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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
Downloaded by [Central Michigan University] at 09:36 27 December 2014

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third week of therapy, and the rest were withdrawn by their physicians during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
which the patients failed to achieve relief
from pain following one or more back
surgeries. Patients were referred by or-
thopedic surgeons, neurosurgeons, anes-
thesiologists, and pain clinics.
A partial list of frequently encountered
causal factors would include trauma,
congenital disease, personality and
psychogenic factors, improper attitude and
poor judgment by the patients towards the
complexity of the back's function. Freese
Downloaded by [Central Michigan University] at 09:36 27 December 2014
(1974) has noted "when you straighten up
from a bent-over position you concentrate a
force of more than a quarter of a ton on the
low back (lumbosacral spine), and if you
lift something while bending, the weight of
the object is actually multiplied some 12 to
16 times by the leverage." Finneson (1974)
states "the mother who leans over to lift her
small child can throw a strain of a half-ton
on herlower back. "
Low back pain may be acute and/or
chronic. This type of pain can be so ex-
cruciating and debilitating that the patients
may become addicted to drugs. Pain may
be so severe and constant that patients be-
come acutely depressed (Levit, 1973), and
in some cases attempt suicide (The Dan
Foster TV Medical Show, 1978). During
the past 20 years therapists have become
cognizant of the utilization of hypnosis in
the treatment of low back pain .(Cheek &
LeCron, 1968; Crasilneck & Hall, 1975;
Erickson, 1967; LeHew, 1970; Levit,
1973; Sacerdote, 1979; Sachs, Feuerstein,
& Vitale, 1977).
Over a period of two years, 29 patients
were referred for hypnotherapeutic
management of low back pain. Five were
excluded as a result of psychological and
personality factors including extreme
masochism, severe depression, negative
motivation during the intitial treatment, and
low frustration tolerance which
contraindicated the use of hypnosis. The
mean age of the remaining 24 patients was
CRASILNECK
47 years; eight were female and sixteen
were male. Eighteen of the patients had
been operated two or more times; the re-
maining six experienced back surgery one
time.
Eighteen patients were treated surgically
for ruptured disc by laminectomy and six
for chronic lumbar disc disease by disc ex-
cision combined with exploratory proce-
dures. In each case the patient's pain re-
turned within three to six months postsurgi-
cally. Transcutaneous stimulation, nerve
block, and sympathectomy had been used
by the referring physicians with each pa-
tient but without permanent relief of pain.
In some cases further surgery was being
considered at the time of referral.
Twenty of the 24 patients were judged by
their physicians to be extremely dependent
on or addicted to medications such as acetyl
salicylic acid, acetaminophen, secobarbi-
tal, codeine phosphate, oxycodone hydro-
chloride, and morphine sulphate. Since
these medications had failed to control
pain, the use of hypnosis was considered
since hypnotherapy may control physiologi-
cal pain (Crasilneck & Hall, 1973; Hilgard
& Hilgard, 1975; Schafer & Hernandez,
1978). Sixty percent of the referrals came
from orthopedic surgeons; the rest were re-
ferred by neurosurgeons, anesthesiologists,
or pain clinics.
TREATMENT
During the initial interview clinical and
psychological assessment of the patient was
made. The most common factors identified
in each patient were: (1) consistent pain,
primarily organic in origin, (2) dependence
on medication, (3) insomnia, (4) reactive
depression, (5) excessive interpersonal de-
pendence, primarily on family members,
and (6) fear of being a lifelong "backache
cripple. "
From the initial visit the patients were
seen individually in the consultation office
 CHRONIC LOW BACK PAIN
or in the hospital. After rapport had been
established on the first session, ample time
was alloted to deal with any questions
concerning the nature of hypnotherapy and
its application to the patient's particular
difficulty. When it was evident that the pa-
tient was comfortable and in accord with
the treatment, induction was begun. An eye
fixation technique was employed. The fol-
lowing approach was used:
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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
your eyes. Concentrate on my voice and pay no
attention to other sounds. You are now begin-
ning to relax and your eyelids are becoming
heavy as you gaze intently and intensely at this
coin. Your body will be free from tension,
tightness, stress and strain. Your breathing is
relaxed and at ease. Your eyelids are so heavy
you are blinking rapidly. Now they are closing,
closing. . . . That's good, let them close
completely. Good. Now, to show you the power
of your unconscious mind, I give you the
suggestion that your eyes are sealed, shut tight
- so tight that even though you try to open
them you cannot. Go ahead and try but you can-
not. Good. Normal sensation returns to your
eyelids and you can open them. Now that we
have demonstrated this control of your mind
over your body, I want you to relax still more.
Let your eyes close. As I count from I to 20,
you will enter a much deeper state. You are
relaxed and at ease, free from tension, stress and
strain.
Now, the finger I touch is becoming very cold
and numb - so much so that even though I
stimulate your finger with this blunt fingernail
file, you do not feel it. Good. This is called
hypnoanesthesia. Now, normal sensation re-
turns to the finger and I stimulate it lightly.
When you feel the touch, pull your finger away.
Good. You felt that. Now I give you the sugges-
tion that you will take three deep breaths and
you will smell a spicy aroma. When you per-
ceive this pleasant aroma, move the thumb of
your right hand. Good. Tell me what you are
smelling. Good. This passes and you are going
into a much deeper and sounder state. Now, I
give you the suggestion that as you blocked pain
in your finger a few minutes ago, you can block
the pain in your back. Nothing is beyond the
power of your unconscious mind. You are going
73
to block most of the pain. Most of the pain will
come under control.
Suggestions of this type were repeated
until the desired goal was reached for the
session. Control of pain was achieved in a
gradual fashion, with a greater percentage
of the pain being brought under control usu-
ally during each successive therapeutic in-
terview.
RESULTS
Twenty of the 24 patients responded with
positive results. Of these 20 patients 17
were outpatients and three were hos-
pitalized. Sixteen reported an average of
80% relief during the first four sessions; all
20 patients reported an average of 70% re-
lief by the sixth session. No difference was
found in the response to treatment by pa-
tients seen in the hospital or in the
therapist's office. The hospitalized patients
were discharged after an average of three
weeks and were seen thereafter at the
therapist's office. Fifteen of the 20 patients
voluntarily decreased their doses of medica-
tion to an average of 60% during the first
week of hypnotherapy, while the remaining
five patients were medically withdrawn by
their physicians. None of the individuals
retained their former addiction nor did they
require more than an occasional over-the-
counter analgesic. Hypnotherapy was used
daily during the first week, every other day
during the second week, every third day
during the third and fourth week and once a
week for an average of two months. The
patients were then seen on a PRN basis.
Each session lasted 30 minutes, 'and the in-
dividuals were seen for an average of 31
sessions over a period of nine months. Each
patient was taught self-hypnosis (Crasil-
neck & Hall, 1975) from the second ses-
sion, and was encouraged to use this as fre-
quently as necessary.
Four patients of this group of 24 failed to
respond to hypnotherapy and could neither
 74 CRASILNECK

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

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
was encouraged to use it whenever neces-
sary. He was cautioned never to remove all
of his back pain.
Eventually the patient was able to return
to a limited type of office management, and
resumed volunteer work with the Boy
Scouts. On several occasions he went pole
fishing, and felt that life was more pleasant.
A conference with the referring physician
indicated that the patient could live a nor-
mal life with certain restrictions. Six
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months later the patient was discharged
with the proviso that he could return for
further hypnotherapeutic sessions if neces-
sary.
Case Two: A 57-year-old widowed
female with five adult children was referred
by a medical school pain clinic. She resided
on her farm with one of her daughters. Five
years before when she had attempted to lift
a sack of manure, she "felt a severe pain
and rip in my lower back." Her local
physician prescribed bed rest and secobar-
bital (100 mg. twice daily). When the pain
worsened she was referred to a neurosur-
geon who diagnosed her as having her-
niated disc (L 2-3). During the next four
years she had three surgeries, including two
disc laminectomies, and one spinal fusion;
two nerve blocks and two sympathectomies.
She was taking codeine phosphate ('h gr. 3
times daily) and diazepam (10 mg. 3 times
daily). Hypnotherapy was recommended by
her neurosurgeon.
The patient was extremely depressed be-
cause of constant pain, dependence on
others for physical and psychological sup-
port and fear of addiction to medication.
She complained, "I feel like a hopeless
cripple because nothing helps me." She
was ambivalent concerning hypnotherapy
but "willing to try hypnosis even though
it probably won't work for me. "
The patient was seen in the hospital, rap-
port was established, and hand levitation
was used for induction. She was able to
75
enter a deep level of trance manifesting
good hypnoanesthesia and hallucinatory re-
sponses. She was given the suggestion
"that nothing is more powerful than your
unconscious mind, and you can block your
severe pain." Approximately 75% of the
pain came under control during the first ses-
sion. The patient was seen once a day for
four consecutive days, and was 90% pain-
free by her own evaluation. During the fol-
lowing weeks she used self-hypnosis
whenever necessary with positive results.
Following discharge and during the first
few weeks at home her reacti ve depression
lifted. The referring physician advised that
she discontinue most of the medication as
soon as possible. Her daughter reported that
the patient was an "independent and happy
person again. "
She is currently seen once a month for
reinforcement and will continue to do so as
necessary. The referring physician ob-
served a marked physical and psychological
improvement. Most of her pain is under
control, and she does limited household
chores. She sleeps well at night, perceives
some pain with changes in weather, and
uses acetyl salicylic acid when necessary.
Emphasis was placed on proper judgment
in all physical activities because this was
crucial to recovery in view of past inde-
pendent behavior.
Case Three: A 62-year-old male physi-
cian was diagnosed with lumbar disc dis-
ease of 30 years duration, and reported
acute and chronic low back pain. He was
married 35 years with two children. In pre-
vious years the patient had two laminec-
tomies, sympathectomy, nerve block,
transcutaneous stimulation, acupuncture,
and biofeedback with poor results. He had
insomnia and depression. The referring
physician reported that the patient was ad-
dicted to morphine sulphate ('h gr. daily),
secobarbital (100 mg. twice daily) and was
 76
an alcoholic. The patient's medical practice
had been reduced drastically.
Cordotomy was being considered when
the neurosurgeon recommended that hyp-
nosis be tried first. The patient was seen in
the hospital. He was in great pain and won-
dered "if a person in such pain could be
hypnotized. " I assured him that the more
pain a patient perceived, the better his re-
sponse to hypnosis, and the severity of the
pain might serve as a motivating factor for
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successful hypnotherapy.
The patient was hypnotized using an eye
fixation technique, responded slowly to
suggestions, and soon entered a deep state
of trance. Suggestions were given to
control the pain, to lessen the need for
medication, and to stimulate the desire to
get well. He was taught self-hypnosis
which would help to control his pain. The
patient stated that 60% of the pain was
gone. He was quite surprised but gratified
and pleased with his response to hyp-
notherapy. For the next 14 days hyp-
noanalysis was used not only to control his
pain but to give this patient intellectual and
emotional insight into his many problems.
The patient continued to respond well,
most of his pain under control. Insomnia
disappeared, depression lifted, and al-
coholism abated. During the course of hyp-
notherapy he was medically withdrawn by
his physician from addicting drugs. Follow-
ing dischcrge he was seen on a PRN basis.
He now enjoys full practice, uses self-
hypnosis twice daily for half-hour sessions,
reports his status by telephone once a week,
and returns for hypnoanalysis once every
eight weeks. When necessary he used
medication as prescri bed by his physician.
Case Four: Thirteen months previously
a 32-year-old married man with two chil-
dren was injured at work when a heavy ob-
ject fell on his back. He was hospitalized
with an acute compression fracture (LI and
L2). After one week of conservative treat-
CRASILNECK
ment the patient was operated. During the
following year he reported no relief from
pain. Additional treatment included nerve
block and transcutaneous stimulation. The
referring physician stated that the patient
was requiring codeine phosphate (V2 gr.
twice daily) and secobarbital (100 mg. once
aday).
Hypnosis was suggested and the patient
reluctantly came to my office. He was
friendly and stated, "I am here because my
physician referred me, not because 1
wanted to come. 1 saw a guy hypnotized
one time on the stage and 1 thought it was a
lot of baloney. Just a fake. ' ,
1 explained that cooperation was neces-
sary and even though his conscious mind
was not agreeable, if unconsciously he de-
.sired to get well hypnosis could be success-
ful.
He was willing to try. During induction
the patient intermittently moved in the
chair, coughed, took deep breaths, and
manifested many other forms of resistance.
At the end of the unsuccessful session the
patient was asked to return for three succes-
sive days. The same responses were ob-
served during the following three days al-
though the pain had "slightly lessened."
Results were poor in spite of the fact that
the patient manifested good glove anes-
thesia.
The patient denied any relief of pain and
cancelled further sessions. His negative at-
titude and failure to accept hypnotherapy
were discussed with the referring physician
who agreed that hypnotherapy was not ap-
plicable in this case.
DISCUSSION
The use of hypnosis in the control of or-
ganic pain problems has been demonstrated
for many years. In our text (Crasilneck &
Hall, 1975), it is hypothesized that the hyp-
notized patient blocks the perception of
pain in the same manner that psychosurgery
 CHRONIC LOW BACK PAIN
obliterates intractible pain. It is akin to the
"gate control theory of pain" (Melzack,
1973), with a cortical hypnotic change serv-
ice as the' 'gate closing stimulus. "
A hypnoanesthetized patient physician in
labor described herself as having a
"psychological prefrontal lobotomy."
From a motivational standpoint, we know
that patients manifesting severe organic
pain are exceptionally good hypnotic sub-
jects because of an extremely intense desire
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to obtain relief from pain. The only excep-
tion to this general rule would be in cases
where masochistic components are deeply
ingrained in the patient's personality struc-
ture.
The question frequently arises regarding
the appropriate amount of supportive
psychotherapy to be given to such patients.
It is my attitude that hypnotherapy should
be used in combination with a psy-
chotherapeutic maneuver which can be
effectively used to speed the patient's full
recovery. One might then be asked how
much of the results are deri ved from hyp-
notherapy, and how much from psycho-
therapy. In the clinical cases presented in
this study, hypnotherapy appears to be
the major factor in controlling most
problems of back pain which has been re-
sistant to recovery prior to treatment. It is
my contention that every referring physi-
cian had previously used all the psy-
chotherapeutic wisdom at his disposal in
the treatment of each referred patient. The
back pain finally came under control only
after the use of hypnosis.
Whether heterohypnosis or self-hypnosis
is used, there are certain precautions which
should be taken with back pain patients. It
is imperative that all pain is not removed
for fear of masking organic symptomato-
logy and preventing patients from perceiv-
ing new pathological developments. Also,
good judgement regarding the type of
77
physical activity engaged in by the patient
should be carefully exercised. Finally, it is
always possible that a psychodynamic
meaning may underlie or be associated with
an organic pain problem. The therapist
must investigate and treat the possibility of
such emotional meaning to the pain, espe-
cially as the pain begins to diminish or
comes under complete control. The un-
derstanding and treatment of secondary
gain is a prerequisite to the successful hyp-
notherapy of organic pain problems.
With patients manifesting marked de-
pression associated with suicidal ideation,
hypnosis should be used only in a hospital
setting. Also, patients who have a history
of masochistic tendencies combined with
low frustration tolerance usually do not re-
spond successfully to this type of treatment.
SUMMARY
Twenty-nine patients had been referred
with histories of low back pain. Five were
excluded on psychological grounds leaving
a treatment group of 24. Four of this re-
maining group did not respond adequately
to the hypnotherapeutic sessions and were
considered failures. Each patient had been
operated one or more times with continued
postoperative pain. Hypnotherapy was suc-
cessful in relieving most of the pain in
twenty patients, enabling them to resume
work at a realistic level in terms of their
limited capabilities. In conclusion, hyp-
notherapy is seen as an excellent method of
relieving low back pain, providing that
specific precautions governing the patient's
level of physical activity are observed. Per-
sonality variables to be considered with this
type of patient are also discussed.
3600 Gaston Avenue
Barnett Tower, Suite 901
Dallas, Texas 75246
 78
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