Efficacy of hypnosis in the management of non-procedural pain: systematic review

Machado, Renata Seixas; Silva, Josinete Cabral da; Silva, Alexandre Sousa da

doi:10.5935/2595-0118.20210045

Brasil

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REVIEW ARTICLE • BrJP 4 (3) • Jul-Sep 2021 • https://doi.org/10.5935/2595-0118.20210045 linkcopy

Efficacy of hypnosis in the management of non-procedural pain: systematic review

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ABSTRACT

BACKGROUND AND OBJECTIVES: Pain has great impact on public health and presents a social cost which transcends the financial aspect. Hypnosis is a focal, quick and low-cost resource with effective change possibilities in pain management. The objective of this study was to identify evidence of the efficiency of hypnosis in pain management.

CONTENTS: This study consists of a systematic literature review held in February 2020. Search was carried out in the Pubmed, Cochrane, LILACS, Scielo and PsycInfo platforms, using the keywords “clinical trials”, “hypnosis”, “pain management”, “pain intensity”, and “quality of life”, totalizing 18 studies after peer review. Most articles are randomized, controlled by comparing hypnosis to standard treatment or other integrative practices, and focus mainly on the aspects of intensity, quality and interference of pain as an outcome variable. Six studies mention quality of life and only two refer catastrophization as an important intervening variable.

CONCLUSION: Hypnosis is an effective technique for pain management, considering that there was an improvement in pain management with the improvement of at least one aspect, be it intensity, interference or quality of pain. However, it’s necessary to highlight important limitations of the studies, such as the small sample size and the complexity of systematizing subjective techniques, which highlights the need for more clinical trials, including multicentric studies, so that larger samples can be obtained.

Keywords: Hypnosis; Pain management; Non-procedural pain

References	Baseline disease	Control	Results/Conclusions
10	Hemophilia	Standard	The EG (n=8) showed greater reduction than the CG (n=10) (d=-0.267) in pain interference. A greater improvement in HRQol (EQ-5D index: d=0.334; EQ-5D VAS: d=1.437) and a trend toward better hemophilia-related QoL were also evident in the EG.
21	Brachial plexus injury	Acupuncture	There was statistically significant improvement in mean pain intensity from pre-treatment to post-treatment scores in both groups. Pain intensity increased four months later; however, it was still significantly reduced compared to pre-treatment scores.
16	Post-operative breast cancer	Standard	Between T1 and T4, there were significant differences between the groups in patient-reported outcomes according to PROMIS, favoring the SCT group compared to the standard treatment (p=0.005, p=0.023 and p=0.021, respectively). The results suggest that the use of SCT in the perioperative period decreased pain perception, fatigue and inflammatory cytokine secretion.
19	Adult men with burns	Placebo	There was no significant difference between the groups in reducing background pain intensity, but there was in background pain quality and pain anxiety in the intervention group during the four hypnosis sessions.
22	Adults with intolerable pain	Mindfulness/ Psychoeducation	The mind-body intervention group presented significantly lower pain intensity post-intervention than the psychoeducation group (p<0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%).
13	Women with multiple sclerosis	Standard	Repeated measures analysis showed significant difference between the groups; pain was lower in the self-hypnosis group, but was not maintained after four weeks.
17	Cancer patients or cancer survivor patients	Educational intervention	There was significant improvement in pain intensity/interference after the active treatment compared with the control condition on all result measures. Treatment gains were maintained at three-month follow-up. However, the findings need to be replicated in larger samples of cancer survivors.
8	Elderly with chronic pain	Massage	Mean measured pain presented the greatest decrease in the hypnosis group compared to the massage group during hospitalization, confirmed by the pain intensity measure before each session, which decreased only in the hypnosis group over time (p=0.008). There was no effect in any in the three months after hospital discharge.
27	Chronic pain in palliative care	Physiotherapy/ Psychoeducation/ Physiotherapy + Psychoeducation/ Standard	The most prominent results were obtained for patients allocated to the self-hypnosis/self-care group. These patients presented significant benefits in the areas of pain intensity, pain interference, anxiety, depression, and QoL, as well as a greater effective economic benefit from this treatment compared to the other interventions.
28	Veterans with chronic low back pain	Biofeedback	The combined EGs reported significantly greater reduction in pain intensity than the CG. There was no significant difference between the three hypnosis conditions. More than half of the participants who received hypnosis reported clinically significant reductions (≥30%) in pain intensity and maintained these benefits for at least six months after treatment.
18	Women with cancer	Before and after outcomes	Analyses revealed (a) significant pre and post-treatment decreases in pain intensity, fatigue, and sleep problems, and (b) that pain intensity continued to decrease from post-treatment to the six-month follow-up.
14	Multiple Sclerosis	Educational Intervention/Cognitive Restructuring	The worse pain intensity and pain interference were lower after HYP than before treatment or after CONT or CR. These differences reached statistical significance when HYP was compared to CONT and HYP before treatment for worse pain intensity and when HYP was compared to CONT for pain interference.
24	Post-traumatic injury	Standard	The pattern of findings as indicated by the effect of the Time × Treatment Condition interaction was statistically significant for the lower pain intensity ratings, but not for the mean pain ratings.
25	Spinal Cord Injury	Biofeedback	Participants in both treatment conditions reported substantial decreases in pain intensity before and after the treatment sessions. However, only HYP reported statistically significant reductions in mean daily pain pre and post-treatment, and these were maintained at three-month follow-up.
15	Multiple Sclerosis	Progressive Relaxation	HYP condition participants reported significantly greater pre and post-session as well as pre and post-treatment decreases in pain and pain interference than PMR condition participants, and the gains were maintained at three-month follow-up.
26	Muscular pain	Standard	The EG improved from their symptoms (change from 62.5 to 55.4), while the CG deteriorated (change from 37.2 to 45.1), (p=0.045). The 12 patients showed a mean improvement from 51.5 to 41.6 (p=0.046). One year later, the corresponding score was 41.3, indicating persistent improvement.
20	Fibromyalgia	Relaxation	Focused hypnosis with analgesic suggestions has a greater effect on pain intensity than focused hypnosis with relaxation suggestions or on relaxation itself.
23	Disability	Before and after outcomes	Analyses showed significant before and after treatment changes in average pain intensity, which were maintained at the three-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain, but not in pain interference or depressive symptoms. Hypnotizability, treatment concentration (e.g., daily versus weekly), and initial response to treatment were not significantly associated with treatment outcome.

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Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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[TFN1] CONT = An education control condition; CR = Cognitive restructuring; VAS = Visual Analog Scale; CG = Control Group; EG = Experimental Group; HRQol = Health Related Quality of Life Questionnaire; HYP = Self-hypnosis training; PMR = Progressive muscle relaxation; PROMIS = Patient-Reported Outcomes Measurement Information System; SCT = Self-care toolkit; T = Time; QoL = Quality of life.