Pain that lasts for more than six months is called "chronic pain" . Chronic pain that doesn't get better can cause a lot of suffering, physical limitations, and emotional stress. Also, chronic pain is one of the most common reasons people go to the doctor, but it often doesn't go away even with painkillers and other treatments. For example, epidemiological studies show that 11% to 45% of people in the United States have chronic back pain . 75% of people with advanced cancer have persistent pain (Bonica, 1990).
Myasthenia gravis patients report pain associated with the disease and chronic pain is the most common reason people use complementary and alternative therapies like hypnosis (Astin, 1998; Eisenberg et al., 1993).
Recent research has shown that hypnosis can reduce the pain and the cost of medical procedures (Lang et al., 2000). This has made people with myasthenia gravis more interested in using hypnosis to treat pain, and there are now enough controlled studies of hypnosis to conclude its effectiveness for use in controlling chronic pain (Jensen & Patterson, 2006; Montgomery, DuHamel, & Redd, 2000; Patterson & Jensen, 2003).
When hypnosis is used to treat chronic pain, it usually starts with suggestions to relax the mind and muscles. This alone can bring relief to patients. It's not always the case, though. Posthypnotic suggestions can be made to reduce pain even after the session is over, or a cue can be used to help the patient feel better quickly and easily (i.e., taking a deep breath and exhaling as eye lids close).
When used to treat chronic pain, hypnosis often involves teaching the patient how to do self-hypnosis or giving them recordings of hypnosis sessions that they can use every day to reduce pain. Many patients feel less pain right away after hypnosis treatment, while others need to practice self-hypnosis or listen to hypnosis sessions over and over again to feel less pain. Just as myasthenia gravis is different for everybody, the hypnosis treatment may vary accordingly.
If you have mild to moderate pain related related to myasthenia gravis, and are frustrated with your current treatment options, hypnosis could help you feel better. You can start by listening to a general pain session or by selecting a session for your particular ailment.
Recommended Links: HypnosisDownloads, SelfHypnosisUSA
Controlled Studies On Using Hypnosis For Pain
Below is a look at controlled trials that consider how well hypnosis works for treating long-term pain. Studies are looked at to see what kinds of chronic pain problems hypnosis can help with. This review of the current state of science looks at some recently published clinical trials that haven't been looked at before. It also talks about what the results mean for future research and clinical applications. While not specifically focused on myasthenia patients, a few of the listed conditions are related, like Fibromyalgia and Temporomandibular.
Thirteen studies were found that compared the results of using hypnosis to treat chronic pain to either baseline data or a control condition. The results of using hypnosis to treat headaches are discussed elsewhere in this issue. Cancer (Elkins, Cheung, Marcus, Palamara, & Rajab, 2004; Spiegel & Bloom, 1983), low-back problems (McCauley, Thelen, Frank, Willard, & Callen, 1983; Spinhoven & Linssen, 1989), arthritis (Gay, Philippot, & Luminet, 2002), sickle cell disease (Dinges et al., 1997), temporomandibular conditions (Si (Appel & Bleiberg, 2005–2006; Edelson & Fitzpatrick, 1989; Melzack & Perry, 1975). These studies are looked at in terms of how the research was done and what happened.
Cancer Pain
Spiegel and Bloom (1983) gave 54 women with chronic cancer pain from breast carcinoma either standard care (n = 24) or weekly expressive-supportive group therapy for up to 12 months (n = 30). The women who were given group therapy were put into groups that either learned self-hypnosis or did not. The goal of the hypnosis intervention was to help the patient feel more capable and in control of dealing with cancer-related pain and stress. During hypnotic training, people were told to "filter out the pain" of any feelings by imagining other feelings in the hurt area. Patients were also shown how to use self-hypnosis when they were not in group therapy. Pain and suffering were a lot less in both treatment groups than in the control group. Hypnosis wasn't the main focus of the expressive-supportive group therapy sessions. However, patients who got hypnosis in addition to group therapy reported significantly (p .05) less pain increase over time (as the cancer got worse) than patients who didn't get the hypnosis intervention.
Elkins et al. (2004) did a prospective, randomized study of 39 cancer patients with malignant bone disease who were in advanced stages III or IV. The patients were given either weekly sessions of supportive attention or an intervention using hypnosis. Patients who were given the hypnosis intervention went to at least four weekly sessions where a standard transcript was used to put them to sleep. In the transcript, there were tips for relaxing and feeling better, as well as instructions on how to self-hypnotize. Patients in the hypnosis intervention group were also given an audiocassette tape recording of a hypnotic induction and told how to practice hypnosis at home. The hypnosis intervention group had less pain overall (p .0001) after all of the sessions. On a scale from 0 to 10, the average rating of how well self-hypnosis practice outside of sessions worked was 6.5.
Lower-back pain
McCauley et al. did a prospective trial in 1983 to compare hypnosis and relaxation training for chronic low-back pain. Self-hypnosis (n = 9) or relaxation (n = 8) was given to 17 outpatients. The first step was an EMG assessment, and eight individual weekly sessions started a week later. During the 1-week baseline period, no significant changes were seen in any of the outcome measures. The patients were checked on a week after their treatment ended and then again 3 months later. The McGill Pain Questionnaire and visual analog ratings of pain showed that patients in both groups had significantly less pain. Patients who were given hypnosis reported significant improvement before and after treatment. The percentages of improvement in the three pain measures were 31%, 25%, and 25%, respectively. But both the hypnosis intervention and the relaxation were helpful; neither was better than the other.
Using a crossover study design, Spinhoven and Linssen (1989) compared self-hypnosis training to an education program for people with chronic low-back pain. Forty-five people with low-back pain were given one of the two treatments first, then went without treatment or follow-up for two months, then got the treatment they hadn't gotten yet, then went without treatment or follow-up for two more months. A pain diary was used to track how bad the pain was, how long it lasted, and how often painkillers were taken. The Symptom Checklist-90 was used to measure anxiety and depression (SCL-90). Patients in the hypnosis condition were given hypnosis, which included suggestions like relaxation, daydreaming, pain displacement, pain transformation, and thinking about what will happen in the future. Patients were shown how to use self-hypnosis, and in the fifth session, they were given an audiotape to help them continue to practice self-hypnosis. Patients in the education condition listened to lectures and talked with a facilitator to help them learn to take control of their pain. A number of patients dropped out of this study, but the 24 patients who finished both phases (and therefore got both treatments) showed significant improvement on all outcome measures except pain intensity from the start of the study to the 2-month follow-up. Also, the post hoc analyses didn't find any significant differences between the two treatment conditions on any measure. It was decided that the treatment package helped people with chronic low-back pain learn how to deal with their pain better and better adjust to living with chronic pain.
Arthritis Caused Pain
Gay et al. (2002) looked at how well hypnosis and Jacobson relaxation helped reduce osteoarthritis pain. 36 people with osteoarthritis pain were randomly given one of three treatments: hypnosis, relaxation training, or standard care (no treatment). The hypnosis intervention was made up of eight sessions that took place once a week. Each session started with a standard relaxation technique, followed by suggestions for positive imagery and a memory from childhood that involved joint mobility. The outcome measures were given to the people in the standard-care control condition, and they were offered treatment after their last follow-up assessment. After 4 weeks of treatment, patients in the hypnosis group had a big and noticeable decrease in pain that lasted for 3 and 6 months of follow-up. Patients in the control group who didn't get any treatment said that their pain didn't change much during the 6 months of this trial. But even though there were statistically significant differences between hypnosis and the standard-care control condition four weeks into treatment, after treatment, and at follow-up, there were not statistically significant differences between the effects of hypnosis and relaxation on pain reduction.
Sickle Cell Disorder
Dinges et al. (1997) put 37 children and adults with sickle cell disease (SCD) who had experienced vaso-occlusive pain into a 2-year treatment plan. A pre- and post-experimental design was used, and participants were asked to keep daily diaries for 4 months of baseline and 18 months of treatment. The treatment consisted of cognitive-behavioral therapy that focused on self-hypnosis training and practice once a week for the first 6 months, twice a month for the next 6 months, and once every 3 weeks for the last 6 months. The hypnosis intervention included suggestions for ideomotor responses, such as the hands moving together or the arm getting lighter and rising. It also encouraged the person to come up with their own metaphors and self-suggestions to help them deal with pain. The results showed that the self-hypnosis intervention led to a big drop in the number of pain days. There were significant differences between the starting point and the treatment phase in (a) the number of days that patients reported both SCD pain (from 20 to 11 days) and non-SCD pain (from 19 to 6 days), (b) the number of days that patients took medication for non-SCD pain (from 6% to 1%), and (c) the number of "bad sleep nights" on non-SCD pain days (from 8% to 2%). No big changes were found in the number of SCD pain days when medication was taken or the number of SCD pain days when sleep was bad. The authors came to the conclusion that the overall decrease in pain was caused by the elimination of less severe pain episodes.
Temporomandibular Pain
Temporomandibular disorder can cause long-term pain from problems with the muscles that help you chew, the temporomandibular joint, or both. Simon and Lewis looked at how hypnosis helped 28 people with temporomandibular pain disorder in 2000. Pain intensity, duration, and frequency were measured four times: while on the waiting list, before treatment, after treatment, and at a 6-month follow-up. The hypnosis intervention included teaching about hypnosis and five sessions that included an eye-closing induction, relaxation imagery, suggestions for limb catalepsy, metaphors, suggestions for hypnotic analgesia and anesthesia, and suggestions that muscle tension would be a sign to relax. Patients were also told to use audiotapes of the hypnotic treatment to help them practice self-hypnosis every day. The results showed a significant decrease in the number of pain episodes (p .001), a decrease in the length of pain (p .001), and an increase in daily functioning. Analyses also showed that the benefits of treatment, like less pain and better daily functioning, lasted for 6 months after treatment ended.
Winocur et al. (2002) compared "hypnorelaxation" to using an occlusal appliance or an education and advice condition to treat temporomandibular pain. The study sample was made up of 40 female patients who were randomly split into three treatment groups: (a) hypnorelaxation (n = 15), (b) occlusal appliance (n = 15), and (c) education/advice (n = 10). The hypnorelaxation intervention included suggestions for gradually relaxing muscles and training in self-hypnosis for relaxing facial muscles. For the occlusal appliance condition, a full-coverage, hard acrylic appliance was made to fit the maxillary arch and given to the patient. Patients in the education and advice group were given suggestions on how to change their activities and diet to better deal with pain. Before and after treatment, pain levels (current and worst) were measured with visual analog scales. Both active treatments (hypnotherapy and an occlusal appliance) were better at reducing sensitivity to touch than education or advice. But only patients in the hypnosis condition (not the occlusal appliance condition) reported a significant decrease in pain intensity: 57% less pain right now and 51% less pain at its worst. Patients in the education/advice condition did not report a significant decrease in pain intensity.
Fibromyalgia
In a controlled study, Haanen et al. (1991) gave 40 patients with fibromyalgia either eight 1-hour sessions of hypnotherapy with a self-hypnosis home-practice tape or three months of physical therapy, which included 12 to 24 hours of massage and muscle relaxation training. The outcome was looked at before and after treatment, as well as 3 months later. The arm-levitation induction and suggestions to strengthen the ego, relax, sleep better, and "control muscle pain" were part of the hypnosis intervention. Patients in the hypnosis group did much better than those in the physical therapy group on measures of muscle pain, fatigue, sleep disturbances, distress, and overall patient assessment of outcome. At the 3-month follow-up, these differences were still there, and the 35% average decrease in pain among patients who got hypnosis was clinically significant, while the 2% average decrease in pain among patients who got physical therapy was not.
Pain Caused by Disability
Jensen et al. (2005) looked at how 10 sessions of standardized (script-driven) hypnotic analgesia treatment affected 33 people with chronic pain caused by a disability in terms of pain intensity, pain unpleasantness, depression, and feeling in control of pain. Outcome measures were taken before and after the baseline period, as well as after treatment and at the 3-month follow-up. The hypnosis intervention started with a hypnotic induction and then went on to include five specific suggestions for changing pain: reducing pain, relaxing, imagining analgesia, making pain less unpleasant, and replacing pain with other sensations that aren't painful. Also, after hypnosis, the patients were told to practice hypnosis every day, but no practice tapes were given to them until the 3-month follow-up. Analyses showed that pain intensity, pain unpleasantness, and the feeling of being in control of pain all got better after treatment, but depressive symptoms didn't change more than they did during the baseline period. At the 3-month follow-up, there was still improvement. The ability to be hypnotized and the amount of treatment (e.g., daily vs. weekly) did not have a big effect on how well treatment worked. But when cognitive expectations were measured after the first session, they were found to have a moderate relationship with pain relief.
Mixed Problems with Chronic Pain
In 1975, Melzack and Perry studied how hypnosis and neurofeedback helped 24 people with different kinds of chronic pain. Baseline data were collected during two sessions with no treatment (baseline). 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 was a taped hypnotic induction with suggestions for relaxation, ego strengthening, a feeling of more peace, and the ability to deal with things that usually upset and worry the person. The hypnosis treatment did not include any direct suggestions for dealing with pain. Before and after each baseline, training, and two post-training practice sessions, the McGill Pain Questionnaire was filled out. During the hypnosis training, pain was lessened (improvement ranged from 21% to 32%, with a median improvement of 23%), but neither the neurofeedback nor the hypnosis changes were statistically significant compared to the baseline phase.
Edelson and Fitzpatrick (1989) looked at hypnosis and cognitive-behavioral therapy as ways to treat chronic pain. Twenty-seven people with chronic pain, mostly back pain, were randomly given either cognitive-behavioral therapy (CBT) alone, CBT plus hypnosis treatment, or an attention control group (supportive, nondirective discussions). With the exception of a hypnotic induction, the hypnosis and CBT treatments were the same. But it's important to note that the CBT intervention used in this study had some parts that could be called "hypnotic." In particular, the CBT intervention told the participants not to call their feelings "pain," (b) reinterpret pain feelings as "numbness" by using imagery (this part in particular could be thought of as a hypnosis intervention), and (c) keep track of and change negative self-talk. The results showed that both the hypnosis intervention and the CBT treatment led to pain relief that lasted for a month. But only the CBT treatment made the pain rating scores significantly lower compared to the attention control condition. Adding a hypnotic induction didn't seem to help much in this study. In this study, pain behaviors were changed more by the CBT treatment without the induction. Given that some parts of the CBT treatment used in this study had "hypnotic qualities," this finding is a little strange. But this does suggest that a hypnotic induction might be bad for some types of CBT for chronic pain.
Appel and Bleiberg (2005–2006) looked into the link between being easy to hypnotize and using hypnosis to treat long-term pain. Twenty-seven people with different types of chronic pain (15 with lumbar pain, 7 with rheumatoid pain, 3 with cervical pain, 1 with peripheral neuropathy, and 1 with gynecological pain) went to hypnosis sessions to "learn how to control the affective and sensory aspects of pain." During the intervention, the word "hypnosis" was never used. Instead, relaxation training, autogenic statements, guided imagery to change pain and improve health and healing, and personalization to use images "in a way that works best for him or her" were used. The results showed that pain ratings were significantly lower before and after treatment. There was no link between levels of relaxation and pain and the ability to be hypnotized. But the Stanford Clinical Hypnotic Scale showed that changes in pain ratings were strongly linked to hypnotizability (r =.55, p .001).
Go to: Discussion
This review found 13 controlled studies that looked at how well hypnosis helped with chronic pain. With the exception of two articles (Appel & Bleiberg, 2005–2006, and Melzack & Perry, 1975), all of the studies looked at had a control condition for comparison. In each of the studies, it was shown that the hypnosis intervention was much better at reducing pain in people with chronic pain than no treatment. Also, hypnosis has been shown to be effective at reducing pain for a wide range of long-term pain conditions (e.g., cancer, low-back pain, arthritis pain, sickle cell disease, temporomandibular pain, disability-related pain).
But there have only been a small number of studies on each of the different types of chronic pain (in some cases only one study). Even though it's good that 13 controlled studies have been done on the use of hypnosis for chronic pain, most of these studies have some problems with how they were designed. Most studies have a small number of participants, which makes it hard to see differences between groups. Most of the time, the control conditions used didn't have good controls for placebo and/or expectation. Follow-up evaluations that last long enough are rarely used, and neither are multiple ways to measure results (i.e., long-term follow-up). So, even though the results show that hypnosis can be used to treat chronic pain in general, a lot more research will be needed to fully figure out how it works for different types of chronic pain (e.g., neuropathic, sickle cell disease, arthritis, etc.).
In studies of hypnosis for treating chronic pain, patients were often taught self-hypnosis as a way to deal with pain and gain more control over it (e.g., Dinges et al., 1997; Elkins et al., 2004; Gay et al., 2002; Haanen et al., 1991; Jensen et al., 2005; McCauley et al., 1983; Simon & Lewis, 2000; Spiegel & Bloom, 1983; Spinhoven & Linssen, 1989; Winocur et al., 2002). This is usually done by giving the patient tape recordings of the hypnosis sessions and instructions on how to do self-hypnosis at home. But more research needs to be done to find out how important self-hypnosis is and what the best way is to teach it. For example, no one knows if standard tapes work as well as personalized recordings. Also, no one has figured out how often you need to practice or if practicing at home is as good as practicing in person. From what we've seen in the clinic, patients who are more involved in self-hypnosis practice seem to get more out of it and may see results that last longer (see Elkins et al., 2004; Jensen & Barber, 2000). We tell patients in clinical practice to practice at least once a day. We help them do this by giving them recordings of the sessions. We also show them how to practice self-hypnosis without using a recording. Some patients choose to do self-hypnosis by listening to a tape, while others do it without a tape. Many people do both.
Chronic pain is a complicated condition that can be affected by emotional, mental, behavioral, and physical responses. For some people with chronic pain, a multimodal treatment approach may be important. But there haven't been many studies that look at how well hypnosis works with other treatments for chronic pain, like programs that try to get people moving more and lessen how pain affects their ability to do things (Patterson & Jensen, 2003). In one study, CBT was compared to CBT plus hypnosis. In that study (Edelson & Fitzpatrick, 1989), only the CBT treatment alone led to significantly lower pain-rating scores compared to an attention-control condition. This finding is a little strange because some parts of the CBT treatment used in this study seemed very similar to a hypnotic intervention. For example, the CBT intervention included instructions to reinterpret pain sensations as "numbness" by using imagery. But this study suggests that the addition of a hypnosis induction may have hurt an intervention that was meant to change unhealthy ways of thinking. For managing chronic pain, more research is needed to find the best ways to combine hypnosis with CBT and other multimodal interventions.
The present review also shows that hypnotic induction and interventions are not standardized. The parts of a hypnotic intervention need to be more clearly defined so that studies can be compared and hypnosis can be distinguished from other "hypnotic-like" interventions like relaxation training. For example, in this review, treatments like progressive muscle relaxation and mental imagery seemed to work about as well as those that were called "hypnosis." It is possible that the way these treatments work and what they do are the same. To find out how well hypnosis and specific hypnotic suggestions and interventions work, more research is needed. Jensen and Patterson (2006) came up with a basic chronic pain hypnotic-analgesia intervention that includes: (a) a standard hypnotic induction that includes focusing attention and relaxing; (b) suggestions to change how the person feels pain; (c) hypnotic suggestions that last at least 20 minutes; (d) four to seven sessions for "brief hypnosis treatment" and eight or more sessions for "hypnosis treatment;" and (e) instructions on how to do self-hypnosis every day at home. More standardization of hypnosis research protocols for chronic pain would make it easier to target treatments and find new ways to make hypnosis interventions that work especially well.
The current review shows that hypnotic interventions for chronic pain lead to big drops in how much pain is felt, which can sometimes last for months. Also, in a few studies, hypnotic treatment was found to be more effective, on average, than some other treatments, such as physical therapy or education, for some types of chronic pain. These results are promising for the first round of studies, but they would be much more convincing if they were part of a more advanced body of research with larger sample sizes and stricter controls. Most studies have looked at how hypnotic suggestion can be used to relieve pain, but hypnosis may also help people with chronic pain feel less anxious, sleep better, and have a better quality of life (Jensen, McArthur, et al., 2006). These goals for hypnosis interventions with people who have chronic pain need more research. So far, the research has been very promising, but more research is needed to fully evaluate the effects and mechanisms of hypnosis interventions for chronic pain in randomized trials and clinical practice.
Go to: Information about Contributors
Gary Elkins works at the Texas A&M University College of Medicine and the Scott and White Clinic and Hospital in Temple, Texas.
Mark P. Jensen, School of Medicine at the University of Washington in Seattle, Washington, USA.
David R. Patterson, School of Medicine, University of Washington, Seattle, Washington, USA.
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