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
http://www.mirtharust.com/articles/Chronic_Pain.pdf

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.
http://www.ncbi.nlm.nih.gov/pubmed/17767210

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?
http://www.tandfonline.com/doi/abs/10.1080/00207140008410045#preview

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.
http://www.ncbi.nlm.nih.gov/pubmed/10499382

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.
http://www.ncbi.nlm.nih.gov/pubmed/9469526

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.
http://www.ncbi.nlm.nih.gov/pubmed/1951141

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
http://www.ncbi.nlm.nih.gov/pubmed/6415744

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.
http://www.ncbi.nlm.nih.gov/pubmed/10700332

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.
http://europepmc.org/abstract/MED/1383302

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
http://www.painjournalonline.com/article/S0304-3959(06)00393-9/abstract

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
http://onlinelibrary.wiley.com/doi/10.1111/pme.12074/abstract;jsessionid=FDE3EE6797A0D9728AC3692148843D74.d01t02

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

Hypnosis and the Brain – Body Connection


I found this article on research at Stanford University School of Medicine that has identified three specific areas of the brain that are altered by hypnosis. It goes on to explain how effective hypnosis can be in using our minds to control our perception and our bodies and also, that there is a brain-body connection that helps the brain process and control what’s going on in the body.

So many benefits to using hypnosis to your advantage.

http://med.stanford.edu/news/all-news/2016/07/study-identifies-brain-areas-altered-during-hypnotic-trances.html

Key to Your Mind.001

Hypnosis and Cancer


Cancer-patients-use-hypnosis-in-healing

There is a huge body of research into the use of hypnosis with cancer patientsAs with many types of complementary therapy, one of the main reasons people with cancer use hypnotherapy is to help them relax and cope better with symptoms and treatment. Hypnotherapy can help people to feel more comfortable and in control of their situation.

People with cancer most often use hypnotherapy for sickness or pain. There is some evidence that hypnotherapy helps with these symptoms. It can also help with depression, anxiety and stress.

Some doctors and dentists have training in hypnotherapy. They may use this alongside conventional treatments such as chemotherapy or radiotherapy.

Research into Hypnotherapy in People With Cancer
Some reports show that hypnosis can help people to reduce their blood pressure, stress, anxiety, and pain. Hypnosis can create relaxing brain wave patterns. Some clinical trials have looked at how well hypnotherapy works for people with cancer.

Research has looked at the following areas:

Hypnosis and Cancer Pain
A report from the American National Institute for Health in 1996 stated that hypnosis can help to reduce some kinds of cancer pain. A large review in 2006 looked at using hypnotherapy to control distress and pain from medical procedures in children with cancer. The review found that hypnotherapy did seem to help to reduce the children’s pain and distress, but it recommended more research. You can look at this cancer pain review on the Research Council for Complementary medicine website.

In 2012, researchers in Spain again reviewed studies of children with cancer and found that hypnosis appeared to help reduce pain and distress from cancer or from medical procedures.

Hypnosis and Sickness
A large review in 2006 looked at research into hypnotherapy for feeling or being sick from chemotherapy. Most of the studies in this area have been in children. Overall, the studies did show that hypnotherapy might be able to help with chemotherapy sickness in children. There has only been 1 study looking at hypnotherapy for sickness after chemotherapy in adults, so we need more research into this. You can look at this cancer and sickness review on the Research Council for Complementary medicine website.

One study found that hypnosis can help to reduce anticipatory nausea and vomiting. Anticipatory nausea or vomiting happens when people have had nausea or vomiting due to cancer drugs and they then have nausea or vomiting just before their next dose.

Hypnosis and Hot Flushes
A clinical trial in America in 2008 found that women having breast cancer treatment who had hypnosis had fewer hot flushes and the flushes were less severe. The women also had less anxiety, depression, and interference with daily activities, and better sleep.

Hypnosis and Breast Cancer Surgery
A study in 2007 in America gave hypnotherapy to a group of women before breast surgery. The researchers found that hypnotherapy lowered the amount of pain, sickness, tiredness and upset that the women had after surgery. Another American study in 2006 found that hypnotherapy helped to lower anxiety and pain during a biopsy for suspected breast cancer.

Hypnotherapy for Symptom Control in Advanced Cancer
In 2005 researchers carried out a review of studies into hypnotherapy for treating symptoms in people with advanced cancer. There were 27 studies but all were small or of poor quality. So it is not possible to tell whether hypnotherapy can help people with advanced cancer. We need research to find this out and this research below goes a long way in helping medical science discover ways to treat and alleviate the symptoms of cancer.

 

Study 1: Cancer and Hypnosis – 2013 Overview

Hypnosis for cancer care: Over 200 years young
http://onlinelibrary.wiley.com/doi/10.3322/caac.21165/full

Notes: Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are:

1) to describe hypnosis and its components and to dispel misconceptions

2) to provide an overview of hypnosis as a cancer prevention and control technique (covering its use in weight management, smoking cessation, as an adjunct to diagnostic and treatment procedures, survivorship, and metastatic disease)

3) to discuss future research directions. Overall, the literature supports the benefits of hypnosis for improving quality of life during the course of cancer and its treatment.

CA: A Cancer Journal for Clinicians, Volume 63, Issue 1, pages 31-44, January/February 2013
By: Guy H. Montgomery Ph.D., Director, Integrative Behavioral Medicine Program, Associate Professor, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY

Julie B. Schnur Ph.D., Co-Director, Integrative Behavioral Medicine Program, Assistant Professor, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY

Kate Kravits MA, RN, HNB-BC, LPC, NCC, ATR-BC, Senior Research Specialist, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA

Study 2: Hypnosis for Cancer: Another Overview and Suggestions for Future Use and Research Hypnosis in Cancer Care.
http://bscw.rediris.es/pub/bscw.cgi/d4501369/Liossi-Hypnosis_cancer_care.pdf

Notes: Despite conclusive evidence for the efficacy of clinical hypnosis in the management of many cancer related symptoms and particularly acute and chronic pain, hypnosis is currently under-utilized in these applications. This paper gives a brief overview of the contemporary uses of hypnosis in pediatric and adult oncology and shows how hypnosis can be integrated into a total therapeutic process based on the needs and goals of the patient and the health care team treating them. The first section describes studies that have evaluated hypnosis in adult oncology. The second half consists of a review of the hypnosis literature in pediatric oncology. The paper concludes with suggestions for future research, and implications for clinical practice.

Contemp. Hypnosis 23(1): 47-57 (2006)
By: Christina Liossi, University of Southampton, UK

Study 3: Self-Hypnosis for Pain and Anxiety During Biopsy Outpatient Procedures
Adjunctive self-hypnotic relaxation for outpatient medical procedures: A prospective randomized trial with women undergoing large core breast biopsy
http://www.painjournalonline.com/article/S0304-3959(06)00393-9/abstract

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 center were prospectively randomized 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 Center/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 4: Pre-Surgery Hypnosis for Breast Biopsies – Post-Surgery Pain and Anxiety
Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients
http://www.tandfonline.com/doi/abs/10.1080/00207140208410088#preview

Results: Hypnosis reduced postsurgery pain and distress.

Notes: Each year, hundreds of thousands of women undergo excisional breast biopsies for definitive diagnosis. Not only do these patients experience pain associated with the procedure, but they also endure distress associated with the threat of cancer. To determine the impact of brief presurgical hypnosis on these patients’ postsurgery pain and distress and to explore possible mediating mechanisms of these effects, 20 excisional breast biopsy patients were randomly assigned to a hypnosis or control group (standard care).

Hypnosis reduced postsurgery pain and distress.
International Journal of Clinical and Experimental Hypnosis, Volume 50, Issue 1, 2002, pages 17-32
By: Guy H. Montgomerya, Christina R. Weltza, Megan Seltza, Dana H. Bovbjerga, Mount Sinai School of Medicine, New York

Study 5: Hypnosis to Reduce Presurgical Distress Regarding Breast Biopsies
Hypnosis decreases presurgical distress in excisional breast biopsy patients.
http://www.ncbi.nlm.nih.gov/pubmed/18227298

Results: Post intervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls. The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

Notes: Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients. Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures.

Anesth Analg. 2008 Feb;106(2):440-4
By: J. B. Schnur, D. H. Bovbjerg, D. David, K. Tatrow, A. B. Goldfarb, J. H. Silverstein, C. R. Weltz, G. H. Montgomery, Department of Oncological Sciences, Box 1130, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York City, NY 10029-6574, USA

Study 6: Hypnosis to Alleviate Anxiety Related to Bone Marrow Aspirates and Biopsies
A Randomized Trial of Hypnosis for Relief of Pain and Anxiety in Adult Cancer Patients Undergoing Bone Marrow Procedures
http://www.tandfonline.com/doi/abs/10.1080/07347332.2012.664261#preview

Results: The hypnosis intervention reduced the anxiety associated with this procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain.

Notes: Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care.

Journal of Psychosocial Oncology, Volume 30, Issue 3, 2012, pages 281-293
By: Alison Snow LCSW-Ra, David Dorfman PhDb, Rachel Warbet LCSWa, Meredith Cammarata LCSWa, Stephanie Eisenman LCSWa, Felice Zilberfein PhDa, Luis Isola MDc & Shyamala Navada MDc

Author Affiliations:
a:  Department of Social Work Services, Mount Sinai Medical Center, New York, NY, USA
b:  Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
c:  Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, USA)

Study 7: Hypnosis Versus Analgesic Cream (Local Anesthetic) to Relieve Lumbar Puncture Induced Pain and Anxiety in Cancer Patients Aged 6 to 16
Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.
http://www.ncbi.nlm.nih.gov/pubmed/16719602

Results: Confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure. The level of hypnotizability was significantly associated with the magnitude of treatment benefit, and this benefit was maintained when patients used hypnosis independently.

Notes: A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6-16 years). The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability. Patients were randomized to 1 of 3 groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention.

Health Psychol. 2006 May;25(3):307-15
By: C. Liossi, P. White, P. Hatira, School of Psychology, University of Southampton, Southampton, United Kingdom

Study 8: Hypnosis for Colonoscopies: Anxiety and Pain (as well as decreasing Colonoscopy Recovery Time)
Hypnosis to Manage Anxiety and Pain Associated with Colonoscopy for Colorectal Cancer Screening: Case Studies and Possible Benefits
http://www.tandfonline.com/doi/abs/10.1080/00207140600856780#preview

Results: Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and recovery time.

Notes: This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and instruction in self-hypnosis on the day of their colonoscopy. Patients’ levels of anxiety were obtained before and after the hypnotic induction using Visual Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient satisfaction with medical care. Hypnotizability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care.

International Journal of Clinical and Experimental Hypnosis, Volume 54, Issue 4, 2006.
By: Gary Elkins, Joseph White, Parita Patel, Joel Marcus, Michelle M. Perfect und Guy H. Montgomery

Author Affiliations:
a:  Baylor University, Waco, Texas, USA
b:  Scott and White Memorial Hospital, Temple, Texas, USA
c:  Texas A & M University College of Medicine, College Station, Texas, USA
d:  Mount Sinai School of Medicine, New York, New York, USA)

Study 9: Hypnosis for Biopsy or Lumpectomy for Breast Cancer – Effect on Amount of Analgesics/Sedatives Required, Pain, Nausea, Fatigue, Discomfort, and Upset (as well as Reduced Surgical Time)
A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients
http://jnci.oxfordjournals.org/content/99/17/1304.full.pdf+html

Results: Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 µg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time.
Conclusions: Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.

Notes: Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective. We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control).. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review.

JNCI J Natl Cancer Inst Volume 99, Issue 17Pp. 1304-1312
By: Guy H. Montgomery, Dana H. Bovbjerg, Julie B. Schnur, Daniel David, Alisan Goldfarb, Christina R. Weltz, Clyde Schechter, Joshua Graff-Zivin, Kristin Tatrow, Donald D. Price and Jeffrey H. Silverstein

Author Affiliations:

  1. Department of Oncological Sciences (GHM, DHB, JBS)
  2. Department of Surgery (AG, CRW), and Department of Anesthesiology Sciences (JHS), Mount Sinai School of Medicine, New York, NY
  3. Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania (DD)
  4. Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (CS)
  5. Department of Health Policy and Management, Columbia University, New York, NY (JGZ)
  6. Department of Psychology, Good Shepherd Rehabilitation Hospital, Allentown, PA (KT)
  7. Departments of Oral and Maxillofacial Surgery and Neuroscience, University of Florida, Gainesville, FL (DDP)

Study 10: Self-Hypnosis for Percutaneous Tumor Treatment – Pain and Anxiety
Beneficial Effects of Hypnosis and Adverse Effects of Empathic Attention during Percutaneous Tumor Treatment: When Being Nice Does Not Suffice
http://www.jvir.org/article/S1051-0443(08)00180-2/abstract

Results: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118).

Notes: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 µg fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (=50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment.

Journal of Vascular and Interventional Radiology, Volume 19, Issue 6, Pages 897-905, June 2008
Elvira V. Lang, MD, Kevin S. Berbaum, PhD, Stephen G. Pauker, MD, Salomao Faintuch, MD, Gloria M. Salazar, MD, Susan Lutgendorf, PhD, Eleanor Laser, PhD, Henrietta Logan, PhD, David Spiegel, MD (Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts 02215, USA

Study 11: Hypnosis for Venipuncture for Blood Sampling of Cancer Patients Aged 6 to 16 – Pain, Anxiety (and also Anxiety of Parents)
A randomized clinical trial of a brief hypnosis intervention to control venipuncture-related pain of pediatric cancer patients
http://www.painjournalonline.com/article/S0304-3959(09)00046-3/abstract

Results: Confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety, and less procedure-related pain and anxiety, and were rated as demonstrating less behavioral distress during the procedure than patients in the other two groups. Parents whose children were randomized to the local anesthetic plus hypnosis condition experienced less anxiety during their child’s procedure than parents whose children had been randomized to the other two conditions. The therapeutic benefit of the brief hypnotic intervention was maintained in the follow-up.

Notes: Venipuncture for blood sampling can be a distressing experience for a considerable number of children. A prospective controlled trial was conducted to compare the efficacy of a local anesthetic (EMLA) with a combination of EMLA with self-hypnosis in the relief of venipuncture-induced pain and anxiety in 45 pediatric cancer outpatients (age 6-16years). A secondary aim of the trial was to test whether the intervention will have a beneficial effect on parents’ anxiety levels during their child’s procedure. Patients were randomized to one of three groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention.

PAIN, Volume 142, Issue 3, Pages 255-263, April 2009
By: Christina Liossi, Paul White, Popi Hatira, School of Psychology, University of Southampton, Highfield, Southampton S017 1BJ, UK

Study 12: Hypnosis for Chemotherapy Related Nausea and Vomiting
Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2354.2006.00736.x/abstract

Results: Studies report positive results including statistically significant reductions in anticipatory and “cancer chemotherapy-induced nausea and vomiting” (“CINV”). Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioral therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer.

Notes: To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A comprehensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases’ inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children.

European Journal of Cancer Care, Volume 16, Issue 5, pages 402-412, September 2007
By: J. RICHARDSON bsc(hons), phd, rn, cpsychol, pgce, rnt, reader in nursing and health studies1,*, J.E. SMITH ba(hons), msc, former research assistant2, G. MCCALL dcr(t), msc, applied hypnosis, senior research radiographer & psychological support3, A. RICHARDSON bn(hons), msc, phd, rn, pgdiped, rnt, professor of cancer and palliative nursing care4, K. PILKINGTON bpharm(hons), dipinfsci, msc, pcme, mrpharms5, I. KIRSCH ba , ma , phd , professor of psychology 6

Author Information:

  1. Faculty of Health and Social Work, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon
  2. NHSP/CAMEO project, Research Council for Complementary Medicine, South-East London Cancer Centre, St Thomas’ Hospital, London
  3. The Florence Nightingale School of Nursing and Midwifery, King’s College London, Franklin Wilkins Building, London
  4. Project Manager/Senior Research Fellow, School of Integrated Health and Research Council for Complementary Medicine, University of Westminster, 115 New Cavendish Street, London
  5. School of Applied Psychosocial Studies, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon, UK

Study 13: Hypnosis and Survivorship (Life with Cancer Post Treatment) – Hot Flashes in Breast Cancer Survivors
Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Survivors
http://jco.ascopubs.org/content/26/31/5022

Results: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency × average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group.
Conclusion: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.

Notes: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities.

Journal of Clinical Oncology, JCO November 1, 2008 vol. 26 no. 31 5022-5026
By: Gary Elkins, Joel Marcus, Vered Stearns, Michelle Perfect, M. Hasan Rajab, Christopher Ruud, Lynne Palamara and Timothy Keith

Author Affiliations:

  1. From the Department of Psychology and Neuroscience, Baylor University, Waco
  2. Scott and White Memorial Hospital and Clinic, Department of Psychiatry and Behavioral Sciences, Temple
  3. Cancer Treatment and Research Center, San Antonio; and University of Texas at Austin, TX; University of Arizona, Tucson, AZ
  4. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD

Study 14: Use of Hypnosis for Terminally Ill Hospice Cancer Patients – Insomnia, Itchiness, Bowel Issues, Pain, Chemotherapy Side Effects, Relaxation (and also suggests best time for Cancer Patients to start Hypnotherapy is right at time of diagnosis.)
Efficacy of Hypnotherapy as a supplement therapy in Cancer Intervention
http://bscw.rediris.es/pub/bscw.cgi/d4431493/Peynovska-Efficacy_hypnotherapy_supplement_therapy_cancer

Results: Of the 20 patients who completed the three sessions of hypnotherapy all reported varying degrees of anxiety. 5 patients wanted to have hypnotherapy for insomnia as a primary presenting complain, 1 for excessive itchiness during night time, 1 for excessively frequent bowel actions – 8 to 10 times a day for the last year, which invariably interfered with his social life and prevented him from going out, 8 wanted to have hypnotherapy for pain control, 3 patients opted for hypnotherapy to prevent the side effects of chemotherapy and 2 patients had it specifically for severe anxiety and panic attacks.
The 5 patients who had hypnotherapy for insomnia all reported improved sleeping patterns even after the first session. After the third session none of them complained of insomnia and this result was sustained till the followup, which was 3 to 4 months after the first session. They also reported increased energy levels, less tiredness and improved appetite. 2 of the patients with insomnia have been on Temazepam 10mg before bed, which they voluntarily stopped taking after the first session.

The patient with nighttime itchiness reported that their itchiness stopped after the first session and she continued with the remaining two hypnotherapy sessions working towards pain control.

The patient with frequent bowel action reported that he managed to half the number of times he went to the toilet after the second session.
Of the 8 patients who had hypnotherapy for pain control, all reported that the intensity of pain has significantly been reduced and as a result they have reduced heir dose of opiate analgesics taken daily.

The 3 patients, who took part in the study to prevent the side effects of chemotherapy, also reported very good results with no nausea, sickness and less loss of energy, which was in contrast with their previous experience with chemotherapy.

Most of the patients (19 out of 20) reported that after the first two hypnotherapy sessions they were able to relax for the first time in a very long period, felt less tired and more energetic, had more refreshing night sleep and as a result were able to cope better with their daily activities.

It appears that the best time for hypnotherapy to be offered to cancer patients is right at the time of diagnosis. In that way, patients will be able to develop better coping skills much earlier in the disease process, which will help them to possibly prevent severe anxiety, depression and panic attacks from developing. They will have better treatment compliance and generally will have a more positive psychological response to their illness, which has been suggested as a good prognostic factor with an influence on survival.

Notes: All the patients who took part in the trial were day hospice patients of Ann Delhom Centre, Wisdom Hospice, Rochester, UK. Patients were offered three hypnotherapy sessions and were assessed before the first session and after the third one together with a follow up after 3/4 months after the last session. On the first session all the patients were taught ”progressive muscle relaxation” and self- hypnosis. Short ego boosting was also incorporated at the end of the session. The second and third sessions were different for every patient depending on the expressed symptoms and because of that were always individually tailored. Most of the sessions included guided imagery and direct therapeutic suggestions.

2 European Journal of Clinical Hypnosis: 2005 Volume 6 – Issue 1
By: Dr Rumi Peynovska, Dr Jackie Fisher, Dr David Oliver, Prof V.M. MathewStone House Hospital, Dartford, West Kent NHS and Social Care Trust, Wisdom Hospice, Rochester, Medway NHS Trust
Dr Rumi Peynovska MD, MSc, FBAMH – Research Fellow, Stone House Hospital, Dartford, West Kent NHS Trust
Dr Jackie Fisher BSc, MRCGP – Consultant in Palliative Medicine, Wisdom Hospice, Rochester, Medway NHS Trust
Dr David Oliver BSc, FRCGP – Consultant and Medical Director, Wisdom Hospice, Rochester, Medway NHS Trust
Prof. V.M. Mathew MBBS, MPhil, MRCPsych – Clinical Director, Stone House Hospital, Dartford, West Kent NHS Trust