Pain Management – Hypnotherapy in Glasgow and the West of Scotland

Hypnotherapy – Cognitive Hypnotherapy  – Glasgow – Pain – Management

American Journal of Clinical Hypnosis

Volume 54Issue 4, 2012

Special Issue: Cognitive Hypnotherapy: Twenty Years Later

Abstract

Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management.

Keywords

Pain is a significant and ubiquitous health problem, costing productivity, employment, income, reducing quality of life, degrading relationships, and negatively affecting physical and psychological well-being. In a National Center for Health Statistics Report, more than one-quarter of Americans (26%) aged 20 and over, or approximately 76.5 million people in the United States in 2006 reported that they had a problem with pain that persisted for more than 24 hours in duration (National Center for Health Statistics, 2006). The costs of pain in the United States are growing, with the total annual incremental cost of health care due to pain ranging from $560–$635 billion in medical care, and costs associated to disability days and lost wages (Institute of Medicine [IOM], 2011). More than half of all hospitalized patients experience pain the last days of their lives and 50–75% of patients die in moderate to severe pain (Knaus et al., 1995).

Analgesic medications are widely prescribed for pain reduction; however, these medications are associated with unwanted side effects such as sedation, dependency, and negative effects on other organs of the body. Also, medications and surgical interventions are not effective or only have limited benefit for many patients. Alternative treatments are needed and as a treatment for pain, hypnotherapy has over 200 years of published works on the efficacy and applications. Though scientific interest and popular opinion has vacillated over the years, interest in hypnotherapy as a treatment for pain management is on the rise (Lang et al., 2000).

Cognitive Hypnotherapy

Hypnotherapy for pain management typically involves a hypnotic induction consisting of suggestions for changes in perception, behavior, and coping. Post-hypnotic suggestions may be used for the reduction of pain post-session, as well as a suggestion for a cue that would allow for the easy return to a state of comfort. In addition, the focus of hypnotherapy generally includes teaching the patient how to use hypnosis, either via audio-recording or by means of self-hypnosis to reduce pain throughout their daily life.

Hypnotherapy can provide analgesia, reduce stress, relieve procedural anxiety, improve sleep, improve mood, and reduce the need for opioids during and after painful medical procedures. Further, hypnotherapy can enhance the efficacy of well-established treatments for pain (Jensen, 2011). Cognitive hypnotherapy (CH) refers to an empirically-based approach using cognitive behavioral therapy (CBT) to achieve an integrative approach to clinical hypnosis (Alladin, 2008). A meta-analysis of 18 studies revealed that the addition of hypnosis substantially enhanced treatment outcome, such that the average client receiving CH showed greater improvement than at least 70% of clients that received non-hypnotic treatment (Kirsch, Montgomery, & Sapirstein, 1995). Chronic pain can be a challenging disorder with physical, behavioral, social, emotional, and cognitive dimensions. Because of this, in clinical practice hypnosis is often used in combination with cognitive-behavioral interventions for pain management.

This article will provide a discussion of clinical techniques and methods of CH for pain management. In addition, an up-to-date review of the literature, with emphasis given to randomized, controlled trials as available in each topic area will be discussed. Evidence will be presented on the efficacy of hypnotherapy for the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pain, concluding with recommendations for practice.

Assessment

The use of hypnotherapy for pain management requires careful assessment to determine the nature of the patients’ pain and in treatment planning. It is vital to obtain a complete diagnostic of the pain patient to determine the physical etiology as well as to determine cognitive appraisals and core beliefs (Thorn, 2004). In addition, a cognitive case formulation includes an assessment of automatic thoughts and cognitive errors related to chronic pain (Alladin, 2008). The psychology of chronic pain is complex and social factors as well as coping strategies should be assessed (Alladin, 2008). For example, a patient may have difficulty coping with pain due to a belief that they have no control over pain, engage in “catastrophizing,” or lack insight into psychological factors. The ramifications of cognitive factors can have a substantial impact on pain-treatment efficacy and the patients’ ability to manage pain. Additionally, it has been recommended that the patient be evaluated for drug dependent or drug-seeking behaviors which can confound treatment. CH is recommended as part of an overall psychological and medical treatment plan. There are a number of hypnotic techniques for treating chronic pain that can be integrated into CH.

Hypnotic Techniques for Treating Pain

Hypnotic Induction

Jensen (2011) described three formal styles of hypnotic induction, a Basic Countdown Induction, “ … and as I count each number, I’d like you to imagine that, as I count each number, you feel yourself settling down, one level of comfort at a time … ” (pp. 147–148), a Relaxation Induction, “ … and now … Allow your whole body to relax … Allow all your muscles to go limp … [wait about three seconds] and then allow special muscle groups to relax even more … . Starting with your right hand. … Imagine that all the muscles and tendons in the right hand are relaxing … ” (p. 150), and a “Safe Place” Induction, “ … Allow yourself to drift off, and find yourself in a wonderful, beautiful and very safe place … and as you step into your safe place, comfortable place … you can notice a sense of relief … a sense of deep physical and emotional comfort … it is like a vacation from stress … you can really let go, knowing that you are so very safe … ” (p. 153). Following induction, hypnotherapists provide suggestions; a few examples of common techniques follow. Hypnotic inductions should be tailored to the patient’s preferences and can be individualized to integrate mental imagery (Hammond, 1990;Jensen, 2011Nash & Barnier, 2008). The hypnotic induction may provide the patient with some greater comfort, which is a source of encouragement to fully engage in the process of CH.

Relaxation

A technique for reducing the intensity of pain is to increase feelings of relaxation. The relaxation response can be facilitated by direct suggestion or through permission suggestions (Jensen & Patterson, 2008, p. 526). An example of a hypnotic suggestion for relaxation follows:

… Notice a wave of relaxation that begins at the top of your head and spreads across your forehead, face, neck, and shoulders. Every muscle and every fiber of your body becomes more and more completely relaxed. More and more, notice a feeling of letting go and becoming so deeply relaxed. (Elkins, Cheung, Marcus, Palamara, & Rajab, 2004)

 

Dissociation

Dissociation refers to a split in consciousness in which the patient can become less aware of the perception of pain. Suggestions are given for becoming absorbed in mental imagery, less aware of bodily sensations, and feeling detached from present pain experience. For example, in treating a patient with painful burns, the hypnotic suggestions for dissociation that may be employed such as:

… you may find that all the areas where you have been burned become cool, numb, and comfortable. You may find that you drift off and you’re asleep, and you’re not even aware of what’s going on. Or, you may feel a couple of little things but mainly the sense of comfort and relaxation. I don’t know exactly how this will seem to you, I only know that your experience will seem surprisingly more comfortable, surprisingly more relaxed, that you will have a profound sense of being more comfortable. You will also find that your wounds begin to heal surprisingly quickly, that your whole experience of being in the hospital begins to move by much more quickly and more comfortably than you ever might have imagined. (Patterson, Wiechman, Jensen, & Sharar, 2006)

Anesthesia/Analgesia

A goal of hypnosis in pain management is that of pain intensity reduction. Suggestions for anesthesia or analgesia are directed toward alteration in the sensations and perception of pain. This can be suggested as a growing perception of comfort or a diminishing pain perception. In each case the goal is that of achieving a feeling of comfort that is associated with numbness or decreased painful sensations. Suggestions for anesthesia and analgesia are provided, such as:

… it is possible to experience a change in sensation in your lower back … to experience more comfort … perhaps a numbness, a coolness, or perhaps a warmth … as the pain becomes less and less. … Your lower back can relax and become numb in sensation, as if it were to go to sleep for few minutes … . As you become deeper relaxed, drifting into a deeper hypnotic state the area of your lower back becomes numb, an analgesic feeling … sleepy and numb … more comfortable than it has been in a long time, [a topical anesthesia] … just imagine painting numbing medicine onto your back, [a local anesthesia] imagine injecting an anesthetic into your lower back … feel it flow into your body … notice the change in feeling as the area becomes numb, [or glove anesthesia] … pay attention to your hand … Notice how you can feel tingling feelings in that hand. … Let it become numb. … When it is very numb, touch that hand to your low back … . Let the numb feeling transfer from the hand to the back. (Liossi & Hatira, 1999)

Alteration in Sensation

Substitution of a painful sensation by a different sensation can be a beneficial direct suggestion. Suggestions that the experience of pain could be supplanted with a less troubling sensation, such as a numbness, warmth, or tingling.

As you probably know, one way that many people manage unpleasant sensations, and feel more comfortable, is to substitute different feelings, such as numbness or warmth, or tingling or pressure, for any unpleasant sensations. As you consider this, you may already be feeling different sensations—sensations that slowly and easily take the place of any uncomfortable feelings even before I suggested it. (Jensen et al., 2005)

Another strategy employs symptom substitution:

When you are ready to begin to resolve your problems, it may be possible to let go of the tension and pain. When you are ready, you can have some other symptom to replace the pain. The pain can fade and become less and less as you become more aware of another sensation that replaces it. (Elkins in Hammond, 1990, p. 81)

Safe Place Imagery

A technique that is often used as part of hypnotic intervention for pain includes hypnotic suggestions to experience a safe place. Suggestions for “safe place imagery” helps the patient to achieve a calm, comfortable feeling of safety, and reduce tension associated with pain. As the patient is able to experience a safe place, it may lead to pleasant memories and a greater ability to experience response to other suggestions such as dissociation and analgesia. Examples of safe place imagery for pain management include:

… and you can imagine yourself in a place that is safe, all by yourself, or with someone else, whatever is needed for this place to be safe, comforting … and interesting. This place might be somewhere you have been before and know well … you can recognize all of the familiar sights, sounds, and smells … or it might be a completely new place … a place that exists in your imagination … yet it feels so real … that you can really imagine yourself there … so comfortable, no one can bother you … it is like a vacation … and in this place you are so absorbed by what you can see … the colors … the sounds … and it is so comfortable for your body … just the right temperature … that you are actually feeling more and [more] comfortable … and this place is so absorbing, so interesting, and so … comfortable, that you hardly notice any other sensations … except maybe the perfect temperature of this place … and how good you feel inside and out. (Jensen & Patterson, 2008, p. 531)

 

Cognitive Restructuring

In CH, patients’ automatic thoughts and beliefs are addressed in order to examine these thoughts and beliefs, determine their validity or negative biases, and construct realistic alternatives (for a review see Thorn, 2004). The hypnotic state can be utilized to facilitate the restructuring of negative cognitive-emotional responses to painful states. Alladin (2008) wrote that CBT-solely was lacking in that it did not permit access to unconscious cognitive restructuring, with its focus on cognitive-restructuring via reason and Socratic dialogue, while hypnotherapy’s focus is on unconscious processing, thus reframing pain, paying less attention to systematic conscious cognitive restructuring. Perhaps taking advantage of both modalities can further help patients to reframe deleterious conceptualizations of their pain.

An example from a suggestion adapted by Jensen (2011):

… and each time throughout the day you encounter a situation or a sensation where the meaning is not clear to you, or can even anticipate such an event before it happens, you can remind yourself that there are many different ways to interpret the event … and you can also, instantly and automatically, remind yourself you don’t know what it means just yet … but you can entertain a variety of interpretations … and you can ask yourself directly how you will know which interpretation, if any, is a correct one … which one is most helpful, reassuring, and accurate … (p. 172)

Distraction

Distraction techniques may be integrated with other hypnotic suggestions to provide pain relief. As the patient is able to focus attention on a thought or suggestion, there can be a reduction in pain due to the decreased attention. For example, young children can achieve relief if the therapist tells an engaging story either in original format or in variations (Olness & Gardner, 1988). Distraction can be especially useful for integrating hypnosis to utilize cognitive mastery as a major coping mechanism. An example of distraction for pain management is:

As you focus your attention on your breathing, you can become aware of all of the sensations associated with breathing … notice the sensations that go along with breathing in … the coolness of the air as you breath in … really notice it … and all of the sensations that go along with breathing out … a feeling of letting go … as you focus on your breathing … now … other things begin to fade into the background … and notice if your breathing begins to change in any way … perhaps a little slower, a little deeper … so absorbed in awareness of breathing in and breathing out … that other things fade into the background …

Pain Metaphors

It can be quite useful in hypnotherapy to provide metaphors for pain that then can be altered to provide relief. An example of such a metaphor might be suggesting that the patient imagine the pain as a red light on the body and slowly changing the hue of that light to a cooling, soothing, numbing blue light, such that the red light becomes less and less bright, and then slowly changing to a cool, comfortable blue. Or perhaps imaging the pain as a fire and watching that fire slowly burning out, getting smaller and smaller before disappearing, leaving behind feelings of coolness or numbness. For example:

There has been this matter of pain … and changes as the pain can become less … less intense … less severe … and it is possible to visualize the pain in a particular way … as having a particular color, or shape, or size, or brightness. As you can see a shape, a red color … and yet it can change … as you enter a deeper hypnotic state, the pain becomes less … less intense … less severe … as the light becomes dimmer … as if a rheostat were being turned down … the color changes … it becomes softer … almost a gentle blue color … and the shape becomes smaller and smaller … as you see this the pain becomes less and less.

Teaching Self-Hypnosis

A common strategy in hypnotherapy as described by Jensen and colleagues (2005) is the suggestions for the ability to practice and experience hypnotic analgesia again on their own with the recommendation that they do so, an increased ability to experience hypnosis and hypnotic analgesia over time and with practice and the extension of the benefit of hypnotic-analgesia practice beyond the treatment and practice sessions. For example:

Each time you practice self-hypnosis or listen to the tape recording that I will provide to you today, you will be able to enter a very deep state of relaxation, just as deep as you are today—and within this relaxed state, you will find a feeling of control. You will be able to become so deeply relaxed that you will become very comfortable, and you will be able to have a feeling of dissociation that keeps from conscious awareness any excessive discomfort. (Elkins et al., 2004)

 

Empirical Support for CH for Pain Management

address the complex nature of pain as a physiological, psychological, and psychosocial phenomenon CH is a very effective treatment that can provide analgesia, reduce stress, relieve anxiety, improve mood, and reduce the need for opioids for some patients. Research is very supportive of adoption of this modality as an evidence-based adjunctive treatment for chronic as well as acute and procedural pain. CH should be implemented within the context of a holistic medical plan, with comprehensive assessment, in order to best and maximize patient benefit. Research is reviewed as related to evidence methods and applications of hypnosis for pain management in various disorders (seeTable 1 for summary) encountered in clinical practice.

TABLE 1 Empirical Research on Hypnosis for Pain Management

 

Cancer Pain

Hypnosis has been utilized to reduce cancer-related pain and to assist patients in coping with the emotional effects. In a study of women with chronic breast cancer pain, patients were randomized to either standard care or weekly expressive-supportive group therapy for 12 months. Within the group therapy condition, participants were further assigned into groups with or without self-hypnosis treatment. Though both treatment groups demonstrated significantly less pain compared to control, the patients who received hypnosis reported significantly less increase in pain over time (as cancer progressed) compared to patients who did not receive hypnosis (Spiegel & Bloom, 1983).

A prospective study of 39 advanced stage cancer patients with malignant bone disease were randomized to either weekly sessions of supportive attention or hypnotherapy (Elkins et al., 2004). The patients assigned to hypnotherapy received at least four weekly session of hypnotic induction following a standard transcript which included suggestionsfor relaxation, comfort mental imagery for dissociation and pain control, and instruction in self-hypnosis. The hypnosis intervention group demonstrated a significant overall decrease in pain for all sessions combined. Participants rated the efficacy of their self-hypnosis practice outside of sessions reporting a mean of 6.5 on a 0–10 scale, with 0 equating “not effective at all” and 10 equating “completely effective.”

Back Pain

Back pain is among the most common causes of chronic pain. Further, many patients with chronic back pain do not improve following surgery or invasive procedures. The research into hypnosis for chronic back pain has generally been favorable. An uncontrolled prospective trial compared hypnosis to relaxation training in 17 outpatients (McCauley, Thelen, Frank, Willard, & Callen, 1983). Patients were assigned to either a self-hypnosis or relaxation group, with patients attending eight individual weekly sessions. Patients in both groups showed significant improvements on the McGill Pain Questionnaire and visual analog ratings of pain at end of treatment and three months post-treatment, with both modalities showing equal improvement (McGill Pain Questionnaire;Katz & Melzack, 2011). Self-hypnosis was compared to an education program for chronic low back pain patients, (n = 45) in a cross-over study design (Spinhoven & Linssen, 1989). A pain diary was used as a measure of pain intensity, up-time, and use of analgesic medication. Distress and depression were assessed via the Symptom Checklist-90 (Derogatis & Cleary, 1977). The results of this study showed that the two treatments both showed significant post-treatment to 2-month follow-up improvement on all outcomes measures, save pain intensity. The authors concluded that the teaching package was effective in helping patients with low back pain to better cope with their pain and improve their adjustment to chronic pain.

A study by Jensen and colleagues (2009a) involved 37 adults with spinal-cord injury and chronic pain who were randomized into 10 sessions of either self-hypnosis or EMG biofeedback relaxation training for pain management. Participants in both conditions reported substantial decreases in pain intensity from before to after treatment sessions. Participants in the hypnosis group, however, in contrast to the EMG biofeedback group reported statistically significant decreases in daily average pain pre- to post-treatment, which were maintained at a 3-month follow-up. Further, participants in the hypnosis group also reported significant pre- to post-treatment improvements in perceived control over their pain; however this change was not maintained at the 3-month follow-up.

Osteoarthritis

According to the Arthritis Foundation, 27 million Americans have the diagnosis of osteoarthritis (OA). OA is a breakdown of cartilage, which as it deteriorates, causes bones to rub against one another causing stiffness and pain (Arthritis Foundation, 2011). A study was conducted comparing the relative efficacy of hypnosis and Jacobson relaxation for the reduction of OA pain (Gay, Phillipot, & Luminet, 2002). In this study, 36 adults with knee OA and/or hip OA were randomized into eight sessions of a hypnosis condition, a relaxation condition, or the control condition. Compared to control, both conditions had a lower level of subjective pain and the level of subjective pain decreased with time. Both treatment groups were effective in reducing the amount of analgesic medication taken by the participants in the study. Analyses of the interaction effects between group treatment and time measurement were performed with the beneficial effects of treatment appearing more rapidly for the hypnosis group, though treatment outcomes for both groups were identical at a 3-month follow-up.

Sickle Cell Disease

Sickle cell disease can result in considerable pain. It is an especially difficult pain problem to treat due to the intensity and episodic nature of the pain associated with sickle cell disease. In a two-year study of 37 children and adults with sickle cell disease, a cognitive-behavioral intervention that was centered on self-hypnosis training and practice was examined for the treatment of vaso-occlusive pain (Dinges et al., 1997). In a pre–post experimental design, participants completed a 4-month baseline, and then 18 months of treatment with weekly sessions for the first 6 months and bi-monthly for the next 6 months and then once every three weeks for the final 6 months. Results indicated a significant reduction in the number of pain days in the self-hypnosis intervention.

Temporomandibular Disorder

Temporomandibular disorders (TMD) are characterized by both acute and chronic pain in the masticatory musculature, the temporomandibular joint, limiting movement, and affecting up to 15% of the population (Drangsholt & LeResche, 1999). A study of evaluating the efficacy of hypnosis for temporomandibular pain disorder (n = 28), pain outcome measures were assessed during four separate occasions: during wait list, before treatment, after treatment, and at 6-month follow-up (Simon & Lewis, 2000). Hypnotherapy involved five hypnosis sessions where participants received education regarding hypnosis and were instructed to practice self-hypnosis. Results report a significant decrease in pain frequency, pain duration, and an increase in daily functioning which were maintained for 6-month follow-up.

Winocur, Gavish, Emodi-Perlman, Halachmi, and Eli (2002) compared “hypnorelaxation” to the use of an occlusal appliance, or an education and advice condition for the treatment of temporomandibular pain. Winocur et al. (2002) randomly assigned 40 female patients to one of three temporomandibular pain treatment groups: hypnorelaxation, occlusal appliance, and education/advice. The hypnorelaxation intervention included progressive muscle relaxation suggestions and self-hypnosis, while the occlusal appliance condition wore a full-coverage, hard acrylic appliance constructed to fit the maxillary arch. After assessing pre- and post-pain intensity via visual analog rating scale, both hynorelaxation and occlusal appliance were more effective than education/advice in alleviating sensitivity to palpation. Participants in the hypnosis condition (not the occusal appliance condition) showed a 57% reduction for current pain intensity and a 51% reduction for worst pain intensity.

Abrahamsen, Zachariae, and Svensson (2009) randomized 40 women suffering from TMD to either four individual sessions of hypnotherapy or to a control condition of simple relaxation. Researchers found that both the groups showed reduction in number of painful muscle palpations, and number of awakenings due to pain. Only the hypnosis group significantly reduced daily pain ratings (4.5, baseline to 2.9 post treatments on a 10-point rating scale). A fMRI study conducted on 19 patients with TBD during hypnotic hypoalgesia and hyperalgesia and a control condition. Pain ratings during hypnotic hypoalgesia were significantly lower than in the control condition and significantly higher in the hypnotic hyperalgesia condition (Abrahamsen et al., 2010).

Fibromyalgia

In a controlled study of 40 fibromyalgia participants, Haanen et al. (1991) randomized participants into a hypnotherapy or physical therapy treatment group. Participants received treatment over 3 months and outcomes were assessed at pre- and post-treatment and again at a 3-month follow up. The hypnosis intervention included eight sessions of hypnotherapy in combination with a self-hypnosis audio recording for home use. The physical therapy condition included 12 to 24 hours of massage and muscle relaxation training. Results showed that the hypnosis intervention post-treatment and in follow up showed significantly superior results on measures of muscle pain, fatigue, distress, sleep disturbance, and patient overall assessment of outcome. Hypnotherapy’s efficacy in treating fibromyalgic pain was further assessed in a comparison between hypnosis and relaxation in a study byCastel, Pérez, Sala, Padrol, and Rull (2007).

An innovative study of hypnotic suggestions on the efficacy of treatment of fibromyalgic pain compared hypnosis with suggestions for analgesia, hypnosis with suggestions for relaxation, and a relaxation condition (Castel et al., 2007). In this study of 45 patients of a pain clinic, all conditions showed decreases in the outcome measures, but to varying degree. Measures of pain intensity showed a 29% reduction in the hypnosis with relaxation suggestions group, a 43% reduction in the relaxation only condition, and a 73% reduction in the hypnosis with analgesia suggestions. The treatment group disparities were further shown on the McGill Pain Questionnaire (Katz & Melzac, 2011). The results of this study suggest that hypnotic suggestions for analgesia are superior to hypnotic suggestion for relaxation or a “relaxation technique” solely for the treatment of fibromyalgic pain. A recent systematic review and meta-analysis of controlled trials investigating the efficacy of hypnosis/guided imagery in fibromyalgia concluded that methodological limitations of the available literature prevent recommendation for fibromyalgia syndrome, though the authors noted that it was a recommended adjunct to efficacious pharmacological and non-pharmacological treatments by the German interdisciplinary guide on fibromyalgia syndrome based on expert consensus (Bernardy, Füber, Klose, & Hauser, 2011Thieme et al., 2008).

Non-Cardiac Chest Pain

Between 10–30 % of patients undergoing coronary angiography for chest pain are found to have normal arteries, and continue to suffer from chest pain symptoms despite no evidence of heart disease (Chambers & Bass, 1990). As a result non-cardiac chest pain (NCCP), is poorly understood and has been estimated to cost the economy many billions of dollars per year (Eslick, Coulshed, & Talley, 2002Esler & Bock, 2004).Jones, Cooper, Miller, Brooks, and Whorwell (2006) conducted a study evaluating the efficacy of hypnosis for NCCP, randomized participants to a 12 session hypnotherapy condition (n = 15) or to a supportive therapy plus placebo medication condition (n = 13) over a 17-week period. Results indicated 80% of hypnotherapy participants compared to 23% of controls experienced a global improvement in pain and pain intensity, although not frequency. The hypnotherapy condition resulted in greater improvement in overall wellbeing in addition to reduction in the use of required medication.

Disability Related Chronic Pain

perceived control over pain and this improvement were maintained at the 3-month follow-up. In an innovative study of the efficacy self-hypnosis and cognitive restructuring on the daily pain intensity and catastrophizing in 15 multiple sclerosis patients in chronic pain,Jensen and colleagues (2011) found that a combined hypnosis-cognitive structuring intervention had greater beneficial effects than the effort of cognitive restructuring or hypnotherapy Chronic pain associated with disability is challenging due to the association with loss of function and secondary gain. In a case-series analysis of 33 patients experiencing chronic pain secondary to a disability,Jensen and colleagues (2005) examined the efficacy of 10 sessions of standardized hypnotic analgesia treatment on pain unpleasantness, depression, and perceived control over pain. Outcomes were assessed before and after a non-treatment baseline, after treatment, and at a 3-month follow-up. Results showed a significant improvement in pre- to post-treatment in pain intensity, pain unpleasantness, and solely.

Conclusions

There is increasing evidence on the efficacy and effectiveness of CH for pain management. Treatment of chronic pain requires careful assessment and consideration of biological, psychological, and interpersonal factors in treatment planning. A variety of techniques have been utilized in hypnotic intervention for pain management. However, suggestions for relaxation, comfort, and alteration of pain perception have been investigated in several studies and examples for clinical practice are provided. CH for chronic pain may also include instructing the patient in the use of self-hypnosis and integrating practice of hypnosis as a “homework assignment.” This approach fits well with a cognitive-behavioral approach and hypnotherapy can be integrated within an overall CBT plan. Research is supportive of hypnosis as both a primary and adjunctive intervention for pain management.

Acknowledgments

Dr. Elkins is supported by NCCAM grant 5U01AT004634.

References

 

Contact:  Linda Alexander at 07875 493 358 or 0141 632 1440 or via website and at linda.alexander@talktalk.net  for hypnotherapy treatment in Glasgow.

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