Hypnotic approaches for chronic pain management: clinical implications of recent research findings

Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis

Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, [95% confidence intervals]) for pain intensity (0-100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: -8.2 [-11.8, -1.9]; medical procedures/surgical pain: -6.9 [-10.4, -3.3]; burn wound care: -8.8 [-13.8, -3.9]). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (-11.5 [-19.7, 3.3]) but not postsurgery pain (-2.0 [-7.8, 3.7]). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (-2 [-3.7, -0.3]). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (-13.2, [-22.5, -3.8]). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted.

Cultivating Comfort: Examining Participant Satisfaction with Hypnotic Communication Training in Pain Management

Context

One in four Canadians experiences chronic pain, yet insufficient services and restrictions surrounding prevailing treatments result in inadequate management and significant negative consequences for these individuals. Previous work indicates that hypnotic communication represents a promising complementary treatment; however, training protocols for healthcare professionals are underdeveloped and understudied.

Aim

To evaluate the level of satisfaction for a training program on hypnotic communication in pain management clinics.

Design

Qualitative study.

Methods

Six health professionals who first completed the hypnotic communication training participated in 30 minutes virtual semi-structured interviews. These testimonials allowed them to elaborate on their user experience and potential areas for improvement. Thematic analysis using qualitative data management software NVIVO was conducted on the interview data.

Results

Two themes emerged from the interviews. 1) Satisfaction: Participants expressed satisfaction on various structural aspects of the training, including the provided materials, atmosphere, training structure, presentation modalities, practical workshops, acquired knowledge, trainer quality, and training duration. 2) Areas for Improvement: Five main improvement suggestions were identified (providing more material; more practical workshops, more concrete and adapted; testimonials from former patients; follow-up training meeting; and continuing education).

Implications for the Profession and/or Patient Care and Conclusion

The results improved the training program to help minimized inherent biases related to this technique, cut associated costs, and identify reasons that would explain its underutilization among medical professionals in Quebec. Our work highlights that healthcare professionals in chronic pain management clinics (eg, respiratory therapists, nurses) can incorporate this simple hypnotic communication technique into their usual care and contribute to the well-being of patients.

Impact

This study aimed to address the lack of training protocols for healthcare professionals, that are underdeveloped and understudied. The main findings on participant' satisfaction and the areas of improvement for the training will help the refinement of the training to better suit healthcare professional's needs in hospitals and chronic pain facilities.

Using hypnosis in clinical practice for the management of chronic pain: A qualitative study

BACKGROUND

Interventions used in chronic pain management do not routinely use clinical hypnosis (CH), despite evidence to suggest its effectiveness in improving pain outcomes. This study aimed to explore the beliefs and attitudes of clinicians' towards the implementation of CH in chronic pain management.

METHOD

We conducted a cross-sectional qualitative analysis following online CH training. Clinicians working in three tertiary pain clinics, were recruited to participate in the online training program and invited to focus groups following completion of the training to explore beliefs and attitudes towards CH and the training program.

RESULTS

We identified three themes regarding barriers and two themes regarding facilitators to implementation of CH. Barriers: (i) misconceptions about CH, (ii) reduced confidence in implementing CH, and (iii) concerns about integrating CH with current treatment frameworks. Facilitators: (i) change in knowledge and attitude following training and (ii) an openness to exploring the technique and skills. The online training program was evaluated as positive with two themes: (i) training structure and (ii) training credibility.

CONCLUSION

Successful implementation of CH requires the development of training programs that address existing misconceptions of CH, allow for knowledge and skills acquisition, and adapt to the contextual setting within which the intervention is implemented.

PRACTICAL IMPLICATIONS

Training of clinicians in the process and skills required to deliver clinical hypnosis for chronic pain should be supported to facilitate its successful implementation into clinical settings.

Brain Functional Correlates of Resting Hypnosis and Hypnotizability: A Review

This comprehensive review delves into the cognitive neuroscience of hypnosis and variations in hypnotizability by examining research employing functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and electroencephalography (EEG) methods. Key focus areas include functional brain imaging correlations in hypnosis, EEG band oscillations as indicators of hypnotic states, alterations in EEG functional connectivity during hypnosis and wakefulness, drawing critical conclusions, and suggesting future research directions. The reviewed functional connectivity findings support the notion that disruptions in the available integration between different components of the executive control network during hypnosis may correspond to altered subjective appraisals of the agency during the hypnotic response, as per dissociated and cold control theories of hypnosis. A promising exploration avenue involves investigating how frontal lobes' neurochemical and aperiodic components of the EEG activity at waking-rest are linked to individual differences in hypnotizability. Future studies investigating the effects of hypnosis on brain function should prioritize examining distinctive activation patterns across various neural networks.

Who Benefits the Most From Different Psychological Chronic Pain Treatments? An Exploratory Analysis of Treatment Moderators

Different psychological chronic pain treatments benefit some individuals more than others. Understanding the factors that are associated with treatment response-especially when those factors differ between treatments-may inform more effective patient-treatment matching. This study aimed to identify variables that moderate treatment response to 4 psychological pain interventions in a sample of adults with low back pain or chronic pain associated with multiple sclerosis, spinal cord injury, acquired amputation, or muscular dystrophy (N = 173). The current study presents the results from secondary exploratory analyses using data from a randomized controlled clinical trial which compared the effects of 4 sessions of cognitive therapy (CT), hypnosis focused on pain reduction (HYP), hypnosis focused on changing pain-related cognitions and beliefs (HYP-CT), and a pain education control condition (ED). The analyses tested the effects of 7 potential treatment moderators. Measures of primary (pain intensity) and secondary (pain interference, depression severity) outcome domains were administered before and after the pain treatments, and potential moderators (catastrophizing, hypnotizability, and electroencephalogram (EEG)-assessed oscillation power across five bandwidths) were assessed at pre-treatment. Moderator effects were tested fitting regression analyses to pre- to post-treatment changes in the three outcome variables. The study findings, while preliminary, support the premise that pre-treatment measures of hypnotizability and EEG brain activity predict who is more (or less) likely to respond to different psychological pain treatments. If additional research replicates the findings, it may be possible to better match patients to their more individually suitable treatment, ultimately improving pain treatment outcomes. PERSPECTIVE: Pre-treatment measures of hypnotizability and EEG-assessed brain activity predicted who was more (or less) likely to respond to different psychological pain treatments. If these findings are replicated in future studies, they could inform the development of patient-treatment matching algorithms.

Virtual adjunctive gut-directed hypnotherapy for people with Crohn's disease: A randomized controlled pilot and feasibility trial

BACKGROUND

Gut-directed hypnotherapy appears to be a promising adjunctive treatment for people with Crohn's disease. The primary objective of this pilot trial was to evaluate feasibility and acceptability of virtually delivered hypnotherapy to determine the parameters for a future definitive trial.

METHODS

This prospective, single-site, randomized controlled pilot and feasibility trial compared a 7-week course of virtually delivered adjunctive gut-directed hypnotherapy to standard medical treatment only for adults with Crohn's disease. Primary outcomes were study feasibility and intervention acceptability. Secondary outcomes were objective disease activity and patient-reported outcomes. Assessments took place at five time-points: baseline, post-intervention, and follow-up three-, six-, and 12-months post-intervention.

KEY RESULTS

Recruitment took place between July 2020 and August 2021 at a tertiary hospital. Recruitment was initially slow and subsequently expanded to community settings. Thirty-seven participants were enrolled in the trial: 95% were retained at post-intervention and 76% at 12-months. Completion of online assessments was high (97-100% across all time-points) whilst objective data collection was low (34-44%). Most intervention participants completed all hypnotherapy sessions (88%) and reported being extremely satisfied (73%), despite 60% experiencing technical issues.

CONCLUSION & INFERENCES

Virtually delivered hypnotherapy was acceptable to participants. Certain aspects of the trial including online assessment were feasible, while recruitment and objective data collection were challenges. Undertaking a future definitive trial will require broader recruitment scope and significant funding for widespread objective data collection.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ANZCTR#1260000348954.

Effects of hypnosis, mindfulness meditation, and education for chronic pain on substance use in veterans: A supplementary analysis of a randomized clinical trial

PURPOSE/OBJECTIVE

To examine the impact of three behavioral interventions for chronic pain on substance use.

RESEARCH METHOD/DESIGN

Participants were 328 Veterans with chronic pain receiving care at one of two Veterans Affairs Medical Centers in the northwest United States. Participants were randomly assigned to one of three 8-week manualized in-person group treatments: (a) hypnosis (HYP), (b) mindfulness meditation (MM), or (c) active education control (ED). Substance use frequency was assessed using 10 individual items from the WHO-ASSIST, administered at baseline prior to randomization and at 3- and 6-month posttreatment.

RESULTS

Baseline substance use (i.e., any use) in the past 3 months was reported by 22% (tobacco), 27% (cannabis), and 61% (alcohol) of participants. Use of all other substances assessed was reported by < 7% of participants. Results showed that MM, as compared to ED, significantly reduced risk of daily cannabis use by 85% and 81% at the 3- and 6-month posttreatment follow-ups, respectively, after adjusting for baseline use. HYP, as compared to ED, significantly reduced risk of daily cannabis use by 82% at the 6-month posttreatment follow-up after adjusting for baseline use. There was no intervention effect on tobacco or alcohol use at either posttreatment follow-up.

CONCLUSIONS/IMPLICATIONS

HYP and MM for chronic pain may facilitate reductions in cannabis use, even when reducing such use is not a focus of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hypnotizability in the Clinic, Viewed from the Laboratory

A recent international survey discovered that clinicians who use hypnosis in their practice rarely assess the hypnotizability of their patients or clients. This contrasts sharply with the practice in laboratory research. One reason offered for this discrepancy is that hypnotizability does not strongly predict clinical outcome. But a comparison of this relationship with similar correlations in other domains shows that this criticism is misleading-especially when the treatment capitalizes on the alterations in perception, memory, and voluntary control that characterize the domain of hypnosis. Routine assessment of hypnotizability improves clinical practice by enabling clinicians to select patients for whom hypnosis is appropriate; and it improves clinical research by providing important information about the mechanisms underlying hypnotic effects.

Clinical Hypnosis for Pediatric Gastrointestinal Disorders: A Practical Guide for Clinicians

Functional abdominal pain disorders (FAPDs) are common in the pediatric population and are associated with a significant reduction in quality of life. Bidirectional communication of the brain-gut axis plays an important role in pain generation and perception in FAPDs. There is a paucity of data on the best approach to treat this group of disorders, with no Food and Drug Administration (FDA)-approved drugs and scarce research to substantiate the use of most medications. Use of hypnosis in pediatric FAPDs is supported by evidence and has long-term benefits of up to at least 5 years beyond completion of treatment, highlighting the importance of incorporating this therapy into the care of these patients. The mechanisms by which clinical hypnosis is beneficial in the treatment of FAPDs is not completely understood, but there is growing evidence that it impacts functioning of the brain-gut axis, potentially through influence on central pain processing, visceral sensitivity, and motility. The lack of side effects or potential for significant harm and low cost makes it an attractive option compared to pharmacologic therapies. This review addresses current barriers to clinical hypnosis including misconceptions among patients and families, lack of trained clinicians, and questions around insurance reimbursement. The recent use of telemedicine and delivery of hypnosis via audio-visual modalities allow more patients to benefit from this treatment. As the evidence base for hypnosis grows, acceptance and training will likely increase as well. Further research is needed to understand how hypnosis works and to develop tools that predict who is most likely to respond to hypnosis. Studies on cost-effectiveness in comparing hypnosis to other therapies for FAPDs will increase evidence for appropriate healthcare utilization. Because hypnosis has applications beyond pain and is child-friendly with minimal to no risk, hypnosis could be an important therapeutic tool in the wider pediatric gastrointestinal population.

Effects of Hypnotic Analgesia and Transcranial Direct Current Stimulation on Pain Tolerance and Corticospinal Excitability in Individuals with Fibromyalgia: A Cross-Over Randomized Clinical Trial

Objective

We compare the effect of HAS, a-tDCS on the left dorsolateral prefrontal cortex (l-DLPFC), and rest-testing on pain measures [(cold pressor test (CPT) (primary outcome) and heat pain threshold]. We also compare their effects on the motor evoked potential (MEP) (primary outcome), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP).

Methods

This randomized, blind, crossover trial included 18 women with fibromyalgia, aged from 18 to 65 years old. They received at random and in a crossover order a-tDCS over the l-DLPFC (2mA), HAS, or a rest-testing.

Results

HAS compared to a-tDCS increased the pain tolerance with a moderate effect size (ES) [Cohen's f=-0.78; (CI 95%; -1.48 to -0.12)]. While compared to rest-testing, HAS increased the CPT with a large ES [Cohen's f=-0.87; (CI 95%; -1.84 to -0.09)]. The a-tDCS compared to HAS increased the MEP amplitude with large ES [Cohen's f=-1.73 (CI 95%; -2.17 to -0.17)]. Likewise, its ES compared to rest-testing in the MEP size was large [Cohen's f=-1.03; (CI 95%; -2.06 to -0.08)].

Conclusion

These findings revealed that HAS affects contra-regulating mechanisms involved in perception and pain tolerance, while the a-tDCS increased the excitability of the corticospinal pathways. They give a subsidy to investigate their effect as approaches to counter regulate the maladaptive neuroplasticity involved in fibromyalgia.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier - NCT05066568.

Clinical hypnosis can reduce lower urinary tract symptoms in individuals with chronic pain

STUDY PURPOSE

Lower urinary tract symptoms (LUTS) can occur in chronic pain populations at high rates and drastically affect quality of life. Hypnosis is a nonpharmacological treatment used in chronic pain known to have beneficial implications to health outside of pain reduction. This study evaluated the potential for hypnosis to reduce LUTS in a sample of individuals with chronic pain, if baseline LUTS severity affected outcomes, and specific LUTS that may respond to hypnosis.

METHODS

Sixty-four adults with chronic pain and LUTS at a level of detectable symptom change (American Urological Association Symptom Index, AUASI   3) participated in an 8-week group hypnosis protocol. Participants completed validated assessments of LUTS, pain, and overall functioning before, after, 3- and 6-months posttreatment. Linear mixed effects models assessed improvement in LUTS over time while accounting for known factors associated with outcome (e.g., age, gender). The interaction of baseline symptom severity and treatment assessed the potential effect of baseline symptoms on change scores.

RESULTS

Participants experienced significant and meaningful improvements in LUTS following group hypnosis (p = 0.006). There was a significant interaction between baseline symptom severity and treatment (p < 0.001), such that those with severe symptoms experienced the most pronounced gains over time (e.g., an 8.8 point reduction). Gains increased over time for those with moderate and severe symptoms. Changes in LUT symptoms occurred independently of pain relief.

CONCLUSIONS

This pilot study suggests hypnosis has the potential to drastically improve LUTS in individuals with chronic pain, even when pain reduction does not occur. Results provide initial evidence for the treatment potential of hypnosis in urologic pain (and possibly non-pain/benign) populations, with randomized trials needed for definitive outcomes.

Medical and Dental Applications of Titania Nanoparticles: An Overview

Currently, titanium oxide (TiO₂) nanoparticles are successfully employed in human food, drugs, cosmetics, advanced medicine, and dentistry because of their non-cytotoxic, non-allergic, and bio-compatible nature when used in direct close contact with the human body. These NPs are the most versatile oxides as a result of their acceptable chemical stability, lower cost, strong oxidation properties, high refractive index, and enhanced aesthetics. These NPs are fabricated by conventional (physical and chemical) methods and the latest biological methods (biological, green, and biological derivatives), with their advantages and disadvantages in this epoch. The significance of TiO₂ NPs as a medical material includes drug delivery release, cancer therapy, orthopedic implants, biosensors, instruments, and devices, whereas their significance as a dental biomaterial involves dentifrices, oral antibacterial disinfectants, whitening agents, and adhesives. In addition, TiO₂ NPs play an important role in orthodontics (wires and brackets), endodontics (sealers and obturating materials), maxillofacial surgeries (implants and bone plates), prosthodontics (veneers, crowns, bridges, and acrylic resin dentures), and restorative dentistry (GIC and composites).

Effects of hypnosis vs mindfulness meditation vs education on chronic pain intensity and secondary outcomes in veterans: a randomized clinical trial

ABSTRACT

Effective, rigorously evaluated nonpharmacological treatments for chronic pain are needed. This study compared the effectiveness of training in hypnosis (HYP) and mindfulness meditation (MM) with an active education control (ED). Veterans (N = 328) were randomly assigned to 8 manualized, group-based, in-person sessions of HYP (n = 110), MM (n = 108), or ED (n = 110). Primary (average pain intensity [API]) and secondary outcomes were assessed at pretreatment, posttreatment, and 3 and 6 months posttreatment. Treatment effects were evaluated using linear regression, a generalized estimating equation approach, or a Fisher exact test, depending on the variable. There were no significant omnibus between-group differences in pretreatment to posttreatment change in API; however, pretreatment to posttreatment improvements in API and several secondary variables were seen for participants in all 3 conditions. Participation in MM resulted in greater decreases in API and pain interference at 6 months posttreatment relative to ED. Participation in HYP resulted in greater decreases in API, pain interference, and depressive symptoms at 3 and 6 months posttreatment compared with ED. No significant differences on outcomes between HYP and MM were detected at any time point. This study suggests that all 3 interventions provide posttreatment benefits on a range of outcomes, but the benefits of HYP and MM continue beyond the end of treatment, while the improvements associated with ED dissipate over time. Future research is needed to determine whether the between-group differences that emerged posttreatment are reliable, whether there are benefits of combining treatments, and to explore moderating and mediating factors.

Effect of Virtual Reality Hypnosis on Pain Threshold and Neurophysiological and Autonomic Biomarkers in Healthy Volunteers: Prospective Randomized Crossover Study

Background

Virtual reality hypnosis (VRH) is a promising tool to reduce pain. However, the benefits of VRH on pain perception and on the physiological expression of pain require further investigation.

Objective

In this study, we characterized the effects of VRH on the heat pain threshold among adult healthy volunteers while monitoring several physiological and autonomic functions.

Methods

Sixty healthy volunteers were prospectively included to receive nociceptive stimulations. The first set of thermal stimuli consisted of 20 stimulations at 60°C (duration 500 milliseconds) to trigger contact heat evoked potentials (CHEPs). The second set of thermal stimuli consisted of ramps (1°C/second) to determine the heat pain threshold of the participants. Electrocardiogram, skin conductance responses, respiration rate, as well as the analgesia nociception index were also recorded throughout the experiment.

Results

Data from 58 participants were analyzed. There was a small but significant increase in pain threshold in VRH (50.19°C, SD 1.98°C) compared to that in the control condition (mean 49.45°C, SD 1.87; P<.001, Wilcoxon matched-pairs signed-rank test; Cohen d=0.38). No significant effect of VRH on CHEPs and heart rate variability parameters was observed (all P>0.5; n=22 and n=52, respectively). During VRH, participants exhibited a clear reduction in their autonomic sympathetic tone, as shown by the lower number of nonspecific skin conductance peak responses (P<.001, two-way analysis of variance; n=39) and by an increase in the analgesia nociception index (P<.001, paired t-test; n=40).

Conclusions

The results obtained in this study support the idea that VRH administration is effective at increasing heat pain thresholds and impacts autonomic functions among healthy volunteers. As a nonpharmacological intervention, VRH has beneficial action on acute experimental heat pain. This beneficial action will need to be evaluated for the treatment of other types of pain, including chronic pain.

Feedforward Control Combined with 4F Management on Postoperative Nursing Effects and Motor Function of Meniscus Sports Injuries: Based on a Prospective Case Analysis

Background

Because active functional training and management after knee cartilage sports injury is the key to treatment, care of patients after an operation with knee cartilage sports injury is critical.

Aims

To explore the effect of feedforward control combined with 4F management and after an operation nursing effect on patients with knee cartilage sports injury.

Materials and Methods

According to the random number table method, 100 patients with knee cartilage sports injury who were nursed in our hospital from June 2019 to June 2021 were selected as the research objects and divided into the control group and the instance of watching, noticing, or making a statement group with 50 cases in each group according to the different nursing order. Among them, the control group adopted 4F management combined with feedforward control nursing mode: all-weather, whole-process, whole-system, and all-around services for patients. On this basis, the instance of watching, noticing, or making a statement group cooperated with early healing/repairing training to compare fear and stress-related self-test of the two groups of patients after an operation. Knee function and quality of care are scored using tables.

Results

After nursing, the knee joint function score of the instance of watching, noticing, or making a statement group was higher than that of the control group, while the pain after the operation, sleep quality, fear, and stress self-rating scale scores were significantly lower than the control group (P < 0.05). The whole-process management, body position placement, risk evaluation, repairing training, all-weather service, whole-system management, and comprehensive service of the two groups of patients were very much improved. The nursing quality of watching, noticing, or making a statement group was significantly higher than the control group (P < 0.05).

Conclusion

Feedforward control combined with 4F management combined with early repairing training can effectively reduce the fear and stress after an operation pain and sleep quality of knee cartilage sports injury and help increase the recovery of knee combined function in a good way.

Delivery of a Group Hypnosis Protocol for Managing Chronic Pain in Outpatient Integrative Medicine

Although strong evidence exists for using individual hypnosis to treat pain, evidence regarding group applications is limited. This project evaluated changes in multiple outcome measures in persons with chronic pain treated with 8 weeks of group hypnosis. Eighty-five adults with diverse chronic pain etiologies completed an 8-session, structured group hypnosis treatment. Pain intensity, pain interference, and global health were evaluated at baseline, posttreatment, and 3- and 6-months posttreatment. Linear mixed effects models assessed changes in outcomes over time. In a model testing, all three outcome measures simultaneously, participants improved substantially from pre- to posttreatment and maintained improvement across follow-up. Analyses of individual outcomes showed significant pre- to posttreatment reductions in pain intensity and interference, which were maintained for pain intensity and continued to improve for pain interference across follow-up. The findings provide compelling preliminary evidence that a group format is an effective delivery system for teaching individual skills in using hypnosis for chronic pain management. Larger randomized controlled trials are warranted to demonstrate equivalence of outcomes between treatment modes.

Hypnoanalgesia: A Bridge Between Neuroscience and Clinical Settings

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Effectiveness of hypnosis on pain and anxiety in dentistry: Narrative review

Hypnosis presents an auxiliary adjunct in medical, dental, physiotherapeutic, and other clinical fields. This narrative review verified the effect of hypnosis in the control of pain and anxiety in dentistry. It presents the importance and effectiveness of hypnosis to aid dental procedures. It´s use in dentistry allows a wide range of applications such as sedation, analgesia, anesthesia, and hemostasis to facilitate treatment and improve the experience of dental care for dental patients. A discussion about the regulation of hypnosis in dentistry in Brazil, the attributions of dentists qualified in hypnosis, as well as the benefits of application based on evidence of hypnosis in dentistry, and the need for certification by hypnosis practitioners due to the possible risks inherent to the use of hypnosis are presented. Hypnosis is useful in the management of pain and anxiety in dentistry, when the dental practitioner is adequately experienced in this modality and the patients are carefully selected.

Positions of French Nurses Regarding the use of Hypnotherapy to Relieve Pain in Postoperative Settings

The objective of this study was to carry out a detailed mapping of the different personal positions of French nurses concerning the practice of hypnotherapy. Factorial design was used to assess the impact of 4 situational factors: type of postoperative care and degree of pain associated with it (chemotherapy, wound cleansing and bandaging, or body grooming that leads to pain on mobilization); whether paracetamol (also known as acetaminophen) was administrated along with hypnosis or not; professional credentials of the hypnotherapist; and patient's identity (adult, young person, elderly person, or young person with learning difficulties). A combination of scenario technique and cluster analysis was implemented. Participants were 91 registered nurses and, for comparison, 19 nurse's aides, 9 physicians, 5 psychologists, and 77 laypersons. Seven qualitatively different positions were found. Only a minority of French nurses were convinced that hypnotherapy is an indisputably acceptable practice in postoperative care. Most of them were indifferent to the issue as long as pain medication was used. Nurses' views appeared to be similar to physicians' views.

Implications on hypnotherapy: Neuroplasticity, epigenetics and pain

We provide a brief review about the significance of hypnosis with respect to applications and physiological processes in hypnotherapy. Our review concludes that hypnosis is a promising method to manage acute and chronic pain. In addition, we discuss indications pointing toward the view that hypnosis can induce changes in neuroplasticity possibly involving epigenetic mechanisms.

Effectiveness of hypnosis for pain and health-related quality-of-life among people with hemophilia: Three-month outcomes of a randomized controlled pilot trial

BACKGROUND AND PURPOSE

Pain is a common condition among people with hemophilia (PWH), negatively impacting quality of life. However, effective treatment remains a challenge. This two-arm, parallel randomized controlled pilot trial aimed to examine the three-month effects of hypnosis intervention on clinical and psychosocial variables, and on the inflammatory profile of PWH.

MATERIALS AND METHODS

The study was conducted between January and October 2018, in a Reference Center for Congenital Coagulopathies. Adult (age ≥18) patients were randomized to experimental group (EG) or control group (CG). The EG received four weekly hypnosis sessions plus treatment-as-usual, and the CG maintained treatment-as-usual only. Outcomes were evaluated at one week and three months post-intervention and included pain, joint status, health-related quality of life (HRQoL), emotional state and inflammatory profile (leukocytes, C-reactive protein, cytokines). The randomization sequence was computer-generated, and allocation was concealed until enrolment. The outcome assessor was blind to allocation, but blinding of the participants was not possible due to the differences in procedure.

RESULTS

Twenty patients were randomized to EG (n = 10; 8 analyzed) or CG (n = 10; 10 analyzed). Two-way mixed ANOVA showed significant time × group interactions on pain interference with normal work and with relations with other people, and on perception of health status. The EG significantly improved in pain interference with normal work and perception of health status. There was no report of harm.

CONCLUSION

Hypnosis may be a promising intervention to manage hemophilia-related pain and promote HRQoL, with benefits lasting up to three months.

An Audio-Recorded Hypnosis Intervention for Chronic Pain Management in Cancer Survivors: A Randomized Controlled Pilot Study

This pilot study evaluated the feasibility, acceptability, and potential efficacy of a 4-week hypnosis audio-recording intervention in cancer survivors with chronic pain. Forty participants were randomly assigned to treatment (n = 21) or wait-list (n = 19) conditions. Pain intensity ratings were lower at Week 4 for both groups. The effect size for pain reduction in the treatment group was d = 0.25 from baseline to 4 weeks, and the interaction effect (Time x Group) was F = .024; η²_p = .001. The small interaction effect may be due to the availability of only one recording and large variability in dose. Qualitative data indicated that the intervention's benefits included participation in self-care, improved relaxation, and an opportunity to focus on oneself in a positive way. Further efficacy testing of an audio-recording intervention in a fully powered clinical trial is warranted.

Long-Term Efficacy of a Home-Care Hypnosis Program in Elderly Persons Suffering From Chronic Pain: A 12-Month Follow-Up

BACKGROUND

Pain is a major public health concern in the aging population. However, medication brings about negative effects that compel healthcare professionals to seek alternative management techniques to alleviate pain. Hypnosis has been recognized as an effective technique to manage pain, but its long-term efficacy has yet to be examined in older adults.

AIMS

The aim was to assess the effectiveness, over a 12-month period, of home-care hypnosis in elderly participants suffering from chronic pain.

DESIGN

Real-life retrospective one-arm study with a 12-month follow-up.

SETTINGS

Elderly Persons Suffering From Chronic Pain enrolled in a clinical health care program that offered home medical follow-up.

PARTICIPANTS/SUBJECTS

Fourteen elderly women (mean age 81 years) with chronic pain participated in the home-care hypnosis program. All participants presented chronic pain (≥6 months) with average pain score >4/10.

METHODS

Participants took part in seven 15-minute hypnosis sessions within 12 months. The Brief Pain Inventory questionnaire was used to evaluate pain perception and pain interference at baseline and at 3-, 6-, and 12-month follow-up period.

RESULTS

Hypnosis home-care program significantly decreased pain perception and pain interference compared to baseline after 3 months (-29% and -40%, p < .001), and remained lower at 6 (-31% and -54%, p < .001) and 12 (-31% and -47%, p < .001) months.

CONCLUSIONS

Seven sessions of 15 minutes allocated throughout a 12-month period produced clinically significant decreases in pain perception and pain interference. Hypnosis could be considered as an optimal additional way for health practitioners to manage chronic pain in an elderly population with long-term efficacy. This study offers a new long-term option to improve chronic pain management at home in elderly populations through a low-cost nonpharmacological intervention.

Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions

ABSTRACT

The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.

Neural Mechanisms of Hypnosis and Meditation-Induced Analgesia: A Narrative Review

Meditation and hypnosis have both been found to attenuate pain; however, little is known about similarities and differences in the cognitive modulation of pain. Hypnotic and meditative states (e.g., mindfulness) reduce pain by sharing and overlapping multiple neuro-cognitive mechanisms, but they differ in many respects. While there are overlapping brain networks involved, the nature of these effects seems different. Both phenomena involve frontal modulation of pain-related areas. The role of the dorsolateral prefrontal cortex appears to depend, in hypnosis, on the type of suggestion given and, in meditation, on the level of practice. Whereas the anterior cingulate cortex seems to be a key node in both hypnosis and meditation, the dorsolateral prefrontal cortex appears to engage in hypnosis as a function of suggestion and, in meditation, as a function of proficiency.

Hypnosis in Treatment of Stomatodynia: Preliminary Retrospective Study of 12 Cases

Stomatodynia is an oral dysesthesia with a psychosomatic component. Twelve consecutive patients with stomatodynia were offered hypnosis sessions. Measures of anxiety, depression, and pain were administered before the first and after the last hypnosis session. Pain severity was assessed with a Numeric Rating Scale (NRS). Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS). The data were collected retrospectively from medical records on the 12 patients. The difference between NRS pain ratings and HADS scores before and after hypnosis was significant (p < .05). Six patients reported receiving treatment for stomatodynia before hypnotherapy; 3 of them stopped treatment for stomatodynia before completion of the hypnosis intervention. Results provide support for potential positive effects of hypnosis intervention for stomatodynia and point to the need for additional research on this issue.

Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis

This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen's guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials-the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.

Hypnotic interventions in the management of chronic pain

This article describes the pain neuro-matrix and shows how hypnotic suggestions can be used directed at each part of this in order to be maximally effective. Although inducing the hypnotic state may be relatively simple, it is important to know how to utilise it effectively using suggestion and imagery. An understanding of the patient’s clinical condition and some counselling or psychological training are essential.

Hypnotic Enhancement of Virtual Reality Distraction Analgesia during Thermal Pain: A Randomized Trial

Excessive pain during medical procedures is a pervasive health challenge. This study tested the (additive) analgesic efficacy of combining hypnotic analgesia and virtual reality (VR) pain distraction. A single blind, randomized, and controlled trial was used to study 205 undergraduate volunteers aged 18 to 20. The individual and combined effects of hypnotic analgesia (H) and VR distraction on experimentally induced acute thermal pain were examined using a 2 X 2, between-groups parallel design (4 groups total). Participants in groups that received hypnosis remained hypnotized during the test phase pain stimulus. The main outcome measure was "worst pain" ratings. Hypnosis reduced acute pain even for people who scored low on hypnotizability. As predicted, H+ VR was significantly more effective than VR distraction alone. However, H+ VR was not significantly more effective than hypnotic analgesia alone. Being hypnotized during thermal pain enhanced VR distraction analgesia.

Synthesis, characterization and advanced sustainable applications of titanium dioxide nanoparticles: A review

Nanotechnology is capturing great interest worldwide due to their stirring applications in various fields. Among nanoparticles (NPs), titanium dioxide (TiO₂) NPs have been widely used in daily life and can be synthesized through various physical, chemical, and green methods. Green synthesis is a non-toxic, cost-effective, and eco-friendly route for the synthesis of NPs. Plenty of work has been reported on the green, chemical, physical and biological synthesis of TiO₂ NPs and these NPs can be characterized through high tech. instruments. In the present review, dense data have been presented on the comparative synthesis of TiO₂ NPs with different characteristics and their wide range of applications. Among the TiO₂ NPs synthesis techniques, the green methods have been proven to be efficient than chemical synthesis methods because of the less use of precursors, time-effectiveness, and energy-efficiency during the green synthesis procedures. Moreover, this review describes the types of plants (shrubs, herbs and trees), microorganisms (bacteria, fungi and algae), biological derivatives (proteins, peptides, and starches) employed for the synthesis of TiO₂ NPs. The TiO₂ NPs can be effectively used for the treatment of polluted water and positively affected the plant physiology especially under abiotic stresses but the response varied with types, size, shapes, doses, duration of exposure, metal species along with other factors. This review also highlights the regulating features and future standpoints for the measurable enrichment in TiO₂ NPs product and perspectives of TiO₂ NPs reliable application.

Clinical Hypnosis in Pediatric Crohn's Disease: A Randomized Controlled Pilot Study

OBJECTIVE

The aim of this study was to implement clinical hypnosis (CH) as an adjunctive therapy for adolescents with Crohn's disease (CD) and to assess the impact of CH on quality of life (QoL), abdominal pain, psychosocial measures, and disease activity compared with standard care.

METHODS

Forty adolescents with CD were randomized to a hypnosis intervention (HI) or waitlist control (WC) group. The intervention consisted of 1 in-person CH session, self-hypnosis education, and recordings for home practice. Data was collected at baseline, after the 8-week intervention, and at week 16. The primary outcome was patient- and parent-reported QoL; secondary outcomes were patient-reported abdominal pain, depression, anxiety, and sleep; school absences; and disease activity by Pediatric Crohn's Disease Activity Index. Paired and independent t-tests were used to compare differences from baseline to postintervention within and between groups.

RESULTS

Forty patients (50% girls, mean 15.8 years) were enrolled from February to May 2019. Seventy-eight percent had inactive disease, and 55% had abdominal pain. Post intervention, significant improvements were noted in HI parent-reported QoL compared with WC in total score (P = 0.05), social functioning (P = 0.01), and school functioning (P = 0.04) but patient-reported QoL was unchanged. Abdominal pain severity significantly improved in HI compared with WC (P = 0.03). School absences decreased in significantly more intervention than control patients (P = 0.01). Patients who practiced self-hypnosis consistently showed a trend toward greater QoL improvement than those who did not (P = 0.1).

CONCLUSIONS

CH is an acceptable and feasible adjunct in CD and may improve psychosocial QoL and abdominal pain. Further research is warranted.

Analgesic hypnotic treatment in a post-stroke patient

In recent years, hypnotic suggestions have been used in several clinical conditions. This treatment is often used for anxiety treatment, somatization, and post-traumatic stress disorder. Hypnotic analgesia is one of the most clinically useful phenomena of hypnosis. The article describes the case of a patient who underwent hypnotic treatments for hypersensitivity and chronic pain. Results showed an improvement of pain control and a decrease of pain hypersensibility. In addition, during rehabilitative treatments, the patient reported a high level of compliance with the multidisciplinary team. These findings suggest that hypnosis could be a useful treatment for post-stroke pain management.

Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management

Chronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies.

Hypnosis in a specialist palliative care setting - enhancing personalized care for difficult symptoms and situations

This is a personal account of using hypnosis as an adjunct to specialist palliative care (SPC) treatment approaches. After a brief systematic review of the literature, one clinician's experience is outlined illustrated by short, anonymized case histories. It argues that the approach is underused in SPC. The barriers currently restricting its routine adoption in SPC are discussed including (1) a lack of SPC clinical trials, (2) a misunderstanding of hypnosis leading to stigma, and (3) its absence from clinicians' training pathways. While the evidence base for the effectiveness of hypnosis in 'supportive care', for example, managing chemotherapy-induced vomiting, is appreciable, there is a gap in SPC. There is little data to guide the use of hypnosis in the intractable symptoms of the dying, for example, breathlessness or the distress associated with missed or late diagnosis. There are many people now 'living with and beyond cancer' with chronic symptomatic illness, 'treatable but not curable'. Patients often live with symptoms over a long period, which are only partially responsive to pharmacological and other therapies. Hypnosis may help improve symptom control and quality of life. SPC trials are needed so that this useful tool for self-management of difficult symptoms can be more widely adopted.

The Hypnotic Analgesia Suggestion Mitigated the Effect of the Transcranial Direct Current Stimulation on the Descending Pain Modulatory System: A Proof of Concept Study

Objective

We evaluated whether active(a)-tDCS combined with hypnotic analgesia suggestion (HS) would be more effective than a single active(a)-tDCS, and/or sham-(s)-tDCS and s-tDCS/HS on the following outcomes: function of descending pain modulatory system (DPMS) during the conditioned pain modulation test (CPM-test) (primary outcome), heat pain threshold (HPT), heat pain tolerance (HPTo) and cold pressor test (CPT) (secondary outcomes). We also examined whether their effects are related to neuroplasticity state evaluated by serum brain-derived-neurotropic factor (BDNF).

Materials and Methods

Forty-eight females received one session of one of the four interventions (a-tDCS/HS, s-tDCS/HS, a-tDCS, and s-tDCS) in an incomplete randomized crossover sequence. The a-tDCS or s-tDCS was applied over the left dorsolateral prefrontal cortex (DLPFC) for 30 minutes at 2mA.

Results

A generalized linear model revealed a significant main effect for the intervention group (P <0.032). The delta-(Δ) pain score on the Numerical Pain Scale (NPS0-10) during CPM-test in the a-tDCS/HS group was -0.25 (0.43). The (Δ) pain score on NPS (0-10) during CPM-test in the other three groups was a-tDCS=-0.54 (0.41), HS -0.01 (0.41) and s-tDCS/HS=-0.19 (0.43). A-tDCS/HS intervention increased the CPT substantially compared to all other interventions. Also, higher baseline levels of BDNF were associated with a larger change in CPT and HPTo.

Conclusion

These findings indicate that the HS combined with a-tDCS mitigated the effect of the a-tDCS on the DPMS. The a-tDCS up-regulates the inhibition on DPMS, and the HS improved pain tolerance. And, together they enhanced the reaction time substantially upon the CPT.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT03744897.

Hypnotizability-Related Effects of Pain Expectation on the Later Modulation of Cortical Connectivity

This study examined hypnotizability-related modulation of the cortical network following expected and nonexpected nociceptive stimulation. The electroencephalogram (EEG) was recorded in 9 high (highs) and 8 low (lows) hypnotizable participants receiving nociceptive stimulation with (W1) and without (noW) a visual warning preceding the stimulation by 1 second. W1 and noW were compared to baseline conditions to assess the presence of any later effect and between each other to assess the effects of expectation. The studied EEG variables measured local and global features of the cortical connectivity. With respect to lows, highs exhibited scarce differences between experimental conditions. The hypnotizability-related differences in the later processing of nociceptive information could be relevant to the development of pain-related individual traits. Present findings suggest a lower impact of nociceptive stimulation in highs than in lows.

A Philosophical Approach to the Rehabilitation of the Patient with Persistent Pain

The use of hypnosis to promote hypnoanalgesia has a long history and has been written about anecdotally as well as having been researched in the last several decades. Research has been both clinical in nature and, in the laboratory, trying to understand the brain physiology and processes involved. This article is not about a review of the research. It is about sharing what I have learned to do clinically using hypnosis to treat patients with persistent pain over the last 40 plus years. Due to the restraints of limited space, I can only discuss the various techniques briefly. I will describe a philosophical perspective that has served me well and driven my approach to treatment. I will discuss the concept of self-regulation training along the dimensions of Sensation, Affect, Cognition, and Behavior and share how hypnosis has been incorporated in working within each of those aspects of experiencing.

Clinical Hypnosis for Chronic Pain in Outpatient Integrative Medicine: An Implementation and Training Model

Introduction: Clinical hypnosis for pain management cultivates specific skills to enhance general self-regulation and address pain. Hypnosis is well suited to integrative medicine settings; however, questions persist about its feasibility. This article describes a financially viable hypnosis practice model implemented in an integrative medicine clinic, providing initial feasibility data about rates of referral, participation, reimbursement, and provider retention. The specific processes required to establish and implement hypnosis services were detailed, including instruction in billing, reimbursement data, and a training model to enhance reach of services. Materials and methods: Insurer reimbursement data and operational costs were examined from three hypnosis groups conducted between September 2017 and March 2018. Furthermore, information on referral patterns and enrollment in treatment was collected from program initiation in September 2017 to January 2019. Provider retention in training with the expansion of supervision in the program's second year was also examined. Results: Of 258 individuals referred to hypnosis, 124 (48%) enrolled in group treatment. Analysis of insurer reimbursement over a subset of enrollees from three completed groups (N = 26) indicated an average collection of $95.85 per patient per session, equating to $706.86 per patient for the eight-session treatment. This extrapolates to $4,926.82 in total per seven-person group for the entirety of the eight-session treatment. After an annual training workshop, provider retention significantly increased (to 81% of eligible trained providers) with the initiation of twice-monthly clinical supervision focusing on transitioning from training to practice. Conclusion: This analysis indicates that a training- and practice-based research model of clinical hypnosis is feasible and financially sustainable in an integrative medicine setting.

Effects of Prehypnotic Instructions on Hypnotizability and Relationships Between Hypnotizability, Absorption, and Empathy

Although hypnotizability exhibits high across-time and across-test consistencies, it is not clear (a) how different preambles to a hypnotic procedure (metasuggestions) influence responsiveness to suggestions and the strength of the association between two hypnotizability scales and (b) how hypnotizability relates to absorption and empathy. In Experiment 1, nonclinical participants (N = 152 women) were administered the Modified Tellegen Absorption Scale (MODTAS), Interpersonal Reactivity Index (IRI), Hypnotic Induction Profile (HIP), and Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). In Experiment 2, nonclinical participants (N = 188; 105 women and 83 men) were administered the MODTAS, IRI, and Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A). The induction scores of the HIP (HIP-IND) and the SHSS:C scores showed a significantly stronger correlation when the HIP was introduced to the participants after hypnosis metasuggestion (HIP-H-IND) than after imagination metasuggestion (HIP-I-IND). Metasuggestion was a moderator of the association between HIP-IND and SHSS:C scores. Participants with low and medium, but not with high, hypnotizability levels on the SHSS:C showed significantly higher scores on the HIP-I-IND than on the HIP-H-IND. The strong correlations between the SHSS:C, HIP-H-IND, and HIP eye-roll (HIP-ER) scores indicate that both the HIP-H-IND and HIP-ER are robust measures of hypnotizability. Absorption and empathy were not significantly associated with hypnotizability. Women were more hypnotizable than men, as assessed by the HGSHS:A. The clinical relevance of metasuggestions, intended to increase responsiveness to suggestions, is discussed as a strategy to improve treatment outcomes.

HYPNOTIZABILITY-RELATED FAAH C385A POLYMORPHISM: POSSIBLE ENDOCANNABINOID CONTRIBUTION TO SUGGESTION-INDUCED ANALGESIA

Fatty acid amide hydrolase (FAAH) degrades the endogenous endocannabinoid (eCB) anandamide and might be involved in the response to suggestions of analgesia in subjects with high hypnotizability scores (highs). Since the A allele of the FAAH C385A polymorphism (rs324420) is associated with lower FAAH activity, it was studied in 21 highs, 66 low hypnotizable individuals (lows), and 172 individuals not selected for hypnotizability (controls) representing the general population. No significant difference was observed among groups, but the A allele frequency showed a significant trend to increase from lows to controls and from controls to highs. Since eCB small differences can be amplified by eCB interactions with other neurotransmitters, a contribution of the FAAH polymorphism to the highs' analgesia should not be excluded.

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

OBJECTIVE

Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health.

METHOD

Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up.

RESULTS

Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02).

CONCLUSIONS

Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

HYPNOTIC AUTOMATICITY IN THE BRAIN AT REST: An Arterial Spin Labelling Study

The feeling of automaticity reported by individuals undergoing a hypnotic procedure is an essential dimension of hypnosis phenomenology. In the present study, healthy participants rated their subjective experience of automaticity and resting-state arterial spin labelling (ASL) scans were acquired before and after a standard hypnotic induction (i.e., "neutral hypnosis"). The increase in perceived automaticity was positively associated with activity in the parietal operculum (PO) and seed-based coactivation analysis revealed additional associations in the anterior part of the supracallosal cingulate cortex (aMCC). This is consistent with the role of these regions in perceived self-agency and volition and demonstrates that these effects can be evidenced at rest, in the absence of overt motor challenges. Future studies should further examine if/how these changes in brain activity associated with automaticity might facilitate the responses to suggestions and contribute to clinical benefits of hypnosis.

HYPNOSIS, HYPNOTIC PHENOMENA, AND HYPNOTIC RESPONSIVENESS: Clinical and Research Foundations-A 40-Year Perspective

The authors summarize research findings, their clinical implications, and directions for future research derived from 40 years of study of hypnosis, hypnotic phenomena, and hypnotic responsiveness at Steven Jay Lynn's Laboratory of Consciousness, Cognition, and Psychopathology and Joseph P. Green's Laboratory of Hypnosis. We discuss (a) the accumulating body of evidence that hypnosis can be used to advantage in psychotherapy; (b) the fact that hypnosis can facilitate a broad array of subjective experiences and suggestions; (c) the failure to find a reliable marker of a trance or radically altered state of consciousness and reservations about conceptualizing hypnosis in such terms; (d) determinants of hypnotic responsiveness, including attitudes and beliefs, personality traits, expectancies, motivation, and rapport; (e) efforts to modify hypnotic suggestibility; and (f) the need to further examine attentional abilities and the role of adopting a readiness response set that the authors argue is key in maximizing hypnotic responsiveness.

Effectiveness of hypnosis for pain management and promotion of health-related quality-of-life among people with haemophilia: a randomised controlled pilot trial

Joint deterioration and associated chronic pain are common among people with haemophilia (PWH), having an impact on quality-of-life. Though non-pharmacological strategies are recommended, psychological interventions to promote pain control and quality-of-life have scarcely been tested in haemophilia. This randomised controlled pilot trial aimed to assess feasibility, acceptability and effectiveness of hypnosis for pain management and promotion of health-related quality-of-life (HRQoL) among PWH. Twenty adults were randomised either to four weekly hypnosis sessions plus treatment-as-usual (experimental group; EG) or treatment-as-usual only (control group; CG). Participants completed sociodemographic and clinical assessment, measures of pain, HRQoL and emotional distress before (T1) and after (T2) intervention. Changes were analysed by calculating the differences between T1 and T2, and the groups were compared through independent-sample t tests (or chi-squared). Retention rates (90%) and analysis of patient satisfaction showed good acceptability and feasibility of the intervention. The EG (n = 8) had a higher reduction on pain interference than the CG (n = 10) (d = −0.267). A higher improvement on HRQoL (EQ-5D index: d = 0.334; EQ-5D VAS: d = 1.437) and a tendency towards better haemophilia-related quality-of-life (A36-Hemofilia QoL) were also evident in the EG. This is the first study showing the effectiveness of hypnosis to reduce pain interference and promote HRQoL among PWH.