Low back pain is the leading cause of disability worldwide. For most people an episode settles within weeks. For some it becomes chronic, lasting months or years, often with no clear structural cause on a scan.
Chronic back pain is now understood to involve the nervous system as much as the spine. The pain system becomes sensitised and keeps firing after tissues have healed. That makes it a good target for approaches that work on how the brain handles pain.
The veterans trial
In a 2015 study, 100 American military veterans with chronic low back pain were randomly assigned to one of four groups:
- Eight sessions of self-hypnosis training
- Eight sessions of self-hypnosis training, plus recordings for home practice
- Two sessions of self-hypnosis training, plus recordings and brief weekly reminder calls
- Eight sessions of biofeedback, as a comparison
Results. People in all four groups reported significant reductions in pain. Improvements were greater in the hypnosis groups than in the biofeedback group, and the gains were maintained at three months.
The surprise. There were no differences between the three hypnosis groups. Two sessions with recordings worked as well as eight.
That matters for cost and access. A brief intervention, backed by home practice, may be enough.
The pain education trial
A 2018 Brazilian study took a different angle. One hundred people with chronic non-specific low back pain were randomly assigned to:
- Pain education alone: classes explaining how pain works
- Pain education plus hypnosis
Pain education is itself an established treatment. It teaches that pain does not always mean damage, which reduces fear and encourages movement.
Adding hypnosis improved the results. Those who had both reported less pain and less catastrophising, the tendency to expect the worst from pain.
What this adds up to
Two reasonably sized randomised trials, in different countries, point the same way: hypnosis reduces chronic low back pain, works alongside education, and need not involve many sessions. This fits the wider evidence on hypnosis for chronic pain.
Limitations remain. Follow-up was short, the first trial was in veterans, mostly men, and as usual with hypnosis, some people respond much more than others.
What guidelines recommend
For chronic low back pain, guidelines favour:
- Staying active and exercise of a kind you will keep doing
- Education and reassurance
- Psychological approaches, such as cognitive behavioural therapy, as part of a package
- Manual therapy alongside exercise, for some
- Avoiding prolonged rest
- Caution with long-term opioid painkillers, which help little and carry risks
Hypnosis is not usually named in guidelines, but it sits naturally with the psychological approaches that are.
Why it might help
- Turning down a sensitised pain system
- Reducing fear of movement, which keeps people inactive and stiff
- Reducing catastrophising
- Relaxing guarded muscles
- Improving sleep
- Rehearsing movement in imagination before doing it
Techniques
- Comfort imagery: warmth spreading through the lower back
- The dial
- Changing the sensation from sharp to dull, hot to warm
- Imagining the spine as strong, flexible and well supported
- Mental rehearsal of bending, lifting or walking comfortably
- A post-hypnotic cue for easing a flare
A fifteen-minute routine
- Lie on your back with your knees bent, or sit well supported.
- Breathe slowly, letting your belly rise and fall.
- Relax from head to toe.
- Imagine warmth in your lower back, like a heat pack, loosening the muscles.
- Picture your pain as a dial. Turn it down by one or two numbers.
- Imagine your spine as strong and flexible.
- See yourself doing an activity you have been avoiding: walking, bending, getting out of a chair. See it going comfortably.
- Tell yourself: “My back is strong. Movement helps it. Each day I can do a little more.”
- Count from one to five. Get up slowly, and then go and do a small amount of that activity.
The last step is the important one. Hypnosis is a way into movement, not a replacement for it.
Two sessions and a recording
Given the veterans trial, a sensible plan is a couple of sessions with a clinician trained in hypnosis for pain, a recording, and daily practice. Home practice was part of what was tested.
Red flags: see a doctor urgently
- Numbness around the genitals or back passage
- New difficulty passing urine, or loss of bladder or bowel control
- Weakness in both legs
- Back pain after a serious injury
- Fever, unexplained weight loss, or a history of cancer
- Severe pain that is worse at night
These are uncommon and need prompt assessment.
The bottom line
For chronic low back pain, hypnosis has good trial support and may need only a couple of sessions plus practice at home. Combine it with understanding your pain and keeping moving.
Next in the series: Hypnosis for Pain in Multiple Sclerosis and Spinal Cord Injury
This article is for general information and is not medical advice.