Hypnosis in Cancer Care

Multimodal benefits of hypnosis on pain, mental health, sleep, and quality of life in patients with chronic pain related to fibromyalgia: A randomized, controlled, blindly-evaluated trial

BACKGROUND AND PURPOSE

Fibromyalgia is a chronic syndrome marked by intense musculoskeletal pain often refractory to pharmacological treatment. Although studies have shown that hypnosis improves fibromyalgia pain, gaps in experimental design limit their reliability. This work aimed to evaluate the effects of hypnosis on pain, mental health, sleep, and quality of life in participants with fibromyalgia chronic pain.

METHODS

In this prospective, parallel, randomized, controlled, blindly-evaluated trial, participants of both sexes (n = 49) diagnosed with fibromyalgia and with moderate to severe chronic pain attended 8 weekly 1-h sessions with a hypnotherapist. For the hypnosis group (n = 24), sessions consisted in induction of hypnotic trance followed by suggestions to promote analgesia. For the control group (n = 25), sessions consisted in casual unscripted conversation. Participants were assessed at baseline (7 days before), post-intervention (7 days after), and follow-up (3 months after). The primary outcome was pain intensity. The secondary outcomes were the sensory and affective dimensions of pain; pain unpleasantness; pain catastrophizing; anxiety and depression; sleep quality; fibromyalgia impact; and quality of life.

RESULTS

Hypnosis significantly reduced pain scores both at post-intervention and follow-up in comparison with baseline. The analgesic effect of hypnosis combined with pharmacological treatment lasted for at least 3 months and was superior to analgesia promoted by first- and second-line pharmacological treatment alone. Hypnosis significantly improved all parameters evaluated as secondary outcomes both at post-intervention and follow-up without inducing adverse events.

CONCLUSION

Our results corroborate that clinical hypnosis is an effective and feasible tool for managing chronic pain and other symptoms of fibromyalgia.

Creating critical palliative hypnotic adjustments: temporality, hope, and meaning

When cure is not possible, suffering often takes form as pain and distressing symptoms, death anxiety, existential distress, and meaninglessness. This paper describes important elements connecting palliative care principles with hypnotic approaches designed to provide support, palliate symptoms, foster hope, and address existential and spiritual distress. We offer a developmental process for and examples of hypnotic suggestions customized to simultaneously ameliorate physical symptoms and address profound distress arising from physical, social, psychological, existential, and spiritual challenges commonly encountered in terminal illness. This process necessarily requires use of the patient's vernacular to hypnotically deepen inwardly focused attention in order to explore and access internal resources, reframe negative automatic thoughts, and create positive meanings for experiences that disinvite suffering. Effective delivery utilizes cognitive tools such as clinical and scientific principles, artistic forms such as poetry and haiku, and a thorough assessment of needs. This approach strategically addresses an overarching dimension of temporality through suggestions that sequentially address multiple sources of suffering that are layered throughout the various dimensions of self. This requires focus and presence in the present moment; it ultimately fosters a therapeutic relationship that can safely hold past painful experience as helpful new meanings emerge that build resiliency for that experience. This work benefits from inwardly focused concentration and a holding environment to identify and access helpful inner resources, which include an increasingly malleable relationship with temporal memories.

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.

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.

Biological Therapy with Complementary and Alternative Medicine in Innocuous Integrative Oncology: A Case of Cervical Cancer

Good medicine is based on good science, inquiry driven and open to new paradigms. For a complex disease such as cancer, a complex treatment regime that is well structured and multifactorial is indispensable. In the present day, Complementary and Alternative Medicine (CAM) therapies are being used frequently for cancer, alongside modern biological therapies and allopathic medicine, in what is called integrative oncology. In all conscience, the use of natural, less invasive interventions whenever possible is ideal. However, a comprehensive understanding of not only the etiopathology of individual cancers, but also the detailed genetic and epigenetic characteristics, the cancer hallmarks, that clearly show the blueprint of the cancer phenotype is a requisite. Different tumors have a common behavioral pattern, but their specific features at the genetic and epigenetic levels vary to a great extent. Henceforth, with so many failed attempts to therapy, drug formulations and combinations need a focused pre-assessment of the inherent features of individual cancers to destroy the tumors holistically by targeting these features. This review therefore presents innocuous therapeutic regimes by means of CAM and integrative medicine approaches that can specifically target the hallmarks of cancer, using the case of cervical cancer.

Clinical Hypnosis and Music In Breast Biopsy:A Randomized Clinical Trial

A randomized clinical study was conducted to evaluate the effects on anxiety, depression, stress and optimism levels of an audio-recorded clinical hypnosis intervention and a music session and compare them with a control group in women scheduled for breast biopsy. We analyzed the data of 170 patients with an average age of 47 years, who were randomly assigned to each of the groups. The psychosocial variables were measured in three moments: baseline, which corresponds to the period before the intervention with hypnosis, music or waiting in the room before biopsy; a second measurement after the interventions and a third measurement after the breast biopsy procedure was finished. The results showed a statistically significant reduction in the stress (p < .001, η²p = .06); pain, (p < .01, η²p = .04); anxiety, (p < .001, ƞ²p = .07) and depression, (p < .001, ƞ²p = .05) in hypnosis and music groups compared with the control group. Before biopsy, hypnosis decrease significantly pain and depression levels compared with music, but after biopsy there were no differences between both groups. It is recommended to use audio-recorded hypnosis and music interventions to reduce physical and emotional discomfort during the biopsy procedure and to improve the quality of life of patients with suspected breast cancer.

Inside the Scrambler Therapy, a Noninvasive Treatment of Chronic Neuropathic and Cancer Pain: From the Gate Control Theory to the Active Principle of Information

Scrambler therapy (ST) is an electro-analgesia therapy for the noninvasive treatment of chronic neuropathic and cancer pain based on a new generation of medical device that uses 5 artificial neurons and is based on a novel theoretical model the differs from gate control theory. The active principle with Scrambler Therapy is such that synthetic "non-pain" information is transmitted by C fiber surface receptors. This is a different theoretical mechanism than the traditional electric stimulation of A-Beta fibers to produce paresthesia and/or block the conduction of nerve fibers to produce an analgesic effect, that is, via TENS (transcutaneous electrical nerve stimulation) machines. Scrambler therapy was developed to treat chronic neuropathic pain and cancer pain resistant to opioids and other types of treatments. The goal of Scrambler Therapy is to eliminate pain during treatment and allow for long-lasting analgesia after a series of 10 to 12 consecutive treatments performed over a 2-week period. The aim of this review is to clarify the underlying theory of Scrambler Therapy and describe the appropriate usage method that maximizes its effectiveness while reducing bias and deepen the explanation of the artificial neuron technology associated with Scrambler Therapy.

Pain in pancreatic ductal adenocarcinoma: A multidisciplinary, International guideline for optimized management

Abdominal pain is an important symptom in most patients with pancreatic ductal adenocarcinoma (PDAC). Adequate control of pain is often unsatisfactory due to limited treatment options and significant variation in local practice, emphasizing the need for a multidisciplinary approach. This review contends that improvement in the management of PDAC pain will result from a synthesis of best practice and evidence around the world in a multidisciplinary way. To improve clinical utility and evaluation, the evidence was rated according to the GRADE guidelines by a group of international experts. An algorithm is presented, which brings together all currently available treatment options. Pain is best treated early on with analgesics with most patients requiring opioids, but neurolytic procedures are often required later in the disease course. Celiac plexus neurolysis offers medium term relief in a substantial number of patients, but other procedures such as splanchnicectomy are also available. Palliative chemotherapy also provides pain relief as a collateral benefit. It is stressed that the assessment of pain must take into account the broader context of other physical and psychological symptoms. Adjunctive treatments for pain, depression and anxiety as well as radiotherapy, endoscopic therapy and neuromodulation may be required in selected patients. There are few comparative studies to help define which combination and order of these treatment options should be applied. New pain therapies are emerging and could for example target neural transmitters. However, until better methods are available, management of pain should be individualized in a multidisciplinary setting to ensure optimal care.