The Power of the Mind in Pain
Total Page：16
File Type：pdf, Size：1020Kb
Special Interest Group for Philosophy and Ethics The Power of the Mind in Pain Rydal Hall, 27th to 30th June 2016 Contents Editor and contributors The Power of the Mind in Pain Introduction 3 Peter Wemyss-Gorman Transforming Suffering: The Movie of Pain in the Cinema of the Mind 4 David Reilly To Heal or Not to Heal: the Hamlet Effect 31 Sarah Goldingay New Perspectives on the Placebo Response 37 Paul Dieppe Brief Psychological and Hypnotic Interventions in the Management of Pain 48 Ann Williamson Hypnotherapy for Migraine 61 Patrick Browning Creativity and the Use of Metaphor in Primary Care 66 Maureen Tilford The Power of Mind: a Surgeon’s Perspective 69 Eamonn Coveny The Role of the Mind in Pain Management Programmes 79 Alistair Turvill Everyday Ethical Conundrums in the Pain Clinic 89 Tim Johnson Shared Reading and Chronic Pain 96 Andrew Jones, Jim Ledson and Josie Billington 1 Editor Peter Wemyss-Gorman Retired Consultant in Pain Medicine Contributors Josie Billington Senior Lecturer and Deputy Director, Centre for Research into Reading Literature and Society, University of Liverpool Patrick Browning Clinical Hypnotherapist Eamonn Coveny Consultant Surgeon, West Suffolk Hospital, Bury St. Edmonds Paul Dieppe Professor Emeritus of Health and Wellbeing, University of Exeter Medical School Sarah Goldingay Department of Drama, College of Humanities, University of Exeter Andrew Jones Consultant in Pain Medicine, Royal Liverpool University Hospitals NHS Trust Jim Ledson Consultant in Pain Medicine, Royal Liverpool University Hospitals NHS Trust David Reilly Senior Lecturer in Medicine at Glasgow University and Visiting Professor of Medicine at the Maryland University, USA Maureen Tilford Retired GP, Clinical Hypnotherapist Alistair Turvill Lecturer in Health Psychology, University of Derby Ann Williamson Retired GP, Clinical Hypnotherapist, NLP Master Practitioner 2 Introduction Peter Wemyss-Gorman The impetus for the first meeting in 2001 of the group which later became the British Pain Society Special Interest Group (BPS SIG) for Philosophy and Ethics was the perception that pain medicine had become more and more dominated by the search for understanding of neurophysiological mechanisms which would lead to the perfection of pharmacological therapy, and the refinement of physical interventions in the hope that they could be relied upon to provide long-lasting relief of chronic pain. Despite many successes in these endeavours we still seemed to be spending more and more time in our clinics dealing with people with complex problems for whom all our therapeutic resources had been of little help. Pain management programmes had helped countless sufferers to enjoy lives less dominated by the tyranny of pain and to reverse the psychological and physical vicious circles that tended to perpetuate it, but the sum of our patients’ suffering nevertheless seemed to be only a little diminished. There has indeed been progress, notably in the field of neuromodulation, in the intervening years but the impression remains – indeed has grown stronger - that pain medicine is approaching an impasse, and that it is difficult to be optimistic that such progress will continue indefinitely. So it seems imperative to explore any new approach that holds even a glimmer of hope, or at least promises to point us in a new direction. In this context, the astonishing power of the placebo response and the therapeutic value of hypnosis have long been recognised but there appears to be a far bigger untapped resource of power for healing, and dealing with pain and suffering, within our own minds than we have hitherto realised or even imagined. Our speakers this year set out to demonstrate this in one of the most fascinating meetings we have ever held, presenting evidence that the most hardened sceptic would find difficult to ignore, and leaving us with renewed optimism that even if we may still have a huge mountain to climb, we may have found one promising route. What is more, it seems that this power to heal and transform is latent both in ourselves and in our patients, even those that most make our hearts sink – and can be manifest in the interaction between us in the therapeutic encounter. It even seems possible that it can operate at a distance! 3 Transforming Suffering: The Movie of Pain in the Cinema of the Mind1 David Reilly I doubt if anything I have to say will be truly new to you. I think my job is to try to create a reflective space so that we can come afresh to our thinking and to our work, and to a dialogue together. I imagine that we all accept the central importance of therapeutic encounter. While we may differ on the practical goals and methods we call on, we can find a unifying foundation emerges from the question: What is this meeting in the service of? All our efforts are in the service of the relief of human suffering, and beyond into flourishing. That is our business: working with human beings restricted in some way – wanting to be free, externally and physically whenever possible, but always at an inner level - at a spiritual, personal, emotional level. Many of us have come from the business of pain management. I think we are collectively beginning to face up to the limits of the models we have been operating in, and the maps we have been navigating by. The call for us now is to become experts in suffering rather than in pain. But we were not trained in this, and we have been attempting to apply the model of pain to the domain of suffering. That would be something I would lay in front of us as we wander into the whole question of suffering and what suffering calls for. Suffering is a call: it is a call for change at any level of our being: culturally, systematically, in our teams or in our own lives and families. For me suffering has ceased to be the enemy that needs to be eliminated. It has become the guiding call. You can’t talk about suffering without speaking of change, and indeed transformation. Transformation is the theme that I would like to explore together. The crucible of change is often relationship: relationship with yourself, and, critically, with a trusted other. This must become a safe relationship. Yet few would now disagree that this human side of care is under considerable and unacceptable levels of strain in today’s care systems. When we think our job is about suffering, release and transformation - and so, humanity and relationship - and the very substrate of it is under unacceptable strain, we realise that we are already in a dense predicament. At the simplest level (I don’t want at this stage to go into any lengthy dialogue) what do you see as the cause of this? [Participants comment] The clash of managerialism and professionalism. 1 An adapted version drawn from this this presentation is published as: Reilly, D. (2016) ‘Suffering as a guiding call towards transformative change: the movie of pain in the cinema of the mind’, Pain News 14(4):164-70. 4 Managerialism is management without presence; management is about the present, leadership is about the future. When we sit with someone it’s about an orientation - a pointing to the future and a hope that the future can be better than the present - that they can be released from this suffering. It’s not just an embedded now; it’s a meeting together within that framework of movement. That is going to imply continuity, safety and a whole range of other things. A national health system which is not a care system. Undervaluing the carers. Measuring success by numbers. We are all specialists and a person may have multiple people dealing with little bits of them who are not whole person centred and nobody holds it together. What do you think are some of the deeper roots - does anyone want to take us back in time? Back to Descartes? Spiritual roles have been subsumed by medicine. Yes - a general collapse of spiritual enquiry, at least in the structural sense. Modern medicine does some things very well but some things terribly but we continue to pour huge resources into drugs and procedures and things that are done terribly. This is our predicament: our desire to engage with others for the relief of suffering is itself embedded within a context which can be road-blocking or destroying of the very the work that we want to do. What we are saying here? This is a call for fresh thinking and I am saying that suffering is the call for change, for growth, for fresh thinking and movement. And that is why people come and sit with us. We are change agents. Again we didn’t think of ourselves in that way and we weren’t trained in processes of change, and we find ourselves adrift in many ways. Let me pick up some of those themes and go back to the cultural transitions that started with Descartes and the dawn of science in the 1700’s, and the massive waves of change within our culture – waves that shape and respond to the nature of our personal and collective suffering. As our suffering changes, the nature of the necessary response changes. Let’s go back: what would have been the epidemics of the day in the 18th century? Cholera, smallpox and all the infectious diseases would have been very dominant. There was periodic famine in the countryside, especially in Scotland accompanied by migration into the cities, with 14 or 15 people to a room, poverty, starvation and dung-heaps in the streets. Cholera was killing 4000 people a year as it swept through the cities of the UK.