Hypnosis and Pain

As a sufferer of chronic pain from various injuries over the years, the main being my left shoulder which is severely arthritic and having had 7 surgeries so far with the 8th planned for a few weeks time to fuse the joint. I am therefore acutely aware of how pain can interfere with everyday functioning both physically and mentally. I have been undertaking a meta analysis of research papers and projects for quite some time now and came across a number of studies which have shown that hypnosis can reduce the pain experienced during a variety of medical conditions including burn-wound debridement, [1] bone marrow aspirations, and childbirth.[2][3] The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.[4]

Hypnosis is effective in reducing pain from[5] and coping with cancer [6] and other chronic conditions.[7]Nausea and other symptoms related to incurable diseases may also be managed with hypnosis.[8][9][10][11] Some practitioners have claimed hypnosis might help boost the immune system of people with cancer. However, according to the American Cancer Society, “available scientific evidence does not support the idea that hypnosis can influence the development or progression of cancer.”[12]

Hypnosis has been used as a pain relieving technique during dental surgery and related pain management regimens as well. Researchers like Jerjes and his team have reported that hypnosis can help even those patients who have acute to severe orodental pain.[13] Additionally, Meyerson and Uziel have suggested that hypnotic methods have been found to be highly fruitful for alleviating anxiety in patients suffering from severe dental phobia.[14]

For some psychologists who uphold the altered state theory of hypnosis, pain relief in response to hypnosis is said to be the result of the brain’s dual-processing functionality. This effect is obtained either through the process of selective attention or dissociation, in which both theories involve the presence of activity in pain receptive regions of the brain, and a difference in the processing of the stimuli by the hypnotised subject.[15]

The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subject’s responsiveness to suggestion, whether within the context of hypnosis or not, that is the main determinant of causing reduction in pain.[16]

Study 1: Hypnosis and Pain – Review of Clinical Trials
Hypnotic Treatment of Chronic Pain

Notes: This paper reviewed various controlled trials involving the use of hypnosis to control pain. It concluded that hypnosis can provide a significantly greater reduction in pain than physical therapy, education, or the management of medications. It even found that the hypnotic treatment did not even have to be called ‘hypnosis’ for it to be effective.

J Behav Med. 2006 Jan 11;1-30 By: M. Jensen, D. R. Patterson
Author Affiliations: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington. University of Washington Multidisciplinary Pain Centre, Box 356044, University of Washington Medical Centre, 1959 N.E. Pacific, Seattle, Washington, 98195-6044

Study 2: Hypnosis and Pain – Another Review of Studies
Pain Management: Hypnosis and Its Place in Modern Pain Management – Review Article.

Notes: This paper reviewed the various scientific studies that showed hypnosis was an effective treatment for pain management. It concluded that in spite of some of the “methodological flaws” involved in many of the studies, there was “sufficient clinical evidence of sufficient quality” to conclude that hypnosis is an effective treatment for chronic pain.
Niger Postgrad Med J. 2007 Sept;14(3):238-41 By: F. E. Amadasun, Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Nigeria

Study 3: Hypnosis and Pain – Yet Another Review of Studies
A Meta-Analysis of Hypnotically Induced Analgesia: How Effective is Hypnosis?

This paper reviewed 18 studies conducted on the use of hypnosis to relieve pain over a two-decade period. It concluded that hypnosis provided an effective way to help people deal with pain because it had a “moderate to large hypnoanalgesic effect.” It further concluded that hypnosis should be more widely used in the treatment of pain.
International Journal of Clinical and Experimental Hypnosis, Volume 48, Issue 2, 2000, pages 138-153 By: Guy H. Montgomerya, Katherine N. Duhamela, William H. Redda, Mount Sinai School of Medicine, New York, New York

Study 4: Hypnosis – Alternative to Sedation for Surgery
Hypnosedation: A Valuable Alternative to Tradition Anaesthetic Techniques.Techniques.

Notes: This paper reports on the anecdotal use of hypnosis in over 1650 surgeries that were performed in the Department of Anaesthesia and Intensive Care, at the University of Liège in Belgium. It confirmed that hypnosedation combined with local anaesthesia can be used as an alternative to more traditional means of sedation.
Acta Chir Belg. 1999; 99:141-146
M. E. Faymonville, M. Meurisse, J. Fissette, Dept. of Anaesthesia & Intensive Care, Univ. of Liega, Beligum

Study 5: Hypnosis for Pain During Plastic Surgery
Psychological Approaches During Conscious Sedation. Hypnosis Versus Stress Reducing Strategies: A Prospective Randomised Study.

Results: Not only did the group using hypnosis require significantly lower levels of midazolam and alfentanil than the control group; they reported experiencing significantly lower levels pain and anxiety; and a greater feeling of being in control during the entire process. Their vital signs were also found to be significantly more stable than those of the control group. This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery.

Notes: Sixty patients patients who were going to have plastic surgery using local anaesthetic and intravenous sedation (they could request midazolam and alfentanil if needed) were randomly placed into a control group where they were taught strategies for reducing stress, or into a group where they would receive hypnosis during the surgery. Their behaviour was monitored by a psychologist before, during, and after surgery where their levels of anxiety and pain, and feelings of being in control, were recorded.
Pain 1997, Dec;73(3)361-7
By: M. E. Faymonvillea, P. H. Mambourg, J. Jorisa, B. Vrijensc, J. Fissetted, A. Alberte, M. Lamyf

Study 6: Hypnosis for Pain – Angioplasty Procedure
Use of Hypnosis Before and During Angioplasty.

Results: This study found that the surgeons involved were able to keep the balloon inflated 25% longer with the hypnotised group. Forty-four percent of the control group also asked for more pain medication, compared with only 13% of the hypnotised group.

Notes: Thirty-two subjects were recruited for this study. Sixteen were randomly assigned to be in the control group and 16 were hypnotised before they underwent an angioplasty (a procedure where a balloon is inserted into a vein and then inflated to help open the vein while the patient remains conscious and aware).
Am J Clin Hypn. 1991 Jul;34(1):29-37
By: E. J. Weinstein, P. K. Au, Kaiser Permanente Center for Health Research, USA

Study 7: Reason Why Hypnosis Alleviates Pain (not Because of release of Endorphins)
Naloxone Fails to Reverse Hypnotic Alleviation of Chronic Pain

Notes: Some researchers had previously believed that the reason hypnosis helps to reduce chronic pain was that it caused the body to produce endorphins (our natural pain killers). To test this theory, 6 patients suffering from chronic pain (caused by peripheral nerve irritation) were taught self-hypnosis to reduce their feelings of pain. They were then randomly given either a saline solution (a placebo) or naloxone (a drug that is known to block the effects of endorphins) and were tested for pain at 5 minute intervals for an hour. If the analgesic effect of hypnosis was somehow caused by the internal production of endorphins, then naloxone would have caused the pain to return. However, the results of this study demonstrated that naloxone had no effect on the power of hypnosis to reduce pain. As a result, it was determined that endorphins are not involved in hypnotic pain control.
Psychopharmacology (Berl). 1983;81(2):140-3
By: D. Spiegel, L. H. Albert, Dept. of Psych., Stanford Univ.

Study 8: Hypnosis for Pain – Fibromyalgia
Functional Anatomy of Hypnotic Analgesia: A PET Study of Patients with Fibromyalgia.

Results: The subjects all reported experiencing less pain when they were in the state of hypnosis, then they did when they were in a state of rest. The researchers also found that there were significant differences in the way the blood flowed through the brain in these two states. They found that during hypnotically-induced analgesia the blood flow “was bilaterally increased in the orbitofrontal and subcallosial cingulate cortices, the right thalamus, and the left inferior parietal cortex, and was decreased bilaterally in the cingulate cortex.” This study proved that hypnosis leads to real physical changes in the brain.

Notes: In an attempt to understand what happens in the brain when a person is hypnotised and then given suggestions for pain relief, subjects were recruited who were suffering from the painful condition of fibromyalgia. PET (positron emission tomography) scans were then taken of their brains when they were resting and then when they were in a state of hypnotically-induced analgesia.
European Journal of Pain. Vol. 3(1) 1999; 7-12
By: G. Wik, H. Fischer, B. Bragée, B. Finer, M. Fredrikson, Department of Clinical Neurosciences, Karolinska Institute and Hospital, Stockholm, Sweden

Study 9: Hypnosis for Burn Pains
Hypnosis for the treatment of burn pain.

Results: Only hypnotised subjects reported significant pain reductions relative to pretreatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain.

Notes: The clinical utility of hypnosis for controlling pain during burn wound debridement was investigated. Thirty hospitalised burn patients and their nurses submitted visual analog scales (VAS) for pain during 2 consecutive daily wound debridements (the process of removing nonliving tissue from burns). On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day’s wound debridement, subjects received hypnosis, attention and information, or no treatment.
Journal of Consulting and Clinical Psychology [1992, 60(5):713-717
By: D. R. Patterson, J. J. Everett, G. L. Burns, J. A. Marvin, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle 98195

Study 10: Self-Hypnosis for Pain and Anxiety During Biopsy Outpatient Procedures
Adjunctive self-hypnotic relaxation for outpatient medical procedures: A prospective randomised trial with women undergoing large core breast biopsy

Results: Women’s anxiety increased significantly in the standard group (logit slope=0.18, p<0.001), did not change in the empathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, p<0.001). Pain increased significantly in all three groups (logit slopes: standard care=0.53, empathy=0.37, hypnosis=0.34; all p<0.001) though less steeply with hypnosis and empathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46min/$161 for standard care, 43min/$163 for empathy, and 39min/$152 for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.

Notes: Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical centre were prospectively randomised to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients’ self-ratings at 10min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model.
PAIN, Volume 126, Issue 1, Pages 155-164, 15 December 2006
By: Elvira V. Lang, Beth Israel Deaconess Medical Centre/Harvard Medical School, Department of Radiology
Kevin S. Berbaum, Salomao Faintuch, Olga Hatsiopoulou, Noami Halsey, Xinyu Li, Michael L. Berbaum, Eleanor Laser, Janet Baum

Study 11: Hypnosis for HIV Neuropathic Pain
Hypnosis for Treatment of HIV Neuropathic Pain: A Preliminary Report

Results: Mean SFMPQ total pain scores were reduced from 17.8 to 13.2 (F[1, 35]?=?16.06, P?<?0.001). The reductions were stable throughout the 7-week post intervention period. At exit, 26 out of 36 (72%) had improved pain scores. Of the 26 who improved, mean pain reduction was 44%. Improvement was found irrespective of whether or not participants were taking pain medications. There was also evidence for positive changes in measures of affect and quality of life.

Notes: Painful HIV distal sensory polyneuropathy (HIV-DSP) is the most common nervous system disorder in HIV patients. The symptoms adversely affect patients’ quality of life and often diminish their capacity for independent self-care. No interventions have been shown to be consistently effective in treating the disorder. The purpose of the present study was to determine whether hypnosis could be a useful intervention in the management of painful HIV-DSP. Participants were 36 volunteers with HIV-DSP who received three weekly training sessions in self-hypnosis. Participants were followed for pain and its sequelae for 7 weeks prior to the intervention, and for 7 weeks post intervention. Participants remained on the same standard-of-care pain regimen for the entire 17 weeks of the protocol. The primary outcome measure was the Short Form McGill Pain Questionnaire scale (SFMPQ) total pain score. Other outcome measures assessed changes in affective state and quality of life.
Pain Medicine online version of journal published online April 8, 2013
By: David Dorfman PhD1,*, Mary Catherine George MM2, Julie Schnur PhD3, David M. Simpson MD2, George Davidson PhD2, Guy Montgomery PhD3
Author Information:

  1. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA

Additional References:

  1. Patterson, David R.; Questad, Kent A.; De Lateur, Barbara J. (1989). “Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement”. American Journal of Clinical Hypnosis 31 (3): 156–163.
  2. Mendoza, M. E.; Capafons, A. (2009). “Efficacy of clinical hypnosis: A summary of its empirical evidence” (PDF). Papeles del Psicólogo 30 (2): 98–116.
  3. Ewin, D.M. (2001). “The use of hypnosis in the treatment of cancer patients” (PDF). International Handbook of Clinical Hypnosis: 274–283.
  4. Nash, Michael R. “The Truth and the Hype of Hypnosis”. Scientific American: July 2001
  5. Butler, B. (1954). “The use of hypnosis in the care of the cancer patient” (PDF). Cancer 7 (1): 1–14.
  6. Peynovska, R.; Fisher, J.; Oliver, D.; Matthew, V. M. (2003). “Efficacy of hypnotherapy as a supplement therapy in cancer intervention” (PDF). Paper presented at the Annual Meeting of The Royal College of Psychiatrists, 30 June – 3 July 2003.
  7. Nash, Michael R. “The Truth and the Hype of Hypnosis”. Scientific American: July 2001
  8. Spiegel, D.; Moore, R. (1997). “Imagery and hypnosis in the treatment of cancer patients”. Oncology 11 (8): 1179–1195.
  9. Garrow, D.; Egede, L. E. (2006). “National patterns and correlates of complementary and alternative medicine use in adults with diabetes”. Journal of Alternative and Complementary Medicine 12 (9): 895–902.
  10. Mascot, C. (2004). “Hypnotherapy: A complementary therapy with broad applications”. Diabetes Self Management 21 (5): 15–18.
  11. Kwekkeboom, K.L.; Gretarsdottir, E. (2006). “Systematic review of relaxation interventions for pain”. Journal of Nursing Scholarship 38 (3): 269–277.
  12. “Hypnosis”. American Cancer Society. November 2008. Retrieved 22 September 2013.
  13. Jerjes; et al. (2007). “Psychological intervention in acute dental pain: Review”. British Dental Journal 202.
  14. Meyerson, J.; Uziel, N. “Application of hypno-dissociative strategies during dental treatment of patients with severe dental phobia”. The International Journal of Clinical and Experimental Hypnosis 63.
  15. Myers, David G. (2014). Psychology: Tenth Edition in Modules (10th ed.). Worth Publishers. pp. 112–13.
  16. “Hypnosis, suggestion, and placebo in the reduction of experimental pain” faqs.org

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