Professional Documents
Culture Documents
Effect of Hypnotic Suggestion On Fibromy PDF
Effect of Hypnotic Suggestion On Fibromy PDF
www.EuropeanJournalPain.com
a
Pain Clinic and UFISS Palliative Care. Hospital Universitari de Tarragona Joan XXIII and Gestió i Prestació de Serveis de Salut,
C/Doctor Mallafré Guasch 4, 43007 Tarragona, Spain
b
Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
c
Departament de Medicina i Cirurgı´a, Universitat Rovira i Virgili, Tarragona, Spain
Received 25 November 2005; received in revised form 17 June 2006; accepted 24 June 2006
Available online 4 August 2006
Abstract
The main aims of this experimental study are: (1) to compare the relative effects of analgesia suggestions and relaxation sugges-
tions on clinical pain, and (2) to compare the relative effect of relaxation suggestions when they are presented as ‘‘hypnosis’’ and as
‘‘relaxation training’’. Forty-five patients with fibromyalgia were randomly assigned to one of the following experimental conditions:
(a) hypnosis with relaxation suggestions; (b) hypnosis with analgesia suggestions; (c) relaxation. Before and after the experimental
session, the pain intensity was measured using a visual analogue scale (VAS) and the sensory and affective dimensions were mea-
sured with the McGill Pain Questionnaire. The results showed: (1) that hypnosis followed by analgesia suggestions has a greater
effect on the intensity of pain and on the sensory dimension of pain than hypnosis followed by relaxation suggestions; (2) that
the effect of hypnosis followed by relaxation suggestions is not greater than relaxation. We discuss the implications of the study
on our understanding of the importance of suggestions used in hypnosis and of the differences and similarities between hypnotic
relaxation and relaxation training.
Ó 2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All
rights reserved.
1090-3801/$32 Ó 2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights
reserved.
doi:10.1016/j.ejpain.2006.06.006
464 A. Castel et al. / European Journal of Pain 11 (2007) 463–468
Table 1
Demographic data
Group Age Sex Pain duration Formal education Marital status
Male Female Low Mid High Married Separated Single
General 43.7 SD 8.6 6 (13%) 39 (87%) 106.6 SD 795 27 (60%) 12 (27%) 6 (13%) 38 (84%) 3 (7%) 4 (9%)
Experimental 48.1 SD 7.5 3 (20%) 12 (80%) 122.8 SD 99.9 10 (67%) 2 (13%) 3 (20%) 11 (74%) 2 (13%) 2 (13%)
condition 1
Experimental 46 SD 9.3 1 (7%) 14 (93%) 103.7 SD 76.9 10 (67%) 4 (26%) 1 (7%) 13 (86%) 1 (7%) 1 (7%)
condition 2
Experimental 47.7 SD 9.2 2 (13%) 13 (87%) 93.2 SD 58.9 7 (47%) 6 (40%) 2 (13%) 14 (93%) 0 (0%) 1 (7%)
condition 3
Table 2
Comparison of pre-experimental condition and after-experimental condition mean pain index
Mean pre-after Experimental condition 1 Experimental condition 2 Experimental condition 3
VAS 1–VAS 2 5.5–3.9** (SD 2.20–2.44) 5.8–1.7** (SD 2.27–1.68) 5.8–3.3* (SD 2.68–2.58)
PRI-S1–PRI-S 2 22.9–13.9** (SD 5.47–8.24) 26.2–6.3** (SD 9.32–6.99) 20.7–15.1* (SD 7.51–8.04)
PRI-Al–PRI-A 2 4.4–1.7** (SD 2.32–2.12) 4.3–0.8** (SD 2.49–1.01 4.7–2.2** (SD 0.56–0.50)
*
p < 0.01.
**
p < 0.001.
466 A. Castel et al. / European Journal of Pain 11 (2007) 463–468
of both procedures is due to the fact that they both Benhaiem JM, Attal N, Chauvin M, Brasseur L, Bouhassira D. Local
use suggestions that are exclusively of well-being and and remote effects of hypnotic suggestions of analgesia. Pain
2001;89:167–73.
comfort, thus focusing only on the affective compo- Busquets C, Vilaplana J, Arxer A. Dolor musculoesquelético de origen
nent of pain. Our results corroborate those of De Pas- mecánico e inflamatorio. In: Rull M, editor. Dolor musculoes-
calis et al. (1999), who concluded that hypnotic quelético. La Coruña, Spain: SED; 2005. p. 63–103.
analgesia is neither the result of relaxation, nor a Carroll D, Seers K. Relaxation for the relief of chronic pain: a
question of distracting attention. systematic review. J Adv Nurs 1998;27:476–87.
Dahlgren LA, Kurtz RM, Strube MJ, Malone MD. Differential effects
Our study has several, important drawbacks. The rel- of hypnotic suggestions on multiple dimensions of pain. J Pain
atively small number of participants is a drawback that Symptom Manage 1995;10(6):464–70.
limits the power of the statistical analyses and the gener- De Pascalis V, Magurano M, Bellusci A. Pain perception, somatosen-
alization of the results obtained, although the significance sory event-related potentials and skin conductance responses to
of the differences between the experimental conditions painful stimuli in high, mid, and low hypnotizable subjects: effects
of differential pain reduction strategies. Pain 1999;83:499–508.
suggests that they are important. Another drawback Faymonville ME, Mambourg PH, Joris J, Vrijens B, Fissette J, Albert
was the fact that the application of each experimental A, et al. Psychological approaches during conscious sedation.
condition was not completely homogeneous. There may Hypnosis versus stress reducing strategies: a prospective random-
have been prosodic changes in language or other varia- ised study. Pain 1997;73:361–7.
tions as a function of the participants’ responses. It Fors EA, Sexton H, Götestam KG. The effect of guided imagery and
amitriptyline on daily fibromyalgia pain: a prospective, random-
should also be borne in mind that the same researcher ised, controlled trial. J Psychiatr Res 2002;36:179–87.
(the first author) applied all the experimental conditions. Gay MC, Philippot P, Luminet O. Differential effectiveness of
Although this is not exceptional in this sort of study (see psychological interventions for reducing osteoarthritis pain: a
Faymonville et al., 1997; Benhaiem et al., 2001; Patterson comparison of Erikson hypnosis and Jacobson relaxation. Eur J
and Jensen, 2003) and it limits the strength of the results, Pain 2002;6:1–16.
Gracely RH, McGrath P, Dubner R. Validity and sensitivity of ratio
it cannot completely conceal their importance. Another scales of sensory and affective verbal pain descriptors: a manipu-
important drawback of the study is that hypnotic suggest- lation of affect by diazepam. Pain 1978;5:19–29.
ibility was not measured. There is evidence to suggest that Haanen HCM, Hoenderdos HTW, van Romunde LKJ, Hop WCJ,
highly suggestionable subjects are more responsive to Mallee C, Terweil JP, et al. Controlled trial of hypnotherapy in
hypnotic suggestion in experimental pain. In clinical the treatment of refractory fibromialgia. J Rheumatol
1991;18:72–5.
pain, however, scale-assessed suggestibility is much less Hilgard ER, Hilgard JR. Hypnosis in the relief of pain. Los Altos,
predictive of the response to intervention with hypnosis CA: William Kaufmann, Inc.; 1975.
(Montgomery et al., 2000; Barber, 2001; Patterson and Jensen MP, Karoly P, Braver S. The measurement of clinical pain
Jensen, 2003). In clinical samples, patients with low sug- intensity: a comparison of six methods. Pain 1986;27:117–26.
gestibility have similar levels of response to hypnotic sug- Jensen MP, Barber J. The effect of hypnotic suggestions on spinal cord
injury pain. J Back Musculoskeletal Rehabil 2000;14:3–10.
gestions as patients with high suggestibility (Jensen and Keel PJ, Bodoky C, Gerhard U, Müller W. Comparison of integrated
Barber, 2000; Gay et al., 2002). group therapy and group relaxation training for fibromyalgia. Clin
Despite the study’s drawbacks, these findings indicate J Pain 1998;14(3):232–8.
that analgesic suggestion can decrease pain intensity and Kiernan BD, Dane JR, Phillips LH, Price DD. Hypnotic
the sensation of pain in patients with fibromyalgia. analgesia reduces R-III nociceptive reflex: further evidence
concerning the multifactorial nature of hypnotic analgesia.
Analgesia suggestion should be studied in the context Pain 1995;60:39–47.
of intervention programmes designed for this type of Kihlstrom JF. Hypnosis. Annu Rev Psychol 1985;36:385–418.
patients. Finally, the findings of this study have implica- Kirsch I, Montgomery G, Sapirsten G. Hypnosis as an adjunct to
tions for: (1) understanding the importance of the sug- cognitive-behavioral psychotherapy: a meta-analysis. J Consult
gestions used in hypnosis; (2) understanding the Clin Psychol 1995;63(2):214–20.
Lázaro C, Bosch F, Torrubia R, Baños JE. The development of a
differences or similarities between hypnotic relaxation Spanish questionnaire for assessing pain: preliminary data con-
and relaxation training. cerning reliability and validity. Eur J Psychol Assess
1994;10(2):145–51.
Meier W, Klucken M, Soyka D, Bromm B. Hypnotic hypo and
hyperalgesia: divergent effects on pain ratings and pain-related
References cerebral potentials. Pain 1993;53:175–81.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science
Arena JG, Blanchard EB. Biofeedback and relaxation therapy for 1965;150:971–9.
chronic pain disorders. In: Gatchel RJ, Turk DC, editors. Psycho- Melzack R, Casey KL. Sensory motivational and central determinants
logical approaches to pain management: a practitioner’s hand- of pain: a new conceptual model. In: Kenshalo D, editor. The skin
book. New York, EEUU: The Guilford Press; 1996. p. 179–230. senses. Springfield, IL: Thomas; 1968. p. 345–52.
Barber J. Hypnosis and suggestion in the treatment of pain. A clinical Melzack R. The McGill pain questionnaire: major properties and
guide. New York: Norton Company Inc.; 1996. scoring methods. Pain 1975;1:277–99.
Barber J. Hypnosis. In: Loeser JD, editor. Bonica’s management of Milling LS, Meunier SA, Levine MR. Hypnotic enhancement of
pain. Philadelphia, EEUU: Lippincott & Wilkins; 2001. p. cognitive-behavioral interventions for pain: an analogue treatment
1768–78. study. Health Psychol 2003;22(4):406–13.
468 A. Castel et al. / European Journal of Pain 11 (2007) 463–468
Montgomery GH, DuHamel KN, Redd WH. A meta-analysis of Stacher G, Schuster P, Baver P, Schulze D. Effects of suggestion of
hypnotically induced analgesia: how effective is hypnosis? Int J Clin relaxation or analgesia on pain threshold and pain tolerance in the
Exp Hypn 2000;48(2):138–53. waking and hypnotic state. J Psychosom Res 1975;19:259–65.
Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychol Bull Syrjala KL. Relaxation and imagery techniques. In: Loeser JD, editor.
2003;129(4):495–521. Bonica’s management of pain. Philadelphia, EEUU: Lippincott &
Price DD, Harkins SW, Baker C. Sensory-affective relationships Wilkins; 2001. p. 543–56.
among different types of clinical and experimental pain. Pain Syrjala KL, Abrams JR. Hypnosis and imagery in the treatment of
1987;28:297–307. pain. In: Gatchel RJ, Turk DC, editors. Psychological approaches
Price DD. Psychological mechanisms of pain and analgesia. Seattle, to pain management: a practitioner’s handbook. New York,
WA: IASP Press; 1999. EEUU: The Guilford Press; 1996. p. 231–58.
Rainville P, Carrier B, Hofbauer RK, Bushnell MC, Duncan GH. Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE.
Dissociation of sensory and affective dimensions of pain using Relaxation and imagery and cognitive-behavioral training reduce
hypnotic modulation. Pain 1999;82:159–71. pain during cancer treatment: a controlled clinical trial. Pain
Russell IJ. Fibromyalgia syndrome. In: Loeser JD, editor. Bonica’s 1995;63:189–98.
management of pain. Philadelphia, EEUU: Lippincott & Wilkins; Wik G, Fischer H, Bragée B, Finer B, Fredrikson M. Functional
2001. p. 543–56. anatomy of hypnotic analgesia: a PET study of patients with
Sachs LB. Comparison of hypnotic analgesia and hypnotic relaxation fibromyalgia. Eur J Pain 1999;3:7–12.
during stimulation by a continous pain source. J Abnorm Psychol Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C,
1970;2:206–10. Goldenberg DL, et al. The American College of Rheumatology.
Schultz JH. El entrenamiento autógeno: autorrelajación contempla- Criteria for the Classification of Fibromyalgia: Report of the
tiva. Barcelona, Spain: Editorial Cientı́fico-Médica; 1969. Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72.