Pain and Breath

by Penny Chiasson, CRNA, BCH, CPHI

Out of curiosity and for continuing education credits, I became a hypnotist. When I saw the science behind the limbic system and hypnosis, I knew it was perfect for pain management. Previously I had developed a pain management course for nurses and taught the pain signaling pathways and how emotion, memories and expectations can influence the pain signal sent from the thalamus (think of it as the balancing point on a seesaw) and ultimately pain perception in the cerebral cortex (result of the seesaw tipping toward or away from pain, and how far?).

The relaxing breath (TRB) and its direct action on the relax and repose (parasympathetic) response of the autonomic nervous system intrigued me. This technique was introduced into medicine in the 70’s, but not taken seriously. I dug deeper into this response, and it was the basis of my Board Certification Exam paper. 5-PATHer’s are fortunate we have found a focused, criteria based approach to helping our clients. Cal has done a fantastic job of honing in on what works, and TRB is one aspect of traditional NGH hypnosis training we should not overlook.

By now you must be wondering what does pain, and using the traditional relaxing breath have to do with one another. Most likely you have become aware that pain perception is unique to each individual and there are different ‘types’ of pain. The pain can be acute, chronic, or acute on chronic. In other words, if you just stubbed your toe, unless you had an irrational response to that, glove analgesia will do. But if you stubbed that toe and you get angry, I mean really cussing, throwing things angry...well then, maybe you need a little 5-PATH®! Don’t discount the value of 5-PATH®in any pain situation. It may not be how you start, but in many cases, that is exactly where you end up. Pre-dentistry analgesia is the same scenario. Maybe 5-PATH® is something to be entertained after the procedure to eliminate any fear that worsens that pain experience.

TRB comes into play not just in pain, but every client we meet! The vagus (the wanderer) nerve is the single nerve for the ‘relax and repose’ or parasympathetic nervous system. It affects respiration, heart rate, blood pressure, circulation, and the function of the immune system, kidneys, gut and liver. Its primary function is to counterbalance the fight or flight response, or excretion of adrenaline hormone. It also affects the release of endorphins, enkephalins, and melatonin which aid in comfort and rest. I find this works best when I teach the breath before the session with an anchor, then in hypnosis at the end of the session, I use compounding to reinforce the anchor. Some of my clients quickly develop a conditioned response and need only to use the anchor to get the response their body is programmed to provide. Using TRB with 5-PATH® is one of many ways we can give the client something they can use between sessions that will build confidence into the process.

We’ve developed this habit that taking a big breath is a chest breath. But to be beneficial, the breath must be diaphragmatic. In other words, the diaphragm pushing down into the abdomen creates the flow of air into the lungs. This activates stretch receptors in the abdomen, lungs, and heart (I’m over simplifying things, they are the same, but different). This slows heart rate, decreases stimulation of adrenals, thereby lowering impact of the sympathetic nervous system on the body, tipping the balance to rest and calm. I instruct my clients to take 3-5 anchored abdominal breaths periodically through the day, preferably every hour. Then at night 5-10” allowing themselves to go as deeply relaxed as they experienced in my office as they go to sleep.

My very first pain client, I’ll call BJ, came to me because she had neck and arm pain. She had a bulging disk in her neck and the doctor had told her she did not need surgery, however, the pain would get so bad she was convinced otherwise. In our first session (I did not know 5 PATH®) I did a pre-talk and interview. Then we spent some time learning the breath with an anchor. Afterward, we did the traditional relaxation induction, DS, then I had her perform TRB, count to 3, have her open her eyes then use the breath to relax and if she chose, go deeper (I had NO idea I was also using a fractionation technique at the time) several times before emerging.

The next week I saw 3 things had happened. First, I had one definitely convinced client. She had used the breath all week and in that short time had already developed some degree of conditioning where she could use the anchor without the breath and feel calmer. Second, her pain was gone at work and home and third, she recognized the pain came back anytime she had to do anything related to her mother. On that second session, we did glove analgesia just as an added convincer. Because of her practice, she quickly went deeply into hypnosis. BJ used TRB to help her through stressful situations at work and mitigate any symptoms when with her mother.

By the time I learned 5-PATH® her mother was very ill and she was caring for her full time. She was managing fairly well and wanted to do more sessions (I had the ace of spades up my sleeve) but she wasn’t able to work it in before I closed my practice and moved. BJ is a perfect example of using the body’s innate neurological and hormonal responses and is one of the cases that convinced me I had to learn 5-PATH®.

TRB is still a part of my sessions, and I teach it to patients I encounter in the hospital all the time. The evidence is the change in expression on their faces when they experience it. I do hope you will seriously consider 5-PATH® in your pain clientele, and the addition of TRB.

Tracey, K. (2007) Physiology and Immunology of the Cholinergic Anti-inflammatory Pathway, The Journal of Clinical Investigation, 117, 2, pp289-296
www.relaxationresponse.org accessed 06/14/2014

Wallace Robert K, Benson Herbert, Wilson AF. (1971) A Wakeful Hypometabolic Physiologic State, American Journal of Physiology, 221, pp795-9

Mayo Clinic Staff. Stress Relief from Laughter? It’s No Joke. Accessed online at http://www.mayoclinic.org/healthy-living/stress-management/in-depth/stress-relief/art-20044456

Braid, J., Edited by Robertson, D (2009) The Discovery of Hypnosis: The Complete Writings of James Braid ‘The Father of Hypnotherapy’, National Council for Hypnotherapy; 1st edition.

Swami Rama, Ballentine, R M.D. and Hymes, A M.D. Science of Breath A practical Guide, Himalayan Institute Press, 1979.

Penny Chiasson, CRNA, BCH, CPHI
Penny Chiasson is a Board Certified Hypnotist with a background in nursing and Nurse Anesthesia. She is also a 5-PATH® Certified Hypnotist, 7th Path Self-Hypnosis® teacher, and Certified Professional Hypnosis Instructor. Penny is a member in good standing with the American Association of Nurse Anesthetists, National Guild of Hypnotists, International Association of Hypnosis Professionals and National Federation of Hypnotists. She is also a speaker at the National Guild of Hypnotists.