Six weekly, remote therapy sessions that combined hypnosis with cognitive therapy significantly reduced pain intensity, compared with usual clinical care, among patients with spinal cord injury. These results are reported in a new study at the University of Washington School of Medicine.
“Not only did the study show that this treatment is effective, but unlike most medications used for pain, it is a treatment with many positive side effects, like improved sleep and a greater sense of self-control,” said senior author Mark P. Jensen, professor of rehabilitation medicine. “I think that, based on the evidence, including the side-effect profile, this is the first treatment that people with chronic pain should be offered.”
The findings are published in the April 28 issue of Neurology, available now online.
About two-thirds of people with spinal cord injury experience chronic pain that can significantly exacerbate their disability and diminish their quality of life. Such pain is typically managed with physical therapy and pain medications.
Previous research has shown that cognitive therapy can decrease the perception of pain. Cognitive therapy takes advantage of the fact that pain is perceived in the brain and can be modulated by a person’s thoughts and beliefs. Negative thoughts, such as believing the pain will never go away, can intensify pain perception, while positive thoughts, such as believing pain relief is possible, can lessen it.
In this recent study, researchers examined whether hypnosis could bolster the effects of cognitive therapy by making patients more receptive to suggestions aimed at changing thoughts and beliefs about pain.
“Hypnosis helps patients be more open to ideas about changing their thinking and internalizing those ideas, so they become automatic,” said first author Charles Bombardier, a UW Medicine psychologist and professor of rehabilitation medicine.
For the study, Bombardier and his colleagues enrolled 127 patients with chronic pain due to spinal cord injuries. Their average age was 51. On average, their injuries occurred about 15 years ago. The enrollees were randomly assigned to hypnotic cognitive therapy or to a continuation of usual care.
The therapy sessions were conducted by phone or via Zoom by coauthor and research associate professor M. Elena Mendoza, who specializes in hypnosis. In these hour-long sessions, Mendoza used hypnosis to induce a relaxed state of attentiveness intended to make patients more open to suggestions.
She then explored the patient’s thoughts and beliefs about pain determined which notions improved or worsened the patient’s experience. Using this information, she made suggestions to encourage thoughts and beliefs that beneficially changed participants’ perceptions about pain.
“We identified both helpful and unhelpful thoughts but focused on reassuring thoughts that help alleviate their pain and enhance coping. Then we reinforced those in the hypnosis sessions,” Mendoza said.
Patients were provided recordings of each therapy session and were instructed to listen daily and to practice self-hypnosis three times a day to reinforce the therapeutic suggestions. Patients were asked to assess their pain four times a week during the six-week study and during a six-week follow-up period.
At the study outset, participants were asked to rate their pain intensity on a scale of 0 to 10, with 0 representing no pain and 10 the most severe pain they had ever experienced. The average score for the hypnosis-cognitive therapy group was 5.99, compared with 5.87 for the usual-care group, a difference that was not statistically significant.
Participants who underwent hypnotic cognitive therapy reported that their pain intensity dropped to 4.83 at six weeks and further declined during the follow-up period to 4.52 at 12 weeks. These decreases were significantly greater than the decreases in pain at six (5.82) and 12 weeks (5.81) in the usual-care group.
“A lot of psychological interventions wear off,” said Bombardier, “but in this case the effect had actually increased at 12 weeks — six weeks after treatment had stopped.”
Depression severity also declined significantly more in the hypnotic cognitive therapy group versus the control group. At 12 weeks, pain interference dropped significantly more in the treatment versus control group. At six weeks, sleep disturbance also declined significantly more with hypnotic cognitive therapy. Hypnotic cognitive therapy was equally effective whether delivered by Zoom or telephone.
Overall, the therapy was well received, with 90% of participants in the therapy group saying they were satisfied or very satisfied with treatment, 35% reporting their pain was much or very much improved, 50% saying that their ability to manage pain was much or very much improved, and 46% reporting a clinically meaningful reduction in pain.
“Pain affects almost every aspect of these patients’ lives, so it was great to see that after just six sessions conducted over six weeks, they were able to make so much progress,” Mendoza said.
A grant from the Craig H. Neilsen Foundation funded the study.
Written by Michael McCarthy