Hypnosis for the Relief and Control of Pain - APA article

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