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International Journal of Clinical
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Hypnosis for Management of
Fibromyalgia
Pascale Picard a , Catherine Jusseaume a , Maryse Boutet
a , Christian Dualé b , Aurélin Mulliez c d & Bruno Aublet-
Cuvellier c d
a CHU Clermont-Ferrand, Pain Clinic, France
b CHU Clermont-Ferrand, Pharmacological Center, France
c French National Institute of Health and Research,
Clermont Ferrand, France
d CHU Clermont-Ferrand, Medical Information
Department, France
Version of record first published: 15 Nov 2012.
To cite this article: Pascale Picard , Catherine Jusseaume , Maryse Boutet , Christian
Dualé , Aurélin Mulliez & Bruno Aublet-Cuvellier (2013): Hypnosis for Management of
Fibromyalgia, International Journal of Clinical and Experimental Hypnosis, 61:1, 111-123
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Intl. Journal of Clinical and Experimental Hypnosis, 61(1): 111–123, 2013
Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
DOI: 10.1080/00207144.2013.729441
HYPNOSIS FOR MANAGEMENT
OF FIBROMYALGIA1
Pascale Picard, Catherine Jusseaume, and Maryse Boutet2
CHU Clermont-Ferrand, Pain Clinic, France
Christian Dualé
CHU Clermont-Ferrand, Pharmacological Center, France
Aurélin Mulliez and Bruno Aublet-Cuvellier
French National Institute of Health and Research, Clermont Ferrand; and CHU
Clermont-Ferrand, Medical Information Department, France
Abstract: This randomized, controlled trial contrasted the effects of
5 not-standardized sessions of hypnosis over 2 months in 59 women
with fibromyalgia who were randomly assigned to treatment (n=30)
or a wait-list control group (n=29). Patients in the treated group
were encouraged to practice self-hypnosis. Fibromyalgia Impact
Questionnaire (FIQ), MOS–Sleep Scale, Multidimensional Fatigue
Inventory (MFI), Cognitive Strategy Questionnaire (CSQ), and Patient
Global Impression of Change (PGIC) were administered at baseline,
3 months (M3), and 6 months (M6) after inclusion. Compared to the
control, the hypnosis group reported better improvement on PGIC
(p=.001 at M3, p=.01 at M6) and a significant improvement in sleep
and CSQ dramatization subscale (both at M6).
Fibromyalgia (FM) is a poorly understood chronic-pain syndrome,
characterized by widespread musculoskeletal pain, nonrestorative
sleep, fatigue, cognitive impairment, psychological distress, and spe-
cific regions of localized tenderness (Yunus, 2007). The etiology of
FM is unclear, although many data suggest that central sensitization
is one mechanism involved in dysfunctional pain processing in FM
patients (Julien, Goffaux, Arsenault, & Marchand, 2005; Mease et al.,
Manuscript submitted December 7, 2011; final revision accepted December 16, 2011.
1This work was funded by the Fondation de France, UB 032115. We wish to thank
Alain Woda for critical review of the manuscript and Vera Picard for translation assis-
tance.
2Address correspondence to Pascale Picard, Centre d’Evaluation et de Traitement de la
Douleur, CHU de Clermont-Ferrand, Rue Montalembert, BP 69, 63003 Clermont-Ferrand
Cedex 1, France. E-mail: ppicard@chu-clermontferrand.fr
111
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112 PASCALE PICARD ET AL.
2007). The triggering and maintenance of FM appear to require both
genetic disposition and environmental influences such as emotional or
physical stressors or illness (Bennett, Jones, Turk, Russell, & Matallana,
2007). The recent European League Against Rheumatism (EULAR)
recommendations suggest that multimodal therapies provide greater
benefit than isolated intervention. Among these, nonpharmacologic
approaches are recommended (Carville et al., 2008). Assessment of com-
plementary and alternative approaches in FM is limited by a dearth of
clinical trials and an effort to evaluate their benefit is needed.
Hypnosis has been largely evaluated in the setting of acute and
chronic pain and was generally found to be more effective than non-
pharmacological interventions such as attention, physical therapy, and
education (Huet, Lucas-Polomeni, Robert, Sixou, & Wodey, 2011; Jensen
et al., 2011; Jensen & Patterson, 2006; Lew, Kravits, Garberoglio, &
Williams, 2011; Nusbaum et al., 2011; Patterson, Jensen, Wiechmann, &
Sharar, 2010). There is growing interest in understanding the effects of
hypnosis on the sensory and affective components of pain. The results
of the various investigations are not totally conclusive on this point, and
it seems to be accepted that hypnosis has greater influence on the affects
of pain than on the sensation of pain (Jensen, 2009; Paterson & Jensen,
2003; Rainville, Carrier, Hofbauer, Bushnell, & Duncan, 1999).
At the moment, only two published clinical studies have been con-
ducted to evaluate hypnosis in the context of FM (Castel, Pérez, Sala,
Padrol, & Rull, 2007; Haanen et al., 1991). Although positive, the results
of these studies need confirmation from additional research. In the
first study, Haanen et al. only used visual analog scales (VAS) for the
study’s primary outcome, which was an overall assessment by the pat-
ient. In the second study by Castel et al., the evaluation took place imm-
ediately after treatment and did not include any long-term follow-up.
The current study was performed to evaluate the effect of hypnosis
on reducing FM symptoms in recently diagnosed FM patients. We chose
to screen relevant domains that more fully constitute FM for use in
a clinical trial as proposed by a workshop for Outcome Measures in
Clinical Rheumatology trials (OMERACT 9). The study was carried out
with validated screening tools well adapted to evaluate the impact of
treatment in FM patients (Mease et al., 2009). An active treatment was
compared with a neutral control (waiting list). Besides these method-
ological improvements, we also included hypnosis suggestions that
extended beyond pain relief and relaxation.
Method
Participants
All female patients referred to the pain clinic who fulfilled the crite-
ria for entry into the study were asked if they wished to take part in
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HYPNOSIS FOR MANAGEMENT OF FIBROMYALGIA 113
the investigation. Study inclusion criteria were women with FM syn-
drome for at least 6 months who were diagnosed by a rheumatologist
following the criteria of the American College of Rheumatology (Wolfe
et al., 1990). Study exclusion criteria were patients who presented with
chronic inflammatory arthritis and/or peripheral or central neuropathic
pain, who were treated with opioids, and/or who presented severe
psychiatric illness, including major depression or major personality
disorders according to the Diagnostic and Statistical Manual of Mental
Disorder, fourth edition (Cantor & Genero, 1986), or who had a history of
substance abuse. The sample size calculation was done on the basis of
a previously published study (Arnold et al., 2002) in which the mean
score for the Fibromyalgia Impact Questionnaire (FIQ) was 43 ±14,
with an expected difference of 12 (-30% of the control), a Type I error of
5%, and a 95% power in unilateral hypothesis. It was then determined
that 30 patients per group were necessary.
Procedure
The referent research ethic committee (CPP Sud Est VI) approved this
study, and 62 patients attending the pain clinic (from March 2008 to
November 2009) and who fulfilled the criteria for entering the study
were invited to sign a consent form. Before randomization, patients
were informed that they possibly would have to be included in the
wait-list group. Then, each patient was randomly assigned to either the
hypnosis trial group or the waiting list control group. We offered par-
ticipants courtesy treatment with hypnosis after their participation if
they were in the wait-list group. The person performing this random-
ization and preparing envelopes was on a separate site from the study
and had nothing to do with the study participants or the collection of
data. Demographic data and the first outcome measure assessments
were filled out on the day of randomization. Follow-up assessments
were then performed during a consultation 3 and 6 months postran-
domization by the same medical doctor who was not blind to the study
condition. At home, the 62 patients were asked to evaluate their pain
intensity once a week during the previous 8 days on a 10-point numeric
rating scale (NRS). After randomization, each patient in both groups
underwent an educative consultation with the same nurse. During this
consultation, participants were educated about FM and questions about
hypnosis were answered if necessary. Participants were allowed to con-
tinue to take their pain medications and antidepressants if necessary,
but they were discouraged from starting new treatment or any other
form of complementary therapy.
Intervention
Hypnosis began 5 to 8 days after randomization and consisted of
five 1-hour sessions. The time interval between each session was 8,
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114 PASCALE PICARD ET AL.
15, 21, and 28 days, respectively. Each patient received five hypnosis
interventions, which were conducted by the same psychologist quali-
fied in hypnotherapy. The hypnosis interventions were directed toward
enhancing patient competence and mastery in managing pain and stress
related to disease.
Each session involved a hypnotic induction including focusing on
body sensation and breathing, developing a trance state, and connect-
ing to a safe place. Various suggestions both analgesic and nonanalgesic
were provided, including reinterpreting pain sensation as numbness
through the use of imagery, improving individual coping with the emo-
tional consequences of pain, improving stress-management skills in
daily life according to their needs, and changing their relationship with
the disease in order to improve acceptance of it.
Inside this framework, the script was unrestricted; each patient’s
intervention was tailored to the patient’s personal needs; and all free-
dom to create was encouraged.
Patients were also instructed to practice self-hypnosis on a daily basis
outside the session.
Outcome Measures
The Fibromyalgia Impact Questionnaire (FIQ; Burckhardt, Clark, &
Bennett, 1991) total score at Month 6 was the primary outcome variable.
The FIQ is a 20-item disease-specific instrument to assess the overall
effect on FM symptomatology. The FIQ measured physical function and
daily activities as well as the severity of pain, fatigue, stiffness, and
anxiety/mood. Individual item scores excluding the two scores dealing
with work status were combined into a total impact score ranging from
0 to 80. Higher scores indicate a patient is more affected by fibromyalgia.
FIQ was evaluated at the time of randomization and 3 and 6 months
later. The French-validated version of the FIQ was used (Perrot,
Dumont, Guillemin, Pouchot, & Coste, 2003).
We evaluated the effect of treatment on important secondary out-
come domains, including pain, fatigue, patient global multidimensional
function, and sleep disturbance, as proposed by a workshop for
OMERACT 9 with a specific fibromyalgia syndrome module (Mease
et al., 2009). These secondary outcomes were assessed using validated
questionnaires.
The Medical Outcomes Study–Sleep Scale (MOS–Sleep; Hays &
Stewart, 1992) is a patient-rated questionnaire consisting of 12 items
that assess key constructs of sleep; two sleep problems indexes were
calculated. Fatigue was assessed with the Multidimensional Fatigue
Inventory (MFI; Smets, Garssen, Bonke, & De Haes, 1995), a 20-
item, self-report instrument designed to measure fatigue. The MFI
total score ranges from 20 to 100 with greater scores indicating
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HYPNOSIS FOR MANAGEMENT OF FIBROMYALGIA 115
more fatigue. Anxiety and depression were assessed by the Hospital
Anxiety and Depression scale (HADS; Zigmond & Snaith, 1983), a
self-reported, 14-item measure with seven items forming a depres-
sion subscale and another seven measuring anxiety. Catastrophizing
was assessed by the Pain Catastrophizing Scale (PCS; Sullivan, Bishop,
& Pivik, 1995), a self-report measure comprising 13 items measur-
ing the degree to which people experiencing pain catastrophize and
to adopting a negative or aversive orientation towards their pain.
Pain-coping strategies were measured using the French version of the
Coping Strategies Questionnaire (CSQ–F; Irachabal, Koleck, Rascle, &
Bruchon-Schweitzer, 2008), consisting of 21 items that yield scores of
five coping subscales (distraction, catastrophizing, reinterpreting pain
sensations, ignoring pain sensations, praying and hoping). Overall
treatment experience and efficacy of chronic pain treatments were
assessed by the Patient Global Impression of Change (PGIC; Guy, 1976),
a self-reported, 7-point instrument. All these secondary outcomes were
evaluated at the time of randomization and 3 and 6 months later.
Besides this evaluation, patients were invited to evaluate each week,
on the same day, the pain intensity of the 8 previous days measured
on a 10-point NRS ranging from no pain (0) to the most intense pain
imaginable (10).
Statistical Analysis
Data analysis was carried out with the SAS system V8.02. Baseline
characteristics of patients were summarized by mean (+/–standard
deviation) for continuous variables and by frequency (percentage) for
categorical variables. Comparisons of continuous variables between
groups were made using ttests and analysis of variance (ANOVA).
Comparisons between two categorical variables have led to the Chi-
squared test and, if necessary, to the Fisher’s Exact test. Pearson’s cor-
relation coefficients were calculated to evaluate the association between
two continuous variables. Significance level was set at 5%.
Results
Among the 62 patients who were randomized, 3 were excluded after
randomization because 2 of them (wait-list group) committed them-
selves to a physical rehabilitation program, and 1 patient (hypnosis
group) who experienced the treatment felt it would not give her any
benefit. Of the 59 remaining patients, 30 were in the hypnosis group
and 29 in the wait-list group. Both groups were similar with respect
to patient demographics, FM history, impaired functioning, and other
clinical baseline characteristics (see Table 1).
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116 PASCALE PICARD ET AL.
Table 1
Key Patient Demographic and Clinical Characteristics at Baseline
Wait Lis t ( n=29) Hypnosis (n=30)
Age (yrs) 49.3 (8.5) 48.1 (9.3)
Chronic pain duration (yrs) 6.8 (4.8) 9.7 (10.5)
FM duration (yrs) 2.6 (2.1) 2.6 (2.4)
Work activity 16 11
Menopausal status 8 13
FIQ total score 50.1 (13.6) 49.5 (11.6)
NRS (out of 10) 6.80 (1.5) 7.16 (0.5)
MFI total 70.2 (11.8) 72.6 (11.9)
HADs Score Anxiety 10.8 (3.7) 9.9 (4.1)
Score Depression 12.1 (4.0) 12.0 (4.6)
PCS 29.1 (10.5) 30.5 (13.2)
Note. Data are expressed as mean (SD)ornumberofpatients.
Abbreviations: FIQ: Fibromyalgia Impact Questionnaire; VAS: Visual Analog Scale; MFI:
Multidimensional Fatigue Inventory; HAD: Hospital Anxiety Depression scale; PCS: Pain
Catastrophizing Scale; NRS: Numeric Rating Scale.
Table 2 shows the outcomes for both groups. FIQ total score at
Month 6, which was the primary outcome, did not change. Compared
to baseline, the difference was –4.6 (11.6) in the hypnosis group and -0.7
(13) in the control group. This difference was not statistically significant
(p=.25). Mean weekly NRS scores monitored throughout the 24-week
study were significantly better in the hypnosis group (p=.05) but this
difference was not clinically relevant (0.6/10).
MOS-Sleep was significantly better at Month 6 in the hypnosis group
(p=.01 for Index 1 and p=.005 for Index 2). CSQ dramatization sub-
scale improved significantly at Month 6 in the patients who benefited
from hypnosis (p=.01). This improvement was parallel to that noted in
the PCS scale (but the latter was not significant). PGIC was reported as
“minimally improved” in the hypnosis group and “no change” in the
control group. This difference is statistically significant at the 3-month
(p=.001) and 6-month follow-ups (p=.01). Results of patients’ char-
acteristics associated with treatment response did not demonstrate any
correlation either with self-hypnosis practice, pretreatment FIQ score,
or pretreatment HADS.
Discussion
This is the first study to address the effects of hypnosis on FM using
adapted and validated tools. Regarding the FIQ, we found no statis-
tically significant difference between patients who received hypnosis
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HYPNOSIS FOR MANAGEMENT OF FIBROMYALGIA 117
Table 2
Primary and Secondary Outcomes at 3 and 6 Months, Expressed in Difference Baseline
Val u e s
M3
Wait-List Hypnosis p
M6
Wait-List Hypnosis p
FIQ total Score 0.19 −0.9 .77 −0.7 −4.6 .25
MFI total Score −1.4 −4.7 .3 −0.77 −5.2 .31
MOS Sleep
Index I −2.3 −5.8 .36 1.7 −8.6 .01
Index II −1.9 −7.2 .15 1.6 −9.2 .005
CSQ
Praying/Hoping −0.08 −0.1 .48 −0.19 −0.36 .35
Diverting attention 0.04 0.21 .23 0 0.2 .15
Reinterpreting pain 0 0.11 .54 0.12 0.22 .63
Catastrophizing −0.1 −0.3 .22 −0.06 −0.47 .01
Ignoring pain −0.02 0.14 .27 0.3 0.08 .15
HADs
A−0.74 −0.86 .87 −0.5 −1.2 .3
D−0.39 −1.12 .35 −0.1 −1.4 .06
PCS −2.6 −5.9 .19 −3 8.7 .057
PGIC 3.8 2.9 .001 3.9 2.9 .01
Mean weekly NRS (24 weeks) 6.64 6.04 .05
Note. Abbreviations: FIQ: Fibromyalgic index questionnaire; MFI: Multidimensional
Fatigue Inventory; MOS–Sleep: Medical Outcome Study; CSQ: Pain Coping Strategy
Questionnaire; HADs: Hospital Anxiety Depression scale; PCS: Patient Catastrophizing
Scale; PGIC: Patient Global Impression of Change; NRS: Numeric Rating Scale.
treatment compared to those in the nontreatment group. Regarding
pain, the effect of hypnosis was statistically significant but clinically
minor, since the improvement was only half a point of the NRS. More
clinically interesting is the improvement of the other variables reflect-
ing the quality of sleep, catastrophizing, and patient global impression
of change. These changes were especially visible at the 6-month follow-
up. These results suggest that hypnosis has a more positive effect on the
cognitive and/or affective side of FM than on the pain itself.
The findings of the current study vary in consistency with the lim-
ited number of previous investigations. Previous reports showed an
effect of hypnotic treatment on pain felt by FM patients (Castel et al.,
2007; Haanen et al., 1991) and other chronic pain conditions (Jensen &
Patterson, 2006; Montgomery, Duhamel, & Redd, 2000). The two pub-
lished studies concerning FM and hypnosis are quite different from our
study. In the study by Castel et al., hypnosis based on analgesia sugges-
tions was followed by pain evaluation before and just after the hypnosis
session. Therefore, the study only evaluated the very short-term effect
of hypnosis. In Haanen et al., most outcome measures, including overall
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118 PASCALE PICARD ET AL.
assessment by the patient, were assessed with the VAS, which is obvi-
ously not adapted to the complex clinical problem including many
symptoms that represent FM. These two studies did not evaluate the
FIQ since they focused on pain.
The improvements in the study sample appeared to be largely
focused on the cognitive and affective side effects of fibromyalgia.
Although pain was not affected by hypnosis in this study, other vari-
ables, such as quality of sleep, catastrophizing in CSQ, and patient
global impression of change, were significantly improved. In addition,
the improvement of the PCS score almost reached the significance level,
underlining that hypnosis corrected maladaptive thoughts. These cog-
nitive and behavioral modifications take time to be effective, explaining
the better results at 6-months posttreatment than at 3-months.
Catastrophizing has been broadly defined as an exaggerated neg-
ative orientation toward pain stimuli and pain experience (Sullivan
et al., 1995). Numerous clinical and experimental investigations have
shown that catastrophizing is associated with heightened pain experi-
ence (Sullivan, Stanish, Waite, Sullivan, & Tripp, 1998; Van Houdenhove
& Egle, 2004). In a recent article, Schütze, Rees, Preece, and Schütze
(2010) demonstrated the strong moderating effect of mindfulness on
the relationship between pain intensity and pain catastrophizing. The
ability to stay focused on present-moment experience with a non-
judgmental attitude (definition of mindfulness) predicted a weaker
relationship between pain intensity and catastrophizing. It must be
noted that patients in this study were suggested to undergo the state
of mindfulness at the hypnosis induction step, before suggestions were
done.
As indicated by the MOS–Sleep score, hypnosis improved sleep in
our sample. Sleep disturbances affect 70% to 90% of patients with FM
and may play an important role in the physiopathology of fibromyalgia
(Harding, 1998). The multiple types of sleep problems and disturbances
may account in part for FM patients’ high levels of emotional distress.
It was recently demonstrated that negative mood mediated the relation-
ship between poor sleep and pain in a sample of chronic pain patients
including FM (O’Brien at al., 2010).
The need for PGIC as a core outcome domain for clinical trials has
been emphasized (Geisser et al., 2010; Turk et al., 2003). Therefore, the
clear improvement seen with PGIC at the 3- and 6-month follow-ups is
a major finding of the study. It is known that patients with FM associate
pain, vitality, physical functioning, sleep, and cognitive-functioning
improvement within PGIC ratings (Hudson et al., 2009). This confirms
the role of cognitive and affective factors since pain and physical func-
tion could not influence the PGIC ratings recorded in this study as these
factors (VAS and FIQ) did not improve significantly. Therefore, the other
comorbid symptoms such as sleep alteration and cognitive impairment
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HYPNOSIS FOR MANAGEMENT OF FIBROMYALGIA 119
(catastrophizing) must be the cause for the changes observed in PGIC
ratings as these factors improved.
The results of the current study failed to demonstrate that the
FIQ, a more broad-based measure of fibromyalgia symptoms, showed
differences as a result of the intervention.
The FIQ is a specific instrument to assess the overall effect of phar-
macological treatments on FM symptomatology and is currently consid-
ered as the gold standard (Burckhardt et al., 1991). The fact that it was
not statistically improved may reflect the lack of consensus on whether
or not it is relevant to evaluate nonpharmacological treatments. Some
authors have pointed out that it is extremely difficult to detect a differ-
ence on generic measures such as the FIQ or Short Form Health Survey
(SF–36) based on just about any type of specific intervention. Hypnosis,
cognitive-behavioral pain therapy, and other interventions usually only
show effects on very specific measures rather than broad-based ones
(Garcia-Martinez, De Paz, & Marquez, 2011). The fact that we did not
test for the patient’s hypnotizability is another possible explanation
for the lack of change in the values of this variable. It is known that
hypnotic analgesia does not help everyone nor does it always pro-
vide complete pain relief in the setting of chronic pain (Jensen, 2009).
Most of the studies evaluating hypnosis’ effect on acute or chronic pain
demonstrated a significantly greater decrease in pain scores in highly
hypnotizable patients. With chronic pain, studies comparing hypnosis
directly with other psychological strategies such as distraction, men-
tal imagery, or placebo further demonstrated that hypnosis typically
produced larger analgesic effects in highly hypnotizable subjects (De
Pascalis, Magurano, Bellusci, & Chen, 2001; Rainville, 2008). Another
explanation for the lack of change of FIQ scores lies in the choice of hyp-
nosis methodology. Pain was not obligatorily considered as the main
symptom on which hypnosis sessions focused. In this study, we chose
to propose hypnosis as a way to not only focus on control or avoidance
of symptoms but also to focus on the patient’s relationship with symp-
toms from a perspective of acceptance of chronic pain and commitment
to new emotional, physical, and social functioning. Maybe this choice
prevented this trial from demonstrating an efficacy in the strict domains
of symptoms.
In spite of some of the unique features of our study, a number of
methodological limitations should be discussed. Our hypnotic proce-
dure was not standardized as is proposed for all clinical trials of the
effects of hypnosis. It has been suggested to examine the efficacy of hyp-
notic analgesia through different chronic pain conditions using more
standardized hypnotic-intervention protocols, which would allow for
better comparison between studies (Jensen & Patterson, 2006). This
questions the foundation of hypnosis, which was classically defined
as a state of consciousness characterized by a markedly increased
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120 PASCALE PICARD ET AL.
receptivity to suggestion and the capacity for modification of per-
ception and memory. The experience of hypnosis creates an unusual
relationship between the person offering the suggestions and the person
receiving them. Through this special relationship, the person experi-
ences a form of transference. This transferential quality of the hypnotic
experience is a powerful determinant of clinical effectiveness (Barber,
1996). Although the procedure and some script parameters can be stan-
dardized, the relationship between therapist and patient, which is an
important determinant of hypnosis, cannot be.
A placebo control group is one of the key factors of evidence-based
medicine. Which placebo can be used for hypnosis? The choice of a
waiting list as a control group does not answer the question of whether
the context effects are as effective or more effective than the intervention
itself.
FM is a heterogeneous condition, and subgroups may exist that have
different pathophysiologies with different response characteristics to
treatment (Sommer, 2010). The heterogeneity of fibromyalgia patients
renders a “one-size-fits-all” approach unlikely to be broadly efficacious.
In the future, instruments assessing pretreatment levels of psychologi-
cal distress or pain-coping strategies should be developed and used to
identify subgroups of FM patients who might benefit differentially from
specific interventions (Karsdorp & Vlaeyen, 2009).
References
Arnold, L. M., Hess, E. V., Hudson, J. I., Welge, J. A., Berno, S. E., & Keck, P. (2002). A
randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the
treatment of women with fibromyalgia. American Journal of Medicine,112, 191–197.
Barber, J. (1996). Hypnosis and suggestion in the treatment of pain: A clinical guide.NewYork,
NY: Norton.
Bennett, R. M., Jones, J., Turk, D. C., Russell, I. J., & Matallana, L. (2007). An Internet
survey of 2,596 people with fibromyalgia. BMC Musculoskel Disorders,9, 27–38.
Burckhardt, C. S., Clark, S. R., & Bennett, R. M. (1991). The Fibromyalgia Impact
Questionnaire: Development and validation. Journal of Rheumatology,18, 728–733.
Cantor, N., & Genero, N. (1986). Psychiatric diagnosis and natural categorization: A close
analogy. In T. Millon & G. Klerman (Eds.), Directions in psychopathology: Toward the
DSM–IV (pp. 233–256). New York, NY: Guilford.
Carville, S. F., Arendt-Nielsen, S., Bliddal, H., Blotman, F., Branco, J. C., Buskila, D., &
Dasilva, J. A. (2008). EULAR evidence-based recommendations for the management
of fibromyalgia syndrome. Ann Rheum Dis,67, 536–541.
Castel, A., Pérez, M., Sala, J., Padrol, A., & Rull, M. (2007). Effect of hypnotic suggestion
on fibromyalgia pain: Comparison between hypnosis and relaxation. European Journal
of Pain,11, 463–468.
De Pascalis, V., Magurano, M. R., Bellusci, A., & Chen, A. C. (2001). Somatosensory event-
related potential and autonomic activity to varying pain reduction cognitive strategies
in hypnosis. Clinical Neurophysiology,112, 1475–1485.
Garcia-Martinez, A. M., De Paz, J. A., & Marquez, S. (2011). Effects of an exercise pro-
gramme on self-esteem, self-concept and quality of life in women with fibromyalgia:
A randomized controlled trial. Rheumatology International,32, 1869–1876.
Downloaded by [195.101.130.177] at 02:36 21 December 2012
HYPNOSIS FOR MANAGEMENT OF FIBROMYALGIA 121
Geisser, M. E., Clauw, D. J., Strand, V., Gendreau, R. M., Palmer, R., & Williams, D.
A. (2010). Contributions of change in clinical status parameters to Patient Global
Impression of Change (PGIC) scores among persons with fibromyalgia treated with
milnacipran. Pain,149, 373–378.
Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology (revised ed.).
Washington, DC: US Department of Health, Education and Welfare.
Haanen, H. C., Hoenderdos, H. T., Van Romunde, L. K., Hop, W. C., Mallee, C., Terwiel,
J.P., & Hekster, G. B. (1991). Controlled trial of hypnotherapy in the treatment of
refractory fibromyalgia. Journal of Rheumatology,18, 72–75.
Harding, S. M. (1998). Sleep in fibromyalgia patients: Subjective and objective findings.
American Journal of the Medical Sciences,315, 367–376.
Hays, R. D., & Stewart, A. L. (1992). Sleep measures. In A. L. Stewart & J. E. Ware, Jr.
(Eds.), Measuring functioning and well-being: The medical outcomes study approach (pp.
36–42). Durham, NC: Duke University Press.
Hudson, J. I., Arnold, L. M., Bradley, L. A., Choy, E. H. S., Mease, P. J., Wang, F.,
... Wohlreich, M. M. (2009). What makes patients with fibromyalgia feel better?
Correlations between Patient Global Impression of Improvement and Changes in clin-
ical symptoms and function: A pooled analysis of 4 randomized placebo-controlled
trials of Duloxetine. Journal of Rheumatology,36, 2517–2522.
Huet, A., Lucas-Polomeni, M., Robert, J., Sixou, J., & Wodey, E. (2011). Hypnosis and
dental anesthesia in children: A prospective controlled study. International Journal of
Clinical and Experimental Hypnosis,59, 424–441.
Irachabal, S., Koleck, M., Rascle, N., & Bruchon-Schweitzer, M. (2008). Pain coping strate-
gies: French adaptation of Coping Strategies Questionnaire (CSQ-F). L’Encephale,34,
47–53.
Jensen, M. P. (2009). Hypnosis for chronic pain management: A new hope. Pain,146,
235–237.
Jensen, M. P., Ehde, D., Gertz, K., Stoelb, B. L., Dillworth, T., Hirsh, A., ...Kraft, G. (2011).
Effect of self-hypnosis training and cognitive restructuring on daily pain intensity and
catastrophizing in individuals with multiple sclerosis and chronic pain. International
Journal of Clinical and Experimental Hypnosis,59, 45–64.
Jensen, M. P., & Patterson, D. R. (2006). Hypnotic treatment of chronic pain. Journal of
Behavioral Medicine,29, 95–124.
Julien, N., Goffaux, P., Arsenault, P., & Marchand, S. (2005). Widespread pain in
fibromyalgia is related to a deficit of endogenous pain inhibition. Pain,114, 295–302.
Karsdorp, P. A., & Vlaeyen, J. W. S. (2009). Active avoidance but not activity pacing is
associated with disability in fibromyalgia. Pain,147, 29–35.
Lew, M. W., Kravits, K., Garberoglio, C., & Williams, A. C. (2011). Uses of preoperative
hypnosis to reduce postoperative pain and anesthesia-related side effects. International
Journal of Clinical and Experimental Hypnosis,59, 406–424.
Mease, P., Arnold, L. M., Bennett, R., Boonen, A., Buskila, D., Carville, S., ...Goldenberg,
D. (2007). Fibromyalgia syndrome. Journal of Rheumatology,34, 1415–1425.
Mease,P.,Arnold,L.M.,Choy,E.H.,Clauw,D.J.,Crofford,L.J.,Glass,J.M.,...Williams,
D. A. (2009). Fibromyalgia syndrome module at OMERACT 9: Domain construct.
Journal of Rheumatology,36, 2318–2329.
Montgomery, G. H., Duhamel, K. N., & Redd, W. H. (2000). A meta-analysis of hypnoti-
cally induced analgesia: How effective is hypnosis? International Journal of Clinical and
Experimental Hypnosis,48, 138–153.
Nusbaum, F., Redouté, J., le Bars, D., Volckmann, P., Simon, F., Hannoun, S., ...Marinier,
D. (2011). Chronic low-back pain modulation is enhanced by hypnotic analgesic sug-
gestion by recruiting an emotional network: A PET imaging study. International Journal
of Clinical and Experimental Hypnosis,59, 27–45.
O’Brien, E. M., Waxenberg, L. B., Atchison, J. W., Gremillion, H. A., Staud, R. M., McCrae,
C. S., & Robinson, M. E. (2010). Negative mood mediates the effects of poor sleep on
pain among chronic pain patients. Clinical Journal of Pain,26, 310–319.
Downloaded by [195.101.130.177] at 02:36 21 December 2012
122 PASCALE PICARD ET AL.
Patterson, D. R., & Jensen, M. P. (2003). Hypnosis and clinical pain. Psychological Bulletin,
129, 495–521.
Patterson, D. R., Jensen, M. P., Wiechmann, S. A., & Sharar, S. R. (2010). Virtual reality
hypnosis for pain associated with recovery from physical trauma. International Journal
of Clinical and Experimental Hypnosis,58, 288–300.
Perrot, S., Dumont, D., Guillemin, F., Pouchot, J., & Coste, J. (2003). Quality of life in
women with fibromyalgia syndrome: Validation of the QIF, the French version of the
fibromyalgia impact questionnaire. Journal of Rheumatology,30, 1054–1059.
Rainville, P. (2008). Hypnosis and the analgesic effect of suggestions Pain,134, 1–2.
Rainville, P., Carrier, B., Hofbauer, R. K., Bushnell, M. C., & Duncan, G. H. (1999).
Dissociation of sensory and affective dimensions of pain using hypnotic modulation.
Pain,82, 159–171.
Schütze, R., Rees, C., Preece, M., & Schütze, M. (2010). Low mindfulness predicts pain
catastrophizing in a fear-avoidance model of chronic pain. Pain,148,120–127.
Smets, E. M., Garssen, B., Bonke, B., & De Haes, J. C. (1995). The Multidimensional Fatigue
Inventory (MFI) psychometric qualities of an instrument to assess fatigue. Journal of
Psychosomatic Research,39, 315–325.
Sommer, C. (2010). Fibromyalgia. IASP Pain Clinical Updates,18(4), 1–5.
Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale:
Development and validation. Psychological Assessment,7, 524–532.
Sullivan, M. J., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. A. (1998). Catastrophizing,
pain, and disability in patients with soft-tissue injuries. Pain,77, 253–260.
Turk, D. C., Dworkin, R. H., Allen, R. R., Bellamy, N., Brandenburg, N., Carr, D. B.,
... Witter, J. (2003). Core outcome domains for chronic pain clinical trials: Impact
recommendations. Pain,106, 337–345.
Van Houdenove, B., & Egle, U. T. (2004). Fibromyalgia: A stress disorder? Piecing the
biopsychosocial puzzle together. Psychotherapy and Psychosomatics,73, 267–275.
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombadier, C., Goldenberg, D.
L., ...Clarck, P. (1990). The American College of Rheumatology 1990 criteria for the
classification of fibromyalgia: Report of the multicenter criteria committee. Arthritis
and Rheumatism,33, 160–172.
Yunus, M. B. (2007). Fibromyalgia and overlapping disorders: The unifying concept of
central sensitivity syndromes. Seminars in Arthritis and Rheumatism,36, 339–356.
Zigmond, A., & Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta
Psychiatrica Scandinavica,67, 361–370.
Hypnose im Fibromyalgiemanagement
Pascale Picard, Catherine Jusseaume, Maryse Boutet, Christian Dualé,
Aurélin Mulliez und Bruno Aublet-Cuvellier
Abstrakt: Dieses randomisierte, kontrollierte Verfahren stellte die Effekte
von fünf nicht-standardisierten Hypnosesitzungen über zwei Monate mit
59 Frauen mit Fibromyalgie, die randomisiert der Behandlung (n=30)
oder einer Wartelisten-Kontrollgruppe (n=29) zugeteilt wurden, einander
gegenüber. Patientinnen in der Behandlungsgruppe wurden dazu ermutigt,
Selbsthypnose anzuwenden. Zu Beginn, 3 Monate (M3) und 6 Monate
(6M) nach Aufnahme wurden der Fibromyalgia Impact Questionnaire (FIQ),
die MOS-Schlaf Skala, das Multidimensional Fatigue Inventory (MFI),
Cognitive Strategy Questionnaire (CSQ) und die Global Impression of
Change (PGIC) angewandt. Verglichen mit der Kontrollgruppe berichtete
die Hypnosegruppe eine Verbesserung im PGIC (p=0,001 zum Zeitpunkt
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HYPNOSIS FOR MANAGEMENT OF FIBROMYALGIA 123
M3, p =0,01 zum Zeitpunkt M6) und eine signifikante Verbesserung in der
Schlaf.- und CSQ-Dramatization Unterskala (beide zum Zeitpunkt M6).
Stephanie Reigel, MD
Le traitement de la fibromyalgie par l’hypnose
Pascale Picard, Catherine Jusseaume, Maryse Boutet, Christian Dualé,
Aurélin Mulliez et Bruno Aublet-Cuvellier
Résumé: Cette étude randomisée contrôlée opposait les effets de 5 séances
non standardisées d’hypnose pendant 2 mois chez 59 femmes souffrant de
fibromyalgie, choisies au hasard pour recevoir un traitement (n=30) ou
pour être inscrites sur une liste d’attente (groupe témoin) (n=29). Les
patientes choisies pour recevoir le traitement étaient encouragées à prati-
quer l’autohypnose. Au départ, après 3 mois (M3) et après 6 mois (M6), les
patientes ont rempli les questionnaires suivants : l’évaluation de l’impact
de la fibromyalgie (QIF), l’échelle de mesure du sommeil MOS, l’inventaire
multidimensionnel de la fatigue (MFI), le questionnaire de stratégie cog-
nitive (CSQ) et l’impression générale de changement du patient (PGIC).
Comparativement au groupe témoin, le groupe de patientes hypnotisées a
signalé une amélioration plus marquée de la PGIC (p=0,001 à M3, p=0,01 à
M6), ainsi qu’une amélioration significative du sommeil et de la sous-échelle
de dramatisation CSQ (toutes les deux à M6).
Johanne Reynault
C. Tr. (STIBC)
La hipnosis para el manejo de la fibromialgia
Pascale Picard, Catherine Jusseaume, Maryse Boutet, Christian Dualé,
Aurélin Mulliez, y Bruno Aublet-Cuvellier
Resumen: Este ensayo, aleatorizado y controlado, contrastó los efectos de
5 sesiones no estandarizadas de hipnosis a lo largo de 2 meses con 59 mujeres
con fibromialgia; quienes fueron asignadas aleatoriamente al tratamiento
(n=30) o al grupo control de lista de espera (n=29). Se alentó a los
pacientes en el grupo de tratamiento a practicar autohipnosis. El Cuestionario
de Impacto de la Fibromialgia (FIQ), la Escala de Sueño MOS, el Inventario
Multidimensional de Fatiga (MFI), el Cuestionario de Estrategia Cognitiva
(CSQ), y la Impresión Global de Cambio del Paciente (PGIC) se adminis-
traron en la línea basal, a 3 meses (M3), y a 6 meses (M6) de la inclusión.
Comparados con el grupo control, el grupo de hipnosis reportó mayor mejora
en la PGIC (p=.001 en M3, =.01 en M6), y una mejora significativa en el
sueño y en la subescala de dramatización del CSQ (ambos en M6).
Omar Sánchez-Armáss Cappello, PhD
Autonomous University of San Luis Potosi,
Mexico
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