Complex or Compound Pain
Pain is often caused by several contributing factors. Sometimes multiple areas of discomfort can be addressed and the root cause can be managed through hypnosis.
Melzack and Perry (1975) examined the effects of hypnosis and neurofeedback in 24 patients who had a variety of chronic-pain problems. Baseline data was collected during two no-treatment (baseline) sessions, and patients were then randomly assigned to one of three treatment conditions: four sessions of hypnosis alone, eight sessions of neurofeedback training alone, or both hypnosis and neurofeedback training. The hypnosis treatment consisted of a taped hypnotic induction with suggestions for relaxation, ego strengthening, a feeling of greater tranquility, and of being able to overcome things that are ordinarily upsetting and worrying. No direct suggestions for pain control were included in the hypnosis treatment. The McGill Pain Questionnaire was administered before and after each of the baseline, training, and two posttraining practice sessions. There was a reduction in pain observed during the hypnosis training (range, 21%–32% improvement; median improvement = 23%), however, none of the observed changes in either the neurofeedback or hypnosis conditions were statistically significant in comparison to the baseline phase.
Edelson and Fitzpatrick (1989) evaluated hypnosis and cognitive-behavior therapy for treatment of chronic pain. Twenty-seven patients with various chronic-pain problems (back pain being the most frequent) were randomly assigned to: cognitive-behavioral therapy (CBT) alone, CBT plus hypnosis treatment, or an attention control (supportive, nondirective discussions). The hypnosis and CBT treatments were identical with the exception of a hypnotic induction. It is noteworthy, however, that the CBT intervention used in this study included some what might be considered “hypnotic components.” Specifically, the CBT intervention encouraged the participants to: (1) avoid using the “pain” label to describe their sensations; (b) reinterpret pain sensations as “numbness” through the use of imagery (this component, in particular, might be considered as a hypnosis intervention); and (c) monitor and restructure negative self-talk. The results indicated decreases in pain intensity for both the hypnosis intervention and the CBT treatment that were sustained at 1-month follow-up. However, only the CBT treatment resulted in significantly lower pain rating scores in comparison to the attention control condition. In this study, adding a hypnotic induction appeared to have little positive effect. In fact, in this study the CBT treatment minus the induction had a greater effect on pain behaviors. Given the “hypnotic characteristics” of some aspects of the CBT treatment used in this study, this finding is somewhat puzzling. However, this does suggest the possibility that a hypnotic induction may detract from some forms of CBT for chronic pain.
Appel and Bleiberg (2005–2006) investigated the association between hypnotizability and hypnosis for treatment of chronic pain. Twenty-seven patients with a variety of chronic-pain problems (15 lumbar pain, 7 rheumatological pain, 3 cervical pain, 1 peripheral neuropathy, 1 gynecological-related pain) received hypnosis treatment sessions directed at “teaching self-regulation of the affective and sensory components of pain.” The word hypnosis was not mentioned during the intervention, which included relaxation training, autogenic statements, guided imagery for pain alteration and health and healing, and individualization to use images “in a way that is best for him or her.” The results indicated a significant reduction in pain ratings pre- and posttreatment. Measures of relaxation and suffering were not related to hypnotizability. However, changes in pain ratings were significantly correlated with hypnotizability (r = .55, p < .001) as measured by the Stanford Clinical Hypnotic Scale.
Hypnotherapy for the Management of Chronic Pain
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