International Handbook of Clinical Hypnosis - E-Lib FK UWKS

CHRONIC PAIN MANAGEMENT 249
Spinhoven, Linssen, van Dyck & Zitman, 1992; Zitman, van Dyck, Spinhoven &
Linssen, 1992) have found that hypnosis or self-hypnosis, especially among the
more hypnotizable, reduces tension headache pain, at least as well as autogenic
training, and better than control groups.
This is not a comprehensive or a critical review of existing studies. No attempt
has been made to review studies using hypnosis in the treatment of cancer pain,
such as the work of Spiegel 1993). It is intended to show that hypnosis may be one
valuable technique to help reduce chronic pain of various origins. These studies use
a wide variety of hypnotic techniques, and they do not indicate which hypnotic
strategies might be more helpful for speci®c painful conditions. Most of the studies
lack appropriate control groups and have inadequate follow-up data. Several of the
studies ®nd no difference in ef®cacy between hypnosis and other active psychosocial
treatment modalities, but some show that hypnosis can be as effective as direct
medical interventions e.g. pain medication). Unfortunately, hypnotic ability is
rarely related to outcome, neither in the hypnosis nor the comparison groups.
Therefore it is not known if the pain reduction is due to hypnosis or to non-speci®c
effects associated with the use of hypnotic interventions. Nor do these studies come
to terms with the dif®cult issue of how best to measure pain reduction. Most have
been forced to rely on subjective pain ratings of unknown reliability. The clinical
criterion of successful treatment outcome for chronic pain patients is far more
complex than mere pain reduction. Multiple outcome measures need to consider
decreased depression and medication and opioid use; improved sleep, social and
family relations and quality of life; increase in range of motion and activity level;
and return to work Evans, 1989; 2001).
HYPNOTIC STRATEGIES FOR PAIN MANAGEMENT
One's theoretical stance about the nature of hypnosis may in¯uence research design
as well as strategies used in hypnotic treatment programs. There is no consensus
de®nition of hypnosis, but most investigators emphasize one or more of four
aspects: expectations and the hypnotist±subject interaction); suggestibility; a
cognitive dimension related to relaxation and/or imagery; and dissociation Evans,
1991; 2001).
Some authors emphasize the social-psychological interaction between hypnotist
and subject as the main component of hypnotic behavior T. Barber, 1969; Chaves
& Brown, 1978; Sarbin & Coe, 1972; Spanos, 1986; Wagstaff, 1981). Pain
reduction involves interpersonal processes or self-generated cognitive and motivational
strategies, such as the reallocation of attention away from the pain, distraction,
imagery, verbal relabeling, role-playing, attribution, anxiety reduction,
forgetting and denial. These strategies are presumably facilitated by the hypnotic
relationship; the hypnotic induction procedure and individual differences in hypnotic
ability are considered incidental or irrelevant.