A 2007 meta-analysis of over 50 years of research on hypnosis found that “hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic pain problems. Also, hypnosis was generally found to be more effective than non-hypnotic interventions such as attention, physical therapy, and education.” These conclusions were upheld in a 2014 meta-analysis.
A 2012 review of 12 pediatric studies also found that hypnosis is an effective pain-control technique for chronic pain and cancer procedure-related pain.
Do they work under experimental conditions when pain is inflicted as part of a study?
Yes! In a randomized controlled trial, healthy adults were subjected to a standard pain stimulus (the cold pressor test). Those randomized to hypnosis reported significantly less pain and pain-related unpleasantness compared to those undergoing the same stimulus without hypnosis. For example, the control group reported pain levels of 70-80 whereas the hypnosis group reported levels of 40-50. Cortisol reactivity (a physiologic measure of stress) was also significantly lower during the pain stimulus in the hypnosis group than among controls.
How are these effects achieved?
A study in normal subjects measuring blood oxygenation level dependent signals in functional magnetic imaging studies (fMRI BOLD signals) showed less activation in the brain’s primary sensory cortex, middle cingulate cortex, precuneus, and visual cortex and increased activity in the anterior basal ganglia and left anterior cingulate cortex in response to a standard pain stimulus (heat) for hypnosis compared with control. These data suggest that clinical hypnosis may prevent nocioceptive inputs from reaching higher brain structures responsible for pain perception.
Let’s look at a few common chronic painful conditions in a bit more detail: chronic low back pain, fibromyalgia, headache, irritable bowel syndrome, and osteoarthritis.
Chronic low back pain (CLBP)
Chronic low back pain is one of the most prevalent chronic pain conditions among adults. A 2010 pilot study conducted in a Houston Veteran’s Administration suggested that as few as four sessions of standardized self-hypnosis sessions combined with standard psycho-education can substantially reduce pain and pain-related disability. Imaging research suggests that the mechanisms for these benefits involve differential activation of cortical areas associated with pain processing and emotional responses to pain. Additional research is needed to determine the optimal approach, duration, and frequency of hypnotherapy and to compare the results of hypnosis or guided imagery to other mind-body techniques to determine the most cost-effective approach to caring for patients with CLBP.
A 2011 systematic review and meta-analysis of six controlled trials of GIH found that GIH reduced pain and modestly improved sleep, but did not impact health-related quality of life significantly for adults with fibromyalgia syndrome.
Multiple case reports and retrospective reviews have documented the benefits of GIH for adults and children with recurrent headaches. Even simply listening to guided imagery recordings has proven helpful in decreasing headache severity and improving quality of life.
In a 2012 controlled trial, guided imagery was more effective than treatment as usual for adults with chronic tension-type headache.
Irritable Bowel Syndrome (IBS)
Patients with irritable bowel syndrome suffer from pain, abdominal distention, diarrhea, and/or constipation. In the textbook, Integrative Gastroenterology, edited by Gerard Mullin, guided imagery is described as the “most effective known treatments for IBS.” (p.165) What’s the evidence for that strong statement?
Whorwell and colleagues reported in 1984 that among 30 patients with severe, refractory IBS, those randomized to hypnotherapy showed a dramatically better improvement in symptoms compared with those randomized to psychotherapy. Since then, over 50 trials have evaluated the effectiveness of GIH for IBS in adults and children.
A 2006 meta-analysis reported a median response rate to hypnosis of 87% with therapeutic gains well-maintained for years after formal hypnotherapy ended.
In a 2008 British study of patients with inflammatory bowel disease, gut-focused hypnotherapy was associated with a significantly decreased heart rate; a 53% drop in serum IL-6 measures; a 53% drop in rectal IL-13; and 35% decrease in rectal histamine, suggesting both local and systemic anti-inflammatory effects.
Lindfors and his Swedish colleagues conducted two studies reported in 2012, randomizing a total of 138 IBS patients to 12 weekly sessions of hypnotherapy or control care; in both studies, symptoms were significantly better at 3 months in the hypnotherapy groups with improvements sustained for up to 1 year follow-up. In a long-term follow up study published in 2012, Lindfors reported that 49% of hypnotherapy patients were “responders” and of these, 73% reported further improvements 2-7 years after the formal treatment, reflected in a lower use of healthcare seeking; 87% of all patients reported that they considered hypnotherapy to be worthwhile, even among those who did not report significant improvement initially.
An Austrian study reported in 2013 compared hypnotherapy to supportive medical care in 90 patients with IBS refractory to usual treatment; they reported improvements in 61% of those assigned to hypnotherapy vs. just 41% in the supportive medical care group (P<0.05) with improvements in physical and psychological well-being maintained over 15 months.
A 2013 review of three controlled trials in pediatric patients concluded that the therapeutic effects of hypnotherapy are superior to standard medical care in children with functional abdominal pain or IBS.
Even if you don’t think they are THE treatment of choice for IBS, hypnosis and guided imagery can certainly be considered one of the best treatments for patients with IBS.
French researchers compared 8 sessions of hypnosis to the same number of sessions of progressive muscle relaxation (PMR) or treatment as usual in patients with hip or knee osteoarthritis. Both mind-body groups had less pain than the treatment-as-usual group. Improvements occurred faster in the hypnosis group.
Pain Secondary to Multiple Sclerosis
Jensen and colleagues at the University of Washington compared self-hypnosis to progressive muscle relaxation (PMR) in 22 patients with multiple sclerosis (MS). In this study, hypnosis was significantly more effective in decreasing pain and pain-related interference in daily activities than PMR.
Pain with Spinal Cord Injury
Case studies have suggested that hypnosis can help relieve pain from combat-related spinal cord injuries. In a study of 37 adults with chronic pain secondary to spinal cord injury, those randomized to hypnosis had substantial decreases in pain and better pain control than those assigned to EMG biofeedback.
Pain associated with Temporomandibular Joint Disorder (TMJD)
A Danish dental group has done several studies on the effects of hypnoanalgesia on chronic dental or facial pain.
Among 41 patients with persistent, idiopathic orofacial pain, those randomized to hypnosis had significantly better improvement in pain scores (33%) compared with those assigned to relaxation training (3%).
In a 2010 study of 19 patients with TMJD who underwent functional magnetic resonance imaging during control and hypnoanalgesia conditions, hypnosis effectively helped reduce pain and was associated with pronounced suppression of cortical activity in several brain areas associated with pain processing.