Hypnosis and Pain Modulation

FIGURE 7-1 Brain areas showing a correlation between blood oxygen level dependent (BOLD) signal and the intensity of internal/self- (blue) and external/environmental awareness (red) in healthy volunteers. Graphical representation shows the hypnosis brain connectivity modulation of the internal/self-awareness (blue) and external/environmental (red) networks, as compared to normal wakefulness state. (Adapted from references [3, 32].)

HYPNOSIS AND CLINICAL MANAGEMENT OF PAIN

Hypnosis and Chronic Pain

Chronic pain is a complex phenomenon characterized by prolonged and persistent pain (lasting at least 3 months), involving biological, psychosocial, and socioprofessional factors that affect the patient, their loved ones, and society in many ways. Currently, no single medication or treatment addresses all aspects of this condition, which can obey to multiples etiologies. Available treatments provide modest improvements in managing pain and daily functioning. There is a real need for an assessment of combinations of treatments. In recent years, studies have shown interest in nonpharmacological approaches to manage chronic pain (for a review, see reference [33]). Physical rehabilitation and psychological treatments are often incorporated as part of multimodal treatment approaches. In addition, studies on pain management should concentrate on functional and psychological disabilities as well as on quality of life, since we have observed that these variables were usually reported as influenced by pain in chronic pain patients. Recently, self-hypnosis combined with self-care activities have demonstrated benefits in a wider variety of biological, psychological, and social dimensions associated with chronic pain when compared with other treatments such as physiotherapy or psychoeducation, in both neuropathic and nonneuropathic pain patients [33]. Indeed, pain intensity, pain interference, anxiety, and depression were shown to decrease after self-hypnosis and self-care treatment in a group of 158 patients suffering from chronic pain (25 male, mean duration of pain 125 ± 89 months; 133 female 98 ± 13 months of pain) with different etiologies (including both neuropathic and nonneuropathic etiologies), while these patients reported an improved quality of life. A meta-analysis on 12 clinical trials shows that for chronic pain patients (both neuropathic and nonneuropathic etiologies) hypnosis is more efficacious than other psychological interventions such as biofeedback, cognitive–behavior therapy, and muscle relaxation [1].

Pain management for chronic pain patients is largely focused upon pain relief or control. The pursuit of pain control is associated with high costs and few positive results. However, some patients seem to be fixated on this strategy despite the negative consequences. As shown in the literature, an exclusive focus on pain control may lead to greater suffering and disability [2] and may hinder adaptation to pain and paradoxically increase frustrations and limitations due to pain. In our opinion, interventions aiming at improving the patient’s capacity for dealing with daily life, and developing strategies to promote positivism and live well in the presence of pain, may indirectly help these patients to gain more control over their pain. In a recent work, we concentrated on patient attitudes and beliefs about pain in a clinical nonrandomized prospective study [33]. Our aim was to assess the effectiveness of different treatments based on psychological and/or physiological approaches, such as physiotherapy, psychoeducation, physiotherapy combined with psychoeducation, and self-hypnosis/self-care learning.

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