Background & Aims
Hypnosis is an effective treatment for chronic pain1–5, relying on a biopsychosocial model encompassing social, psychological, and biological factors. Research on the neurophysiological responses to hypnosis in patients in a clinical setting are rare. Hence, this study was designed to evaluate autonomic responses of chronic pain patients undergoing hypnosis treatment at a tertiary pain center. Moreover, the standardized measures of hypnotizability, used in experimental settings involve time-consuming procedures unsuitable for routine clinical care6–9. Yet, self-rated Visual Analog Scales (VAS) for dissociation and absorption show promise in assessing hypnotizability in a more practical manner10. This preliminary analysis focuses on perceived benefits of treatment and their correlations with patient attitudes, dissociation, and absorption.
Methods
Patients undergoing hypnosis treatment for chronic pain management were included. Data collection occurred during the first hypnosis session, an intermediate session and towards the end of treatment. At the 1st session, demographic information, medical history, and expectations regarding hypnosis were gathered. Overall pain intensity, desire for pain relief and beliefs were assessed using VASs. Practitioner expectations for patient relief were collected on a numerical rating scale after the 1st session.
Before and after each hypnosis session, the patients rated pain intensity and relaxation state on separate VASs.
At the end of each session, participants rated their satisfaction, absorption, and dissociation levels on specific VASs and reported the frequency of self-hypnosis practice and overall health evolution. Practitioners additionally rated their perception of the patient’s adherence to the session, absorption, dissociation, and imaginative capacity on separate VASs.
Results
This intermediate analysis includes the clinical data of n=110 patients (63% women, mean age: 47.8±15.8) who underwent session 1 and 2 (and of which n=56 had a 3rd session). They suffered from long-lasting pain (mean years: 9.9±10.6), moderate to intense (mean: 6.0±2.1) and expressed a strong desire for pain relief (mean: 9.3±0.7). Pain intensity was significantly lower at patient’s arrival on session 2 vs. session 1 (p=0.002) and after hypnosis vs. before at each session (all p’s<0.0001). Over the 3 sessions, patients’ absorption and dissociation correlated with pain relief (pre-post hypnosis VAS) (rrm(163)=0.2, p<0.01 and rrm(163)=0.16, p<0.05). Patient and caregiver-rated scales also correlated for absorption (rrm(163)=0.36, p<0.0001) and dissociation (rrm(163)=0.31, p<0.0001). After 3 to 4 hypnosis sessions, 58% of patients reported some improvement, and 77% towards end of treatment. This improvement correlated with the frequency of self-hypnosis practice (r(108)=0.33, p<0.001).
Conclusions
This study shows a long-lasting pain relief with a significant reduction in pain intensity between pain ratings before hypnosis session 2 vs. session 1. Over the 3 sessions, mean pain VAS ratings were immediately reduced by 0.9 to 1.5 point/10, which aligns with recent meta-analyses2, highlighting the consistency of hypnosis-induced pain relief. Moreover, the study’s longitudinal design will allow exploration of potential learning effects and pain evolution over time, according to patient’s individual trait-like differences, and implication in treatment. Expectation effects, both on the patient and provider level will be explored and put into relationship. Furthermore, the analysis of physiological signals will allow to evaluate if there is a link between neurophysiological responses and patient’s attitude and abilities during the treatment as well as perceived benefits, considering pre-existing expectation effects.
References
1.Jensen, M. P. Hypnosis for chronic pain management: a new hope. Pain 146, 235–237 (2009).
2. Langlois, P. et al. Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews 135, 104591 (2022).
3. Montgomery, G. H., DuHamel, K. N. & Redd, W. H. A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? Int J Clin Exp Hypn 48, 138–153 (2000).
4. Patterson, D. R. & Jensen, M. P. Hypnosis and clinical pain. Psychol Bull 129, 495–521 (2003).
5. Tomé-Pires, C. & Miró, J. Hypnosis for the Management of Chronic and Cancer Procedure-Related Pain in Children. International Journal of Clinical and Experimental Hypnosis 60, 432–457 (2012).
6. Spiegel, H. & Spiegel, D. Trance and Treatment: Clinical Uses of Hypnosis. (American Psychiatric Pub, 2008).
7. Shor, R. E. & Orne, E. C. Harvard Group Scale of Hypnotic Susceptibility, Form A. (1961) doi:10.1037/t02246-000.
8. Spanos, N. P., Radtke, H. L., Hodgins, D. C., Stam, H. J. & Bertrand, L. D. The Carleton University responsiveness to suggestion scale: normative data and psychometric properties. Psychol Rep 53, 523–535 (1983).
9. Näring, G. W., Roelofs, K. & Hoogduin, K. A. The Stanford Hypnotic Susceptibility Scale, Form C: normative data of a Dutch student sample. Int J Clin Exp Hypn 49, 139–145 (2001).
10. Vanhaudenhuyse, A. et al. CAN SUBJECTIVE RATINGS OF ABSORPTION, DISSOCIATION, AND TIME PERCEPTION DURING ‘NEUTRAL HYPNOSIS’ PREDICT HYPNOTIZABILITY?: An exploratory study. Int J Clin Exp Hypn 67, 28–38 (2019).
Presenting Author
Aimie Chiron
Poster Authors
Aimie Chiron
MSc
Center for Integrative and Complementary Medicine, CHUV, Switzerland
Lead Author
Nina Rimorini MSc
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Corine Guyaz
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Fanny Castro Balasch MD
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Cyril Chams MD
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Noëmí Zurrón MD
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Aurore Fernandez
CHUV
Lead Author
Chantal Berna Prof. MD PhD
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Topics
- Treatment/Management: Complementary and Alternative therapies