AT WORK – surgery

P
ain is a common component of many medical conditions
and has been defined as more than purely physical sensa-
tions. While some research has claimed hypnosis to be
effective for inclusion within pain-management treatment regimes,
a recent Cochrane review has suggested that many of the trials are
inadequate1. The aim of this paper is to clarify the existing views in
relation to the usefulness of hypnosis in pain management.

Multidimensional pain and hypnosis

Pain is a multidimensional psychosensory disease process in-
volving physical symptoms and emotional responses, such as
fear and anxiety, leading to depression, frustration and anger.2
Chronic pain requires multidimensional assessment and treat-

Analgesic
ment.3 For effective treatment, each dimension of the pain state
(physical and emotional) must be identified2, assessed and ad-
dressed. Treating the psychological facets of pain is considered
an integral part of a comprehensive pain management plan.
Hypnosis is being increasingly used as part of psychological

hypnosis
management of pain and is defined as a natural state of being,
existing ‘when suggestions from one individual seemingly alter
the perceptions and memories of another’.4 Randomised con-
trolled studies into the efficacy of hypnosis have increased over
the past two decades.5,6 Research into hypnosis as an adjunct to
orthodox pain treatments is showing that hypnosis can be of as-
sistance in the management of pain.6
Three Cochrane1,7–9 reviews have indicated that more high-
quality research is required before hypnosis can be determined to
How effective is hypnosis for pain relief? Leon
be efficacious. However two studies — needle-related procedural Cowen explores the power of suggestion.
pain9 and pain management in labour8 — have data that suggest
the efficacy of hypnosis in both situations. In irritable bowel syn- Leon W Cowen, DCH, DipHypMast, GradDipAppHyp, MastCH,
drome (IBS), studies reported beneficial effects for symptoms.10,11 FAHA, RMASCH, MATMS, is a Masters Candidate with the
but few studies so far have used randomised clinical trials.1 These Australian Centre for Educational Studies, Macquarie University,
deficits preclude a definitive judgement on the efficacy of hypno- and Executive Director of the Academy of Applied Hypnosis
sis for IBS. While many of the research studies produce data that
may be considered promising, the results cannot be generalised to The Editor thanks Werner Meyer, GradCertNLP, DipClinHyp,
other conditions and more high-quality research is required for practitioner of Ericksonian hypnosis; and Tamo Nakamura, BSc,
hypnosis to be validated. PhD, Senior Research Assistant, Laboratory of Neuroimmunology,
School of Psychology, University of Newcastle for their kind
Understanding hypnotic analgesia assistance in the peer review of this article
A summary of a review on research into the use of hypnosis for clini-
cal pain3 can assist with the understanding of the broader approach
to hypnotic pain control. Laboratory pain research studies have naloxone, suggesting that the mechanism of hypnotic pain control is
examined the effects of hypnosis on the client’s perception of pain. different to endogenous opioid production.7, 8
These studies indicate an association between hypnotic responsive- Researchers have endeavoured to identify key physiological
ness and response to hypnotic analgesia. Research also showed that markers unique to hypnosis as distinct from other states of con-
individuals engaged in successful hypnotic analgesia invoked physi- sciousness, such as wakefulness or sleep. Currently, there are no
ological inhibitory processes in the brain.3 The effects of the hypnotic unique markers that distinguish hypnosis from other states of con-
analgesia were maintained in the presence of an opioid antagoinist, sciousness3; hypnosis exhibits similar characteristics and may be

18 Complementary Medicine NOVEMBER / DECEMBER 2009


Summary
• Hypnosis has been suggested to be effective in
managing pain, especially for labour and needle-related
procedures
• Mechanism of hypnotic pain control is different to
endogenous opioid production
• Quality research is needed
analogous to a form of deep relaxation.9 Significantly higher theta
activity (5.5–7.5Hz) in electroencephagrams is reported in the an-
terior temporal area from highly suggestible patients.10 Different ar-
eas were involved during hypnotic analgesia compared with a con-
dition where subjects were subjected to cold pressor pain and this
may be related to whether the suggestions were designed to evoke
attention or disassociate mechanisms. In a study using positron
emission tomography (PET), hypnosis-related changes were associ-
ated with changes in the anterior cingulate cortex with no changes
in the primary somatosensory cortex.11 Hypnotic suggestions for in-
creased or decreased unpleasantness altered both the perception of
pain and the activation within some of the pain-related cortical re-
gions.11 Hypno-analgesia can diminish the pain impulses arriving at
the somatosensory cortex, which may affect the emotional response
to pain by its effects on the limbic system.12
Treatment spectrum in studies
Hypnosis has demonstrated pain management efficacy2,3,13–15 as
part of a treatment regime for conditions such as cancer,14 dentist-
ry16, emergency medicine15, IBS17, labour18, phantom limb pain19,
palliative care20 and burn care3 in a variety of peer-reviewed jour-
nals. Hypnosis also has been suggested to be effective in reducing
pain associated with arthritis, cancer, lower-back and needle-relat-
AT WORK – surgery
ed procedures in children21, sickle cell disease, temporomandibu-
lar pain, fibromyalgia, disability and chronic pain problems.22 In
these areas, there is relatively strong evidence for the efficacy of
hypnosis in pain management for labour18 and needle-related pro-
cedures in children.21
Direct, indirect and post-hypnotic suggestions have been admin-
istered to assist in treating chronic headache and wound care. Treat-
ments encompassed areas of analgesia, anaesthesia, local anaesthesia
and topical anaesthesia. The studies have indicated that hypnotic
suggestion is a valid inclusion into a pain management plan. The
standard therapy is between one and six sessions, dependent upon
the patient’s issue.6 Prior to the hypnotic induction, a thorough pa-
tient history is taken to determine the focus of the intervention.
The description of a typical session involves an eye-fixation in-
duction technique, followed by a deepening technique that involves
the patient’s imagination, then the appropriate suggestions are given
and the client is awakened. Patients became involved with a favourite
story that incorporated reinterpretations of the procedural noxious
experience, comfort, dissociation, distraction, mastery, normality of
pregnancy and labour, numbness, pain reduction, pleasant imagery,
positive affect, post-surgical outcomes, posthypnotic suggestions for
practising and re-entering hypnosis, reduction of anxiety, reframing
pain, relaxation, self-efficacy, self-hypnosis and well-being. When
cognitive behavioural therapy (CBT) and hypnosis are combined,
the results are greater than with CBT alone.6 In general, there is a
paucity of high-quality randomised controlled trials (RCTs) in hyp-
nosis for pain control.1 As hypnosis has produced promising results
in various studies23, the logical progression is for the replication of ex-
isting research with a stronger methodological foundation.
Review evidence
Hypnosis has been reviewed in separate studies involving pain man-
agement in labour, needle-related procedural pain in children and in
the treatment of IBS. In these studies, hypnosis was found to be ef-
ficacious separately and also in conjunction with existing treatment
regimes.1,21 In the review of the pain management in labour study18,
25 RCTs were considered and 14 trials (including 749 women) sat-
isfied the inclusion criteria. Women in the hypnosis group required
less pharmacological intervention than the control. In the hypnosis
group, there were no adverse effects to the mother or neonate. It also
appears that a secondary benefit of hypnosis may be the increased
incidence of vaginal birth. Overall, current data suggest that hypno-
sis used adjunctively is useful in the management of labour pain.
Hypnosis was included in a review to assess the efficacy of
CBT interventions for needle-related procedural pain and distress
in children and adolescents.21 Twenty-eight trials with 1951 par-
ticipants were included. The review suggests that when hypnosis
is combined with CBT and distraction, self-reports from children
and adolescents indicated reduced pain and distress. The results
NOVEMBER / DECEMBER 2009 Complementary Medicine 19
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Reviews 2007, Issue 4. Art. No.: CD005110. DOI:

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For more information and to order
shows efficacy in IBS and needle-related DOI: 10.1002/14651858.CD003521.pub2.
online, visit www.vsl3.com.au. 19 Ray T. Helping Phantom Limb Pain. [updated
procedures in children and adolescents.
1998; cited 2006 February 16]; URL hubel.sfasu.
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2007;55(3):275–87.
and childbirth, it is now appropriate for 23 Uman LS, et al. Cochrane Database of
the efficacy of hypnosis to be investigated Systematic Rev 2006(4):Art. No.: CD005179.
VSL#3TM is a registered trademark of
VSL Pharmaceuticals, Inc (USA), used
across a broader scope of conditions. DOI:10.1002/14651858.CD005179.pub2.
under licence by Orphan Australia Pty. Ltd.
48 Kangan Drive Berwick, Victoria, 3806.
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