Hypnosis and clinical pain.

Abstract

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.

Neurophysiology of pain and hypnosis for chronic pain

“…Trait theories [41] state that individuals vary in their level of hypnotizability, with individuals high in hypnotic suggestibility responding better to hypnotic suggestions. While there is evidence that level of suggestibility has been significantly related to hypnotic outcomes [15,18], studies have also found that individuals low in hypnotizability can also experience improvements in pain after hypnosis [42][43][44], and some research had found no association between level of hypnotizability and outcome [45,46]. Social-cognitive theories suggest that expectancies, motivation, and environmental cues contribute to an individual's responsiveness to hypnotic suggestions and that improvements are made via cognitive changes that alter the affective components of pain [18,45,47,48].…”

“…For instance, one study found treatment outcome expectancies to be moderately to strongly associated with improvements in pain intensity over time [45]. Overall, while research suggests that there is evidence to support both theories, there is a lack of consistent evidence to suggest that either theory is entirely sufficient to explain why hypnosis is effective [18]. This is an area that needs continued research.…”

“…Additionally, suggestions may focus on improvements in other areas of life that can be influenced by or that influence pain, such as improved selfefficacy, changes in beliefs or attitudes, increased activity, or improved sleep quality. Studies evaluating hypnosis for chronic pain have used different combinations of these types of suggestions, with overall findings demonstrating hypnosis to be at least as effective as other active treatments (e.g., relaxation, biofeedback), and advantageous when compared to treatment as usual [15][16][17][18].…”

“…Training patients to use hypnosis is one treatment for chronic pain that has been evaluated across a variety of conditions, including fibromyalgia, low back pain, disabilityrelated pain, cancer-related pain, arthritis, irritable bowel syndrome, and headache [16][17][18][19][20][21][22][23]. Hypnosis can be used as a stand-alone or adjunctive treatment, with some research demonstrating the ability Implications Researchers: Researchers should consider evaluating suggestion type when studying pain-related and functional outcomes and the neural networks implicated in both pain and hypnosis.…”

“…During hypnosis, individuals are given an invitation to focus their attention through an induction, followed by suggestions for change or improvement [31]. While the format of hypnosis can vary greatly, such as the length of the induction or the types of suggestions given, overall research suggests that hypnosis is a viable treatment option for chronic pain, demonstrated through improvements in several pain-related outcomes, including pain intensity, duration, and frequency [16][17][18]32]. Patients can also learn self-hypnosis, which is self-guided and can be practiced away from the clinical setting.…”