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Hypnosis has also a part to play in the management of the chronic pain patient, though in rather more complex ways. Although these findings are contested by some, there is evidence that the best analgesic effects for acute experimental pain are obtained by good hypnotic subjects using hypnotic procedures rather than non-hypnotic ones (Eastwood et al 1998). Subjects low in susceptibility do not do very well with these methods and it may be better to adopt a non-hypnotic, cognitivebehavioural approach with them. However, as we shall see, some of the pain-control methods described in this chapter may be used effectively by patients with low measured susceptibility. The implication of this is that the therapist wishing to offer pain management to a range of patients should be familiar with the methods developed from the cognitive-behavioural perspective (see Weisenberg 1998 for a review). If readers are already using these, then we are sure that they can profitably add hypnotic procedures to their repertoire of techniques. THEORETICAL CONSIDERATIONS It is also not possible in this chapter to present much in the way of theory. However, severe and persistent pain, where no immediate relief is possible, is debilitating and may have consequences that compromise survival. Sometimes, the distraction of severe pain may interfere with life-protecting action, and on occasions, such as when one is receiving first aid, the fight-or-flight response has to be suppressed and the most appropriate response may actually lead to an increase in the pain. Therefore, we can argue that the ability to tolerate and manage pain, like pain itself, is of survival value. Endogenous physiological mechanisms have been identified that modulate the pain experience, but behavioural and cognitive responses may also be acquired through operant conditioning (e. . negative reinforcement by reduction in discomfort) and classical conditioning (e. . with relaxation as the conditioned response in anticipation of pain).

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