A report by the National Institutes of Health (NIH) cites
evidence supporting the efficacy of hypnosis for relief of chronic pain in
cancer, irritable bowel syndrome, and tension headaches.1 The October issue of
the Annals of Palliative Medicine includes a review of relevant findings and
techniques.2
“In recent years, clinical hypnosis and modified states of
consciousness, like meditative states, have become significant topics of
researchers in psychology, philosophy, medicine, and neuroscience,” author Maria
Paola Brugnoli, MD, from the Department of Surgical Sciences, Anesthesiology,
Intensive Care and Pain Therapy at the University of Verona in Italy, told
Clinical Pain Advisor.
Clinical hypnosis aligns with the World Health
Organization's global perspective for palliative care, including the aspect of
providing relief from symptoms such as pain, anxiety and depression, fatigue,
nausea, and sleep impairment.
Results of brain imaging studies demonstrate that “hypnosis
influences all of the cortical areas and neurophysiological processes that
underlie pain and emotions,” according to a review.3 "Neurophysiological
top-down regulatory processes — like attention, cognitive control, and
monitoring — play a central role in mediating responses to hypnotic suggestions
for pain relief,” said Dr Brugnoli.
Hypnotic analgesia has been linked with more significant
reductions in pain-related outcomes, compared to standard care and non-hypnotic
interventions such as education and physical therapy.4 In the review, Dr Brugnoli
details various hypnotic techniques that clinicians may use with pain patients,
as well as brief self-hypnosis techniques that patients can use.
“The use of hypnosis often includes an induction phase to
increase mental absorption, followed by a suggestion phase providing directions
to elicit particular changes in thoughts, behaviors, and sensations such as
pain,” explained Dr Brugnoli.
For example, once a state of relaxation has been induced in
patients, they may be trained to interpret the sensation of pain or other
distressing symptoms as a different sensation, such as anesthetizing pressure
or warmth.
Another technique uses mental imagery to shift attention
from the painful sensation to a different part of the body that is unaffected
by pain. In self-hypnosis for acute pain relief, a patient might do a brief
exercise in which they say to themselves, “Now I will sleep for X minutes while
my pain decreases,” and then, count down from 20 to 1.
In light of the evidence regarding the efficacy of hypnosis
in pain treatment, these treatments represent an option for patients who
indicate an interest in them.
“Clinical hypnosis in palliative care increases comfort by
lessening pain, controlling symptoms… and lessening stress for the patient and
family, and should not be delayed when it is indicated,” Dr Brugnoli concluded
in the review.
Summary and Clinical
Applicability
A variety of hypnotic techniques may be effectively used as
adjuvant treatment in the management of pain and other distressing symptoms in
patients with severe chronic diseases.
References
National Institutes of Health. Integration of behavioral and
relaxation approaches into the treatment of chronic pain and insomnia. JAMA.
1996; 276(4):313-318.
Brugnoli MP. Clinical hypnosis for palliative care in severe
chronic diseases: a review and the procedures for relieving physical,
psychological and spiritual symptoms. Ann Palliat Med. 2016; 5(4):280-297.
Tononi G, Koch C. The neural correlates of consciousness: an
update. Ann N Y Acad Sci. 2008; 1124:239-261.
Adachi T, Fujino H, Nakae A, Mashimo T, Sasaki J. A
meta-analysis of hypnosis for chronic pain problems: a comparison between
hypnosis, standard care, and other psychological interventions. Int J Clin Exp
Hypn. 2014; 62(1):1-28.
