Article

Effects of Self-Hypnosis Training and Cognitive Restructuring on Daily Pain Intensity and Catastrophizing in Individuals With Multiple Sclerosis and Chronic Pain

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Abstract

Fifteen adults with multiple sclerosis were given 16 sessions of treatment for chronic pain that included 4 sessions each of 4 different treatment modules: (a) an education control intervention; (b) self-hypnosis training (HYP); (c) cognitive restructuring (CR); and (d) a combined hypnosis-cognitive restructuring intervention (CR-HYP). The findings supported the greater beneficial effects of HYP, relative to CR, on average pain intensity. The CR-HYP treatment appeared to have beneficial effects greater than the effects of CR and HYP alone. Future research examining the efficacy of an intervention that combines CR and HYP is warranted.

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... The mean age of the participants was approximately 48 years. The diseases associated with pain were: three studies on multiple sclerosis [13][14][15] ; three on cancer [16][17][18] ; one on hemophilia 10 ; one on burns 19 ; one on fibromyalgia 20 ; one on brachial plexus injury 21 ; one on chronic pain in the elderly 8 ; one on intolerable pain 22 ; one on disability 23 ; one on post-traumatic injury 24 ; one on spinal cord injury 25 ; one on muscle pain 26 ; one on patients in palliative care 27 ; and one on chronic low back pain 28 . Table 1 shows the summary of the main characteristics of the included studies. ...
... Only one study included the ''quality of pain'' category, without, however, defining the expression. Three studies evaluated the pain intensity through the VAS 19.20,27 and seven used the NRS [13][14][15]17,18,24,25 . Four studies used the McGill Pain Questionnaire for measuring pain 8,13,19,20 and six used the BPI 8,14,15,21,23,28 . ...
... Three studies evaluated the pain intensity through the VAS 19.20,27 and seven used the NRS [13][14][15]17,18,24,25 . Four studies used the McGill Pain Questionnaire for measuring pain 8,13,19,20 and six used the BPI 8,14,15,21,23,28 . Study 1 also used the Patient-Reported Outcomes Measurement Information System (PROMIS) and study 5 used the Privately Completed A Brief Self-Report Assessment of Patient-Reported Outcomes (PROs). ...
Article
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BACKGROUND AND OBJECTIVES Pain has great impact on public health and presents a social cost which transcends the financial aspect. Hypnosis is a focal, quick and low-cost resource with effective change possibilities in pain management. The objective of this study was to identify evidence of the efficiency of hypnosis in pain management. CONTENTS This study consists of a systematic literature review held in February 2020. Search was carried out in the Pubmed, Cochrane, LILACS, Scielo and PsycInfo platforms, using the keywords “clinical trials”, “hypnosis”, “pain management”, “pain intensity”, and “quality of life”, totalizing 18 studies after peer review. Most articles are randomized, controlled by comparing hypnosis to standard treatment or other integrative practices, and focus mainly on the aspects of intensity, quality and interference of pain as an outcome variable. Six studies mention quality of life and only two refer catastrophization as an important intervening variable. CONCLUSION Hypnosis is an effective technique for pain management, considering that there was an improvement in pain management with the improvement of at least one aspect, be it intensity, interference or quality of pain. However, it’s necessary to highlight important limitations of the studies, such as the small sample size and the complexity of systematizing subjective techniques, which highlights the need for more clinical trials, including multicentric studies, so that larger samples can be obtained. Keywords: Hypnosis; Pain management; Non-procedural pain
... A systematic review of hypnosis for general pain relief found moderate to strong analgesia for all pain parameters in addition to other key findings [9]. Hypnosis can therefore not only be used as the sole therapy, but also adjuvant to local anaesthesia and to support non-hypnotic techniques and improve their effects [10]. In the field of acute dental pain and its reduction or elimination by dental hypnosis, a lot has been done in recent years, and several clinical studies have been published. ...
... Possibilities and limitations of hypnotic interventions should be demonstrated and be an impulse for the scientific community to continue to pursue this exciting field. Already several studies [6][7][8][9][10] could prove the mainly supporting and supplementing effects of hypnosis by clinical trials. Of course, the limitations of hypnotic pain therapy have also been shown several times [12,13,37], whereby not infrequently the attitude and abilities of the subject towards the alternative therapy were the cause of the lack of success [25][26][27][28]39,40]. ...
Article
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Introduction/objectives : The effects of hypnosis on acute pain have been discussed recently, resulting in increased attention in the dental/maxillofacial field offering new perspectives, especially in emergency situations, trauma, or acute inflammatory situations where conventional pharmaceuticals are contraindicated due to allergies or intolerance reactions. Data : To systematically evaluate and assess the effects of hypnosis on acute dental/facial pain relief. Randomized controlled trials, cohort studies, controlled clinical trials, cross-sectional studies, evaluation, and validation studies, following the PRISMA guidelines, of human subjects of all ages were included. Sources : Five electronic databases (Cochrane, Embase, MEDLINE via PubMed, LILACS, Scopus) were screened for studies published between 1989 – 2021. A NIH quality-assessment-tool was performed. Study selection/results : 27 papers have been included and a meta-analysis was performed. Hypnosis has been reported to reduce intraoperative and postoperative pain as well as the use of analgesics in various dental procedures such as tooth extraction. Highly hypnotizable subjects generally respond better to hypnosis. Different hypnosis techniques were used for pain relief and relaxation. The studies show a large heterogeneity. Conclusion : Although there are only a small number of studies on the subject so far, evidence can be confirmed for the effects of hypnosis on acute pain relief in dental/maxillofacial area. Despite the promising results, further research is needed. Clinical significance : Hypnosis offers a possible alternative to conventional pain medications for acute dental and maxillofacial pain, especially in cases of allergies or contraindications; it can be easily applied by a trained practitioner.
... Ziele sind hier, das Immunsystem anzusprechen, zu stärken und die Sensibilität gegenüber bestimmten (allergenen) Reizen zu redu- Bornstein & Devine, 1980;Bornstein & Pittman, 1989;Coman & Evans, 1996;Heusinger & Krause, 1991;Entwistle et al., 2014;Steyer & Ables, 2009 -Düker, 2005;Scholz, 2006;Turner et al., 2005;Jensen et al., 2011;Jenssen & Patterson, 2014;Rodrigo et al., 2018). ...
... Hierbei ist z. B. bei der Bewältigung chronischer Schmerzen häufig besonders die Kombination von Hypnose und kognitiv-behavioraler Umstrukturierung die effektivste Methode vor vielen anderen (Jensen et al., 2011;s. Abschn. ...
... The present findings do not allow us to confirm our first hypothesis, i.e., the advantage of self-hypnosis combined with self-care, compared to the three other approaches. Jensen et al. [43] showed that compared to a self-hypnosis training alone or cognitive restructuring (CBT) alone, a combination of both hypnosis and CBT improved daily pain intensity, worst pain intensity, pain interference, and catastrophizing in 15 patients suffering from multiple sclerosis [43]. More recently, Castel et al. [44] randomized 93 patients suffering from fibromyalgia into three groups: standard care, CBT alone and CBT/hypnosis (14 weekly-sessions of 2 hours). ...
... The present findings do not allow us to confirm our first hypothesis, i.e., the advantage of self-hypnosis combined with self-care, compared to the three other approaches. Jensen et al. [43] showed that compared to a self-hypnosis training alone or cognitive restructuring (CBT) alone, a combination of both hypnosis and CBT improved daily pain intensity, worst pain intensity, pain interference, and catastrophizing in 15 patients suffering from multiple sclerosis [43]. More recently, Castel et al. [44] randomized 93 patients suffering from fibromyalgia into three groups: standard care, CBT alone and CBT/hypnosis (14 weekly-sessions of 2 hours). ...
Article
Background: In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects. Methods: An open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up. Results: 203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed. Conclusions: The present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended.
... Only one RCT (Ehde et al., 2015) has so far focused on pain in people with MS (along with depression and fatigue), and the psychological literature concerning pain and MS appears to be rather limited, with only three additional studies retrieved. Of these, one was an uncontrolled pretest-posttest design (Jensen et al., 2011), one a case-series (Rona Moss- Morris et al., 2017), and one a case report (Dane, 1996). ...
... Other approaches that had been investigated in only one or two studies and for which at least one outcome was improved include an insight-oriented psychotherapy group (Crawford & McIvor, 1985); a 15 month psychotherapy group (Langenmayr & Schottes, 2000), psychotherapy including psychodrama (Sproesser et al., 2010), a psychodynamic hypnosisbased intervention (Kleinbub et al., 2015), self-hypnosis with cognitive restructuring (Jensen et al., 2011), EMDR for PTSD (Carletto et al., 2016), DBT (Blair et al., 2017), positive psychology (LeClaire et al., 2018), supportive expressive therapy (Abolghasemi et al., 2016;Mohr et al., 2001), and a relationship enrichment programmes for couples (Tompkins et al., 2013). ...
Technical Report
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This document was produced as part of Lancaster University’s Minds and Movement project funded by the British Psychological Society. Guidance on psychological interventions for psychological difficulties in individuals with Huntington’s disease, Parkinson’s disease, motor neurone disease, and multiple sclerosis was produced for the British Psychological Society and is available at www.bps.org.uk/news-and-policy/psychological-interventions-huntingtons-parkinsons-motor-neurone-multiple-sclerosis. The current document presents extended evidence, covering the literature reviewed more comprehensively than was possible for the BPS published guidance, and is referred to by that guidance.
... Chronic pain is one of the most prevalent and disabling symptoms associated with multiple sclerosis (MS) [1,2]. Psychosocial interventions -including cognitive behavioral therapy (CBT), hypnosis, and mindfulness -are increasingly recommended for reducing chronic pain and its impact on functioning and mood, and evidence supports their use in MS. [3][4][5] However, similar to pharmacologic approaches, as much as 50% of those who try these approaches may not achieve satisfactory pain improvement. This may be due to a mismatch between a specific treatment and a specific individual. ...
... Data completion and quality will be monitored and tracked by the research coordinator, and the principal investigator (DME) will review recruitment and retention reports during weekly meetings and quickly implement changes if needed. We have successfully used these and other strategies in our past trials, with a retention rate of 90-98% across similar studies [3,4,40]. Further details on the trial's retention and data management procedures may be found in the Manual of Procedures. ...
Article
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Background: Chronic pain is one of the most prevalent and disabling symptoms associated with multiple sclerosis (MS). Individuals with MS are interested in nonpharmacologic pain management approaches. Cognitive-behavioral therapy (CBT) is efficacious in improving MS-related pain outcomes. Mindfulness-based cognitive therapy (MBCT) is a promising, alternative approach. Little is known about moderators of these treatments' outcomes, however. This article describes the study protocol for the first randomized controlled trial comparing MBCT, CBT, and usual care and examining treatment effect moderators in individuals with chronic pain and MS. Methods: We will conduct a single-center, randomized, single blind, parallel-group trial comparing MBCT, CBT, and usual care in adults with MS and chronic pain. Both interventions will be delivered via eight group sessions using videoconferencing technology. Primary (average pain intensity) and secondary outcomes (including pain interference, depressive symptoms, fatigue, and sleep) will be assessed pre-treatment, mid-treatment, post-treatment, and at 6-month follow up. Potential treatment moderators will be assessed pre-treatment. We hypothesize that participants randomly assigned to MBCT or CBT will report significantly greater reductions in average pain intensity than participants assigned to usual care at post-treatment (primary study endpoint) and 6-month follow up. We also hypothesize that mindfulness, pain catastrophizing, and behavioral activation pre-treatment will moderate response to both active treatments, but not response to usual care. Discussion: Findings will provide important new information about the efficacy and moderators of two nonpharmacologic pain management approaches delivered using technology to overcome common barriers to treatment access. The knowledge gained may lead to better patient-treatment matching and, ultimately, better pain treatment outcomes in MS. Trial registration: ClinicalTrials.gov, NCT03782246. Registered on 20 December 2018.
... Studies related to the use of MI as treatment of MS pain were limited and the most common technique recognized was self-hypnosis. The use of self-hypnosis was identified in three studies [68][69][70] but the methodology adopted in all the studies was not similar. In one study, Jensen et al. [68] compared hypnosis with progressive muscle relaxation and found that pain scores improved with hypnotic treatment. ...
... However, since progressive muscle relaxation has similar mechanism of pain relief as hypnosis, it behaved like an active condition rather than a control for comparison. In another study, each patient underwent 4 sessions of 4 different treatment modules; hence, isolated effects of each intervention could not be ascertained [69]. Although most available studies indicate the beneficial effects of self-hypnosis in MS pain, there was a wide range of hypnotic suggestions used in these studies. ...
Article
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Mental imagery is a quasi-perceptual experience in the absence of external stimuli. This concept has intrigued psychologists, sportspersons, neurologists and other scientists for over a decade now. Imagery has been used in rehabilitation and the results have been promising. Researchers refer to this as healing the body through the mind. However, the challenge is lack of standardized protocols, homogeneity and consistency in application of mental imagery in different populations. The purpose of this review is to discuss and understand the role of mental imagery in the treatment of central neuropathic pain (CNP). Treatment options of CNP are inadequate and their benefits are short lived. We conducted an extensive search on various databases using combinations of different keywords and reviewed the available literature in this area. We were able to finalize twelve studies where mental imagery was used for treating CNP in spinal cord injury (SCI), stroke and multiple sclerosis. However, the methodology and techniques of mental imagery training used in these studies were non-homogeneous and inconsistent. This review provides a guiding framework to further explore the different techniques of mental imagery and their roles in treating CNP.
... Hypnosis as a clinical intervention has been shown to have beneficial effects on pain (Montgomery, Duhamel, & Redd, 2000), anxiety (Hammond, 2010), depression (de Klerk, Du Plessis, Steyn, & Botha, 2004;Schnur et al., 2008), and pain catastrophizing (Jensen et al., 2010;Mendoza et al., 2017;Rizzo et al., 2018). A systematic review of metaanalyses found that adding clinical hypnosis to standard treatment was superior to standard treatment or attention control, exerting small effects on pain and small to large effects on emotional distress (Häuser, Hagl, Schmierer, & Hansen, 2016). ...
... The current findings suggest that hypnosis may also exert large beneficial effects on pain catastrophizing, whereas minimal-effect control did not result in much meaningful changes in this outcome. Previous studies examining the effects of hypnotic treatments on pain catastrophizing have shown that incorporating a hypnotic component to cognitive therapy (Jensen et al., 2010), cognitive behavioral therapy (Mendoza et al., 2017), and pain education (Rizzo et al., 2018) can result in significant reductions in pain catastrophizing. Our study suggests that prerecorded hypnotic intervention with suggestions tailored to maintain realistic expectations and continuous effort for recovery could be an effective stand-alone treatment for reducing pain catastrophizing. ...
Article
This pilot study evaluated the effect sizes associated with prerecorded hypnotic interventions provided during the perisurgical period for reducing risk factors associated with chronic postsurgical pain, including acute postsurgical pain, anxiety, depression, and pain catastrophizing. A total of 25 participants (N = –25) were randomly assigned to receive a hypnotic intervention (n = 8), minimal-effect treatment (n = 8), or treatment as usual (n = 9) during their hospital stay for total knee replacement (TKR). Participants were followed for 6 months after hospital discharge. Results indicate that prerecorded hypnotic intervention exerted medium effects for reducing acute postsurgical pain and large effects for reducing perisurgical anxiety and pain catastrophizing. The findings indicate that a fully powered clinical trial to evaluate the beneficial effects of prerecorded hypnosis to manage pain and psychological distress in patients undergoing TKR is warranted.
... The feasibility and tolerability ratios found in the current study are consistent with those reported in the literature, and treatment acceptability ratings coming into treatment and at post-treatment were moderately high across all three treatment conditions [22,32,52,53]. Importantly, past research has shown poorer pain treatment outcomes when comorbid depression goes undiagnosed, untreated, or undertreated as depression can interfere with attendance and motivation to participate [54]. ...
... For example, both CT and MBCT are effective in treating major depressive disorder, so adapting these interventions to target both pain and depression merits scientific study [27,[57][58][59]. Overall, however, the three treatments were well tolerated with very few adverse events, and retention rates were similar to those reported in prior research [22,32,52,53]. These findings further support the feasibility and acceptability of MBCT for CLBP. ...
Article
Objective This pilot trial compared the feasibility, tolerability, acceptability, and effects of group-delivered mindfulness meditation (MM), cognitive therapy (CT), and mindfulness-based cognitive therapy (MBCT) for chronic low back pain (CLBP). Setting University of Queensland Psychology Clinic. Subjects Participants were N = 69 (intent-to-treat [ITT] sample) adults with CLBP. Design A pilot, assessor-blinded randomized controlled trial. Methods Participants were randomized to treatments. The primary outcome was pain interference; secondary outcomes were pain intensity, physical function, depression, and opioid medication use. The primary study end point was post-treatment; maintenance of gains was evaluated at three- and six-month follow-up. Results Ratings of acceptability, and ratios of dropout and attendance showed that MBCT was acceptable, feasible, and well tolerated, with similar results found across conditions. For the ITT sample, large improvements in post-treatment scores for pain interference, pain intensity, physical function, and depression were found (P < 0.001), with no significant between-group differences. Analysis of the follow-up data (N = 43), however, revealed that MBCT participants improved significantly more than MM participants on pain interference, physical function, and depression. The CT group improved more than MM in physical function. The MBCT and CT groups did not differ significantly on any measures. Conclusions This is the first study to examine MBCT for CLBP management. The findings show that MBCT is a feasible, tolerable, acceptable, and potentially efficacious treatment option for CLBP. Further, MBCT, and possibly CT, could have sustained benefits that exceed MM on some important CLBP outcomes. A future definitive randomized controlled trial is needed to evaluate these treatments and their differences.
... Psychotherapy for pain in MS has been studied as part of an interdisciplinary treatment program and certain strategies, such as cognitive restructuring and self-hypnosis, have been explored with beneficial results. 16,17 However, to date there has not been a randomized clinical trial of CBT for MS-related pain. ...
... www.ijmsc.org International Journal of MS Care Preprint O n l i n e F i r s t 17 The findings of this study should be interpreted with caution. Of particular relevance is the fact that the study is substantially underpowered to detect effects of the two treatment conditions and especially between group effects. ...
Article
Background: Pain is a common and often debilitating symptom among persons with multiple sclerosis (PwMS). Besides interfering with daily functioning, pain in MS is associated with higher levels of depression and anxiety. While cognitive-behavioral therapy (CBT) for pain has been found to be an effective treatment in other populations, there has been a dearth of research in PwMS. Methods: PwMS with at least moderate pain severity (N = 20) were randomly assigned to one of two groups: CBT plus standard care (CBT/SC) or MS-related education plus standard care (ED/SC), each of which met for 12 sessions. Changes in pain severity, pain interference, and depressive symptom severity from baseline to the 15 week follow-up were assessed using a 2×2 factorial design. Participants also rated their satisfaction with their treatment and accomplishment of personally meaningful behavioral goals. Results: Both treatment groups rated their treatment satisfaction as very high and their behavioral goals as largely met, although only the CBT/SC group's mean goal accomplishment ratings represented significant improvement. While there were no significant differences between groups post-treatment on the three primary outcomes, there was an overall improvement over time for pain severity, pain interference, and depressive symptom severity. Conclusions: CBT or education-based programs may be helpful adjunctive treatments for PwMS experiencing pain.
... Therefore, our findings also support the potential of informing people about the effectiveness of multimodal activities on motivating them to change their everyday activities (cf. Jensen et al., 2010;Avitabile and De Hoyos, 2018;Bergman and Chan, 2021;Maldonado and De Witte, 2021). ...
Article
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Research over the past few decades has shown the positive influence that cognitive, social, and physical activities have on older adults’ cognitive and affective health. Especially interventions in health-related behaviors, such as cognitive activation, physical activity, social activity, nutrition, mindfulness, and creativity, have shown to be particularly beneficial. Whereas most intervention studies apply unimodal interventions, such as cognitive training (CT), this study investigates the potential to foster cognitive and affective health factors of older adults by means of an autonomy-supportive multimodal intervention (MMI). The intervention integrates everyday life recommendations for six evidence-based areas combined with psychoeducational information. This randomized controlled trial study compares the effects of a MMI and CT on those of a waiting control group (WCG) on cognitive and affective factors, everyday life memory performance, and activity in everyday life. Three groups, including a total of 119 adults aged 65–86 years, attended a 5- or 10-week intervention. Specifically, one group completed a 10-week MMI, the second group completed 5-week of computer-based CT followed by a 5-week MMI, whereas the third group paused before completing the MMI for the last 5 weeks. All participants completed online surveys and cognitive tests at three test points. The findings showed an increase in the number and variability of activities in the everyday lives of all participants. Post hoc analysis on cognitive performance of MMI to CT indicate similar (classic memory and attention) or better (working memory) effects. Furthermore, results on far transfer variables showed interesting trends in favor of the MMI, such as increased well-being and attitude toward the aging brain. Also, the MMI group showed the biggest perceived improvements out of all groups for all self-reported personal variables (memory in everyday life and stress). The results implicate a positive trend toward MMI on cognitive and affective factors of older adults. These tendencies show the potential of a multimodal approach compared to training a specific cognitive function. Moreover, the findings suggest that information about MMI motivates participants to increase activity variability and frequency in everyday life. Finally, the results could also have implications for the primary prevention of neurocognitive deficits and degenerative diseases.
... 35 Hypnotic therapy aims to promote cognitive flexibility and adaptive pain responses through increased awareness of pain sensations and promotion of relaxation. 36 These results indicate that interventions that focus on shifting pain appraisals and behavioral responses may lead to longer term changes in pain catastrophizing. ...
Article
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Background: Pain catastrophizing is a maladaptive cognitive strategy that is associated with increased emotional responses and poor pain outcomes. Total knee replacement procedures are on the rise and 20% of those who have the procedure go on to have ongoing pain. Pain catastrophizing complicates this pain and management of this is important for recovery from surgery and prevention of chronic pain. This study examines the effect of interventions on PC for patients undergoing total knee replacement (TKR). Methods: Multiple search engines were searched from inception up to March 2021 for relevant studies measuring PC in adults who have undergone TKR. Studies were screened using the Downs and Black Checklist. We included 10 studies (n = 574) which recruited peri surgical TKR participants. Effect sizes were calculated and compared on effect of intervention on PC. Results: Five studies examined the effect of cognitive behavioral therapy-based intervention on PC with low to moderate effects. Two studies examined the effect of a pain neuroscience education on PC with small effects short term. One study examined the effect of hypnotic therapy on PC with small, short-term effect (1 month) but large effect at 6 months. One study compared the effect of an isometric quadricep exercise with auditory and visual feedback on PC to treatment as usual with small, short-term effects. One study compared the effects of an activity and goal setting diary on PC with a moderate effect at 4 weeks. Conclusion: PC is a modifiable characteristic. Several interventions show modest benefit, however more research is needed to aid in clinical decision-making for this population. Interventions are most likely to produce benefits when they are targeted to people with high levels of PC.
... This finding has important clinical implications as positive reframing is also used as a fundamental psychological technique known as cognitive restructuring in cognitive-behavioural therapy to change the way a situation or experience is viewed. A previous study could show the positive impact of cognitive restructuring on pain symptoms in multiple sclerosis patients (Jensen et al., 2011). ...
Article
Multiple sclerosis (MS) symptoms and unpredictability can damage patient well-being. This study is aimed to investigate the relation between sociodemographic and clinical characteristics and the use of coping strategies as well as social support on health-related quality of life (HRQOL). We evaluated 314 MS outpatients of Virgen Macarena University Hospital in Sevilla/Spain (mean age 45 years, 67.8% women) twice over an 18-months period by Brief COPE Questionnaire (COPE-28), Multidimensional Scale of Perceived Social Support (MSPSS) and 12-Item Short Form Health Survey (SF-12). Female gender was significantly related to religion (r= 0.175, p< 0.001), self-distraction (r= 0.160, p< 0.001) and self-blame (r= 0.131, p< 0.05). Age correlated positively with religion (r= 0.240, p< 0.001), and self-blame (r= 0.123, p< 0.05). Progressive MS as well as functional impairment (EDSS) showed a positive relation with denial (r= 0.125, p< 0.05; r= 0.150, p< 0.001). Longer duration since diagnosis was related to lower perceived support from family (r= -0.123, p< 0.05). EDSS (β= -0.452, p< 0.001) was the strongest negative predictor of physical HRQOL followed by age (β= -0.123, p< 0.001), whereas family support was a protective factor (β= 0.096, p< 0.001). Denial (β= -0.132, p< 0.05), self-blame (β= -0.156, p< 0.05), female gender (β= -0.115, p< 0.05) and EDSS (β= -0.108, p< 0.05) negatively impacted on mental HRQOL 18 months later, whereas positive reframing (β= 0.142, p< 0.05) was a protective factor. Our study could identify sociodemographic and clinical variables associated with dysfunctional coping strategies, such as self-blame and denial, which specifically predict worse mental HRQOL as opposed to positive reframing. Diminishing dysfunctional coping and supporting cognitive reframing may contribute to improve HRQOL in MS.
... In a pilot study by Jensen et al, 35 15 participants with MS underwent 4 sessions each of 4 different treatment conditions: (1) a psychoeducational intervention, (2) a self-hypnosis intervention, (3) cognitive restructuring, and (4) a combined cognitive restructuring and hypnosis intervention. The study design provided that patients were randomly assigned to receive four sessions each of Hypnosis and cognitive restructuring in one of two orders: (a) Hypnosis followed by Cognitive Restructuring; or (b) Cognitive Restructuring followed by Hypnosis. ...
Context: Stress and chronic pain are the factors that most influence the quality of life and well-being of people with MS, and 90% of adults with MS suffer from persistent fatigue. These symptoms can be associated with other disorders such as depression, and drug treatments provide inadequate comfort for most people with them. Objective: The study intended to examine the impact of hypnosis and hypnotherapy in the management of symptoms of people with multiple sclerosis (MS), such as stress, chronic pain, an inferior quality of life, and a lack of psychological well-being. Design: The research team performed a systematic narrative review by searching the PubMed and Web of Science databases, including review articles and other studies for additional citations. Setting: The study was conducted at our Scientific Institute for Research (IRCCS) in Messina. Results: Only 14 of 121 publications met the inclusion criteria and were selected. Hypnotic treatment is an effective therapy that has beneficial impacts on the intensity of perceived pain, psychological well-being, mood disorders, and fatigue, and in addition, it significantly improves physical functioning in MS patients. The same effects haven't been obtained with other nonpharmacological techniques. Conclusion: Hypnosis is an appropriate psychological therapy for the management of MS patients' symptoms.
... Exem plarisch soll noch der RCT von Jensen, Mendoza, Ehde et al. (2020) zur Behandlung unterschiedlicher chronischer Schmerzsyndrome beschrieben werden. Er könnte im Prinzip zusätzlich in Tabelle 2 aufgelistet sein, weil die Autor:innen unter anderem eine Kombination von Hypnose und Kognitiver Therapie (KT) evaluierten, bestärkt durch entsprechende Ergebnisse einer Pilotstudie (Jensen, Ehde, Gertz et al., 2011). In dem nun publizierten RCT wurden insgesamt vier psychosoziale In ter ventions ansätze zum Umgang mit chronischen Schmerzen (z. ...
Article
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Im Auftrag der Milton Erickson Gesellschaft für Klinische Hypnose e. V. erfolgt jährlich eine systematische Literatursuche zu randomisierten kontrollierten Studien (randomized controlled trials; RCTs) und zu Metaanalysen, die sich mit der Wirksamkeit von klinischer Hypnose und Hypnotherapie befassen. Für das Jahr 2020 wurden neun RCTs mit klinischen Stichproben gefunden, die Hypnose oder Hypnotherapie mit einer Kontrollgruppe verglichen haben, sowie zwei RCTs zu Hypnotherapie bzw. Hypnose und Achtsamkeit zur Stressreduktion bei subklinischen Stichproben. Bei vier weiteren RCTs wurde Hypnose kombiniert mit anderen Methoden eingesetzt und evaluiert. Mit Ausnahme der beiden Studien zu Stressreduktion und einer Studie zu Schlafstörungen bei Kindern handelte es sich bei den Behandlungsanlässen durchwegs um somatische Indikationen. Dies gilt gleichermaßen für die 2020 publizierten Metaanalysen und auch für das Gros der zahlreichen neu bei den entsprechenden Trialregistern angemeldeten RCTs. Gerade für den Einsatz von hypnotherapeutischen Techniken zur besseren Bewältigung medizinischer Eingriffe hat sich die schon vorhandene Evidenzbasis weiter verbreitert und es ist in den nächsten Jahren mit einer Reihe von neuen Publikationen bzw. Ergebnissen zu rechnen. Im Bereich der hypnotherapeutischen Behandlung von psychischen Störungen wurden zumindest einige neue Studien gemeldet. Efficacy and effectiveness research in the field of clinical hypnosis in 2020. Each year, a systematic literature search on the efficacy and effectiveness of clinical hypnosis and hypnotherapy is conducted on behalf of the Milton Erickson Society of Clinical Hypnosis in Germany. For 2020, nine randomized controlled trials (RCTs) that evaluated clinical hypnosis or hypnotherapy in comparison to a control group were identified. Two other RCTs evaluated a hypnotherapeutic group program or a mindfulness training including hypnosis, respectively, for stress reduction in samples with subclinical symptom levels. In addition, four RCTs evaluated hypnosis or hypnotherapeutic techniques in combination with other interventional approaches. Except from the two studies on stress reduction and one study targeting sleep problems in children, all other studies targeted somatic complaints or evaluated hypnosis as a method to alleviate the burden of invasive medical procedures. This is equally true for the meta-analyses published in 2020 and also for the bulk of the many newly registered RCTs identified in trial registers. Concerning the efficacy of hypnosis in adults undergoing surgery or other medical procedures, the already existing evidence base has grown some more and will most likely continue to do so. Searching trial registers also revealed that a few new studies targeting psychological disorders or behavior problems were registered.
... Although the exact mechanisms by which HC specifically acts, we can cautiously extrapolate from the neuroimaging literature on clinical hypnosis. Based on these studies [31][32][33][34][35], the soothing properties of hypnosis depends on the activation of frontal cortical areas, particularly the dorsolateral prefrontal cortex involved in executive functions such as planning and selective attention, and the median prefrontal cortex involved in the regulation of attention and emotions. Independent of the underlying mechanisms, the majority of participants found HC to be a nice and relaxing addition for symptom management during chemotherapy. ...
Article
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Purpose This pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology. Methods The trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale. Results Forty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses ( N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion. Conclusions Our results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology. Trial registration Clinical Trial Identifier: NCT04173195, first posted on November 19, 2019
... Jensen et al. (2015aJensen et al. ( , 2015b point to the importance of an increased responsivity to new ideas and cognitive information via a hypnotic induction followed by the presentation of these ideas and cognitive content. Although hypnosis is a traditional healing method it has recently generated a multitude of techniques (Jensen, 2010;Jensen et al., 2010). However, the consequences of a deep rapport and therapist-patient relationship are controversial. ...
Article
Using multi-modal brain imaging techniques we found pronounced changes in neuronal activity after hypnotic trance induction whereby state changes seem to occur synchronously with the specific induction instructions. In clinical patients, hypnosis proved to be a powerful method in inhibiting the reaction of the fear circuitry structures. The aim of the present paper is to critically discuss the limitations of the current neuroscientific research database in the light of a debate in defining relevant hypnotic constructs and to suggest ideas for future research projects. We discuss the role of hypnotic suggestibility (HS), the impact of hypnotic inductions and the importance of the depth of hypnotic trance. We argue that future research on brain imaging studies on the effects of hypnosis and hypnotherapy should focus on the analysis of individual cross-network activation patterns. A most promising approach is to simultaneously include physiological parameters linked to cognitive, somatic, and behavioral effects.
... While the pathophysiology of chronic pain in MS involves a complex interplay of neural and non-neural mechanisms, multiple studies have confirmed the role of psychosocial factors (including distress, negative thoughts/beliefs about pain, insufficient coping skills, and activity avoidance) in pain intensity and painrelated disability in people with MS. 64,65 The narrow therapeutic window of non-opioid pharmacologic treatments 58 requires that non-pharmacologic management including rehabilitation (e.g. cognitive behavioral, 58 mindfulness-based interventions, [66][67][68] self-hypnosis training, [69][70][71] imagery, 72 physical activity interventions, and stretching or exercise) 73 be incorporated into the overall analgesic strategy, 74 yet they often are underutilized for pain management in MS. 75 The need for strategies that are focused on identifying biomarkers (including neuromodulatory markers), somatosensory and psychosocial factors, and clinical outcomes assessments are recognized for a variety of painful syndromes globally (e.g. in low back pain), 76 and should be applied to pain mechanisms research in MS. In the United States, the Federal Pain Research Strategy, an effort of the Interagency Pain Research Coordinating Committee (IPRCC) and the Office of Pain Policy (National Institutes of Health), also includes the need for precision medicine research to prevent and treat pain syndromes. ...
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Background: People with multiple sclerosis (MS) experience myriad symptoms that negatively affect their quality of life. Despite significant progress in rehabilitation strategies for people living with relapsing-remitting MS (RRMS), the development of similar strategies for people with progressive MS has received little attention. Objective: To highlight key symptoms of importance to people with progressive MS and stimulate the design and implementation of high-quality studies focused on symptom management and rehabilitation. Methods: A group of international research experts, representatives from industry, and people affected by progressive MS was convened by the International Progressive MS Alliance to devise research priorities for addressing symptoms in progressive MS. Results: Based on information from the MS community, we outline a rationale for highlighting four symptoms of particular interest: fatigue, mobility and upper extremity impairment, pain, and cognitive impairment. Factors such as depression, resilience, comorbidities, and psychosocial support are described, as they affect treatment efficacy. Conclusions: This coordinated call to action-to the research community to prioritize investigation of effective symptom management strategies, and to funders to support them-is an important step in addressing gaps in rehabilitation research for people affected by progressive MS.
... The results provide empirical support for self-hypnosis in promoting weight loss. Further, self-hypnosis has also produced positive results in decreasing pain and improving headaches for up to 12 months after treatment [34,35]. Self-monitoring activities, such as self-hypnosis, food diary and physical activity, may help individuals become aware of their current behaviors [36], develop selfregulatory skills to achieve personal goals, promoting behavioral changes that support weight loss [37]. ...
Article
Obesity and overweight problems are serious global health issues today and despite many efforts, the prevalence has continued to rise for decades. Interestingly, hypnotherapy has been gaining recognition as an effective treatment for obesity and overweight problems. This review compiles contemporary scientific research on the effectiveness of hypnotherapy for weight reduction. Scopus, PubMed and EBSCO Host databases were applied in the study. The search identified 119 articles, of which seven met the inclusion criteria. A total of 539 respondents (82.7% women and 17.3% men) between the ages of 17 and 67 years were represented in the seven studies. Most studies incorporated lifestyle changes, such as changes of dietary habit and behavioral recommendations in the hypnotic procedure. Their results suggested that the use of hypnotherapy not only promoted weight reduction during the treatment period but also after treatment cessation, and in some cases, one to ten kilograms were lost during follow-up periods. In addition, one study even showed increased physical activity among the hypnotised individuals. This use of hypnotherapy also improved respondents’ eating behavior and quality of life. However, a definitive conclusion could not be drawn due to several methodological flaws and the limited number of published studies in this area. Therefore, further well-designed studies are needed to substantiate the effectiveness of hypnotherapy for this modern-day health problem.
... Hypnosis does not necessarily need a provider and can be practiced as self-hypnosis (usually with the help of an audio recording). Recent clinical trials have shown that self-hypnosis may be effective in reducing pain in patients with multiple sclerosis [33,34], low-back pain [35], fibromyalgia [36], and postoperative [37] and procedural pain [38,39]. Despite many studies yielding promising results and the widespread use of hypnosis, the effectiveness of hypnosis as a pain management intervention is still under debate, particularly for chronic pain, mostly because of low-quality evidence [40]. ...
Thesis
Pain is the most common symptom for which people seek medical care. Chronic pain is common worldwide, and often not treated adequately, thereby leading to reduced quality of life and high healthcare costs. Recently, there has been increasing attention toward the complexity and biopsychosocial nature of pain, and the need for multidisciplinary pain management has been increasingly acknowledged. Various mind-body interventions are being used for pain management, and some of them have been found to be effective. Slow, deep breathing is a commonly applied mind-body intervention for the management of pain. Some of the previous experimental studies found an influence of slow, deep breathing on pain outcomes. However, the results have not been consistent across studies and the underlying mechanisms are largely unknown. Some of the proposed mechanisms are emotional and cognitive modulation of pain perception and stimulation of the arterial baroreceptors and pulmonary vagal afferents. The aim of this Ph.D. project was to evaluate the effect of slow, deep breathing on pain perception in healthy subjects and to investigate the underlying psychophysiological mechanisms. To further investigate the arterial baroreceptors and pulmonary vagal afferents as possible mechanisms for the hypoalgesic effects of slow, deep breathing, we first determined whether adding an inspiratory threshold load to slow, deep breathing can enhance its effects on the cardiovascular responses (Chapter 3). We found an increase in the amplitude of blood pressure variation accompanied by an increase in respiratory sinus arrhythmia in response to increasing loads, suggesting that applying inspiratory threshold loads during slow, deep breathing results in stronger stimulation of the arterial baroreceptors. In a complementary study (Chapter 4) we compared four slow, deep breathing techniques (loaded slow, deep breathing, left and right unilateral nostril breathing, and pursed-lips breathing) with regards to psychophysiological responses. We found that loaded slow, deep breathing and pursed-lips breathing techniques are associated with a larger amplitude of blood pressure variation and respiratory sinus arrhythmia, suggesting stronger stimulation of the arterial baroreceptors with these techniques. Moreover, the pursed-lips breathing technique was associated with lower emotional arousal and more pleasantness and a sense of control. Based on these two studies, we investigated the effect of loaded slow, deep breathing and pursed-lips breathing on somatic pain perception (Chapter 5). We found that loaded slow, deep breathing, but not pursed-lips breathing, reduces pain intensity compared with a control condition. However, physiological responses to loaded slow, deep breathing did not mediate its effect on pain perception. Finally, we evaluated the effect of slow, deep breathing on visceral pain perception. We found that slow, deep breathing reduces visceral pain intensity compared with uncontrolled breathing, but the effect is similar to controlled breathing at normal breathing frequency. Physiological and emotional responses to slow, deep breathing did not mediate its effects on visceral pain perception. The studies in this PhD project helped us to better test and understand the role of different psychophysiological mechanisms in somatic and visceral pain modulation by slow, deep breathing. Overall, our studies do not support the role of baroreceptors and vagal afferents stimulation as possible mechanisms mediating the effect of slow, deep breathing on pain perception, suggesting other potential mechanisms, notably attentional modulation may be at play. Further experimental studies are required to better investigate the role of attentional and emotional modulation on pain inhibition by breathing exercises. Also, clinical studies are required to test whether breathing exercises can modulate pain perception in various patient populations and if so, the underlying mechanisms will need elucidation.
... Regarding the problems of pharmacotherapy and its side effects and the fact that MS patients suffer different psychological problems, it is necessary to use psychological treatments for these patients. The effectiveness of some treatment methods has been proven for MS patients including cognitive-behavioral therapy (17)(18)(19), teaching coping skills (20), supportive-expressive group psychotherapy (21), stress inoculation training (22), mindfulness-based intervention (23), Internet-delivered behavioral intervention (24), and self-hypnosis training (25). ...
Article
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: This study aimed to investigate the effectiveness of solution-focused group therapy in generalized anxiety disorder in patients with multiple sclerosis. In this semi-experimental study with a pretest-posttest design and unequal control group, 40 patients with multiple sclerosis were selected randomly from the MS Society of Mashhad. They were selected through purposive sampling and randomly assigned into two treatment and control groups. Then, six training sessions were held for the treatment group based on the short-term solution-focused treatment protocol for generalized anxiety disorder. This intervention was not implemented for the control group. Participants answered a seven-item generalized anxiety inventory. Descriptive statistics (mean and standard deviation) and analysis of covariance were used to analyze the data. The results showed a significant difference (P = 0.021) between the control and treatment groups in generalized anxiety disorder. In other words, solution-focused therapy could significantly reduce generalized anxiety in the treatment group when compared to the control group.
... All study procedures were piloted and developed in preliminary work by the investigative team. Specifically germane to this proposal, we have conducted numerous clinical trials examining psychological interventions based on the techniques investigated in this study for CLBP and other pain conditions [19][20][21][22], including telehealth assessment and treatment delivery [23][24][25][26][27]. We have also published multiple studies examining treatment mechanisms and have a great deal of experience in implementing EMA, with compliance rates exceeding 85% [14,15,21,. ...
Article
This randomized trial will evaluate the mechanisms of three chronic pain treatments: cognitive therapy (CT), mindfulness meditation (MM), and activation skills (AS). We will determine the extent to which late-treatment improvement in primary outcome (pain interference) is predicted by early-treatment changes in cognitive content, cognitive process, and/or activity level. The shared versus specific role of these mechanisms across the three treatments will be evaluated during treatment (Primary Aim), and immediately post-treatment to examine relapse mechanisms (Secondary Aim). We will enroll 300 individuals with chronic pain (with low back pain as a primary or secondary condition), with 240 projected to complete the study. Participants will be randomly assigned to eight, 1.5 h telehealth group sessions of CT, MM, or AS. Mechanisms and outcomes will be assessed twice daily during 2-week baseline, 4-week treatment period, and 4-week post-treatment epoch via random cue-elicited ecological momentary assessment (EMA); activity level will be monitored during these time epochs via daily monitoring with ActiGraph technology. The primary outcome will be measured by the PROMIS 5-item Pain Interference scale. Structural equation modeling (SEM) will be used to test the primary aims. This study is pre-registered on clinicaltrials.gov (Identifier: NCT03687762). This study will determine the temporal sequence of lagged mediation effects to evaluate rates of change in outcome as a function of change in mediators. The findings will provide an empirical basis for enhancing and streamlining psychosocial chronic pain interventions. Further, results will guide future efforts towards optimizing maintenance of gains to effectively reduce relapse risk.
... [58,59] The EDU materials will include 8 informational group sessions that participants in prior trials have indicated are compelling, informative, and credible. [59,63] Topics included in the EDU intervention are shown in Table 4. In session 1, basic information about confidentiality, group members' roles, and the value of pain education will be presented. ...
Article
Objectives: To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions. Methods: Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypnosis (HYP), (2) Mindfulness Meditation (MM), or (3) Education Control (EDU). Projected outcomes: The primary aim of the study is to compare the effectiveness of HYP and MM to EDU on average pain intensity measured pre- and post-treatment. Additional study aims will explore the effectiveness of HYP and MM compared to EDU on secondary outcomes (i.e., pain interference, sleep quality, depression and anxiety), and the maintenance of effects at 3- and 6-months post-treatment. Participants will have electroencephalogram (EEG) assessments at pre- and post-treatment to determine if the power of specific brain oscillations moderate the effectiveness of HYP and MM (Study Aim 2) and examine brain oscillations as possible mediators of treatment effects (exploratory aim). Additional planned exploratory analyses will be performed to identify possible treatment mediators (i.e., pain acceptance, catastrophizing, mindfulness) and moderators (e.g., hypnotizability, treatment expectations, pain type, cognitive function). Setting: The study treatments will be administered at a large Veterans Affairs Medical Center in the northwest United States. The treatments will be integrated within clinical infrastructure and delivered by licensed and credentialed health care professionals.
... Cultural factors may therefore influence pain beliefs/ appraisal, coping responses, and catastrophizing [19][20][21][22]-all of which are targeted by psychologically based treatments [23][24][25][26][27][28][29][30]. However, "culture" is notoriously difficult to define and operationalize. ...
Article
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Objective: To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy. Design: Systematic review. Methods: Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20-0.49), medium (0.50-0.79), or large (≥0.80). Results: We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate. Conclusions: In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.
... As such, the next step would be to conduct an interventional trial that teaches adaptive coping strategies. There has been a growing literature on pain-focused interventions for PwMS that utilize psychotherapeutic techniques, including self-management (Ehde et al., 2015), cognitive behavioral therapy , cognitive restructuring and self-hypnosis (Jensen et al., 2010), and collaborative care . Understanding how to increase engagement in activities outside of the home could have significant benefits for PwMS' quality of life. ...
Article
Background Pain can interfere with the daily functioning of persons with multiple sclerosis (PwMS). Furthermore, beliefs about pain and activity engagement are reliably associated with persons’ experience of chronic pain. This study aimed to explore the extent to which different aspects of PwMS’ activity engagement is related to pain-related illness intrusiveness, and whether certain coping and support systems mediate that relationship. Methods Participants (N = 161) were PwMS with at least mild pain who were recruited electronically through the North American Research Committee on MS (NARCOMS). Pain-related illness intrusiveness was measured using a modified version of the Illness Intrusiveness Ratings Scale (IIRS). Activity engagement was assessed with Section III of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Correlations analyses were followed by multiple hierarchical regressions, with disability and depression symptom severity as covariates. Exploratory mediation analyses were then conducted with the subscales of the MS Resiliency Scale (MSRS). Results Pain-related illness intrusiveness was significant correlated with activities away from home (r = −0.37, p < .001), social activities (r = −0.26, p = .001), and household chores (r = −0.16, p < 0.05). After controlling for covariates, pain-related illness intrusiveness exclusively remained a significant predictor of activities away from home. Coping strategies from MSRS mediated the effect of pain-related illness intrusiveness on activities away from home (b = −0.01, p < .05), which represents a relatively small effect (R2med = 0.07). Conclusions These findings highlight the influence that PwMS’ pain experience can have on engagement in activities away from home and the indirect effects of positive coping strategies on that relationship.
... The content for the T-Ed condition was also adapted from prior studies conducted by investigators in this group, and in prior studies was perceived as a credible and useful treatment. Participants assigned to the education intervention in prior studies reported a high level of satisfaction with the educational intervention [42,43]. The sessions cover a variety of topics, including the definition and mechanisms underlying chronic pain, common pain-related conditions and their treatments (e.g., sleep disturbance, depression, PTSD), communication, and building resilience. ...
Article
Background and objectives: Chronic pain is a highly prevalent and potentially disabling condition in Veterans who have had a traumatic brain injury (TBI) and access to non-pharmacological pain treatments such as cognitive behavioral therapy is limited and variable. The purpose of this randomized controlled trial (RCT) is to evaluate the efficacy of a telephone-delivered cognitive behavioral therapy (T-CBT) for pain in Veterans with a history of TBI. Methods: Veterans with a history of TBI and chronic pain of at least six months duration (N = 160) will be randomized to either T-CBT or a telephone-delivered pain psychoeducational active control condition (T-Ed). The eight-week T-CBT intervention builds on other efficacious CBT interventions for chronic pain in the general population but is novel in that it is conducted via telephone and adapted for Veterans with a history of TBI. Outcome variables will be collected pre, mid-, and post-treatment, and 6 months following randomization (follow-up). Projected outcomes: In addition to evaluating the effects of the interventions on pain intensity (primary outcome), this study will determine their effects on pain interference, sleep, depression, and life satisfaction. We will also examine potential moderators of treatment outcomes such as cognition, PTSD, and alcohol and drug use. This non-pharmacologic one-on-one therapeutic intervention has the potential to reduce pain and pain-related dysfunction, improve access to care, and reduce barriers associated with geography, finances, and stigma, without the negative effects on physical and cognitive performance and potential for addiction as seen with some pharmacologic treatments for pain. This trial is registered at ClinicalTrials.gov, protocol NCT01768650.
... The content for the T-Ed condition was also adapted from prior studies conducted by investigators in this group, and in prior studies was perceived as a credible and useful treatment. Participants assigned to the education intervention in prior studies reported a high level of satisfaction with the educational intervention [42,43]. The sessions cover a variety of topics, including the definition and mechanisms underlying chronic pain, common pain-related conditions and their treatments (e.g., sleep disturbance, depression, PTSD), communication, and building resilience. ...
Article
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Angka Kematian Ibu (AKI) dan komplikasi merupakan permasalahan dimasa perinatal yang disebabkan kondisi ibu hamil maladaptif selama kehamilan. Diperlukan terapi selama trimester III untuk meningkatkan kenyamanan kehamilan. Tujuan riset ini untuk menguji pengaruh self hypnosis terhadap penurunan ketidaknyamanan kehamilan pada ibu hamil trimester III. Penelitian ini merupakan randomized clinical trial dengan penentuan kelompok intervensi dan kontrol menggunakan randomisasi blok. Sampel penelitian berjumlah 66 responden, terdiri dari 33 responden sebagai kelompok intervensi yang diberikan self hypnosis selama dua minggu dan 33 responden sebagai kelompok kontrol. Instrumen yang digunakan yaitu kuesioner Maternal Physical Discomfort Scale (MPDS) dan Prenatal Self- Evaluation Questionnaire (PSEQ-II). Hasil penelitin menunjukkan penurunan rerata ketidaknyamanan kehamilan setelah self hypnosis pada kelompok intervensi (p=0,001; α=0,05). Penelitian ini merekomendasikan instrumen MPDS untuk mengukur ketidaknyamanan kehamilan dan self hypnosis dapat dikombinasikan dengan intervensi lain yang meningkatkan kenyamanan selama kehamilan.
Chapter
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The following research focused on psycho-social determinants of health perception from the perspective of patient self-analysis underlying aspects of diagnostics and therapy directly linked to the patient's personal experience, for Quality Improvement Purposes. In particular, the study analyzed the importance of factors such as environment, personal belief and perspective on life, as a way to relate the patient's viewpoint within the specific structure of therapeutic groups led by the University of Vermont Medical Center (UVMMC, former Fletcher Allen Health Care) Inpatient Psychiatry Activities Therapists on the units Shepardson 3 and 6. Methods: The research is comprised of two parts: Part 1 has been represented by the Focus Group Questionnaire (FGQ), as previously approved by UVMMC Quality Council Meeting, and administered verbally (through printed handouts) on both units by UVMMC Activities therapists. Part 2, the Health Perception Survey, has been presented as printed attachment to the FGQ and followed the same structure, rules, and requirements of the FGQ. The data collected have been part of a retrospective cohort study in the case of the FGQ and have been implemented by the HPS, an empirical research questionnaire conducted over a period of six months, as approved by the Institutional Review Boards (IRBs). Patients have been able to choose to participate in the therapeutic focus group and not allow their responses to be used for research. Furthermore, patients have been able to decide to only answer the questions in the FGQ and not take part in the HPS. In the case of patients changing their mind after the focus group interview has been completed and wishing to withdraw from the study, the information collected has been used as part of the research study because the information was recorded with no identifiers, and with no link to patients' name.
Article
Chronic low back pain (CLBP) is a debilitating and burdensome condition , and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants. A priori feasibility and intervention acceptability criteria were set. Twenty participants with CLBP were recruited and randomized to receive: (1) hypnotically delivered pain science education that utilizes hypnotic suggestions to enhance uptake of pain science concepts; or (2) pain science education with progressive muscle relaxation as an attention control. Twenty participants were recruited, however, not solely from the hospital waitlist as intended; community sampling was required (13 hospital, 7 community). Most criteria were met in the community sample but not the hospital sample. Protocol modifications are needed before progressing to a full scale randomized controlled trial for hypnotically reinforced pain science education. Improvements in relevant secondary outcomes paired with moderate-high treatment acceptability ratings are promising.
Article
L'auto-ipnosi è una generalizzazione dell'etero-ipnosi, di cui rappresenta la necessaria integrazione. Benché largamente applicata in ambito clinico, poco si sa della sua fenomenologia, della relazione con l'etero-ipnosi e la mindfulness, dei suoi meccanismi neurofisiologici e neuropsicologici, della sua efficacia clinica e del suo profilo di sicurezza. La letteratura in merito è sorprendentemente scarna e aneddotica. L'auto-ipnosi costituisce un'importante risorsa interiore auto-regolatoria e terapeutica, qualitativamente differente dall'etero-ipnosi, ma verosimilmente di non diversa efficacia clinica in numerosi ambiti di applicazione (e.g. controllo del dolore, dell'ansia, dei disturbi della condotta alimentare, ecc.). I correlati neurofisiologici e neuropsicologici dell'auto-ipnosi restano virtualmente sconosciuti per la mancanza di studi dedicati e di confronto con l'etero-ipnosi. Si discute ancora se l'esperienza auto-ipnotica possa essere autogena o indotta dalla suggestione etero-ipnotica, mentre sembra accertata una correlazione positiva tra ipnotizzabilità e profondità della trance auto-indotta. Anche il profilo di sicurezza rimane largamente impregiudicato, perché la stragrande maggioranza degli studi clinici omette la prevalenza e la tipologia di eventi avversi e/o effetti collaterali dipendenti dalla pratica ipnotica in generale. Assiomaticamente, si tende a considerare l'auto-ipnosi come una pratica altamente sicura e priva di effetti collaterali. In conclusione, all'importanza clinica dell'auto-ipnosi corrisponde paradossalmente una sostanziale mancanza di studi clinico-sperimentali. L'auto-ipnosi è dunque una Terra Incognita che aspetta urgentemente di essere esplorata.
Article
The purpose of this paper is to describe in detail a specific age progression approach that we use in our clinical practice and clinical trials in interventions including hypnosis for chronic pain and fatigue in individuals with disabilities. Moreover, we present preliminary evidence regarding the effects of the hypnosis sessions that use age progression suggestions compared to hypnosis sessions that provide different suggestions, as well as to sessions that did not include hypnotic procedures. Findings indicate that age progression suggestions for pain management with individuals participating in hypnosis treatment resulted in substantial immediate reductions in pain intensity, which were greater than pain reductions associated with treatments sessions providing pain education or cognitive therapy. In addition, age progression sessions provided to individuals receiving online hypnosis treatment for fatigue resulted in immediate large reductions in fatigue severity. Although the design of these two studies does not allow to report specific or long-term effects of the age progression techniques, findings indicate that including age progression suggestions to hypnosis protocols for pain and fatigue management is effective for reducing the immediate level of both symptoms. The development and continued evaluation of hypnotic interventions that increase or restore hope in, and optimism, for the future has the potential for enhancing the psychosocial well-being and quality of life of individuals with pain and fatigue.
Article
Background: Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is a typical symptom of central nervous system demyelination, affecting 63% of adults with MS. Recently, the role of non-pharmacological pain management in patients is growing because the non-pharmacological interventions are considered safe, affordable, easy, and accessible. However, to date, no systematic reviews or meta-analyses have comprehensively examined the therapeutic effects of the variety of non-pharmacological therapeutic interventions in the management of pain in patients with MS. Objective: The study aimed to conduct a systematic review with meta-analysis to assess the effectiveness of the non-pharmacological rehabilitation interventions in pain management in patients with MS. Methods: A comprehensive search using PubMed, Cochrane, and Science Direct databases was performed and included all randomized controlled trials, randomized cross-over trials, and quasi-experimental trials assessing the effect of non-pharmacological interventions for managing pain in patients with MS. This study was conducted according to PRISMA guidelines of a systematic review and pair-wise meta-analysis. Meta-analyses were performed by calculating the standardized mean difference at a 95% confidence interval using Review Manager software. Results: Twenty-nine papers were included in the systematic review, and only 22 of them were included in the meta-analysis. The pooled analysis showed a significant effect of neuromodulation and transcranial direct current stimulation on pain intensity reduction in patients with MS (SMD -0.51, 95% CI -0.51 to -0.09, P = 0.02), (SMD -0.67, 95% CI -1.18 to -0.16 P = 0.01), respectively. The analysis showed significant improvement in pain intensity in patient with MS after mind-body therapies (SMD -0.45, 95% CI -0.82 to -0.7, P = 0.02), mindfulness (SMD -0.55, 95% CI -0.96 to -0.14, P = 0.009), hypnosis (SMD -0.88, 95% CI -1.30 to -0.46, P = 0.0001), trigger point therapies (SMD -0.83, 95% CI -1.65 to -0.01, P = 0.05) and cognitive behavioral therapy (SMD -0.64, 95% CI -1.18 to -0.11, P = 0.02). However, there is no significant effect of relaxation therapy on pain reduction in patients with MS (SMD -0.82, 95% CI -1.94 to 0.31, P = 0.15). Conclusions: The results indicated that the majority of the non-pharmacological rehabilitation interventions showed potential therapeutic effects in reducing pain intensity in patients with MS.
Article
Effective, rigorously evaluated nonpharmacological treatments for chronic pain are needed. This study compared the effectiveness of training in hypnosis (HYP) and mindfulness meditation (MM) to an active education control (ED). Veterans (N=328) were randomly assigned to 8 manualized, group-based, in-person sessions of HYP (n = 110), MM (n = 108), or ED (n = 110). Primary (average pain intensity; API) and secondary outcomes were assessed at pretreatment, posttreatment, and 3- and 6-months posttreatment. Treatment effects were evaluated using linear regression, a generalized estimating equation approach, or a Fisher exact test, depending on the variable. There were no significant omnibus between-group differences in pre- to posttreatment change in API, however pre- to posttreatment improvements in API and several secondary variables were seen for participants in all three conditions. Participation in MM resulted in greater decreases in API and pain interference at 6-months posttreatment relative to ED. Participation in HYP resulted in greater decreases in API, pain interference, and depressive symptoms at 3- and 6-months posttreatment compared to ED. No significant differences on outcomes between HYP and MM were detected at any time point. This study suggests that all three interventions provide posttreatment benefits on a range of outcomes, but the benefits of HYP and MM continue beyond the end of treatment, while the improvements associated with ED dissipate over time. Future research is needed to determine whether the between-group differences that emerged posttreatment are reliable, whether there are benefits of combining treatments, and to explore moderating and mediating factors.
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Chronic pain is a complex phenomenon which includes biological, psychological, and socio-professional factors that undermine patients’ everyday life. Currently, only few patients significantly benefit from pharmacological treatments and many have to stop them because of negative side effects. Moreover, no medication or treatment addresses all aspects of chronic pain at once (i.e., sensations, emotions, behaviors, and cognitions), positioning chronic pain as an important public health issue and thus contributing to high health-care costs. Consequently, patients and health-care providers are increasingly turning to complementary non-pharmacological techniques such as hypnosis. Clinical research has demonstrated a decrease of pain perception, pain interference, depression and anxiety, and an increase in global quality of life when patients with chronic pain have benefited from hypnosis learning. Neuroimaging studies offer a possible explanation of these results by focusing on neural processes of pain modulation in chronic pain patients’ brain. Studies conducted with chronic pain patients showed a modulation of pain matrix activity during hypnosis with a specific involvement of the anterior cingulate cortex (related to emotional and cognitive processing of pain). Therefore, hypnosis seems to act upon regions underlying emotion and cognition, with an influence on pain perception and emotional regulation. In this review, we propose to carry out a review of the recent literature on hypnosis in chronic pain management. A better understanding of the beneficial effects of hypnosis on chronic pain and its neurophysiology should enable more systematic use of this technique in the management of this complex health problem.
The high prevalence and societal burden of chronic pain, its undertreatment, and disparities in its management have contributed to the acknowledgment of chronic pain as a serious public-health concern. The concurrent opioid epidemic, and increasing concern about overreliance on opioid therapy despite evidence of limited benefit and serious harms, has heightened attention to this problem. The biopsychosocial model has emerged as the primary conceptual framework for understanding the complex experience of chronic pain and for informing models of care. The prominence of psychological processes as risk and resilience factors in this model has prompted extensive study of psychological treatments designed to alter processes that underlie or significantly contribute to pain, distress, or disability among adults with chronic pain. Cognitive-behavioral therapy is acknowledged to have strong evidence of effectiveness; other psychological approaches, including acceptance and commitment therapy, mindfulness, biofeedback, hypnosis, and emotional-awareness and expression therapy, have also garnered varying degrees of evidence across multiple pain conditions. Mechanistic studies have identified multiple pathways by which these treatments may reduce the intensity and impact of pain. Despite the growing evidence for and appreciation of these approaches, several barriers limit their uptake at the level of organizations, providers, and patients. Innovative methods for delivering psychological interventions and other research, practice, and policy initiatives hold promise for overcoming these barriers. Additional scientific knowledge and practice gaps remain to be addressed to optimize the reach and effectiveness of these interventions, including tailoring to address individual differences, concurrently addressing co-occurring disorders, and incorporating other optimization strategies.
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Chronic pain increases the risk of sleep disturbances, depression and disability. Even though medical treatments have limited value, the use of prescription-based analgesics have increased over the recent years. It is therefore important to evaluate the effect of non-pharmacological treatments. A systematic search for studies evaluating the effect of relaxation techniques on chronic pain was conducted. Randomized controlled trials were included. Significant effects on pain, or on pain and one or more secondary outcome measure, were found in 21 studies. Four studies found significant effects on secondary outcome measures only. Four studies showed no significant effects on any outcome measure. Thus, most of the studies reported that relaxation techniques reduced pain and / or secondary outcome measures. However, the included studies have evaluated effects across a wide variety of chronic pain conditions and relaxation techniques. Hence, there is a large degree of heterogeneity among the included studies. This complicates the effect evaluation and makes it difficult to draw a clear and unambiguous conclusion. Relaxation techniques are probably most effective when used through regular and continued practice. Future studies should therefore investigate long-term effects of relaxation technique interventions, evaluate the dose-response relationship and examine efficacy differences between pain conditions and interventions.
Article
Background Pain catastrophizing underpins several psychosocial theories of pain, but there is limited evidence to support the proposal that changes in pain catastrophizing cause changes in pain. Results from mediation analyses have conflicting results, and one reason for these might be the timing of the assessment of pain catastrophizing. This study aimed to test the effect of the timing of pain catastrophizing on pain intensity. Methods Causal mediation analysis using data from a randomized controlled trial which included 100 participants with chronic low back pain. The trial found that clinical hypnosis, compared to pain education, reduced worst pain intensity and pain catastrophizing. In model 1, we used data from 2-week follow-up for pain catastrophizing and 3-month follow-up for pain. In model 2, we used data from 3-month follow-up for both pain catastrophizing and pain. Results The intervention had a significant average total effect on pain (-1.34 points, 95% CI -2.50 to -0.13). The average causal mediation effect was significant when pain catastrophizing and pain were measured at the same time (-0.62 points, 95% CI -1.30 to -0.11), but not significant when pain catastrophizing and pain intensity were measured at different times (-0.10 points, 95% CI -0.42 to 0.09). Conclusions The timing of the assessment influenced the mediating role of pain catastrophizing on pain intensity. These results raise questions on the casual role that pain catastrophizing has on pain intensity. Psychosocial interventions such as clinical hypnosis can reduce pain intensity even when there has been no change in pain catastrophizing.
Article
Integrative models of health care have garnered increasing attention over the years and are currently being employed within acute and secondary health care services to support medical treatments in a range of specialities. Clinical hypnosis has a history of working in partnership with medical treatments quite apart from its psychiatric associations. It aims to mobilise the mind–body connection in order to identify and overcome obstacles to managing symptoms of ill health, resulting in overall improved emotional and physical well-being. This article aims to encourage the use of hypnotherapy in physical health care by highlighting the effectiveness of hypnosis as an adjunct to medical treatment and identifying barriers preventing further integrative treatments.
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Background and objective Dental patients often experience the fear of pain induced by injectable anesthesia. This study aimed to investigate the impact of hypnosis on relieving the pain of injected dental infiltration anesthesia. Materials and methods This single‐blind clinical trial was conducted on 32 healthy volunteers to assess the pain perception in mucosal injection. The visual analog scale was applied for the measurement of one‐sided pain intensity in the maxilla without hypnosis. When hypnosis was implemented, the same procedure was performed on the other side of the maxilla reversely within one session. Results Hypnosis implementation significantly decreased the intensity of the perceived pain before anesthesia injection (p = 0.05). Conclusion Hypnosis before the injection of dental infiltration anesthesia could decrease the pain intensity caused by the injection. Therefore, hypnosis therapy is recommended as an effective approach to pain control for anesthesia injection.
Technical Report
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The aim of this guidance is to provide evidence-based recommendations for providing psychological support to individuals living with the following four motor neurodegenerative conditions: Huntington’s disease, Parkinson’s disease, motor neurone disease, and multiple sclerosis. It focuses on psychological interventions for specific psychological outcomes in adults experiencing each of these four neurological conditions. This guidance is for all psychologists, and other health professionals, who may work with individuals with these conditions and who wish to have easy access to up-to-date guidance and recommendations. This work was facilitated by a grant from the Division of Clinical Psychology, part of the British Psychological Society and with the support of the BPS’s Faculty for the Psychology of Older People (FPOP). The support and endorsement of the Division of Neuropsychology is also gratefully acknowledged.
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Physical medicine providers work to cure organic aspects of disease while simultaneously enhancing quality of life and well-being. Mind-body interventions are evidence-based, cost-effective approaches to serve these aims. This article enhances provider knowledge and acceptance of the most effective and prevalent mind-body modalities: meditation, guided imagery, clinical hypnosis, and biofeedback. The scientific evidence is strongest for mind-body applications for chronic pain, primary headache, cardiac rehabilitation, and cancer rehabilitation, with preliminary evidence for traumatic brain injury and cerebrovascular events. Mind-body interventions are well-tolerated by patients and should be considered part of standard care in physical medicine and rehabilitation settings.
Article
Chronic pain is a significant health problem worldwide with limited pharmacological treatment options. This study evaluated the relative efficacy of four treatment sessions each of four non-pharmacological treatments: (1) hypnotic cognitive therapy (using hypnosis to alter the meaning of pain); (2) standard cognitive therapy; (3) hypnosis focused on pain reduction, and (4) pain education. One hundred seventy-three individuals with chronic pain were randomly assigned to receive four sessions of one of the four treatments. Primary (pain intensity) and secondary outcome measures were administered by assessors unaware of treatment allocation at pre-treatment, post-treatment, and 3-, 6- and 12-month follow-up. Treatment effects were evaluated using ANOVA, a generalized estimating equation approach, or a Fisher Exact Test, depending on the outcome domain examined. All four treatments were associated with medium to large effect size improvements in pain intensity that maintained up to 12 months post-treatment. Pre- to post-treatment improvements were observed across the four treatment conditions on the secondary outcomes of pain interference and depressive symptoms, with some return towards pre-treatment levels at 12-months follow-up. No significant between group differences emerged in omnibus analyses, and few statistically significant between-group differences emerged in the planned pairwise analyses, although the two significant effects that did emerge favored hypnotic cognitive therapy. Future research is needed to determine if the significant differences that emerged are reliable.
Article
Pain is a significant public healthcare challenge. There is growing support for the use of music and suggestive techniques as adjuvant pain treatments. The purpose of this study was to (1) examine the effects of music listening combined with relaxation suggestions compared to music alone and silence on experimental pain, and (2) to explore the potential mechanisms of music-induced analgesia. Sixty-six healthy females were randomized to receive either (1) music plus relaxation suggestions, (2) music alone, or (3) silence. Pain and psychological constructs were assessed following two cold-pressor trials. Between-group comparisons indicated that music and suggestions for relaxation are not superior to music alone for pain. More research is needed to explore the effect of analgesic suggestions in combination with music to further investigate music’s potential in clinical pain management.
Article
Multiple sclerosis is a chronic, demyelinating disease of the central nervous system mainly affecting young adults. In addition to physical problems, the patients suffer from many psychological problems affecting their psychological well-being. The aim of the present study was to determine the effectiveness of group-based cognitive hypnotherapy on the psychological well-being of patients suffering from multiple sclerosis. This study was designed as a clinical trial with a pretest-posttest control group. From 60 patients diagnosed with multiple sclerosis referred to Beheshti hospital in Yasuj, Iran, 45 patients who met the inclusion criteria were selected by the convenience sampling method. The patients were randomly assigned to intervention (23 individuals) and control (22 individuals) groups through stratified random allocation. After completing the Ryff Scales of Psychological Well-Being, the intervention group attended eight sessions of group-based cognitive hypnotherapy on a weekly basis. The control group did not attend any intervention sessions. At the end of the eight intervention sessions, both groups completed the Ryff’s Scale of Psychological Well-being again. The collected data were analyzed using the SPSS software (Version 23). Analysis of Covariance (ANCOVA) and two-way Analysis of variance (ANOVA) tests were used in order to compare the groups. The results indicated that cognitive hypnotherapy had a significant effect on the total score of psychological well-being (F (45, 1) = 6.07, p = .018, η2 = 0.12) and the dimension of environmental mastery (p < .05). Therefore, it is recommended to use hypnotherapy to promote the psychological well-being of patients suffering from multiple sclerosis.
Article
This case study reports on a 28-year-old male with spinal cord injury (SCI), quadriplegia, and chronic pain with neuropathic characteristics. The treatment had to be adapted to address the patient’s needs, as he was on a respirator and paralyzed from the chin down. The intervention consisted of eight 90-minute sessions. The first four sessions were based on a standardized hypnotic cognitive therapy protocol developed for a randomized controlled trial (RCT). The sessions included training in cognitive restructuring skills and a hypnosis session with suggestions that was audiorecorded. Instructions to practice at home, both with the recording and by using self-hypnosis, were provided as well. Most of the outcome domains assessed (i.e., pain intensity, pain interference, sleep quality) showed clinically meaningful improvements that were maintained (or increased) at one-year follow-up. The patient reported that he was still using self-hypnosis at one-year follow-up. His subjective impression of change was positive and he did not report any negative side effects. Results show that the hypnotic cognitive therapy protocol used is a promising intervention that can benefit individuals with SCI presenting with complex symptomatology. Such therapy helps patients by teaching them effective coping strategies that they can use on their own to manage pain and its effects. In addition, it is important to note that this therapy provided benefits to someone who had not experienced any benefits from numerous medications he had tried before treatment. Therefore, the findings support continued efforts to make this treatment more accessible to patients who could benefit from this approach.
Article
Objectives: Pain has been identified as a highly prevalent and common correlate of physical and emotional dysfunction among persons with multiple sclerosis (PwMS). Yet, it remains unknown how PwMS experience the intrusiveness of pain relative to other challenges associated with living with MS. This study aimed to determine the extent to which PwMS experience pain as a particularly intrusive problem among the totality of their experience of MS-related challenges and to examine how cognitive and affective factors, including resiliency, are associated with PwMS's pain-related illness intrusiveness. Method: Participants (N = 161) were PwMS with at least mild pain who were recruited through the North American Research Committee on Multiple Sclerosis Registry for this cross-sectional study. Participants completed the Illness Intrusiveness Ratings Scale twice regarding their (a) MS and (b) pain. Multiple regression analyses were run to evaluate the relationship between MS- and pain-related illness intrusiveness, as well as the cognitive and affective predictors of the latter. Results: Controlling for level of disease severity, pain-related illness intrusiveness was a significant predictor of MS-related illness intrusiveness (p < .001). Depressive symptom severity was the strongest predictor of pain-related illness intrusiveness (p < .001), followed by pain catastrophizing (p < .001). The relationship between pain-related illness intrusiveness and pain catastrophizing was mediated (med) by coping strategies (Rmed2 = .15) and support from family and friends (Rmed2 = .07), with the latter mediating pain-related illness intrusiveness's relationship with depressive symptom severity (Rmed2 = .10). (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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In Study 1, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (n = 15) or noncatastrophizers (n = 15) on the basis of their PCS scores and participated in an cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity.
Article
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In Study I, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers ( n = 15) or noncatastrophizers ( n = 15) on the basis of their PCS scores and participated in a cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We report on the development of a new cognitive screening test administered over the telephone. The Telephone Interview for Cognitive Status correlates very highly with the Mini-Mental State Examination in Alzheimer's disease. It has high sensitivity and specificity to the diagnosis of Alzheimer's disease (AD) and high test-retest reliability in this population. The instrument is acceptable to patients and has a sufficient range to be useful in follow-up and field research studies of AD and possibly other disorders associated with cognitive impairment. (C) Lippincott-Raven Publishers.
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Missing information is inevitable in longitudinal studies, and can result in biased estimates and a loss of power. One approach to this problem is to impute the missing data to yield a more complete data set. Our goal was to compare the performance of 14 methods of imputing missing data on depression, weight, cognitive functioning, and self-rated health in a longitudinal cohort of older adults. We identified situations where a person had a known value following one or more missing values, and treated the known value as a "missing value." This "missing value" was imputed using each method and compared to the observed value. Methods were compared on the root mean square error, mean absolute deviation, bias, and relative variance of the estimates. Most imputation methods were biased toward estimating the "missing value" as too healthy, and most estimates had a variance that was too low. Imputed values based on a person's values before and after the "missing value" were superior to other methods, followed by imputations based on a person's values before the "missing value." Imputations that used no information specific to the person, such as using the sample mean, had the worst performance. We conclude that, in longitudinal studies where the overall trend is for worse health over time and where missing data can be assumed to be primarily related to worse health, missing data in a longitudinal sequence should be imputed from the available longitudinal data for that person.
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Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.
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Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.
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Recent evidence demonstrating multiple regions of human cerebral cortex activated by pain has prompted speculation about their individual contributions to this complex experience. To differentiate cortical areas involved in pain affect, hypnotic suggestions were used to alter selectively the unpleasantness of noxious stimuli, without changing the perceived intensity. Positron emission tomography revealed significant changes in pain-evoked activity within anterior cingulate cortex, consistent with the encoding of perceived unpleasantness, whereas primary somatosensory cortex activation was unaltered. These findings provide direct experimental evidence in humans linking frontal-lobe limbic activity with pain affect, as originally suggested by early clinical lesion studies.
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It is well accepted that pain is a multidimensional experience, but little is known of how the brain represents these dimensions. We used positron emission tomography (PET) to indirectly measure pain-evoked cerebral activity before and after hypnotic suggestions were given to modulate the perceived intensity of a painful stimulus. These techniques were similar to those of a previous study in which we gave suggestions to modulate the perceived unpleasantness of a noxious stimulus. Ten volunteers were scanned while tonic warm and noxious heat stimuli were presented to the hand during four experimental conditions: alert control, hypnosis control, hypnotic suggestions for increased-pain intensity and hypnotic suggestions for decreased-pain intensity. As shown in previous brain imaging studies, noxious thermal stimuli presented during the alert and hypnosis-control conditions reliably activated contralateral structures, including primary somatosensory cortex (S1), secondary somatosensory cortex (S2), anterior cingulate cortex, and insular cortex. Hypnotic modulation of the intensity of the pain sensation led to significant changes in pain-evoked activity within S1 in contrast to our previous study in which specific modulation of pain unpleasantness (affect), independent of pain intensity, produced specific changes within the ACC. This double dissociation of cortical modulation indicates a relative specialization of the sensory and the classical limbic cortical areas in the processing of the sensory and affective dimensions of pain.
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Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment.
Article
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Article
purpose of this chapter is to critically evaluate the available self-report measures of pain / our hope is that the chapter will assist clinicians and researchers to select the procedures that best serve their purposes / begin with a brief discussion of issues relevant to the use of self-report pain scales / describe and critique the methods currently available for assessing three dimensions of the pain experience: pain intensity, pain affect, and pain location (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
"cognitive behavioral therapy" (CBT) for chronic pain is a term that covers a wide variety of interventions provided in diverse clinical environments / all CBT interventions share a set of theoretical assumptions regarding interactions among environmental events, cognitions, and behaviors that determine patients' subjective pain perceptions and their overt displays of pain / reviews these assumptions and describes the treatment components that are common to all CBT interventions / examines the efficacy of these interventions and the important issue of treatment gain maintenance / [emphasizes] the use of these interventions for patients with rheumatological or gastroenterological illnesses / concludes with suggestions for helping patients maintain their improvements after treatment is completed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Objective: To determine the feasibility of a cognitive restructuring intervention relative to an education intervention for treatment of pain in persons with chronic pain secondary to disability. Study Design: Quasi-experimental. Participants: 18 adults with chronic pain and disability. Interventions: Cognitive restructuring (n = 13) or education (n = 5) group intervention. Main Outcome Measure: Average pain intensity. Results: Participants in the cognitive group reported greater pre- to posttreatment decreases in pain than those in the education group. Participants rated both interventions positively and expressed enthusiasm for psychosocial interventions for pain. Conclusions: Preliminary findings suggest that decreases in pain can occur as a result of a cognitive restructuring intervention and support the feasibility of conducting intervention trials in persons with disability-related chronic pain. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Sleep disturbance in multiple sclerosis has received little research attention despite the potential influence it may have on disease impact. To estimate the prevalence of sleep disorders in a large community sample of individuals with multiple sclerosis. A cross-sectional self-report survey of 1063 persons with multiple sclerosis. Sleep was assessed using the Women's Health Initiative Insomnia Rating Scale and Medical Outcomes Study Sleep measure. The prevalence of sleep problems in multiple sclerosis is significantly higher than in the general population or other chronic diseases and may affect women with multiple sclerosis more than men. Sleep disturbance should routinely be evaluated in patients with multiple sclerosis and new interventions developed.
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Article
This study investigated the effect of hypnosis in patients with temporomandibular disorders (TMD) with focus on oral function and psychological outcomes. Forty women (mean age +/- s.d.: 38.6 +/- 10.8 years) suffering from TMD (mean duration 11.9 +/- 9.9 years) were randomized to four individual 1-hour sessions of either hypnotic intervention or a control condition of simple relaxation. Pain intensity was assessed three times daily on a 0-10 Numerical Rating Scale. Additional outcomes were TMD-associated symptoms assessed by the Research Diagnostic Criteria examination form and questionnaire, psychological symptoms (Symptom Check List 60), pain coping strategies (Coping Strategies Questionnaire), sleep difficulties (Pittsburgh Sleep Quality Index) and use of analgesics. Data were analyzed with between-groups within-subjects anovas. The hypnosis group significantly reduced the daily NRS pain scores from 4.5 +/- 2.1 at baseline to 2.9 +/- 2.4 after treatment (P < 0.001) compared to the control group where no significant changes were found (4.2 +/- 1.4 to 3.9 +/- 1.5) (P = 0.733). Number needed to treat for a 50% pain reduction was 4.0. The hypnosis group also increased use of the coping strategy 'reinterpreting pain sensations' from 5.2 +/- 6.9 to 10.3 +/- 6.8 (P < 0.001). Both groups exhibited significant reductions in the number of painful muscle palpation sites and pain on palpation (P < 0.004), in number of awakenings due to pain (P < 0.006), and in somatization, obsessive compulsive symptoms and anxiety (P < 0.004). Hypnosis thus appears to effectively reduce some aspects of complex TMD pain.
Article
Unlabelled: This focus article argues that it may be useful to consider, and expand research into, studying the associations between psychological treatments and cortical activity. Matching our current understanding of the content and goals of psychological pain treatments with knowledge regarding the primary cortical areas involved in the processing and experience of pain provides an initial step towards a neuropsychological model of pain. This model can be used to: (1) inform research and increase knowledge about the associations between cortical activity, pain treatment, and pain experience; (2) facilitate communication about psychological treatments with patients to facilitate treatment engagement; and (3) help guide the development of more effective treatment plans. In this way, the development, testing, and modification of a neuropsychological model of pain could result in more patients receiving more effective care. Perspective: A model that describes the effects of psychological treatments on specific pain-related cortical areas and processes could inform researchers who test hypotheses concerning the mechanisms of those treatments, and help pain clinicians develop more effective treatment plans.
Article
Pain catastrophizing is conceptualized as a negative cognitive-affective response to anticipated or actual pain and has been associated with a number of important pain-related outcomes. In the present review, we first focus our efforts on the conceptualization of pain catastrophizing, highlighting its conceptual history and potential problem areas. We then focus our discussion on a number of theoretical mechanisms of action: appraisal theory, attention bias/information processing, communal coping, CNS pain processing mechanisms, psychophysiological pathways and neural pathways. We then offer evidence to suggest that pain catastrophizing represents an important process factor in pain treatment. We conclude by offering what we believe represents an integrated heuristic model for use by researchers over the next 5 years; a model we believe will advance the field most expediently.
Article
This paper reports the development of a self-report instrument designed to assess pain in cancer and other diseases. It is argued that issues of reliability and validity should be considered for every pain questionnaire. Most research on measures of pain examine reliability to the relative neglect of validity concerns. The Wisconsin Brief Pain Questionnaire (BPQ) is evaluated with regard to both reliability and validity. Data from patients with cancer at 4 primary sites and from patients with rheumatoid arthritis suggest that the BPQ is sufficiently reliable and valid for research purposes. Additional methodological and theoretical issues related to validity are discussed, and the need for continuing evaluation of the BPQ and other measures of clinical pain is stressed.
Article
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Article
Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. To address this problem, the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.
Article
Videotaped treatment sessions in conjunction with 1-month, 1-year, and 8-year follow-up allow a unique level of analysis in a case study of hypnotic treatment for pain and neuromuscular rehabilitation with multiple sclerosis (MS). Preparatory psychotherapy was necessary to reduce the patient's massive denial before she could actively participate in hypnosis. Subsequent hypnotic imagery and posthypnotic suggestion were accompanied by significantly improved control of pain, sitting balance, and diplopia (double vision), and a return to ambulatory capacity within 2 weeks of beginning treatment with hypnosis. Evidence regarding efficacy of hypnotic strategies included (a) direct temporal correlations between varying levels of pain relief and ambulatory capacity and the use versus nonuse of hypnotic strategies, (b) the absence of pharmacological explanations, and (c) the ongoing presence of other MS-related symptoms that remained unaltered. In conjunction with existing literature on hypnosis and neuromuscular conditions, results of this case study strongly suggest the need for more detailed and more physiologically based studies of the phenomena involved.
Article
Previous studies with undergraduates have provided support for the reliability and oblique three-factor structure of a new scale, the Pain Catastrophizing Scale (PCS). We examined the reliability and validity of the PCS in adult community and pain outpatient samples. The PCS showed a high internal consistency in both groups. Using data from the community sample, confirmatory factor analyses showed that the PCS taps a single construct characterized by three related dimensions. Gender differences were obtained on the PCS total score in the community and the outpatient samples. The analyses also showed significant differences between the community and the outpatient samples on the PCS total and subscales. Overall, the results showed strong evidence of criterion-related, concurrent, and discriminant validity for the PCS in the community sample. Limitations of the present study are discussed.
Article
This article summarizes aspects of effective psychotherapy for major depression and describes how hypnosis can further enhance therapeutic effectiveness. Hypnosis is helpful in reducing common symptoms of major depression such as agitation and rumination and thereby may decrease a client' sense of helplessness and hopelessness. Hypnosis is also effective in facilitating the learning of new skills, a core component of all empirically supported treatments for major depression. The acquisition of such skills has also been shown to not only reduce depression, but also the likelihood of relapses, thus simultaneously addressing issues of risk factors and prevention.
Article
Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.
Article
To provide recommendations for the core outcome domains that should be considered by investigators conducting clinical trials of the efficacy and effectiveness of treatments for chronic pain. Development of a core set of outcome domains would facilitate comparison and pooling of data, encourage more complete reporting of outcomes, simplify the preparation and review of research proposals and manuscripts, and allow clinicians to make informed decisions regarding the risks and benefits of treatment. Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 27 specialists from academia, governmental agencies, and the pharmaceutical industry participated in a consensus meeting and identified core outcome domains that should be considered in clinical trials of treatments for chronic pain. There was a consensus that chronic pain clinical trials should assess outcomes representing six core domains: (1) pain, (2) physical functioning, (3) emotional functioning, (4) participant ratings of improvement and satisfaction with treatment, (5) symptoms and adverse events, (6) participant disposition (e.g. adherence to the treatment regimen and reasons for premature withdrawal from the trial). Although consideration should be given to the assessment of each of these domains, there may be exceptions to the general recommendation to include all of these domains in chronic pain trials. When this occurs, the rationale for not including domains should be provided. It is not the intention of these recommendations that assessment of the core domains should be considered a requirement for approval of product applications by regulatory agencies or that a treatment must demonstrate statistically significant effects for all of the relevant core domains to establish evidence of its efficacy.
Article
Unlabelled: This article provides an overview of current research on psychological aspects of persistent pain. It is divided into 3 sections. In section 1, recent studies are reviewed that provide evidence that psychological factors are related to adjustment to persistent pain. This section addresses research on factors associated with increased pain and poorer adjustment to pain (ie, pain catastrophizing, pain-related anxiety and fear of pain, and helplessness) and factors associated with decreased pain and improved adjustment to pain (ie, self-efficacy, pain coping strategies, readiness to change, and acceptance). In section 2, we review recent research on behavioral and psychosocial interventions for patients with persistent pain. Topics addressed include early intervention, tailoring treatment, telephone/Internet-based treatment, caregiver-assisted treatment, and exposure-based protocols. In section 3, we conclude with a general discussion that highlights steps needed to advance this area of research including developing more comprehensive and integrative conceptual models, increasing attention to the social context of pain, examining the link of psychological factors to pain-related brain activation patterns, and investigating the mechanisms underlying the efficacy of psychological treatments for pain. Perspective: This is one of several invited commentaries to appear in The Journal of Pain in recognition of The Decade of Pain Research. This article provides an overview of current research on psychological aspects of persistent pain, and highlights steps needed to advance this area of research.
Article
Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.
Article
Group therapy for chronic pain management, particularly that using cognitive-behavioral treatment (CBT), has become a common treatment format. This article provides a rationale and framework for group CBT, including the research evidence and clinical considerations related to the practitioner and patient. We then present an example of group therapy focusing on the cognitive components of CBT for chronic pain. Examples from group therapy are used in order to illustrate the principles of optimizing the group approach in the context of cognitive therapy.
Article
Valid measures of pain-related interference with functioning could serve as useful outcome measures in much needed clinical trials of pain treatments for persons with multiple sclerosis (MS). The purpose of this study was to examine the psychometric properties of two pain interference measures in persons with MS and chronic pain. Modified versions of the Interference scale of the Brief Pain Inventory (BPI) and the Disability scale of the Graded Chronic Pain Scale were administered via a mailed survey to 187 community-dwelling persons with MS. Data from the 125 participants who reported pain were analyzed. Although both measures demonstrated excellent internal consistency, in the current sample, evidence regarding the construct and concurrent validity was stronger for the modified versions of the BPI Interference scale. These results provide preliminary support for the reliability and validity of modified versions of the BPI Interference scale in persons with MS and chronic pain.
Article
Biopsychosocial models of chronic pain that recognize psychological and environmental factors as important aspects of adjustment to pain have been proposed for understanding chronic pain and related suffering in persons with multiple sclerosis (MS), but such models have not been empirically tested. The objective of this study was to test such a model by evaluating the associations of several psychosocial variables (i.e., pain-related catastrophizing, perceived social support, pain beliefs, and pain coping) with pain intensity, pain interference with functioning, and psychological functioning in persons with chronic pain and MS, after controlling for demographic and disease-related factors. Participants were 125 community-dwelling persons with MS and pain who completed a mailed questionnaire that included measures of pain intensity and interference, psychological functioning, catastrophizing, social support, and pain beliefs and coping. The psychosocial variables accounted for an additional 25% of the variance in average pain intensity after controlling for demographic and disease-related variables (p<.001). These variables explained an additional 22% of the variance in pain-related interference (p<.001) and 43% of the variance in psychological functioning (p<.001), after adjusting for demographic and MS-related variables and average pain intensity. Catastrophizing was consistently and independently associated with all criterion measures, whereas social support, pain beliefs, and pain coping were associated with some criterion measures but not others. The results provide empirical support for a biopsychosocial understanding of chronic pain in MS and suggest that specific psychosocial factors (e.g., catastrophizing) may be important regarding adjustment to pain in persons with MS.
Article
Pain is a common problem of patients with multiple sclerosis (MS) and may be due to central/neuropathic or peripheral/somatic pathology. Rarely MS may present with pain, or pain may herald an MS exacerbation, such as in painful tonic spasms or Lhermitte's sign. In other patients, pain may become chronic as a long-term sequela of damage to nerve root entry zones (trigeminal neuralgia) or structures in central sensory pathways. Migraine headache may develop as a consequence of MS, and headache can also be a side effect of interferon treatment. The pathophysiology of pain in MS may be linked to certain plaque locations which disrupt the spinothalamic and quintothalamic pathways, abnormal impulses through motor axons, development of an acquired channelopathy in affected nerves, or involve glial cell inflammatory immune mechanisms. At this time, the treatment of pain in MS employs the use of antiepileptic drugs, muscle relaxers/antispasmodic agents, anti-inflammatory drugs, and nonpharmacological measures. Research concerning cannabis-based treatments shows promising results, and substances which block microglial or astrocytic involvement in pain processing are also under investigation.
Article
This controlled and patient blinded study tested the effect of hypnosis on persistent idiopathic orofacial pain (PIOP) in terms of clinical and psychosocial findings. Forty-one PIOP were randomized to active hypnotic intervention or simple relaxation as control for five individual 1-h sessions. Primary outcome was average pain intensity scored three times daily in a pain diary using visual analogue scale (VAS). Secondary outcome measures were pain quality assessed by McGill pain questionnaire (MPQ), psychological symptoms assessed by symptom check list (SCL), quality of life assessed by SF36, sleep quality, and consumption of analgesic. Data were compared between groups before and after treatment using ANOVA models and paired t-tests. The change in VAS pain scores from baseline to the last treatment (t4) was (33.1+/-7.4%) in the hypnosis group and (3.2+/-5.4%) in the control group (P<0.03). In the hypnosis group, highly hypnotic susceptible patients had greater decreases in VAS pain scores (55.0+/-12.3%) when compared to less susceptible patients (17.9+/-6.7%) (P<0.02). After the last treatment there were also statistically significant differences between groups in perceived pain area (MPQ) and the use of weak analgesics (P<0.03). There were no statistically significant changes in SCL or SF36 scores from baseline to t4. In conclusion, hypnosis seems to offer clinically relevant pain relief in PIOP, particularly in highly susceptible patients. However, stress coping skills and unresolved psychological problems need to be included in a comprehensive management plan in order also to address psychological symptoms and quality of life.
Article
Unlabelled: This randomized clinical trial (RCT) examined the efficacy of a cognitive-behavioral treatment (CBT) specifically targeted toward reducing pain catastrophizing for persons with chronic headache. Immediate treatment groups were compared with wait-list control groups. Differential treatment gains based on the order of presentation of 2 components of CBT (cognitive restructuring and cognitive/behavioral coping) and the role of catastrophizing in treatment outcome were examined. Thirty-four participants enrolled in a 10-week group treatment and 11 completed a wait-list self-monitoring period. Participants reported significant reductions in catastrophizing and anxiety and increased self-efficacy compared with wait-list control subjects, and these were maintained at follow-up. Although we did not find overall differences in the reduction of headache frequency or intensity compared with wait-list control subjects, calculation of clinical significance on headache indicators suggest that approximately 50% of treated participants showed meaningful changes in headache indices as well. Order of treatment modules was not related to gains during treatment or at follow-up; however, almost all changes occurred during the second half of treatment, suggesting that duration of treatment participation is important. Perspective: Cognitive-behavioral treatment targeting reduction of catastr