Hypnosis: an alternative in pain management for nurse practitioners

Hrezo, R. J. (1998). “Hypnosis: an alternative in pain management for nurse practitioners.” Nurse Pract Forum 9(4): 217-226.

Hypnosis and the trance phenomenon is an age-old tool for the treatment of a variety of conditions, including pain. Medically accepted for over 50 years as a legitimate therapy, research continues into its mechanisms and actions. In this article, its origins, history, theoretical basis, and various uses are discussed. Case presentations from the author are provided, showing its use for a variety of pain management scenarios. Sample hypnotic scripts allow the reader to better visualize the applicability of hypnotic suggestion to general inductions and pain management. References are provided for individuals seeking further information and/or training in hypnosis.

The use of pre-, intra-, and posthypnotic suggestion in anesthesia and surgery

Hernandez, A., Jr. and A. M. Tatarunis (2000). “The use of pre-, intra-, and posthypnotic suggestion in anesthesia and surgery.” CRNA 11(4): 167-172.

While under hypnosis, patients can be taught to alter their psychophysiological functions. With this ability to alter these functions, patients can overcome the anxiety associated with surgery. Patients with high anxiety often experience more depression, can have increased complications, need more anesthesia and medication, have suppressed immune function, and often take longer to heal. The purpose of this article is to review the research literature related to the use of hypnosis in preparing the patient for surgery and to present 2 approaches used by the authors to prepare patients for surgery. The first approach is used when there is enough time to condition the patient, and the second approach is used when the anesthetist meets the patient shortly before the surgery is to begin and there is no time to induce formal trance.

Hypnosis for pain management in the older adult

Cuellar, N. G. (2005). “Hypnosis for pain management in the older adult.” Pain Manag Nurs 6(3): 105-111.

Pain is a physical, emotional and psychologic phenomenon that is often ignored in older adults causing depression and poor quality of life. Older adults report the use of complementary and alternative medicine in some form with 80% of these users reporting improvement in their health conditions. Although physical pain in the older adult is usually managed with pharmacologic interventions, methods that may reduce the use of prescription drugs may decrease adverse effects that can compromise the physiologic state of the older adult. Hypnosis has continued to gain acceptance within mainstream medicine as an appropriate treatment and can be integrated safely with conventional medicine as an effective treatment for a variety of conditions in the older adult. It is an intervention that can be used for relaxation and pain control, especially when conventional pharmacologic regimens have failed. The purpose of this article is to review the concepts related to pain in older adults; the use of complementary and alternative medicine in the older adult; hypnosis and the older adult (i.e., background, definition, benefits, research, mechanism of action, hypnotizability, and the process); and the implications of using hypnosis for pain management in the older adult.

Hypnotherapy for treatment of irritable bowel syndrome.

Webb, A. N., R. H. Kukuruzovic, et al. (2007). “Hypnotherapy for treatment of irritable bowel syndrome.” Cochrane Database Syst Rev(4): CD005110.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms. OBJECTIVES: To evaluate the efficacy of hypnotherapy for the treatment of irritable bowel syndrome. SEARCH STRATEGY: Published and unpublished randomised clinical trials and quasi-randomised clinical trials were identified through structured searches of MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), PsycINFO (1806 to March 2006), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to March 2006), AMED (Allied and Complementary Medicine Database, 1985 to March 2006) and The Cochrane Central Register of Controlled trials. Conference proceedings from Digestive Disease Week (1980 to 2005) were also searched. SELECTION CRITERIA: Eligible studies included all randomised and quasi-randomised clinical studies comparing hypnotherapy for the treatment of irritable bowel syndrome with no treatment or another therapeutic intervention. DATA COLLECTION AND ANALYSIS: All studies were evaluated for eligibility for inclusion. Included studies were assessed for quality and data were extracted independently by four authors. The primary outcome measure of interest was the overall bowel symptom severity score which combines abdominal pain, diarrhoea or constipation and bloating. Secondary outcomes included abdominal pain, diarrhoea, constipation, bloating, quality of life, patient’s overall assessment of well-being, psychological measures as per validated questionnaires, and adverse events. MAIN RESULTS: Four studies including a total of 147 patients met the inclusion criteria. Only one study compared hypnotherapy to an alternative therapy (psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-list controls and the final study compared hypnotherapy to usual medical management. Data were not pooled for meta-analysis due to differences in outcome measures and study design. The therapeutic effect of hypnotherapy was found to be superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy. Harmful side-effects were not reported in any of the trials. However, the results of these studies should be interpreted with caution due to poor methodological quality and small size. AUTHORS’ CONCLUSIONS: The quality of the included trials was inadequate to allow any conclusion about the efficacy of hypnotherapy for irritable bowel syndrome. More research with high quality trials is needed.

Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms

Whorwell, P. J. (2008). “Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms.” J Psychosom Res 64(6): 621-623.

There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonic symptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis. The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.

Hypnotherapy for functional gastrointestinal disorders: a review.

Miller, V. and P. J. Whorwell (2009). “Hypnotherapy for functional gastrointestinal disorders: a review.” Int J Clin Exp Hypn 57(3): 279-292.

Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

Hypnotizability, absorption and negative cognitions as predictors of dental anxiety: two pilot studies

DiClementi, J. D., J. Deffenbaugh, et al. (2007). “Hypnotizability, absorption and negative cognitions as predictors of dental anxiety: two pilot studies.” J Am Dent Assoc 138(9): 1242-1250; quiz 1267-1248.

BACKGROUND: The authors conducted two pilot studies that investigated the roles of hypnotizability, absorption (defined as the ability to maintain focused attention on a task or stimulus) and state versus trait anxiety as predictors of dental anxiety. One of the studies also examined the effectiveness of hypnosis in managing dental anxiety. METHODS: Participants in study 1 completed measures of hypnotizability and anxiety, viewed a video of a dental procedure either under hypnosis or not, and completed dental anxiety questionnaires. Participants in study 2 were told either that the video showed major dental work or a routine polishing. All subjects watched the video and then completed measures assessing their perceptions of the video and their anxiety. RESULTS: The authors found a positive relationship between hypnotizability and scores on the Dental Anxiety Scale (DAS) (F(1,290) = 3.45, P = .06), as well as an interaction between hypnotizability and hypnosis (F(1,290) = 6.55, P = .01). An analysis of covariance found a relationship between trait and dental anxiety (F(1,290) = 11.50; P = .001). A two-way analysis of variance found a main effect for hypnosis (F(1,290) = 3.20, P = .07). The authors found an effect for group on the DAS (F(1,228) = 3.67, P = .057), such that subjects in the negative-cognition group scored higher on the DAS. The authors found an interaction between absorption and cognition in perceptions of pain experienced by the patient in the video (F(1,228) = 3.70, P = .05) and in ratings of one’s own pain level if in the same situation (F(1,228) = 4.38, P < .05). CONCLUSIONS: Hypnotizability or absorption, pre-existing anxiety and cognitions about dental procedures predict dental anxiety, and hypnosis may be helpful for some, but not all, patients. CLINICAL IMPLICATIONS: Characteristics such as hypnotizability, trait anxiety and negative cognitions predict which people develop dental anxiety and who will be more responsive to hypnosis. The authors provide suggestions for dentists treating anxious patients.

Clinical applications of hypnotherapy

Manusov, E. G. (1990). “Clinical applications of hypnotherapy.” J Fam Pract 31(2): 180-184.

Hypnosis has been used as a therapeutic tool for centuries, but only in the past 50 years have the clinical applications been delineated. As evident in the medical literature, the use of hypnosis by the medical community has increased, partly as a result of a growing awareness of hypnotherapy as an available treatment modality, and also as a result of major improvements in research methodology through strict standardization. Hypnotherapy, once considered to be limited to entertainment, has now proven useful in the treatment of a wide variety of medical illness. Two cases of the use of hypnosis are presented. In the first case, hypnosis is used to alleviate pain in a gravid patient in sickle cell crisis. In the second case, hypnosis is used for desensitization of dental phobia in a 27-year-old women. The historical, theoretical, and clinical applications of hypnosis are reviewed.

What we can do with hypnosis: a brief note

Wark, D. M. (2008). “What we can do with hypnosis: a brief note.” Am J Clin Hypn 51(1): 29-36.

This article summarizes the search for efficacious hypnotic treatments. Eighteen major meta analyses were reviewed and the results evaluated using the criteria of Chambless & Hollon, (1998). The analysis identified 32 disorders for which hypnosis can be considered a possible treatment, 5 for which it seems effective, and 2 for which it appears specific. If clinicians use hypnosis in the situations where it seems to be efficacious, and systematically expand the list of conditions where it will be helpful, the results will be even more impressive for the 100th anniversary of this Journal.

Chronic pain syndromes and their treatment by psychological interventions

Kroner-Herwig, B. (2009). “Chronic pain syndromes and their treatment by psychological interventions.” Curr Opin Psychiatry 22(2): 200-204.

PURPOSE OF REVIEW: Treatment of chronic pain has become a multidisciplinary endeavour including psychological interventions. Databases for life science journals were searched for citations from 2007 and 2008 to determine the current focus of research and the state of evidence. RECENT FINDINGS: Several reviews on systematic research studies confirm that psychological interventions are efficacious in the treatment of chronic musculoskeletal pain, especially back pain, though effect sizes are small and, in some cases, moderate. Findings from clinical practices and treatment centres corroborate these conclusions. The integration of psychological treatment into primary care has not yet proven its utility. Cost-effective interventions to reduce relapse are currently being examined. Psychological headache treatment has again become a topic of research. Evidence is inconsistent, with improvement ranging from an extraordinary size to none at all. Hypnotherapy in children and adolescents with recurrent gastrointestinal pain, examined in a study of high methodological quality, achieved an exceptional level of symptom relief. The aim of two studies on therapy for fibromyalgia and temporomandibular disorder was the identification of mediators and moderators of treatment outcome. SUMMARY: Regarding different pain syndromes such as chronic back pain, headache, fibromyalgia, and temporomandibular disorder, as well as gastrointestinal pain in children, psychological interventions proved their significance for the achievement of favourable treatment outcome.