Not very many people enjoy injections or procedures involving needles - except when they have found treatments such as trigger point injections, prolotherapy, perineural injections therapy so helpful that they eagerly anticipate their next visit to the clinic. Some, however, who could benefit from dental visits or medical procedures, postpone or avoid them due to a needle phobia. Needle Phobia is much more than a simple dislike of the discomfort associated with needles; a person with a needle phobia feels sudden severe anxiety, panic, perhaps nausea or may even faint at the the mere thought of a needle, or hearing someone describe an injection, or sees a picture or movie about medical procedures. Clinical hypnosis addressing the root cause of such fears can eliminate the phobia, usually in one or two sessions. You don't have to actually like having injections to be free of an unnecessary phobia. 

The following abstracts represent just a few of the many peer-reviewed scientific journal articles on clinical hypnotherapy for IBS. Our program is based largely the research of Palsson and Whorwell, mentioned below. 

Tan, G., Hammond, D. C., & Gurrala, J. (2005). Hypnosis and Irritable Bowel Syndrome: A Review of Efficacy and Mechanism of Action. American Journal of Clinical Hypnosis, 47(3), 161–178. doi:10.1080/00029157.2005.1040 Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, distension, and an altered bowel habit for which no cause can be found. Despite its prevalence, there remains a significant lack of efficacious medical treatments for IBS to date. In this paper we reviewed a total of 14 published studies (N = 644) on the efficacy of hypnosis in treating IBS (8 with no control group and 6 with a control group). We concluded that hypnosis consistently produces significant results and improves the cardinal symptoms of IBS in the majority of patients, as well as positively affecting non-colonic symptoms. When evaluated according to the efficacy guidelines of the Clinical Psychology Division of American Psychological Association, the use of hypnosis with IBS qualifies for the highest level of acceptance as being both efficacious and specific. In reviewing the research on the mechanism of action as to how hypnosis works to reduce symptoms of IBS, some evidence was found to support both physiological and psychological mechanisms of action.

Palsson, O. S., Turner, M. J., Johnson, D. A., Burnett, C. K., & Whitehead, W. E. (2002). Hypnosis Treatment for Severe Irritable Bowel Syndrome Investigation of Mechanism and Effects on Symptoms. Digestive Diseases and Sciences, 47(11), 2605–2614. doi:10.1023/a:1020545017390 Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.

Palsson, O. S., & Whitehead, W. E. (2002). The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders. Gastroenterology, 123(6), 2132–2135. doi:10.1053/gast.2002.37286 The availability and affordability of this therapy would be vastly increased if the same kind of face-toface hypnosis treatment found effective for FD and IBS would also help patients when administered exclusively in a home-treatment audio format. No data have been presented to date to make it possible to conclude whether this is feasible. In conclusion, although some of the studies to date on hypnotherapy for functional GI disorders have been small and lacking in methodological rigor, and many research questions remain unanswered, the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS.

Review of the Empirical Evidence. American Journal of Clinical Hypnosis, 58(2), 134– 158. doi:10.1080/00029157.2015.1039 Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain’s handling of sensory signals from the GI tract.

Whitehead, W. E. (2006). Hypnosis for Irritable Bowel Syndrome:The Empirical Evidence of Therapeutic Effects. International Journal of Clinical and Experimental Hypnosis, 54(1), 7–20. doi:10.1080/00207140500328708 Abstract: Irritable bowel syndrome (IBS) is a complex and prevalent functional gastrointestinal disorder that is treated with limited effectiveness by standard medical care. Hypnosis treatment is, along with cognitive-behavioral therapy, the psychological therapy best researched as an intervention for IBS. Eleven studies, including 5 controlled studies, have assessed the therapeutic effects of hypnosis for IBS. Although this literature has significant limitations, such as small sample sizes and lack of parallel comparisons with other treatments, this body of research consistently shows hypnosis to have a substantial therapeutic impact on IBS, even for patients unresponsive to standard medical interventions. The median response rate to hypnosis treatment is 87%, bowel symptoms can generally be expected to improve by about half, psychological symptoms and life functioning improve after treatment, and therapeutic gains are well maintained for most patients for years after the end of treatment.

​Whorwell, P. J., Prior, A., & Faragher, E. B. (1984). CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME. The Lancet, 324(8414), 1232–1234. doi:10.1016/s0140-6736(84)92793-4 30 patients with severe refractory irritable bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.
​

If the only experience one has had or observed about hypnosis is a stage or other entertainment venue, or perhaps from cartoons (such as Scooby-Doo) or movies, one may not be aware of how gentle, yet powerful, respectful and effective clinical hypnosis can be in a medical setting. In this video, Dr. Rob McNeilly in Australia is working with a young girl who wanted to get rid of her fear of dogs.The interaction is playful, enjoyable, and safe, and released her permanently from that old phobia. 

Despite robust evidence for myriad ailments and sound
mechanistic data, hypnosis is underused by internists. Using
hypnosis fulfills our pledge to abide by evidence-based
treatments that alleviate suffering with the least collateral
harm, but there is a discrepancy between its benefits and
physicians who offer the treatment. Although hypnosis may
appear in the medical curricula at academic powerhouses
like Baylor, Harvard, Columbia, and Stanford, hypnosis
training is rare even at these institutions. Here is why a
modern resurrection of the oldest Western form of psychotherapy
should inspire internists to get trained and offer
medical hypnosis broadly.
Hypnosis, and its myths and misconceptions, have
evolved since the 18th century when Franz Mesmer inadvertently
led hypnosis into obscurity with his theory about
manipulating a force called “animal magnetism.” These
claims were dispelled by the French Royal Academy of Sciences,
and it took nearly 100 years for Scottish physician
James Braid to first describe a mental and suggestive theory
of hypnosis as a waking physiologic state. The 2014 definition
from the American Psychological Association’s Division
30 describes hypnosis as “a state of consciousness
involving focused attention and reduced peripheral awareness
characterized by an enhanced capacity for response to
suggestion.” Long-standing empirical evidence demonstrates
that hypnosis impacts perception, symptoms, and
habits, which have recently been explained by advanced
diagnostic modalities like functional magnetic resonance
imaging (fMRI). Changes during hypnosis include reduced
activity in the dorsal portion of the anterior cingulate cortex
(a key component of the salience network) and connectivity
between the prefrontal cortex and the insula (a pathway
for mind-body control).1 Augmented by data on neurotransmitter
metabolism and genetics, the neurophysiologic
basis of hypnosis is no longer mysterious. Though our
understanding of the mechanism of action of hypnosis is
more robust than that of even acetaminophen, this has not
sufficed to enhance its use.
Skeptics describe hypnosis in 1 of 3 ways: dangerous
mind control, an ineffective farce, or placebo. It is often
viewed as a loss of control and, therefore, dangerous, when
in fact it is a powerful means of teaching patients how to
control mind and body. The ability to enter into hypnosis,
termed hypnotizability, is a stable trait possessed by most
people, which can be entered into or terminated by the
patient. It is not effective in the presence of conditions such
as stroke or schizophrenia or impaired focused attention or
language processing. Hypnosis is more powerful than placebo
(though patient expectancy is a moderating factor),
and placebo effect is blocked by administration of naloxone,
while the hypnotic analgesia is not.2
Reviews on hypnosis for internal medicine topics are
impressive,3 with demonstrated efficacy for migraine headache,
4 irritable bowel syndrome,5 and anxiety.6 Hypnosis
improves procedural pain and emotional distress and
reduces medication consumption up to 40%7--in short, if
hypnosis were a drug, it would be standard of care. Internists
should prescribe hypnosis particularly when it outperforms
the current standard of care by safety and efficacy, as
in the case of opioids and sedatives.
Patients have a strong appetite for taking charge of their
symptoms; online hypnosis videos for anxiety and insomnia
boast 15-19 million views, and medical hypnosis is quite
acceptable by patients.8 But patients cannot be expected to
differentiate between legitimate and manipulative sources
of hypnosis online any more than if they bought pills off
the street. This treatment modality falls under the purview
of medicine, and our duty is to provide safe access. To do
this, we must improve the supply.
Formal training for medical providers is offered through
national societies, such as the American Society of Clinical
Hypnosis (ASCH) and Society for Clinical and Experimental
Hypnosis (SCEH). Trainings span 4 days and include
ethics and informed consent in addition to practical skills.
Hospital credentialing for the privilege of hypnosis may be
required: If none exists, designing one to include formal
training and mentorship requirement is advised. For
ARTICLE IN PRESS
Funding: None.
Conflicts of Interest: None.
Authorship: Both authors had access to the data and a role in writing
this manuscript.
Requests for reprints should be addressed to Jessie Kittle, MD, 300
Pasteur Dr MC 5210, Stanford, CA, 94305.
E-mail address: jkittle@stanford.edu
0002-9343/© 2020 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjmed.2020.10.010
COMMENTARY

A new 7-session private-pay Gut-Directed Hypnotherapy program is being offered via Telemedicine by Dr. David Bowler. Chiefly intended for irritable bowel syndrome, it can be adapted for GERD and for symptom reduction as an adjunct to conventional therapy for inflammatory bowel disorders, using the validated peer-reviewed North Carolina protocol. Patients must have been appropriately evaluated and referral must include all relevant investigations and GI consults if available. Initial session is 60-90 minutes, subsequent ones 30-45 minutes, at approximately 2-week intervals.
 
A medical consultation, online or in person, to review the history and provide information will be arranged prior to the first hypnotherapy session. 
 
 
Physicians and nurse practitioners can fax referrals to 1-844-820-7073.
 

Fibromyalgia
Fibromyalgia is a common long-term condition, affecting 2-4% of the population, more commonly women than men, that causes pain all over the body along with many other symptoms.  People with fibromyalgia often have:

• Tenderness to touch or pressure affecting the skin or soft-tissues – this is the most obvious complaint and often is misdiagnosed as tendonitis, tennis elbow, or arthritis.   This tenderness is generally in a fairly symmetrical pattern over the shoulders, neck, base of the skull, upper chest, arms, legs, lower back, buttocks, hips, thighs, and lower legs - in short, all over. 
• Severe fatigue – fibromyalgia is often thought to be related to chronic fatigue syndrome – there is debate about whether they are different conditions or both on the same spectrum of illnesses
• Sleep problems (waking up unrefreshed) – called non-restorative sleep
• Problems with memory, concentration, or thinking clearly (cognitive symptoms, often referred to as “fibro-fog”)
• Depression or anxiety
• Migraine or tension headaches
• Irritable bowel syndrome (commonly called IBS) with cramps, bloating, constipation or diarrhea
• Gastroesophageal reflux disease (often referred to as GERD) or heartburn
• Irritable or overactive bladder, often labelled as interstitial cystitis
• Pelvic pain
• Temporomandibular disorder - often called TMJD that may include face or jaw pain, jaw clicking, and ringing in the ears. 

While not part of fibromyalgia itself, it is not unusual for patients to also complain of multiple chemical sensitivities. They may be told they have costochondritis because the upper chest is tender.They may also have numbness or tingling in the hands and feet suggestive of a nerve disorder. 

Books and articles often say that the causes of fibromyalgia are unknown. It may be that it is the final destination arrived at from a variety of different starting points. For some people it occurs after an illness such as influenza; for others after an accident or other traumatic event. For many it develops gradually after an overwhelming incident or as the culmination of years of accumulated stressful events, often dating back to childhood. Numerous studies have found that between 50 and 63% of patients with fibromyalgia also meet the criteria for post-traumatic stress disorder, frequently reporting adverse childhood events or subsequent physical or emotional trauma. Adverse childhood events (such as the loss of a parent, abusive or chaotic households, early hospitalizations, accidents, neglect etc), and later traumas all can prime the nervous system's fight/flight/freeze response, giving rise to a sense of being unsafe in the world, and cause the body to respond with physical symptoms. Chronically elevated stress hormones change the way our glucose metabolism and digestive function work, cause increased muscular tone (tight muscles), and affect our immune system function. 

There is a complex inter-relationship between our nervous systems, our hormones, immune systems, gastrointestinal system, and our muscular function, including how the energy powerhouses (mitochondria) in our cells function. In other words, although it is a very real physical condition, the pain is being produced in the nervous system in response to (usually prolonged and cumulative) internal (such as the demands or expectations we place on ourselves) and external sources of stress. It can also be triggered by sleep deprivation in some people.  

For this reason, it is possible to turn the pain down or even off, by means of techniques that address past trauma, anxiety, stress, beliefs and expectations, as well as by optimizing nutrition, sleep and general well-being through regular exercise (while avoiding extreme of activity).  Coming to an understanding of the condition reduces fear, which in turn can substantially reduce pain intensity.

Fibromyalgia can be best thought of as a central nervous system condition in which the brain and spinal cord are sensitized and therefore respond to sensations which are perceived as much more painful than the same sensation would be experienced by someone without fibromyalgia. It is sometimes referred to as a Central Pain Amplification Disorder. Similarly, people with irritable bowel syndrome will perceive the same degree of gaseous intestinal distension as being much more painful than someone without IBS would do. It is as though the pain ‘thermostat’ or dial has been turned up to a very high level. 

Unlike rheumatoid arthritis or lupus, fibromyalgia is not an autoimmune or inflammatory condition. It can co-exist with arthritis but it is not primarily a joint condition. It does not lead to any ilife-threatening disease.

Fibromyalgia may run in families to some extent but whether this is genetic or due to a common environment (similar stresses) or a learned response to adverse circumstances is not clear. A small subset of people with symptoms suggestive of fibromyalgia have been found on skin biopsy to have an abnormality of small nerve fibres. Genetics alone cannot explain fibromyalgia. Symptoms tend to be worse with stress, over-work, excessive exercise, or sleep deprivation. 

Diagnosing Fibromyalgia

1. symptoms as mentioned above, present for more than 3 months with no other explanation
2. pressure at certain common soft tissue points on physical exam can be helpful to detect tenderness and to exclude other causes of muscle pain.

There is no specific blood test or X-ray that can diagnose fibromyalgia. Commonly tests will be ordered to exclude other conditions, for example, sleep apnea, an underactive thyroid, or polymyalgia rheumatica, anemia, iron-deficiency, rheumatoid arthritis or lupus. 

Treating fibromyalgia

While there is no one specific cure for fibromyalgia, approaching it from a number of different angles – certain medications, carefully structured aerobic exercise within one’s capabilities, and mind-body approaches such as relaxation, stress-reduction, Cognitive Behavioural Therapy, mindfulness, Tai Chi, and clinical hypnosis or guided imagery, can be helpful. Ensuring adequate sleep is essential. Some people have co-existent anxiety, depression, PTSD, panic disorder, all of which can also be treated.  Proper nutrition is also important. Anecdotally, some patients report a correlation between pain intensity and diet, such as refined carbohydrates, gluten, nightshades, or meat. This may be an individual response. 

A number of medications are often tried to reduce symptoms. Most of these are “off-label”. 

Low doses of an antidepressant called amitriptyline (Elavil) or related medications (such as nortriptyline or trazodone) can often be very helpful for pain, sleep, and to reduce migraines. 
A muscle relaxant such as cyclobenzaprine (Flexeril) can be helpful.  This is structurally similar to tricyclic antidepressants (TCAs) such as amitriptyline. 
A newer SNRI medication, duloxetine (Cymbalta) can sometimes help. 
Additional medications include pregabalin (Lyrica) and gabapentin (Neurontin) can be used. 
Another off-label medication is low dose naltrexone. 

Opioid narcotic medications are best avoided as they have significant side-effects, are largely ineffective, addictive and can lead to a conditions known as opiate-induced hyperalgesia, a parodoxical increase in pain the more opiates one cosumes. Of the opiates Tramadol may be better than the others but shares all the same risks as other opiates and interacts with other medications. 

Acetaminophen and anti-inflammatories (such as ibuprofen) are generally not effective for fibromyalgia but may help other co-existing pain. Sleeping tablets such as Zopiclone and benzodiazepines are not recommended. 

One small study published in December 2018 suggested that some patients with fibromyalgia may respond to treatment with a diabetes drug called metformin if their average sugar level (HBA1C) was in the high normal or elevated range. 

Gaining an understanding of fibromyalgia, engaging in self-care, ensuring good sleep, reducing stress, modifying behaviour, counselling, dietary modifications and supplements, and a judicious exercise regimen can all be helpful. 

In my own practice a combination of tender point injections, counselling, relaxation techniques, clinical hypnosis, medication and nutritional advice, and patient-education (which may include recommended reading and journalling) can lead to a significant reduction in symptoms, periods of remission, or even resolution. 

Steven Blake, a therapist in the UK, has skillfully woven together a number of therapeutic techniques by which it is possible for one to persuade the unconscious or subconscious mind to reduce or eliminate chronic pain which has outlived its usefulness. 

This technique has a number of premises including the understanding that acute (new) pain is helpful and protective, even though unpleasant, inasmuch as it is a warning that something is amiss (like an alarm signal) and needs to be sorted out, whereas, chronic (old) pain in general no longer serves a purpose, rather like something that is past its "sell-by date", or like an alarm which has malfunctioned and continued to ring long after the cause has been dealt with. Once chronic pain has been appropriately and thoroughly investigated medically and it has been determined that conventional medical therapy is either not available, effective or needed, then alternative means of relieving the suffering are appropriate, provided they are safe and effective.

Steven describes this process on his website.  This technique does not require a formal trance or hypnotic induction though it does require deep relaxation and can be combined with other therapies. 

It goes without saying that cause of a pain needs to be appropriately investigated before using these kinds of techniques to relieve the pain. The advantages of this technique include its safety, speed of onset, and remarkable effectiveness, not to mention that no drugs are involved. This technique has been effectively used in my office for a number of patients with chronic pain. Not everyone responds but there is nothing to lose but your pain. 



​

There has  been extensive research into the use of hypnosis for pain management over the years. 

A brief google scholar search bears this out. 

Hypnosis for the Relief and Control of Pain

Hypnosis is likely to be effective for most people suffering from diverse forms of pain, with the possible exception of a minority of patients who are resistant to hypnotic interventions.FindingsHypnosis is a set of techniques designed to enhance concentration, minimize one's usual distractions, and heighten responsiveness to suggestions to alter one's thoughts, feelings, behavior, or physiological state. Hypnosis is not a type of psychotherapy. It also is not a treatment in and of itself; rather, it is a procedure than can be used to facilitate other types of therapies and treatments. People differ in the degree to which they respond to hypnosis. The key to becoming hypnotized is the extent to which a person is hypnotizable, which is a very reliable and stable individual difference trait that indexes one's openness to hypnotic suggestions.
Research shows that hypnosis works as part of a treatment program for a number of psychological and medical conditions, with pain relief being one of the most researched areas, as shown in a 2000 study by psychologists Steven Lynn, PhD, Irving Kirsch, PhD, Arreed Barabasz, PhD, Etzel Cardeña, PhD, and David Patterson, PhD. Among the benefits associated with hypnosis is the ability to alter the psychological components of the experience of pain that may then have an effect on even severe pain.
In recent years, the anecdotal and sometimes exaggerated evidence for the effectiveness of hypnosis to decrease sensitivity to pain - known as hypno-analgesia - has been supplemented by well-controlled experiments. In their 2003 review of controlled clinical studies, Dr. Patterson and fellow psychologist Mark Jensen, PhD, found that hypno-analgesia is associated with significant reductions in: ratings of pain, need for analgesics or sedation, nausea and vomiting, and length of stay in hospitals. Hypnosis has also been associated with better overall outcome after medical treatment and greater physiological stability. Surgeons and other health providers have reported significantly higher degrees of satisfaction with their patients treated with hypnosis than with their other patients.
Depending on the phrasing of the hypnotic suggestion, the sensory and/or affective components of pain and associated brain areas may be affected (as shown by the brain imaging research of neuropsychologist Pierre Rainville, PhD, and collaborators in 1999). Patients who are most receptive to hypnotic suggestions in general, or highly hypnotizable, have found the greatest and most lasting relief from hypnosis techniques, but people with moderate suggestibility (the majority of people) also show improvement. Factors such as motivation and compliance with treatment may also affect responsiveness to hypnotic suggestions.
Drs. Patterson and Jensen's review concluded that hypnotic techniques for the relief of acute pain (an outcome of tissue damage) are superior to standard care, and often better than other recognized treatments for pain. Furthermore, a 2002 cost analysis by radiologists Elvira Lang, MD and Max Rosen, MD, that compared intravenous conscious sedation with hypnotic sedation during radiology treatment found that the cost of the hypnotic intervention was twice as inexpensive as was the cost for the standard sedation procedure. Chronic pain, which continues beyond the usual time to recover from an injury, usually involves inter-related psychosocial factors and requires more complex treatment than that for acute pain. In the case of chronic pain, Patterson and Jensen's review found hypnosis to be consistently better than receiving no treatment, and equivalent to the other techniques that also use suggestion for competing sensations, such as relaxation and autogenic training (which is similar to self-hypnotism).
SignificanceA meta-analysis (a study of studies) in 2000 of 18 published studies by psychologists Guy Montgomery, PhD, Katherine DuHamel, PhD, and William Redd, PhD, showed that 75% of clinical and experimental participants with different types of pain obtained substantial pain relief from hypnotic techniques. Thus, hypnosis is likely to be effective for most people suffering from diverse forms of pain, with the possible exception of a minority of patients who are resistant to hypnotic interventions. Drs. Patterson and Jensen indicate that hypnotic strategies are equivalent or more effective than other treatments for both acute and chronic pain, and they are likely to save both money and time for patients and clinicians. Evidence suggests that hypnosis might be considered a standard of treatment unless the person fails to respond to it or shows a strong opposition against it.Practical ApplicationHypno-analgesia is likely to decrease acute and chronic pain in most individuals, and to save them money in surgical procedures. Hypnotic analgesia has been used successfully in a number of interventions in many clinics, hospitals, and burn care centers, and dental offices. For acute pain, it has proven effective in interventional radiology, various surgical procedures (e.g., appendectomies, tumor excisions), the treatment of burns (dressing changes and the painful removal of dead or contaminated skin tissue), child-birth labor pain, bone marrow aspiration pain, and pain related to dental work, especially so with children. Chronic pain conditions for which hypnosis has been used successfully include, among others, headache, backache, fibromyalgia, carcinoma-related pain, temporal mandibular disorder pain, and mixed chronic pain. Hypnosis can alleviate the sensory and/or affective components of a pain experience, which may be all that is required for acute pain. Chronic conditions, however, may require a comprehensive plan that targets various aspects besides the pain experience. The patient may need help increasing behaviors that foster well-being and functional activity (e.g., exercise, good diet) challenging faulty thinking patterns (e.g., "I cannot do anything about my pain"), restoring range of motion and appropriate body mechanics, and so on. Clinicians using hypno-analgesia should be up to date in other treatments for pain besides hypnosis, consult with other specialists as appropriate, and integrate different strategies to provide the most effective and enduring relief for pain.Cited ResearchLang, E. V., & Rosen, M. P. (2002). Cost analysis of adjunct hypnosis with sedation during outpatient interventional radiologic procedures. Radiology, 222, pp. 375-82.
Lynn, S. J., Kirsch, I., Barabasz, A., Cardeña, E., & Patterson, D. (2000). Hypnosis as an empirically supported clinical intervention: The state of the evidence and a look to the future. International Journal of Clinical and Experimental Hypnosis, Vol. 48, pp. 235-255.
Montgomery, G. H., DuHamel, K. N., & Redd, W. H. (2000). A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? International Journal of Clinical and Experimental Hypnosis, Vol. 48, pp. 138-153.
Patterson, D. R., & Jensen, M. P. (2003). Hypnosis and clinical pain. Psychological Bulletin, Vol. 129, pp. 495-521.
Rainville, P., Carrier, B., Hofbauer, R. K., Bushnell, M. C., & Duncan, G. H. (1999). Dissociation of sensory and affective dimensions of pain using hypnotic modulation. Pain, Vol. 82, pp. 159-71.

American Psychological Association, July 2, 2004