Clinical hypnosis in pediatric care: An adjunctive tool or therapeutic illusion

Figure 2 Neurocognitive modulation of pain by hypnotherapy. This diagram illustrates how pain hypnotherapy initiates top-down neurocognitive modulation to influence pain perception. Pain is processed along two primary dimensions within the Brain: The sensory-discriminative dimension, involving the primary and secondary somatosensory cortices, thalamus, and posterior insula, which processes the location, intensity, and quality of pain. The affective-motivational dimension, processed by the dorsal anterior cingulate cortex and anterior insula, contributes to the unpleasantness and emotional response to pain. The prefrontal cortex plays a crucial role in evaluating and appraising pain, influencing how pain signals are interpreted and responded to. Hypnotherapy, by altering activity in these higher cortical regions, initiates several downstream effects on the spinal cord and peripheral nervous system: It leads to the activation of descending inhibitory systems that suppress pain signals. This central modulation contributes to a reduced R-II reflex (a spinal withdrawal reflex), indicating decreased spinal excitability. Furthermore, hypnotherapy influences the hypothalamic-pituitary-adrenal axis, a neuroendocrine system governed by the brain that modulates the body's stress response. These central influences also impact the autonomic nervous system, resulting in a reduced sympathetic response, which in turn lessens physiological reactions associated with pain and distress. Ultimately, these descending effects lead to the downregulation of A-delta and C fibers within the peripheral nervous system, which are the primary nerve fibers responsible for transmitting noxious (painful) stimuli from the periphery to the central nervous system. Together, these mechanisms highlight how hypnotherapy provides powerful top-down inhibitory control over the entire pain processing pathway. ACC: Anterior cingulate cortex; HPA: Hypothalamic-pituitary-adrenal; ANS: Autonomic nervous system; PNS: Peripheral nervous system.