MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Chronic pain is a common and serious problem for many patients. Treatment often includes non-pharmacological approaches despite the mostly flimsy evidence to support them. The objective of this study was to measure the feasibility and efficacy of hypnosis (including self-hypnosis) in the management of chronic pain in older hospitalized patients.

A single center randomized controlled trial using a two arm parallel group design (hypnosis versus massage). Inclusion criteria were chronic pain for more than 3 months with impact on daily life activities, intensity of > 4; adapted analgesic treatment; no cognitive impairment. Fifty-three patients were included. Pain intensity decreased significantly in both groups after each session. Average pain measured by the brief pain index sustained a greater decrease in the hypnosis group compared to the massage group during the hospitalization. This was confirmed by the measure of intensity of the pain before each session that decreased only in the hypnosis group over time. Depression scores improved significantly over the time only in the hypnosis group. There was no effect in either group 3 months post hospitals discharge.

The authors concluded that hypnosis represents a safe and valuable tool in chronic pain management of hospitalized older patients. In hospital interventions did not provide long-term post discharge relief.

So, hypnotherapy is better than massage therapy when administered as an adjunct to conventional pain management. As it is difficult to control for placebo effects, which might be substantial in this case, we cannot be sure whether hypnotherapy per se was effective or not.

Who cares? The main thing is to make life easier for these poor patients!

There are situations where I tend to agree with this slightly unscientific but compassionate point of view. Yes, the evidence is flimsy, but we need to help these patients. Hypnotherapy has very few risks, is relatively inexpensive and might help badly suffering individuals. In this case, does it really matter whether the benefit was mediated by a specific or a non-specific mechanism?

18 Responses to Hypnotherapy against chronic pain: does it matter whether it’s ‘just a placebo’?

  • The philosophical issue I have with hypnosis as a treatment for chronic pain is that it is essentially a completely passive modality. The evidence suggests active psychological interventions such as CBT and mindfulness based cognitive therapy are more associated with superior long term outcomes. Hypnotherapy is probably better than nothing, but is not the standard of care for chronic pain clinics.

  • Who cares is exactly right ! I am so pleased to see you say this because one of the interesting questions that my hypnotherapy clients ask me is “Do I need to believe that it will work?” I always say that they do not, they just have to WANT it to work. It’s all part of them making their own mind up as to whether they would prefer to feel better or not. How can taking some time out for yourself away from worry, stress and pain be anything other than useful!?

    • I am most interested in Mark’s insights from his stance as a practitioner.
      I only use hypnotic techniques for entertainment purposes!

      Many practitioners will say all hypnosis is self-hypnosis. The hypnotist facilitates but does not otherwise do anything. Certainly does not transmit ‘animal magnetism’!

      I am unable to distinguish between the response expectances raised during hypnotic induction, and patients’ non-specific responses to placebo effects resulting from being in a constructive therapeutic relationship.
      Nor from the expectances created by the pummelling, pin pricking, remedy preparation, preternatural force manipulation or promises of CAM – which derive any benefit they have through the placebo mechanism – what else?

      So, I cannot meaningfully differentiate between hypnosis and placebo effects. In my book, they are different representations of the same phenomenon. Sometimes one might be more useful than the other. Some practitioners might get better outcomes using one or the other. Or try both!

      The real key and essential principle is that patients must always give fully informed consent to be treated.
      Before being hypnotised: (“I am going to help you experience…”).
      By the same token, patients should give fully informed consent to receiving homeopathy, acupuncture, osteopathy, chiropractic, Reiki, energy therapy et al (“I am going to provide you with experiences which are placebo in that there is no plausible evidence that they provide any specific effect, but from which you may benefit…”).

  • “Who cares?” and “What’s the harm?” are the questions repeatedly asked across the whole range of complementary and alternative medicines. Hypnotherapy is one of the good examples of harmless and possibly beneficial treatments that work, most probably, by creating a placebo response.
     
    Hypnotherapy doesn’t claim to cure every kind of disease, including cancers and infectious diseases: it limits itself to a small number of situations that are clearly psychological or psychosomatic problems. Hypnotherapists don’t advise patients to stop taking other medications and to avoid vaccination. Hypnotherapists don’t use curious props, ranging from potions that contain nothing to eletrically activated diddly sticks. Hypnotherapists don’t tug your neck or forcibly manipulate your spine.
     
    Above all, hypnotherapists recognize that what they do is simply to relax patients and focus their minds in a manner that reduces stress (see the first response to the blog post). They do not offer either spiritual or pseudoscientific mumbo-jumbo as the basis for what they do. If only all the practitioners of medical witchcraft could follow their example!

  • If we teach patients to relax and avoid stress in a way that they can help themselves and control themselves (just relaxing, listen to music, go fishing, take a daily walk, take up gardening, knitting of whatever), they wil not become dependent on “therapists” and that is also a way to reduce stress.

    • I find it rather offensive that you assume all chronic pain is due to stress and can be relieved by simply learning to relax. If that were truly the case, I would not be in excruciating pain right now.

      Nor would I still be in pain when I wake up after a full and refreshing night’s sleep.

      PS the post is about *hospitalised* patients. Not the sort of person in a position to go for walks, nor take up gardening or fishing.

  • If we can isolate the reason why the actions of the hypnotherapist leads to an effect then we may be able to enhance that effect. On its own that should suffice for further investigation if the reduction is reliably confirmed. There is also just the joy of finding out.

  • But what is the difference to, say, homeopathy? The highly diluted versions (above D23) are not effective beyond placebo, have no (direct) risk associated with them (besides perhaps diabetes, if you take too much of the sugar pills), and in theory, these sugar pills would be quite inexpensive, as their cost is probably much less than the price they are sold for.

    • the difference, as I see it, is twofold:
      1) hypnotherapists tell their patients honestly what they do, while homeopaths pretend to administer real medicines.
      2) hypnotherapists do not claim to cure, while homeopaths most certainly do.

      • Based on your points “So, hypnotherapy is better than massage therapy when administered as an adjunct t… As it is difficult to control for placebo effects, which might be substantial in this case, we cannot be sure whether hypnotherapy per se was effective or not.

        Who cares? The main thing is to make life easier for these poor patients!

        There are situations where I tend to agree with this slightly unscientific but compassionate point of view. Yes, the evidence is flimsy, but we need to help these patients. Hypnotherapy has very few risks, is relatively inexpensive and might help badly suffering individuals. In this case, does it really matter whether the benefit was mediated by a specific or a non-specific mechanism?”

        That is big difference from acupuncture! Prof Ernst is it right? why don’t treat acupunctures same as hypnotherapy: You should have no problem to see both have same difficulty to have placebo; had same non-specific mechanism , not claiming cure disease but holistic assistance, who care slightly unscientific as long as for the poor patients… Or if Prof had no record against acupuncture he would have to be just like people he always criticise say; does it really matter whether the benefit was mad mediated by intervention or just a placebo.

        Clearly he will say No here. Why not treat acupuncture as same as hypnotherapy? We would like to hear Prof Ernest.

    • see Frank Odds comments above plus the Alternatives encourage patients to avoid real, evidence based and scientifically trained physicians and/or discontinue or avoid proper care.

  • “Hypnotherapy has very few risks…” Are you sure?
    http://skepdic.com/hypnosis.html

    There are far too many hypnotherapists who perform things such as past life regression. It is extraordinarily easy within the UK to obtain a diploma in hypnotherapy and a license to practise.

    • @Pete

      Sigh! You’re right, of course. It seems every human activity invites some bad ‘uns. Dare I mention Harold Shipman as an extreme example?

      • Frank, Hypnotherapy is listed by the Complementary and Natural Healthcare Council and the British Institute of Hypnotherapy & NLP. So using Harold Shipman as an extreme example was not an example at all.

        • Apologies, Pete. You are correct, as ever. My spirits were raised too high by the optimistic tone of the original post and by Dr Vagg’s eminently reasonable opening comment. Scrub Shipman. Substitute all those properly trained and qualified doctors who sign up formally to one or other form of witchcraft.

          • Frank, I’m not an expert in any branch of health care, but mental health is my particular area of interest and I’ve been especially concerned (for a very long time) by the way it is mishandled by vendors of woo, including: self-help literature; various religions; alt-med; pop-psychology; and more recently, pop-neuroscience.

            Perhaps the two most common logical fallacies of which everyone falls foul are the fallacy of division and the fallacy of composition. These are heavily exploited by vendors of woo.

            If a fully qualified clinician decides that the best course of treatment for one of their patients is, say, hypnotherapy combined with cognitive behaviour therapy (CBT), it means: An element of hypnotherapy [probably “mindfulness” in the clinical meaning of this term] has been combined with elements of CBT that have been carefully tailored to best match this patient.

            Vendors of woo turn this into claims along the lines of: “Hypnotherapy, mindfulness [in the quackery meaning of this term], and the learning of coping skills are all used within the NHS. I’m a qualified hypnotherapist, NLP practitioner, Master Life Coach, Reiki Master, blah blah blah, therefore I can enable you to cure yourself of all physical and mental dis-eases, enable you to stop smoking, to lose weight, and to reach your full potential — which will enable you to find your ideal job, find your perfect partner, and obtain a life of bliss.”

            What I detest the most about vendors of woo is that they rely on [out of necessity] blaming the victim/client for both the initial problem and the lack of long-term progress made with the ‘treatment/therapy’. In the context of mental health issues, this serves only to keep fuelling the awful stigma that is still attached to those suffering mental health problems.

            I have no problem with evidence-based aspects of clinical hypnotherapy being used within the realm of evidence-based clinical psychotherapy; I do have a huge problem with it being referred to as “hypnotherapy” or the practitioner being referred to as a “hypnotherapist” because these are not protected terms. Compare: “thoothologist” versus “dentist”, and “nutritionist” versus “dietician”.

            I apologise to you, Frank, and to the other readers, for failing to clarify my initial comment. Many thanks for your thoughtful replies,
            Pete

  • Hypnotherapy is a better treatment for chronic pain and stress illness.Its relatively cost saving and has less side effects. Hopefully its more helpful and beneficial for poor patients suffering and struggling at the same time.A fine article with useful info. I appreciate your perspective. Thanks for a good post.

  • Hypnotherapy is getting popular day by day because of its effectiveness in treatment of stress and chronic pains. Being cost saving and no side effects its a better option for patients. I think its a nice and thought provoking article.Thanks for sharing. Keep it up.

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