Clinical Hypnosis in Palliative Care

Hypnotic analgesia has been linked with significant reductions in pain-related outcomes.

A report by the National Institutes of Health (NIH), for example, cites evidence supporting the efficacy of hypnosis for relief of chronic pain in cancer, irritable bowel syndrome, and tension headaches.1 The October issue of the Annals of Palliative Medicine includes a review of relevant findings and techniques.2

“In recent years, clinical hypnosis and modified states of consciousness, like meditative states, have become significant topics of researchers in psychology, philosophy, medicine, and neuroscience,” author Maria Paola Brugnoli, MD, from the Department of Surgical Sciences, Anesthesiology, Intensive Care and Pain Therapy at the University of Verona in Italy, told Clinical Pain Advisor.

Clinical hypnosis aligns with the World Health Organization‘s global perspective for palliative care, including the aspect of providing relief from symptoms such as pain, anxiety and depression, fatigue, nausea, and sleep impairment.

Results of brain imaging studies demonstrate that “hypnosis influences all of the cortical areas and neurophysiological processes that underlie pain and emotions,” according to a review.3 “Neurophysiological top-down regulatory processes–like attention, cognitive control, and monitoring–play a central role in mediating responses to hypnotic suggestions for pain relief,” said Dr Brugnoli.

Hypnotic analgesia has been linked with more significant reductions in pain-related outcomes, compared to standard care and non-hypnotic interventions such as education and physical therapy.In the review, Dr Brugnoli details various hypnotic techniques that clinicians may use with pain patients, as well as brief self-hypnosis techniques that patients can use.

“The use of hypnosis often includes an induction phase to increase mental absorption, followed by a suggestion phase providing directions to elicit particular changes in thoughts, behaviors, and sensations such as pain,” explained Dr Brugnoli.

For example, once a state of relaxation has been induced in patients, they may be trained to interpret the sensation of pain or other distressing symptoms as a different sensation, such as anesthetizing pressure or warmth.

Another technique uses mental imagery to shift attention from the painful sensation to a different part of the body that is unaffected by pain. In self-hypnosis for acute pain relief, a patient might do a brief exercise in which they say to themselves, “Now I will sleep for X minutes while my pain decreases,” and then, count down from 20 to 1. 

In light of the evidence regarding the efficacy of hypnosis in pain treatment, these treatments represent an option for patients who indicate an interest in them.

“Clinical hypnosis in palliative care increases comfort by lessening pain, controlling symptoms… and lessening stress for the patient and family, and should not be delayed when it is indicated,” Dr Brugnoli concluded in the review.

Summary and Clinical Applicability

A variety of hypnotic techniques may be effectively used as adjuvant treatment in the management of pain and other distressing symptoms in patients with severe chronic diseases.

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  1. National Institutes of Health. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA. 1996; 276(4):313-318.
  2. Brugnoli MP. Clinical hypnosis for palliative care in severe chronic diseases: a review and the procedures for relieving physical, psychological and spiritual symptoms. Ann Palliat Med. 2016; 5(4):280-297.
  3. Tononi GKoch C. The neural correlates of consciousness: an update. Ann N Y Acad Sci. 2008; 1124:239-261.
  4. Adachi TFujino HNakae AMashimo TSasaki J. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions. Int J Clin Exp Hypn. 2014; 62(1):1-28.