Hypnotic Pain Research Articles

Hypnotic pain management during ultrasound-guided infiltration of the hand

Ultrasound-guided infiltration, performed to relieve pain, is a common and sometimes painful procedure, particularly on the hand. This potential pain, induced by the treatment, can cause apprehension in patients prior to such a procedure. The rheumatology team at the departmental hospital center (CHD) in Vendée hypothesized that a hypnosis session, by creating an imaginary glove on the patient's painful hand prior to the procedure, could help reduce the pain felt, as well as anxiety.

Influences of hypnotic suggestibility, contextual factors, and EEG alpha on placebo analgesia

ABSTRACT We tested the role of hypnotic suggestibility, involuntariness, pain expectation, and subjective hypnotic depth in the prediction of placebo analgesia (PA) responsiveness. We also tested the link of lower and upper alpha sub-band (i.e., ‘alpha1ʹ and ‘alpha2ʹ) power changes with tonic PA responding during waking and hypnosis conditions. Following an initial PA manipulation condition, we recorded EEG activity during waking and hypnosis under two treatments: (1) painful stimulation (Pain); (2) painful stimulation after application of a PA cream. Alpha1 and alpha2 power were derived using the individual alpha frequency method. We found that (1) PA in both waking and hypnosis conditions significantly reduced relative pain perception; (2) during waking, all the above mentioned contextual measures were associated with pain reduction, while involuntariness alone was associated with pain reduction within hypnosis. Enhanced alpha2 power at the left-parietal lead was solely associated with pain reduction in waking, but not in hypnosis condition. Using multiple regression and mediation analyses we found that: (i) during waking, the enhancement of relative left-parietal alpha2 power, directly influenced the enhancement in pain reduction, and, indirectly, through the mediating positive effect of involuntariness; (j) during hypnosis, the enhancement of left-temporoparietal alpha2 power, through the mediation of involuntariness, influenced pain reduction. Current findings obtained during waking suggest that enhanced alpha2 power may serve as a direct-objective measure of the subjective reduction of tonic pain in response to PA treatment. Overall, our findings suggest that placebo analgesia during waking and hypnosis involves different processes of top-down regulation.

Hypnotic responding and the Five Factor Personality Model: Hypnotic analgesia and Openness to Experience

This study evaluated Openness to Experience as a moderator of the effect of hypnosis on pain. Four hundred and sixty-one introductory psychology students were randomly assigned to analogue versions of hypnotic analgesia, cognitive-behavioral, or placebo-control pain treatments. Thereafter, participants completed a questionnaire measure of the Big Five factors. Openness to Experience moderated the effect of treatment condition. Openness was more strongly related to the relief produced by our hypnotic analgesia condition than to the relief generated by our cognitive-behavioral and placebo-control conditions. This study is the first to clearly place individual differences in hypnotic pain reduction, and by extension, individual differences in hypnotic responding, within the broad domain of the Openness to Experience factor of the Five Factor Personality Model.

Hypnotize Yourself Out of Pain Now: A Powerful, User-Friendly Program for Anyone Searching for Immediate Pain Relief – Second edition Hypnotize Yourself Out of Pain Now: A Powerful, User-Friendly Program for Anyone Searching for Immediate Pain Relief – Second edition

This exceptional book and CD comprehensively describe ways that self-hypnosis can aid pain management. Readers are encouraged to identify hypnotic pain management strategies that will best meet their needs, and use them skilfully. This helps reduce the powerlessness reported by many people with ongoing pain.

Effect of hypnotic pain modulation on brain activity in patients with temporomandibular disorder pain

Hypnosis modulates pain perception but the associated brain mechanisms in chronic pain conditions are poorly understood. Brain activity evoked by painful repetitive pin-prick stimulation of the left mental nerve region was investigated with use of fMRI in 19 patients with painful temporomandibular disorders (TMD) during hypnotic hypoalgesia and hyperalgesia and a control condition. Pain intensity and unpleasantness of the painful stimulation was scored on a 0–10 Numerical Rating Scale (NRS). NRS pain and unpleasantness scores during hypnotic hypoalgesia were significantly lower than in the control condition and significantly higher in the hypnotic hyperalgesia condition. In the control condition, painful stimulation caused significant activation of right posterior insula, primary somatosensory cortex (SI), BA21, and BA6, and left BA40 and BA4. Painful stimulation during hypnotic hyperalgesia was associated with increased activity in right posterior insula and BA6 and left BA40 whereas hypnotic hypoalgesia only was associated with activity in right posterior insula. Unexpectedly, direct contrasts between control and hypnotic hyperalgesia conditions revealed significant decreases in S1 during hyperalgesia. Direct contrasts between control and hypnotic hypoalgesia conditions demonstrated significant decreases in right posterior insula and BA21, as well as left BA40 during hypoalgesia. These findings are the first to describe hypnotic modulation of brain activity associated with nociceptive processing in chronic TMD pain patients and demonstrate that hypnotic hypoalgesia is associated with a pronounced suppression of cortical activity and a disconnection between patient-based scores and cortical activity in S1 during hypnotic hyperalgesia.

Expanding Hypnotic Pain Management to the Affective Dimension of Pain

Experimental (Price & Barber, 1987) and neuroimaging studies (Rainville, Carrrier, Hofbauer, Bushnell, & Duncan, 1999), suggest that it is the affective dimension of pain as processed in the anterior cingulate cortex (ACC) that is most associated with suffering and autonomic arousal. Conversely, pain related emotions (Rainville, Bao, & Chretien, 2005) and expectations (Koyama, McHaffie, Laurenti, & Coghill, 2005) modulate pain perception and associated pain affect. This paper presents both the scientific background and the general clinical steps involved in a practical hypnotic approach that uses emotion specific wording and the elicitation of prior positive experience to intervene at both the affective and sensory dimensions of pain. Such an approach enables patients to therapeutically use hypnosis to reduce their subjective distress even if they are not able to greatly reduce the sensation of pain. The utilization of positive state dependent learning (Rossi, 1986), following the advice of Milton Erickson to “discover their patterns of happiness” (Parsons-Fein, 2005) is emphasized.

The Fearfulness of Chronic Pain and the Centrality of the Therapeutic Relationship in Containing It: An Interpretative Phenomenological Analysis

This paper presents an in-depth, idiographic study of the experience of chronic benign pain sufferers going through a simple hypnotic pain management relaxation exercise. The objective of this study was not to evaluate the efficacy of the intervention but to explore the participant's experience of any change that might occur. Semi-structured interviews were conducted with patients before and after the exercise and the resultant transcripts subjected to interpretative phenomenological analysis. Two themes emerged in the analysis and are discussed here: “The fearfulness of pain” and “The containment of fear through a social connection.” The participants' conceptions of their chronic pain did not change but their beliefs and feelings about themselves did. Through an alliance with the therapist, the participants described how they felt better able to contain the fear they felt toward their pain and were less disabled as a result. The importance or relevance of the relationship between patients and staff in chronic pain management and the social context of the fear of pain is discussed.

Recent developments in the study of hypnotic pain reduction: a new golden era of research?

AbstractThis article presents a selective review of recent developments in research on hypnotic pain reduction. A profusion of well‐controlled studies of hypnotic analgesia in children suggests that hypnosis ranks among the more effective psychological tools for managing the distress experienced by youngsters undergoing invasive medical procedures. This literature also draws attention to the importance of matching interventions to natural pain coping strategies. Virtual reality hypnosis shows much promise as a treatment and may offer hope to people who might otherwise be unable to experience hypnotic analgesia. Response expectancies appear to be a key psychological mechanism of hypnotic pain reduction. Neuroimaging studies point to activity in the midcingulate cortex as a possible biological mechanism of hypnotic analgesia. More generally, based upon the findings of a sound empirical literature, important meta‐analytic and qualitative reviews have concluded that hypnosis is effective for reducing both experimental and clinical pain. Indeed, the study of hypnotic pain reduction is vigorous, innovative, and may well have entered a golden era of research. Copyright © 2008 British Society of Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd.

Is high hypnotic suggestibility necessary for successful hypnotic pain intervention?

Hypnotic suggestibility is a trait-like, individual difference variable reflecting the general tendency to respond to hypnosis and hypnotic suggestions. Research with standardized measures of hypnotic suggestibility has demonstrated that there are substantial individual differences in this variable. Higher suggestibility has been found to be associated with greater relief from hypnotic pain interventions. Although individuals in the high suggestibility range show the strongest response to hypnotic analgesia, people of medium suggestibility, who represent approximately one third of the population, also have been found to obtain significant relief from hypnosis. Thus, high hypnotic suggestibility is not necessary for successful hypnotic pain intervention. However, the available evidence does not support the efficacy of hypnotic pain interventions for people who fall in the low hypnotic suggestibility range. However, some studies suggest that these individuals may benefit from imaginative analgesia suggestions, or suggestions for pain reduction that are delivered while the person is not in hypnosis.

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.

Response expectancies, treatment credibility, and hypnotic suggestibility: Mediator and moderator effects in hypnotic and cognitive-behavioral pain interventions

Several studies have shown that response expectancies are an important mechanism of popular psychological interventions for pain. However, there has been no research on whether response expectancies and treatment credibility independently mediate hypnotic and cognitive-behavioral pain interventions and whether the pattern of mediation is affected by experience with the interventions. Also, past research has indicated that hypnotic pain interventions may be moderated by hypnotic suggestibility. However, these studies have typically failed to measure the full range of suggestibility and have assessed pain reduction and suggestibility in the same experimental context, possibly inflating the association between these variables. To clarify the mediator role of response expectancies and treatment credibility, and the moderator role of hypnotic suggestibility in the hypnotic and cognitive-behavioral reduction of pain. Approximately 300 participants were assessed for suggestibility. Then, as part of an apparently unrelated experiment, 124 of these individuals received analogue cognitive-behavioral, hypnotic, or placebo control pain interventions. Response expectancies and credibility independently mediated treatment. The extent of mediation increased as participants gained more experience with the interventions. Suggestibility moderated treatment and was associated with relief only from the hypnotic intervention. Response expectancies and treatment credibility are unique mechanisms of hypnotic and cognitive-behavioral pain interventions. Hypnotic suggestibility predicts relief from hypnotic pain interventions and this association is not simply an artifact of measuring suggestibility and pain reduction in the same experimental context. The relationship between suggestibility and hypnotic pain reduction appears to be linear in nature.

Reaction to Pain Stimulus before and during Hypnosis Measured by Pupillary Reaction

The aim of this study was to investigate the analgesic effects of hypnotic pain control on experimental pain by measuring pupil reactions as an objective psycho-physiologic parameter. Twenty-two healthy volunteers (11 female and 11 male) aged between 22 and 35 years participated in the study. Pupil diameter was measured as baseline measurement (i.e., static measurement) in the non-hypnotic and in the hypnotic state. Pupil diameter changes to a standardized pain stimulus were measured in the non-hypnotic and hypnotic state and compared. Additionally, a Fourier analysis of pupil oscillations reflecting central nervous activation during the static measurement (25.6 sec) was calculated. During the hypnotic state the pain related pupil dilation was significantly smaller than during the non-hypnotic state. Pupil oscillations were significantly reduced during hypnosis.

Cam Perry, Heraclitus, and Hypnosis: An Appreciative Understanding

The authors summarize personal, intellectual, and social influences on Campbell Perry’s (1937–2003) life and research on hypnosis. His education in Australia reflected the influences of a public primary school, a prestigious private high school, and undergraduate and graduate work at Australia’s oldest university. His approach to hypnosis was influenced initially by Gordon Hammer and Philip Sutcliffe, and his life generally was influenced by John Anderson, the leader of the Libertarian Society, the intellectual core of a broader group known as the Push. This group reflected in part the thinking of the pre-Socratic Greek philosopher, Heraclitus, who taught that change was the only reality. The article summarizes Perry’s work on hypnosis and memory, and his contributions concerning uncancelled hypnotic suggestions, pain and surgery, and imagery and hypnotizability are summarized.

Mediation and moderation of hypnotic and cognitive‐behavioural pain reduction

AbstractThe mediator function of response expectancies and the moderator function of hypnotic and non‐hypnotic imaginative suggestibility were evaluated in the analogue treatment of pain. One hundred and sixty‐seven participants previously assessed for hypnotic and imaginative suggestibility were randomly assigned to distraction, cognitive‐behavioural package (i.e., Stress Inoculation Training), hypnotic cognitive‐behavioural package, hypnotic analgesia suggestion, placebo control, or no‐treatment control conditions. The four ‘active’ treatments reduced pain more than the no‐treatment control condition. There was no statistical difference in effectiveness between these four treatments, but only the cognitive‐behavioural package reduced pain more than the placebo control condition. Response expectancies partially mediated the effects of treatment on pain. Imaginative suggestibility, defined as a generalized tendency to respond to imaginative suggestions delivered outside of hypnosis, moderated the effects of the cognitive‐behavioural package. Contrary to prediction, neither hypnotic suggestibility, nor hypnotizability (operationalized as hypnotic suggestibility with imaginative suggestibility statistically controlled) moderated the effects of the hypnotic treatments. Copyright © 2003 British Society of Experimental and Clinical Hypnosis

Hypnotic mirrors and phantom pain: a single case study

AbstractUsing hypnosis, two main approaches to modifying phantom limb pain experience can be identified: ipsative imagery, which makes use of the patient's own imaginative interpretation of how the pain is generated, and a simulated movement approach. The latter approach shares many similarities with the ‘mirror’ technique recently advocated and used by Ramachandran (in non‐hypnotic settings) to create the experience of movement and in some (but not all cases) relief from pain in patients with a phantom limb. In this case study, we report the use of a hypnotically induced ‘virtual’ mirror experience that modified long standing intractable phantom limb pain despite generating a qualitatively inferior experience of movement in the phantom limb compared to that produced with an actual mirror. These preliminary findings suggest that the use of hypnotic movement imagery for the management of phantom limb pain is worth further investigation both in terms of its comparative ease of use and because of its potential for informing discussion as to the possible neurocognitive mechanisms involved. Copyright © 2002 British Society of Experimental and Clinical Hypnosis

A meta-analysis of hypnotically induced analgesia: How effective is hypnosis?

Over the past two decades, hypnoanalgesia has been widely studied; however, no systematic attempts have been made to determine the average size of hypnoanalgesic effects or establish the generalizability of these effects from the laboratory to the clinic. This study examines the effectiveness of hypnosis in pain management, compares studies that evaluated hypnotic pain reduction in healthy volunteers vs. those using patient samples, compares hypnoanalgesic effects and participants' hypnotic suggestibility, and determines the effectiveness of hypnotic suggestion for pain relief relative to other nonhypnotic psychological interventions. Meta-analysis of 18 studies revealed a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain. The overall results suggest broader application of hypnoanalgesic techniques with pain patients.

Potentialities and limitations of hypnosis for the treatment of pain

With regard to the potentialities of hypnosis for the treatment of pain, relevant studies on hypnotic pain control are discussed. Studies with experimentally produced pain unanimously show that hypnosis is effective in controlling pain, whereas clinical studies are much more ambiguous in this respect. Three basic strategies of hypnotic pain control are outlined to which the different techniques can be subsumed: dissociative, associative, and symbolic strategies. Accountable for the limitations of hypnosis are some issues like hypnotic state, hypnotizability, rapport, hypnotic techniques, and pain as a multifactorial process. These issues are discussed and their contribution to contraindications are outlined. Especially the differences between symptom- and problem-oriented hypnotic approaches are highlighted.

Hypnotic pain control: Some theoretical and practical issues

Pain management programs assist patients to use their behavioral and cognitive skills for the purpose of rendering their experience of pain as more tolerable in some way. Hypnotic procedures may be included in this perspective. Thus, hypnosis may be best conceived as a set of skills to be deployed by the individual rather than as a state. The authors contend that such an emphasis is more compatible with the approaches of some pain management practitioners who have been generally slow to acknowledge the value of hypnosis and to incorporate hypnosis in their range of treatment skills. In this article, the authors present a minimal and atheoretical definition of hypnosis, and they list the basic properties of hypnosis that may be used in the treatment of pain. For a number of reasons, it is suggested that undertaking hypnosis as though the individual were indeed being placed into a special trance state may in some cases promote an effective outcome. However, it should be acknowledged that there may be instances when the relevant skills may be more effectively engaged at the expense of a strict special trance state by targeting the specific skills that are to be used for therapeutic benefit.

Factors Predicting Hypnotic Analgesia in Clinical Burn Pain

The use of hypnosis for treating pain from severe burn injuries has received strong anecdotal support from case reports. Controlled studies provide less dramatic but empirically sound support for the use of hypnosis with this problem. The mechanisms behind hypnotic analgesia for bum pain are poorly understood with this patient population, as they are with pain in general. It is likely that, whatever the mechanisms are behind hypnotic pain analgesia, patients with burn injuries are more receptive to hypnosis than the general population. This article postulates some variables that may account for this enhanced receptivity including motivation, hypnotizability, dissociation, and regression.

Hypnosis treatment of clinical pain: understanding why hypnosis is useful.

Clinical and experimental research literature indicates hypnosis is very useful for severe and persistent pain, yet reviews suggest hypnosis is not widely used. To encourage more widespread clinical application, the author reviews recent controlled clinical studies in which hypnosis compares favorably with other interventions; links advances in understanding endogenous pain modulation to a neurophysiologic view of hypnosis and hypnoanalgesia; relates the neurophysiology of hypnoanalgesia to management of chronic pain; challenges the view that hypnotic pain control is only for the highly hypnotizable patient; and raises issues about how people learn to control pain with hypnosis. Training in hypnotic analgesia may usefully enhance nervous system inhibitory processes that attenuate pain.