the course of hypnotherapy, and
frequent consultations between the therapists created a combination of treat-
ments best suited for each patient. It is concluded that hypnosis may be utilized
maximally as an important adjunct to other therapeutic methods in the treat-
ment of low back pain.

The mention of disabling low back pain This paper is concerned with the care and
may be found in the Old Testament? and in hypnotherapy of 29 consecutive cases in
the writings of Hippocrates. Spinal disor-
ders in the lumbar region remain the second I This paper was read in part at the Annual Meet-
most common cause of disability in the ing of the American Society for Clinical Hypnosis,
adult population in the United States. St. Louis, Missouri in 1978. The author wishes to
Eighty percent of all individuals with lum- thank Ms. Sherry Knopf for her research assistance
bar disc disease can be managed on a and Reginald B. Humphreys for reading this
conservative basis. Surgery is required for manuscript. Reprint requests should be sent in a
stamped self-addressed envelope to Harold B.
the other 20%. Of 195 patients in one study Crasilneck, Ph. D., 3600 Gaston Avenue, Barnett
(Rothman, Marvel, & Booth, 1977),61% Tower, Suite 901, Dallas, Texas 75246.
obtained total relief with disc surgery. 2 Psalms 38: 4 & 7 .

71
 72 CRASILNECK

which the patients failed to achieve relief 47 years; eight were female and sixteen
from pain following one or more back were male. Eighteen of the patients had
surgeries. Patients were referred by or- been operated two or more times; the re-
thopedic surgeons, neurosurgeons, anes- maining six experienced back surgery one
thesiologists, and pain clinics. time.
A partial list of frequently encountered Eighteen patients were treated surgically
causal factors would include trauma, for ruptured disc by laminectomy and six
congenital disease, personality and for chronic lumbar disc disease by disc ex-
psychogenic factors, improper attitude and cision combined with exploratory proce-
poor judgment by the patients towards the dures. In each case the patient's pain re-
complexity of the back's function. Freese turned within three to six months postsurgi-
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(1974) has noted "when you straighten up cally. Transcutaneous stimulation, nerve
from a bent-over position you concentrate a block, and sympathectomy had been used
force of more than a quarter of a ton on the by the referring physicians with each pa-
low back (lumbosacral spine), and if you tient but without permanent relief of pain.
lift something while bending, the weight of In some cases further surgery was being
the object is actually multiplied some 12 to considered at the time of referral.
16 times by the leverage." Finneson (1974) Twenty of the 24 patients were judged by
states "the mother who leans over to lift her their physicians to be extremely dependent
small child can throw a strain of a half-ton on or addicted to medications such as acetyl
on herlower back. " salicylic acid, acetaminophen, secobarbi-
Low back pain may be acute and/or tal, codeine phosphate, oxycodone hydro-
chronic. This type of pain can be so ex- chloride, and morphine sulphate. Since
cruciating and debilitating that the patients these medications had failed to control
may become addicted to drugs. Pain may pain, the use of hypnosis was considered
be so severe and constant that patients be- since hypnotherapy may control physiologi-
come acutely depressed (Levit, 1973), and cal pain (Crasilneck & Hall, 1973; Hilgard
in some cases attempt suicide (The Dan & Hilgard, 1975; Schafer & Hernandez,
Foster TV Medical Show, 1978). During 1978). Sixty percent of the referrals came
the past 20 years therapists have become from orthopedic surgeons; the rest were re-
cognizant of the utilization of hypnosis in ferred by neurosurgeons, anesthesiologists,
the treatment of low back pain .(Cheek & or pain clinics.
LeCron, 1968; Crasilneck & Hall, 1975;
Erickson, 1967; LeHew, 1970; Levit, TREATMENT
1973; Sacerdote, 1979; Sachs, Feuerstein, During the initial interview clinical and
& Vitale, 1977). psychological assessment of the patient was
Over a period of two years, 29 patients made. The most common factors identified
were referred for hypnotherapeutic in each patient were: (1) consistent pain,
management of low back pain. Five were primarily organic in origin, (2) dependence
excluded as a result of psychological and on medication, (3) insomnia, (4) reactive
personality factors including extreme depression, (5) excessive interpersonal de-
masochism, severe depression, negative pendence, primarily on family members,
motivation during the intitial treatment, and and (6) fear of being a lifelong "backache
low frustration tolerance which cripple. "
contraindicated the use of hypnosis. The From the initial visit the patients were
mean age of the remaining 24 patients was seen individually in the consultation office
 CHRONIC LOW BACK PAIN 73

or in the hospital. After rapport had been to block most of the pain. Most of the pain will
established on the first session, ample time come under control.
was alloted to deal with any questions Suggestions of this type were repeated
concerning the nature of hypnotherapy and until the desired goal was reached for the
its application to the patient's particular session. Control of pain was achieved in a
difficulty. When it was evident that the pa- gradual fashion, with a greater percentage
tient was comfortable and in accord with of the pain being brought under control usu-
the treatment, induction was begun. An eye ally during each successive therapeutic in-
fixation technique was employed. The fol- terview.
lowing approach was used:
RESULTS
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I want you to be as comfortable as you can and

stare at this coin I am holding above the level of Twenty of the 24 patients responded with
your eyes. Concentrate on my voice and pay no positive results. Of these 20 patients 17
attention to other sounds. You are now begin- were outpatients and three were hos-
ning to relax and your eyelids are becoming pitalized. Sixteen reported an average of
heavy as you gaze intently and intensely at this
80% relief during the first four sessions; all
coin. Your body will be free from tension,
tightness, stress and strain. Your breathing is 20 patients reported an average of 70% re-
relaxed and at ease. Your eyelids are so heavy lief by the sixth session. No difference was
you are blinking rapidly. Now they are closing, found in the response to treatment by pa-
closing. . . . That's good, let them close tients seen in the hospital or in the
completely. Good. Now, to show you the power therapist's office. The hospitalized patients
of your unconscious mind, I give you the
suggestion that your eyes are sealed, shut tight were discharged after an average of three
- so tight that even though you try to open weeks and were seen thereafter at the
them you cannot. Go ahead and try but you can- therapist's office. Fifteen of the 20 patients
not. Good. Normal sensation returns to your voluntarily decreased their doses of medica-
eyelids and you can open them. Now that we
have demonstrated this control of your mind
tion to an average of 60% during the first
over your body, I want you to relax still more. week of hypnotherapy, while the remaining
Let your eyes close. As I count from I to 20, five patients were medically withdrawn by
you will enter a much deeper state. You are their physicians. None of the individuals
relaxed and at ease, free from tension, stress and retained their former addiction nor did they
strain. require more than an occasional over-the-
Now, the finger I touch is becoming very cold counter analgesic. Hypnotherapy was used
and numb - so much so that even though I daily during the first week, every other day
stimulate your finger with this blunt fingernail
file, you do not feel it. Good. This is called
during the second week, every third day
hypnoanesthesia. Now, normal sensation re- during the third and fourth week and once a
turns to the finger and I stimulate it lightly. week for an average of two months. The
When you feel the touch, pull your finger away. patients were then seen on a PRN basis.
Good. You felt that. Now I give you the sugges- Each session lasted 30 minutes, 'and the in-
tion that you will take three deep breaths and
you will smell a spicy aroma. When you per-
dividuals were seen for an average of 31
ceive this pleasant aroma, move the thumb of sessions over a period of nine months. Each
your right hand. Good. Tell me what you are patient was taught self-hypnosis (Crasil-
smelling. Good. This passes and you are going neck & Hall, 1975) from the second ses-
into a much deeper and sounder state. Now, I sion, and was encouraged to use this as fre-
give you the suggestion that as you blocked pain
in your finger a few minutes ago, you can block
quently as necessary.
the pain in your back. Nothing is beyond the Four patients of this group of 24 failed to
power of your unconscious mind. You are going respond to hypnotherapy and could neither
 74 CRASILNECK

enter an adequate level of trance nor could pain. Both surgeon and internist felt that the
they cooperate properly with the therapist. patient was becoming addicted to medica-
Further hypnotherapeutic attempts were tion and requested that I see him for the use
discontinued at the end of the first week. of hypnosis to control the back pain and
withdraw him from medication.
CASE HISTORIES The patient entered my office walking in
a stooped position. He was suffering from
Case One: A 42-year-old male was em-
reactive depression and felt "hopelessly
ployed as plant manager of a large com-
crippled. " The pain was constant. The
pany and had been considered one of
conscious motivation of the patient for the
the expert mechanics in his field before
use of hypnosis was good (Crasilneck &
being promoted into a managerial position.
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Hall, 1975). In spite of the severe pain he

He was highly respected by his peers, was
was a pleasant person. When asked how he
happily married for 15 years, had three
felt about the use of hypnosis the patient
children and was a decorated World War II
stated that he was perfectly agreeable to try
veteran.
it but doubted that he could be hypnotized.
Six months previously, the patient was
involved in a serious industrial accident. After making the patient as comfortable
While walking through his plant the patient as possible an eye fixation induction was
wearing a steel helmet saw a crack in the used. He manifested an excellent response
floor which looked unusual. He was stoop- exhibiting good hypnoanesthesia, auditory
ing to examine it when a forklift suddenly hallucinations, and a positive response to
turned into his path striking him repeatedly. posthypnotic suggestions. Eighty percent of
The patient remembered losing conscious- the pain came under control during the first
ness, "coming to in horrible pain, and a session with relief lasting several hours.
state of shock." At a local hospital he was The patient was told to contact my office
found to have multiple cerebral contusions, day or night at the first sign of exacerbation
and an acute compression fracture (Ll). of pain. He called four hours later stating
The patient was operated on that night. the pain was returning.
After leaving the hospital recovery and The patient was seen 20 minutes later
rehabilitation of the patient continued for and within 10 minutes after induction he
four months. He was never free of lum- reportedly perceived approximately 50%
bosacral pain, and required an ever increas- less pain. By the end of the 30-minute ses-
ing amount of analgesic medication. sion approximately 80% of the pain was
One day while shopping in a supermar- under control. He returned early the next
ket, he lifted a ten pound sack of flour and morning. Treatment continued with one
immediately felt excruciating back pain. He session daily for three days, and he reported
was diagnosed as having a traumatic disc that 80% of the pain was under control. He
injury, and operated for a ruptured disc was seen every other day during the second
(L3-4). The postoperative course was week, for two sessions during the third
marked by extreme pain and discomfort, week, one session for the next three weeks
and further complicated by a myocardial in- and once a month for the next six months.
farction. Following the first session, the patient
Following his arduous recovery, the pa- voluntarily reduced his medication. By the
tient became more and more dependent on third week he was using acetyl salicylic
codeine phosphate (Y2 gr. twice daily) and acid occasionally. He was taught self-
secobarbital (100 mg. twice daily) for back hypnosis during the second session, and
 CHRONIC LOW BACK PAIN 75

was encouraged to use it whenever neces- enter a deep level of trance manifesting
sary. He was cautioned never to remove all good hypnoanesthesia and hallucinatory re-
of his back pain. sponses. She was given the suggestion
Eventually the patient was able to return "that nothing is more powerful than your
to a limited type of office management, and unconscious mind, and you can block your
resumed volunteer work with the Boy severe pain." Approximately 75% of the
Scouts. On several occasions he went pole pain came under control during the first ses-
fishing, and felt that life was more pleasant. sion. The patient was seen once a day for
A conference with the referring physician four consecutive days, and was 90% pain-
indicated that the patient could live a nor- free by her own evaluation. During the fol-
mal life with certain restrictions. Six lowing weeks she used self-hypnosis
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months later the patient was discharged whenever necessary with positive results.
with the proviso that he could return for Following discharge and during the first
further hypnotherapeutic sessions if neces- few weeks at home her reacti ve depression
sary. lifted. The referring physician advised that
Case Two: A 57-year-old widowed she discontinue most of the medication as
female with five adult children was referred soon as possible. Her daughter reported that
by a medical school pain clinic. She resided the patient was an "independent and happy
on her farm with one of her daughters. Five person again. "
years before when she had attempted to lift She is currently seen once a month for
a sack of manure, she "felt a severe pain reinforcement and will continue to do so as
and rip in my lower back." Her local necessary. The referring physician ob-
physician prescribed bed rest and secobar- served a marked physical and psychological
bital (100 mg. twice daily). When the pain improvement. Most of her pain is under
worsened she was referred to a neurosur- control, and she does limited household
geon who diagnosed her as having her- chores. She sleeps well at night, perceives
niated disc (L 2-3). During the next four some pain with changes in weather, and
years she had three surgeries, including two uses acetyl salicylic acid when necessary.
disc laminectomies, and one spinal fusion; Emphasis was placed on proper judgment
two nerve blocks and two sympathectomies. in all physical activities because this was
She was taking codeine phosphate ('h gr. 3 crucial to recovery in view of past inde-
times daily) and diazepam (10 mg. 3 times pendent behavior.
daily). Hypnotherapy was recommended by
her neurosurgeon. Case Three: A 62-year-old male physi-
The patient was extremely depressed be- cian was diagnosed with lumbar disc dis-
cause of constant pain, dependence on ease of 30 years duration, and reported
others for physical and psychological sup- acute and chronic low back pain. He was
port and fear of addiction to medication. married 35 years with two children. In pre-
She complained, "I feel like a hopeless vious years the patient had two laminec-
cripple because nothing helps me." She tomies, sympathectomy, nerve block,
was ambivalent concerning hypnotherapy transcutaneous stimulation, acupuncture,
but "willing to try hypnosis even though and biofeedback with poor results. He had
it probably won't work for me. " insomnia and depression. The referring
The patient was seen in the hospital, rap- physician reported that the patient was ad-
port was established, and hand levitation dicted to morphine sulphate ('h gr. daily),
was used for induction. She was able to secobarbital (100 mg. twice daily) and was
 76 CRASILNECK

an alcoholic. The patient's medical practice ment the patient was operated. During the
had been reduced drastically. following year he reported no relief from
Cordotomy was being considered when pain. Additional treatment included nerve
the neurosurgeon recommended that hyp- block and transcutaneous stimulation. The
nosis be tried first. The patient was seen in referring physician stated that the patient
the hospital. He was in great pain and won- was requiring codeine phosphate (V2 gr.
dered "if a person in such pain could be twice daily) and secobarbital (100 mg. once
hypnotized. " I assured him that the more aday).
pain a patient perceived, the better his re- Hypnosis was suggested and the patient
sponse to hypnosis, and the severity of the reluctantly came to my office. He was
pain might serve as a motivating factor for friendly and stated, "I am here because my
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successful hypnotherapy. physician referred me, not because 1

The patient was hypnotized using an eye wanted to come. 1 saw a guy hypnotized
fixation technique, responded slowly to one time on the stage and 1 thought it was a
suggestions, and soon entered a deep state lot of baloney. Just a fake. ' ,
of trance. Suggestions were given to 1 explained that cooperation was neces-
control the pain, to lessen the need for sary and even though his conscious mind
medication, and to stimulate the desire to was not agreeable, if unconsciously he de-
get well. He was taught self-hypnosis .sired to get well hypnosis could be success-
which would help to control his pain. The ful.
patient stated that 60% of the pain was He was willing to try. During induction
gone. He was quite surprised but gratified the patient intermittently moved in the
and pleased with his response to hyp- chair, coughed, took deep breaths, and
notherapy. For the next 14 days hyp- manifested many other forms of resistance.
noanalysis was used not only to control his At the end of the unsuccessful session the
pain but to give this patient intellectual and patient was asked to return for three succes-
emotional insight into his many problems. sive days. The same responses were ob-
The patient continued to respond well, served during the following three days al-
most of his pain under control. Insomnia though the pain had "slightly lessened."
disappeared, depression lifted, and al- Results were poor in spite of the fact that
coholism abated. During the course of hyp- the patient manifested good glove anes-
notherapy he was medically withdrawn by thesia.
his physician from addicting drugs. Follow- The patient denied any relief of pain and
ing dischcrge he was seen on a PRN basis. cancelled further sessions. His negative at-
He now enjoys full practice, uses self- titude and failure to accept hypnotherapy
hypnosis twice daily for half-hour sessions, were discussed with the referring physician
reports his status by telephone once a week, who agreed that hypnotherapy was not ap-
and returns for hypnoanalysis once every plicable in this case.
eight weeks. When necessary he used
medication as prescri bed by his physician. DISCUSSION

Case Four: Thirteen months previously The use of hypnosis in the control of or-
a 32-year-old married man with two chil- ganic pain problems has been demonstrated
dren was injured at work when a heavy ob- for many years. In our text (Crasilneck &
ject fell on his back. He was hospitalized Hall, 1975), it is hypothesized that the hyp-
with an acute compression fracture (LI and notized patient blocks the perception of
L2). After one week of conservative treat- pain in the same manner that psychosurgery
 CHRONIC LOW BACK PAIN 77

obliterates intractible pain. It is akin to the physical activity engaged in by the patient
"gate control theory of pain" (Melzack, should be carefully exercised. Finally, it is
1973), with a cortical hypnotic change serv- always possible that a psychodynamic
ice as the' 'gate closing stimulus. " meaning may underlie or be associated with
A hypnoanesthetized patient physician in an organic pain problem. The therapist
labor described herself as having a must investigate and treat the possibility of
"psychological prefrontal lobotomy." such emotional meaning to the pain, espe-
From a motivational standpoint, we know cially as the pain begins to diminish or
that patients manifesting severe organic comes under complete control. The un-
pain are exceptionally good hypnotic sub- derstanding and treatment of secondary
jects because of an extremely intense desire gain is a prerequisite to the successful hyp-
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to obtain relief from pain. The only excep- notherapy of organic pain problems.
tion to this general rule would be in cases With patients manifesting marked de-
where masochistic components are deeply pression associated with suicidal ideation,
ingrained in the patient's personality struc- hypnosis should be used only in a hospital
ture. setting. Also, patients who have a history
The question frequently arises regarding of masochistic tendencies combined with
the appropriate amount of supportive low frustration tolerance usually do not re-
psychotherapy to be given to such patients. spond successfully to this type of treatment.
It is my attitude that hypnotherapy should
be used in combination with a psy-
chotherapeutic maneuver which can be SUMMARY
effectively used to speed the patient's full
recovery. One might then be asked how Twenty-nine patients had been referred
much of the results are deri ved from hyp- with histories of low back pain. Five were
notherapy, and how much from psycho- excluded on psychological grounds leaving
therapy. In the clinical cases presented in a treatment group of 24. Four of this re-
this study, hypnotherapy appears to be maining group did not respond adequately
the major factor in controlling most to the hypnotherapeutic sessions and were
problems of back pain which has been re- considered failures. Each patient had been
sistant to recovery prior to treatment. It is operated one or more times with continued
my contention that every referring physi- postoperative pain. Hypnotherapy was suc-
cian had previously used all the psy- cessful in relieving most of the pain in
chotherapeutic wisdom at his disposal in twenty patients, enabling them to resume
the treatment of each referred patient. The work at a realistic level in terms of their
back pain finally came under control only limited capabilities. In conclusion, hyp-
after the use of hypnosis. notherapy is seen as an excellent method of
Whether heterohypnosis or self-hypnosis relieving low back pain, providing that
is used, there are certain precautions which specific precautions governing the patient's
should be taken with back pain patients. It level of physical activity are observed. Per-
is imperative that all pain is not removed sonality variables to be considered with this
for fear of masking organic symptomato- type of patient are also discussed.
logy and preventing patients from perceiv-
3600 Gaston Avenue
ing new pathological developments. Also, Barnett Tower, Suite 901
good judgement regarding the type of Dallas, Texas 75246
 78 CRASILNECK

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