Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. -- Tim Brunson, PhD

Systematic review of psychological treatment in fibromyalgia.



Fibromyalgia (FM) is a debilitating rheumatic disorder characterized mainly by the presence of continual and widespread musculoskeletal pain, in addition to other disturbing symptoms. There is inconsistent evidence about the effectiveness of the treatments developed so far, making FM a chronic disease that is difficult to treat. The aim of this literature review was to analyze the empirical studies about psychological treatment of FM that have been published over the last twenty years. We conducted a literature search of studies published between 1990 and 2012 using Medline and PsycINFO in the Ovid and ProQuest platforms and hand searching. In total, 58 original studies were identified. The present review presents a comprehensive analysis of the main characteristics of these studies and a description of the interventions developed in order to improve FM symptoms. The most used intervention modality was group treatment with a cognitive-behavioral approach. We also found intensive and remote treatments as well as multimodal therapy, hypnosis, cognitive-behavioral therapy for insomnia, behavioral therapies, mind-body-based techniques, and biofeedback components. Finally, we discuss the clinical relevance of addressing the symptoms of patients with FM and its scientific validation.

Curr Pain Headache Rep. 2013 Jul;17(7):345. doi: 10.1007/s11916-013-0345-8. Lami MJ, Martínez MP, Sánchez AI. Department of Personality, Assessment, and Psychological Treatment. School of Psychology, University of Granada, Granada, Spain, mjlamih@correo.ugr.es.

Mind-body therapies - Use in chronic pain management.



Chronic pain is a common presentation to general practice. This article explores the role of the mind in the experience of pain and describes how mind-body techniques can be used in the management of chronic pain. The mind, emotions and attention play an important role in the experience of pain. In patients with chronic pain, stress, fear and depression can amplify the perception of pain. Mind-body approaches act to change a person's mental or emotional state or utilise physical movement to train attention or produce mental relaxation. They are occasionally used as a sole treatment, but more commonly as adjuncts to other therapies. Mind-body approaches include progressive muscle relaxation, meditation, laughter, mindfulness based approaches, hypnosis, guided imagery, yoga, biofeedback and cognitive behavioural therapy. Studies have shown that mind-body approaches can be effective in various conditions associated with chronic pain, however levels of evidence vary. Group delivered courses with healthcare professional input may have more beneficial effects than individual therapy. General practitioners are well placed to recommend or learn and provide a range of mind-body approaches to improve outcomes for patients with chronic pain.

Aust Fam Physician. 2013 Mar;42(3):112-7. Hassed C. MBBS, FRACGP, is Senior Lecturer, Department of General Practice, Monash University, Melbourne, Victoria.

Waking Hypnosis for Alleviating Pain and Promoting Healing



by Tim Brunson PhD

Can you rapidly stop bleeding or eliminate pain using only the sound of your voice? If not, continue reading.

The use of Waking Hypnosis must be included as a required skill for all medical and dental practitioners. The National Institutes of Health public access database of hypnosis-related research is quiet clear that hypnosis is indicated for the treatment of acute and chronic pain and for accelerating healing. Therefore, physicians and dentists need practical and rapid hypnosis methods. However, since 1958 when the American Medical Association approved hypnosis as part of treatment plans, popular techniques have too often consisted of lengthy, cost-prohibitive methods. Seemingly the only solution was to employ the services of a competently trained hypnotherapist or to entirely forego this wonderful alternative. In contrast, Waking Hypnosis is a powerful and natural technique, which almost always gets the same results as other hypnosis protocols, but within seconds or minutes. When used by the non-hypnotherapist clinician, it can be a valuable tool that will enhance their healing abilities.

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Effect of hypnosis on induction of local anaesthesia, pain perception...



Full title: Effect of hypnosis on induction of local anaesthesia, pain perception, control of haemorrhage and anxiety during extraction of third molars: A case-control study.

INTRODUCTION: Systemic conditions are considered limiting factors for surgical procedures under local anaesthesia in the oral cavity. All the pharmacological methods to control pain in patients have some disadvantages, such as side effects and extra costs for rehabilitation. Therefore, in such cases alternative treatment modalities are considered, such as hypnosis in dentistry. The aim of the present study was to evaluate the effect of hypnosis on haemorrhage, pain and anxiety during the extraction of third molars.

MATERIALS AND METHODS: In this case-control study, 24 female and male volunteers were included. The subjects had been referred to the Department of Oral and Maxillofacial Surgery, Kerman University of Medical Sciences, for extraction of third molars. Demographic data for all the subjects were recorded. Patients with chronic medical conditions were excluded. The patients were used as their own controls, with the third molars on one side being removed under hypnosis and on the opposite side under local anaesthetic. Hypnosis was induced by one of the two methods, either fixing the gaze on one point or Chiasson's technique; both these methods are appropriate for patients in the dental chair. The Spielberger State-Trait Anxiety Inventory was used to determine patient anxiety levels before hypnosis and anaesthesia. Pain was scored using VAS (visual analogue scale). After surgery the patient was asked to bite on a sterile gauze pad over the surgical site for 30 min when haemorrhage from the area was evaluated. If there was no haemorrhage the patient was discharged. If haemorrhage persisted, the gauze pad was left in place for another 30 min and the area was re-evaluated. Any active oozing from the area after 30 min was considered haemorrhage. Haemorrhage, anxiety and pain were compared between the two groups. Data was analyzed using the t-test, McNemar's test and Wilcoxon's signed rank test using SPSS 18 statistical software.

RESULTS: Twenty-four patients were evaluated; there were 14 males (58.3%) and 10 females (41.7%). The mean age of the subjects was 24.1 ± 2.7 years (age range = 18-30 years). A total of 48 third molars were extracted. In each patient, one-third molar was extracted under hypnosis and the other under local anaesthesia. All the patients were in the ASA 1 category (normal) with no significant medical history. Of the subjects who underwent hypnosis, only two subjects (8.3%) reported pain after induction of hypnosis. In the local anaesthetic group, 8 subjects (33.3%) reported pain. There was a significant difference between the two groups. The results of the study showed that patients in the hypnosis group had less pain during the first few hours post-operatively. Anxiety scores in the two groups were very close to each other and no statistically significant differences were observed in general and when each person was compared with himself or herself. Pain intensity in the two groups at 5- and 12-h post-operatively exhibited significant differences. In the hypnosis group, 10 patients (41.7%) took analgesic medication; in the local anaesthesia group, 22 patients (91.7%) took the analgesic medication (P = 0.0001). In other words, patients reported less pain when they were under hypnosis.

CONCLUSION: The results of the study showed that hypnosis can effectively reduce anxiety, haemorrhage and pain. More studies are necessary to collect data on the effect of hypnosis on oral and maxillofacial surgeries.

J Craniomaxillofac Surg. 2012 Dec 14. pii: S1010-5182(12)00224-7. doi: 10.1016/j.jcms.2012.10.009. Abdeshahi SK, Hashemipour MA, Mesgarzadeh V, Shahidi Payam A, Halaj Monfared A. Kerman Oral and Dental l Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Challenges in management of complex panic disorder in a palliative care setting.



This is a complex case of post-traumatic stress disorder (PTSD) with comorbid panic disorder occurring in a woman in her mid-60s, with a family history of neurotic illness. PTSD arose in the context of treatment for terminal lung cancer. This patient who had been close to her father watched him die of cancer, when he was about her age. Her diagnosis and treatment prompted traumatic recollections of her father's illness and death that resulted in her voluntary withdrawal from cancer treatment. The goals of treatment were to promptly reduce anxiety, minimise use of sedating pharmacotherapy, promote lucidity and prolong anxiety-free state thereby allowing time for important family interactions. Prompt, sustained relief of severe anxiety was necessary to achieve comfort at the end of life. Skilled additions of psychological therapies (eye movement desensitisation reprocessing, clinical hypnosis and breathing exercises) with combined pharmacotherapy (mirtazepine and quetiapine) led to control of anxiety and reduction of post-traumatic stress.

BMJ Case Rep. 2012 Oct 9;2012. pii: bcr2012006800. doi: 10.1136/bcr-2012-006800. Udo I, Gash A. Liaison Psychiatry, Roseberry Park Hospital, Tees, Esk, Wear Valleys NHS Foundation Middlesbrough Trust, UK. dr_itoro@yahoo.com

Hypnosis for management of fibromyalgia.



This randomized, controlled trial contrasted the effects of 5 not-standardized sessions of hypnosis over 2 months in 59 women with fibromyalgia who were randomly assigned to treatment (n?=?30) or a wait-list control group (n?=?29). Patients in the treated group were encouraged to practice self-hypnosis. Fibromyalgia Impact Questionnaire (FIQ), MOS-Sleep Scale, Multidimensional Fatigue Inventory (MFI), Cognitive Strategy Questionnaire (CSQ), and Patient Global Impression of Change (PGIC) were administered at baseline, 3 months (M3), and 6 months (M6) after inclusion. Compared to the control, the hypnosis group reported better improvement on PGIC (p = .001 at M3, p = .01 at M6) and a significant improvement in sleep and CSQ dramatization subscale (both at M6).

Int J Clin Exp Hypn. 2013 Jan;61(1):111-23. doi: 10.1080/00207144.2013.729441. Picard P, Jusseaume C, Boutet M, Dualé C, Mulliez A, Aublet-Cuvellier B. a CHU Clermont-Ferrand, Pain Clinic , France.

Psychological interventions for symptomatic management of non-specific chest pain...



Full title: Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy.

Recurrent chest pain in the absence of coronary artery disease is a common problem that sometimes leads to excess use of medical care. Although many studies examine the causes of pain in these patients, few clinical trials have evaluated treatment. The studies reviewed in this paper provide an insight into the effectiveness of psychological interventions for this group of patients. To update the previously published systematic review. We searched the Cochrane LIbrary (CENTRAL and DARE) (Issue 3 of 4 2011), MEDLINE (1966 to August Week 5, 2011), CINAHL (1982 to Sept 2011) EMBASE (1980 to Week 35 2011), PsycINFO (1887 to Sept Week 1, 2011), and Biological Abstracts (January 1980 to Sept 2011). We also searched citation lists and approached authors. Randomised controlled trials (RCTs) with standardised outcome methodology that tested any form of psychotherapy for chest pain with normal anatomy. Diagnoses included non-specific chest pain (NSCP), atypical chest pain, syndrome X, or chest pain with normal coronary anatomy (as either inpatients or outpatients). Two authors independently selected studies for inclusion, extracted data and assessed quality of studies. The authors contacted trial authors for further information about the RCTs included. Six new RCTs were located and added to the existing trials, therefore, a total of 15 RCTs (803 participants) were included. There was a significant reduction in reports of chest pain in the first three months following the intervention; fixed-effect relative risk = 0.68 (95% CI 0.57 to 0.81). This was maintained from three to nine months afterwards; relative risk = 0.59 (95% CI 0.45 to 0.76). There was also a significant increase in the number of chest pain free days up to three months following the intervention; mean difference = 2.81 (95% CI 1.28 to 4.34). This was associated with reduced chest pain frequency (random-effects mean difference = -2.26 95% CI -4.41 to -0.12) but there was no evidence of effect of treatment on chest pain frequency from three to twelve months (random-effects mean difference -0.81 95% CI -2.35, 0.74). There was no effect on severity (random-effects mean difference = -4.64 (95% CI -12.18 to 2.89) up to three months after the intervention. Overall there was generally a low risk of bias, however, there was high heterogeneity and caution is required in interpreting these results. Wide variability in outcome measures made integration of studies for secondary outcome measures difficult to report on. This review suggests a modest to moderate benefit for psychological interventions, particularly those using a cognitive-behavioural framework, which was largely restricted to the first three months after the intervention. Hypnotherapy is also a possible alternative. The evidence for brief interventions was less clear. Further RCTs of psychological interventions for NSCP with follow-up periods of at least 12 months are needed.

Cochrane Database Syst Rev. 2012 Jun 13;6:CD004101. Kisely SR, Campbell LA, Yelland MJ, Paydar A. School of Population Health, The University of Queensland, Brisbane, Australia.s.kisely@uq.edu.au.

Hypnosis and pain: current and perspective knowledge.



After further controversies, the definition of hypnosis is to be at the same time a modified state of consciousness and a particular intersubjective relation between a practitioner and his patient. In a synthetic way, we can say that mechanisms of hypnosis on acute pain are now well known, and its efficiency is particularly proved in the pain provoked by the care. On the other hand, the knowledge concerning the action of the hypnosis on chronic pain is much more complex to understand. If the hypnosis allows connoting differently pain and to decrease its implication in patient's life, otherWise the long-term reorganizations of hypnosis on chronic pain are still for the study. In practice, the field which his particularly in development is the analogical processes of the speech, because they are particularly present in pain medicine, and easy to use in hypnotic method.

Rev Med Suisse. 2012 Jun 27;8(347):1399-400, 1402-3. Bioy A. Centre de prise en charge des douleurs et des soins palliatifs du CHU Bicêtre, Institut français d'hypnose Centre de recherches et de formation, Paris. antoine.bioy@u-bourgogne.fr

Hypnosis for the management of chronic and cancer procedure-related pain in children.



Abstract The aim of this study was to review published controlled trials of hypnotic treatments for chronic and cancer procedure-related pain in children. Trials were included if participants were 18 years of age or below, were randomized and had populations with chronic pain or cancer procedure-relatedctory patients. The published evidence for the efficacy of various treatments relies mostly upon case series or case reports.

Int J Clin Exp Hypn. 2012 Oct;60(4):432-57. Tomé-Pires C, Miró J. Unit for the Study and Treatment of Pain-ALGOS, Centre de Recerca en Avaluació i Mesura de la Conducta, and Institut d'Investigació Universitària Pere Virgili , Catalonia , Spain.

Pain management for women in labour: an overview of systematic reviews.



BACKGROUND: The pain that women experience during labour is affected by multiple physiological and psychosocial factors and its intensity can vary greatly. Most women in labour require pain relief. Pain management strategies include non-pharmacological interventions (that aim to help women cope with pain in labour) and pharmacological interventions (that aim to relieve the pain of labour).

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Virtual reality hypnosis pain control in the treatment of multiple fractures: a case series.



This case series evaluated the use of virtual reality hypnosis (VRH) for the treatment of pain associated with multiple fractures from traumatic injuries. VRH treatment was administered on 2 consecutive days, and pain and anxiety were assessed each day before and after VRH treatment as well as on Day 3, which was 24 hours after the second treatment session. Pain reduction from baseline to Day 3 was from 70% to 30%, despite opioid analgesic use remaining stable. The subjective pain reduction reported by patients was encouraging, and the results of this case series suggest the importance of further study of VRH with larger samples using randomized controlled trials.

Am J Clin Hypn. 2012 Jan;54(3):184-94. Teeley AM, Soltani M, Wiechman SA, Jensen MP, Sharar SR, Patterson DR. Department of Rehabilitation Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA.

Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose.



(Headache 2012;52:785-791) Background.- Although both pharmacological and behavioral interventions may relieve tension-type headache, data are lacking regarding treatment preference, long-term patient compliance, and feasibility of behavioral intervention in a standard neurological outpatient clinic setting.
Objective.- To describe patient choice, long-term compliance, and clinical outcome in a neurological clinic setting where patients are given the choice of the approach they wish to pursue. Design.- Patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic tension-type headache or chronic tension-type headache) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly. Patients were given the option to cross-over to the other treatment group at each visit. HR was performed during standard length neurology clinic appointments by a neurologist trained to perform hypnosis (Y.E.). Follow-up interviews were performed between 6 and 12 months following treatment initiation to evaluate patient compliance, changes in headache frequency or severity, and quality-of-life parameters.

Results.- Ninety-eight patients were enrolled, 92 agreed to receive prophylactic therapy of some kind. Fifty-three (57.6%) patients chose HR of which 36 (67.9%) actually initiated this treatment, while 39 (42.4%) chose pharmacological therapy with AMT of which 25 (64.1%) patients actually initiated therapy. Patients with greater analgesic use were more likely to opt for AMT (P?=?.0002). Eleven of the patients initially choosing AMT and 2 of the patients initially choosing HR crossed over to the other group. Seventy-four percent of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches (P?=?.16). Long-term adherence to treatment with HR exceeded that of AMT. At the end of the study period, 26 of 47 patients who tried HR compared with 10 of 27 who tried AMT continued receiving their initial treatment. Conclusions.- HR treatment was a more popular choice among patients. Patients choosing HR reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance. Patients receiving HR were less likely to change treatments. HR practiced by a neurologist is feasible in a standard neurological outpatient clinic setting; HR training should be considered for neurologists involved in headache treatment.

Headache. 2012 May;52(5):785-91. doi: 10.1111/j.1526-4610.2011.02055.x. Ezra Y, Gotkine M, Goldman S, Adahan HM, Ben-Hur T. From the Department of Neurology, the Agnes Ginges Center for Human Neurogenetics, Hadassah University Medical Center, Jerusalem, Israel (Y. Ezra, M. Gotkine, and T. Ben-Hur); Epidemiology Unit, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel (S. Goldman); Division of the Orthopedic Rehabilitation Department, The Chaim Sheba Medical Rehabilitation Center Tel Hashomer, Israel (H.M. Adahan).

Meta-analysis of psychosocial interventions to reduce pain in patients with cancer.



PURPOSE: Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010.
METHODS: Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures.
RESULTS: Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04).
CONCLUSION: Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.

Comprehensive Cancer Center, ColumbiaUniversity, New York, NY, USA. J Clin Oncol. 2012 Feb 10;30(5):539-47. Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, Mohr DC, Berendsen MA, Jacobsen PB.

Use of hypnosis in the treatment of pain.



Hypnosis is an altered state of consciousness that comprises of heightened absorption in focal attention, dissociation of peripheral awareness, and enhanced responsiveness to social cues. Hypnosis has a long tradition of effectiveness in controlling somatic symptoms, such as pain. Pain, the most common symptom in clinical practice, is a multi-dimensional experience, which includes sensory-discriminative, affective-emotional, cognitive and behavioral components. There is a growing recognition for hypnosis and related techniques in pain management. Psychological approaches to pain control, such as hypnosis, can be highly effective analgesics, but are underused in Korea. In this article, we would like to review the basic concepts of hypnosis, the mechanism, and the outcome data of the analgesic effects of hypnosis, and also, its limitations.

Korean J Pain. 2012 Apr;25(2):75-80. Epub 2012 Apr 4. Lee JS, Pyun YD. Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Korea.

A randomized trial of hypnosis for relief of pain and anxiety...



Full title: A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures.

Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study.

J Psychosoc Oncol. 2012 May;30(3):281-93. Snow A, Dorfman D, Warbet R, Cammarata M, Eisenman S, Zilberfein F, Isola L, Navada S. a Department of Social Work Services , Mount Sinai Medical Center , New York , NY , USA.

Cognitive hypnotherapy for pain management.



Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management.

Am J Clin Hypn. 2012 Apr;54(4):294-310. Elkins G, Johnson A, Fisher W. Department of Psychology & Neuroscience, Baylor University, Waco, Texas 76798, USA. Gary_Elkins@baylor.edu

Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis...



Full title: Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis through cognitive-behavioral intervention, including hypnosis: a randomized study.

OBJECTIVE: This study evaluated the efficacy of a cognitive-behavioral therapy (CBT), including hypnosis, in patients with temporomandibular disorders (TMDs) with muscular diagnosis. STUDY DESIGN: Seventy-two patients (65 women and 7 men with an average age of 39 years) were selected according to the Research Diagnostic Criteria for TMD, and assigned to the experimental group (n = 41), receiving the 6-session CBT program, and the control group (n = 31). All patients received conservative standard treatment for TMD. The assessment included pain variables and psychologic distress. RESULTS: There were significant differences between the groups, the experimental group showing a higher improvement in the variables evaluated. Specifically, 90% of the patients under CBT reported a significant reduction in frequency of pain and 70% in emotional distress. The improvement was stable over time, with no significant differences between posttreatment and 9-month follow-up. CONCLUSIONS: CBT, including hypnosis, significantly improved conservative standard treatment outcome in TMD patients.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jan;113(1):81-9. Epub 2012 Feb 3. Ferrando M, Galdón MJ, Durá E, Andreu Y, Jiménez Y, Poveda R. Department of Personality, Assessment, and Psychologic Treatments, University of Valencia, Valencia, Spain.

Guided Imagery for Non-Musculoskeletal Pain: A Systematic Review of Randomized Clinical Trials.



CONTEXT: Our previous review of the literature concluded that there is encouraging evidence that guided imagery alleviates musculoskeletal pain, but the value of guided imagery in the management of non-musculoskeletal pain remains uncertain. OBJECTIVES: The objective of this systematic review was to assess the effectiveness of guided imagery as a treatment option for non-musculoskeletal pain. METHODS: Six databases were searched from their inception to February 2011. Randomized clinical trials were considered if they investigated guided imagery in human patients with any type of non-musculoskeletal pain in any anatomical location and assessed pain as a primary outcome measure. Trials of motor imagery and hypnosis were excluded. The selection of studies, data extraction, and validation were performed independently by two reviewers. RESULTS: Fifteen randomized clinical trials met the inclusion criteria. Their methodological quality was generally poor. Eleven trials found that guided imagery led to a significant reduction of non-musculoskeletal pain. Four studies found no change in non-musculoskeletal pain with guided imagery in comparison with progressive relaxation, standard care, or no treatment. CONCLUSION: The evidence that guided imagery alleviates non-musculoskeletal pain is encouraging but remains inconclusive.

J Pain Symptom Manage. 2012 Jun 5. Posadzki P, Lewandowski W, Terry R, Ernst E, Stearns A. Department of Complementary Medicine, University of Exeter, Peninsula Medical School, Exeter, Devon, United Kingdom.

Hypnosis for hot flashes among postmenopausal women study: a study protocol of an ongoing randomized



BACKGROUND: Hot flashes are a highly prevalent problem associated with menopause and breast cancer treatments. The recent findings from the Women's HealthInitiative have important implications for the significance of a non-hormonal, mind-body intervention for hot flashes in breast cancer survivors. Women who take hormone therapy long-term may have a 1.2 to 2.0 fold increased risk of developing breast cancer. In addition, it is now known that hormone therapy with estrogen and progestin is associated with increased risk of cardiovascular disease and stroke. Currently there are limited options to hormone replacement therapy as non-hormonal pharmacological agents are associated with only modest activity and many adverse side effects. Because of this there is a need for more alternative, non-hormonal therapies. Hypnosis is a mind-body intervention that has been shown to reduce self-reported hot flashes by up to 68% among breast cancer survivors, however, the use of hypnosis for hot flashes among post-menopausal women has not been adequately explored and the efficacy of hypnosis in reducing physiologically measured hot flashes has not yet been determined. METHODS/DESIGN: A sample of 180 post-menopausal women will be randomly assigned to either a 5-session Hypnosis Intervention or 5-session structured-attention control with 12 week follow-up. The present study will compare hypnosis to a structured-attention control in reducing hot flashes (perceived and physiologically monitored) in post-menopausal women in a randomized clinical trial. Outcomes will be hot flashes (self-report daily diaries; physiological monitoring; Hot Flash Related Daily Interference Scale), anxiety (State-Trait Anxiety Inventory; Hospital Anxiety and Depression Scale (HADS); anxiety visual analog scale (VAS rating); depression (Center for Epidemiologic Studies Depression Scale), sexual functioning (Sexual Activity Questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and cortisol. DISCUSSION: This study will be the first full scale test of hypnosis for hot flashes; one of the first studies to examine both perceived impact and physiologically measured impact of a mind-body intervention for hot flashes using state-of-the-art 24 hour ambulatory physiological monitoring; the first study to examine the effect of hypnosis for hot flashes on cortisol; and the first investigation of the role of cognitive expectancies in treatment of hot flashes in comparison to a Structured-Attention Control. TRIAL REGISTRATION: This clinical trial has been registered with ClinicalTrials.gov, a service of the U.S. National Institutes of Health, ClinicalTrials.gov Identifier: NCT01293695.

BMC Complement Altern Med. 2011 Oct 11;11:92. Elkins GR, Fisher WI, Johnson AK. Mind-Body Medicine Research Laboratory, Department of Psychology and Neuroscience, One Bear Place # 97334, Baylor University, Waco, TX, USA. Gary_Elkins@baylor.edu

Hypnosis and touch-massage to relieve pain at the end of life.



The treatment of pain in palliative care requires specific expertise. "Complementary" methods, such as hypnosis or "Toucher-Massage", for example, not only have an effect on the prevention and treatment of pain, but also contribute to the overall support of the patient.

Soins Pediatr Pueric. 2011 Sep-Oct;(262):35-8. Bioy A, Moreaux T, Pasturel A, Wood C. Unité de Prise en Charge des Douleurs et des Soins Palliatifs, CHU Bicêtre, AP-HP Le Kremlin-Bicêtre. antoine.bioy@bct.aphp.fr

Treating persistent nausea of pregnancy with hypnosis: four cases.



Persistent nausea of pregnancy is often caused by some unresolved emotional or psychological issue that can be rapidly resolved through hypnosis. Four cases of women who were nauseated throughout their pregnancy were treated with a brief form of hypnosis that used a psychodynamic investigation of the cause of the problem. David Cheek's ideomotor questioning was used to discover the reason for the disturbance; once uncovered, the solution was obvious and quick.

Am J Clin Hypn. 2011 Oct;54(2):107-15. Madrid A, Giovannoli R, Wolfe M. Russian River Counselors, Monte Rio, California 95462, USA. madrid@sonic.net

Hypnosis in pregnancy with intrauterine growth restriction and oligohydramnios...



Full Title: Hypnosis in pregnancy with intrauterine growth restriction and oligohydramnios: an innovative approach.

The clinical application of hypnosis has been effective in obstetrics. Intrauterine growth restriction and oligohydramnios are dreaded complications of pregnancy that may result in preterm deliveries causing increased perinatal morbidity and mortality. In this longitudinal prospective study, clinical hypnosis was used in addition to the conventional medical management in such pregnancies. The perinatal outcome was compared with the control group wherein hypnosis was not used. The hypnosis group had a significantly shorter preterm delivery rate (p = .004) and fewer incidence of low birth weight babies (p = .009). Significantly reduced operative intervention in terms of lower rate of cesarean section (p = .008) was also observed in the experimental group. Hence, the use of clinical hypnosis as a viable adjunct to medical management is suggested to help to prevent neonatal morbidity and fetal loss. A multicenter randomized, controlled clinical trial is encouraged in this area.

Am J Clin Hypn. 2011 Oct;54(2):116-23. Shah MC, Thakkar SH, Vyas RB. Medical College and SSG Hospital, Vadodara, Gujarat, India. chetan1373@hotmail.com

Experimental Pain Ratings and Reactivity of Cortisol and Soluble Tumor Necrosis ...



Full Title: Experimental Pain Ratings and Reactivity of Cortisol and Soluble Tumor Necrosis Factor-? Receptor II Following a Trial of Hypnosis: Results of a Randomized Controlled Pilot Study.

Objective.? Current evidence supports the efficacy of hypnosis for reducing the pain associated with experimental stimulation and various acute and chronic conditions; however, the mechanisms explaining how hypnosis exerts its effects remain less clear. The hypothalamic-pituitary-adrenal (HPA) axis and pro-inflammatory cytokines represent potential targets for investigation given their purported roles in the perpetuation of painful conditions; yet, no clinical trials have thus far examined the influence of hypnosis on these mechanisms. Design. Healthy participants, highly susceptible to the effects of hypnosis, were randomized to either a hypnosis intervention or a no-intervention control.Using a cold pressor task, assessments of pain intensity and pain unpleasantness were collected prior to the intervention (Pre) and following the intervention (Post) along with pain-provoked changes in salivary cortisol and the soluble tumor necrosis factor-? receptor II (sTNF?RII). Results.? Compared with the no-intervention control, data analyses revealed that hypnosis significantly reduced pain intensity and pain unpleasantness. Hypnosis was not significantly associated with suppression of cortisol or sTNF?RII reactivity to acute pain from Pre to Post; however, the effect sizes for these associations were medium-sized. Conclusions.? Overall, the findings from this randomized controlled pilot study support the importance of a future large-scale study on the effects of hypnosis for modulating pain-related changes of the HPA axis and pro-inflammatory cytokines.

Pain Med. 2012 Jan;13(1):29-44. doi: 10.1111/j.1526-4637.2011.01293.x. Goodin BR, Quinn NB, Kronfli T, King CD, Page GG, Haythornthwaite JA, Edwards RR, Stapleton LM, McGuire L.

Multicomponent Cognitive-Behavioral Group Therapy With Hypnosis for the Treatment of Fibromyalgia:



This study compared the efficacy of 2 psychological treatments for fibromyalgia with each other and with standard care. Ninety-three patients with fibromyalgia (FM) were randomly assigned to 1 of the 3 experimental conditions: 1) multicomponent cognitive-behavioral therapy (CBT); 2) multicomponent CBT with hypnosis; and 3) pharmacological treatment (standard care control group). The outcome measures of pain intensity, catastrophizing, psychological distress, functionality, and sleep disturbances were assessed before treatment, immediately after treatment, and at 3- and 6-month follow-up visits. CBT and CBT with hypnosis participants received the standard pharmacological management plus 14 weekly, 120-minute-long sessions of psychological treatment. All but 1 session followed a group format; the remaining session was individual. The analyses indicated that: 1) patients with FM who received multicomponent CBT alone or multicomponent CBT with hypnosis showed greater improvements than patients who received only standard care; and 2) adding hypnosis enhanced the effectiveness of multicomponent CBT. This study presents new evidence about the efficacy of multicomponent CBT for FM and about the additional effects of hypnosis as a complement to CBT. The relevance and implications of the obtained results are discussed. PERSPECTIVE: This article highlights the beneficial effects of adding hypnosis in a multicomponent cognitive-behavioral group treatment of fibromyalgia patients. Also, this research showed that by adding hypnosis the length of treatment did not increase.

Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

J Pain. 2012 Jan 27. Castel A, Cascón R, Padrol A, Sala J, Rull M. Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Multidimentional Pain Research Group, IISPV, Tarragona, Spain; Department of Psychology, Universitat Rovira i Virgili, Spain.

Mind-Body Interventions for Treatment of Phantom Limb Pain in Persons with Amputation.



ABSTRACT: Phantom limb pain (PLP) is a significant source of chronic pain in most persons with amputation at some time in their clinical course. Pharmacologic therapies for this condition are often only moderately effective and may produce unwanted adverse effects. There is growing empirical evidence of the therapeutic effectiveness of mind-body therapies for the relief of chronic pain; therefore, an exploration of their role in relieving amputation-related chronic pain iswarranted. We undertook a focused literature review on mind-body interventions for patients with amputation who experience PLP. Because of study heterogeneity, only descriptive presentations of the studies are presented. Only studies of hypnosis, imagery, and biofeedback, including visual mirror feedback, were found; studies on meditation, yoga, and tai chi/qigong were missing from the literature. Few studies of specific mind-body therapies were dedicated to management of PLP, with the exception of mirror visual therapy. Overall, studies were largely exploratory and reflect considerable variability in the application of mind-body techniques, making definitive conclusions inadvisable. Nevertheless, the weight of existing findings indicates that a mind-body approach to PLP pain management is promising and that specific methods may offer either temporary or long-term relief, either alone or in combination with conventional therapies. The authors discuss the potential for usefulness of specific mind-body therapies and the relevance of their mechanisms of action to those of PLP, including targeting cortical reorganization, autonomic nervous system deregulation, stress management, coping ability, and quality-of-life. The authors recommend more and better quality research exploring the efficacy and mechanisms of action.

Am J Phys Med Rehabil. 2012 Jan 26. Moura VL, Faurot KR, Gaylord SA, Mann JD, Sill M, Lynch C, Lee MY. From the Department of Physical Medicine and Rehabilitation (VLM, KRF, SAG, MS, CL, MYL), and Department of Neurology, University of North Carolina at ChapelHill (JDM).

Complementary and alternative medicine in the treatment of pain in fibromyalgia...



Full Title: Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials.

OBJECTIVE: The purpose of this study was to systematically review the literature for randomized trials of complementary and alternative medicine (CAM) interventions for fibromyalgia (FM). METHODS: A comprehensive literature search was conducted. Databases included the Cochrane library, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Natural Medicines Comprehensive Database Manual, Alternative and Natural Therapy Index System (MANTIS), Index for Chiropractic Literature, and Allied and Complementary Medicine (AMED). Inclusion criteria were (a) subjects were diagnosed with fibromyalgia and (b) the study design was a randomized controlled trial that compared a CAM therapy vs a control group. Studies were subgrouped by CAM treatment into 11 categories. Evidence tables and forest plots were organized to display quality ratings and effect sizes of each study. RESULTS: The literature search yielded 1,722 results; 102 abstracts were selected as potential articles for inclusion. Sixty studies met criteria and were rated by 2 reviewers; 18 were rated as good quality; 20, moderate; 18, low; and 4, very low. Synthesis of information for CAM categories represented by more than 5 studies revealed that balneotherapy and mind-body therapies were effective in treating FM pain. This study analyzed recent studies and focused exclusively on randomized controlled trials. Despite common use of manual therapies such as massage and manipulation to treat patients with FM, there is a paucity of quality clinical trials investigating these particular CAM categories. CONCLUSION: Most of these studies identified were preliminary or pilot studies, thus had small sample sizes and were likely underpowered. Two CAM categories showed the most promising findings, balneotherapy and mind-body therapies. Most of the other CAM categories showed a trend favoring the treatment group. It appears that several CAM therapies show some preliminary treatment effect for FM pain, but larger trials that are more adequately powered are needed.

J Manipulative Physiol Ther. 2011 Sep;34(7):483-96. Terhorst L, Schneider MJ, Kim KH, Goozdich LM, Stilley CS. Assistant Professor, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA. lat15@pitt.edu

Hypnosis for functional abdominal pain.



Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder.

Am J Clin Hypn. 2011 Jul;54(1):56-69. Gottsegen D. Department of Pediatrics, Baystate Medical Center Tufts University, Springfield, Massachusetts, USA. daveygmd@charter.net

Chronic daily headache: helping adolescents help themselves with self-hypnosis.



Although the evidence is clear that hypnosis has been an effective treatment for recurrent headaches in children, review of the literature revealed no previous reports of hypnosis for youth with the condition of chronic daily headache. Two adolescents with continuing chronic daily headaches were taught self-hypnosis through careful attention to individual strengths and finding the hypnotic elements within the clinical encounters. Self-reports of intensity, frequency, and duration of headaches described substantial benefit from learning and practicing self-hypnosis after little to no benefit from pharmacologic and other nonpharmacologic therapies. These results and analogous success with several other adolescents with chronic daily headache support the further use of self-hypnosis training for this condition. As a self-regulation technique that is quickly and easily learned by most young people, self-hypnosis training holds considerable promise for effectively treating and perhaps preventing chronic daily headaches in children and adolescents.

Am J Clin Hypn. 2011 Jul;54(1):32-46. Kohen DP. Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55414, USA. dpkohen@umn.edu

Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects.



Abstract The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. The unique features of this study were: (a) use of a standardized nurse-delivered hypnosis protocol, (b) intervention administration immediately prior to surgery in the preoperative holding area, and (c) provision of hypnosis to breast cancer surgery patients receiving general anesthesia. A mixed-method design was used. Data collected from the intervention group and historical control group included demographics, symptom assessments, medication administration, and surgical, anesthesia, and recovery minutes. A semi-structured interview was conducted with the intervention group. A reduction in anxiety, worry, nervousness, sadness, irritability, and distress was found from baseline to postintervention while pain and nausea increased. The results support further exploration of the use of nurse-led preoperative hypnosis.

Int J Clin Exp Hypn. 2011 Oct-Dec;59(4):406-23. Lew MW, Kravits K, Garberoglio C, Williams AC. a City of Hope , Duarte , California , USA.

Hypnotizability and sensorimotor gating: a dopaminergic mechanism of hypnosis.



Abstract Dopaminergic mechanisms have been theorized to influence hypnotizability and sensorimotor gating. In this study, the authors investigated an association between sensorimotor gating, as measured by prepulse inhibition (PPI), and hypnotizability, as assessed by the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). They found an inverse correlation between the SSHS:C and PPI. This finding, which replicates an earlier study, provides further evidence for a dopaminergic basis for hypnotizability and suggests additional avenues for research, including a method for possibly enhancing hypnotizability through pharmacological interventions.

Int J Clin Exp Hypn. 2011 Oct-Dec;59(4):399-405. Levin R, Heresco-Levy U, Edelman S, Shapira H, Ebstein RP, Lichtenberg P. a Herzog Memorial Hospital and Hebrew University , Jerusalem , Israel.

Virtual reality and pain management: current trends and future directions.



Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. While the exact neurobiological mechanisms behind VR's action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance.

Pain Manag. 2011 Mar;1(2):147-157. Li A, Montaño Z, Chen VJ, Gold JI. Children's Hospital Los Angeles, Departments of Anesthesiology Critical Care Medicine & Radiology, 4650 West Sunset Boulevard, MS#12, Los Angeles, CA 90027, USA.

Mind-Body Therapies and Osteoarthritis of the Knee.



Osteoarthritis of the knee is a major cause of disability among adults worldwide. Important treatment options include nonpharmacologic therapies, and especially symptom management strategies in which patients take an active role. Among these, mind-body therapies may have particular promise for alleviating the distressful symptoms associated with osteoarthritis of the knee. However, systematic reviews are lacking. The objective of this paper is to review English-language articles describing clinical studies evaluating the effects of patient-driven mind-body therapies on symptoms of knee osteoarthritis. Eight studies, representing a total of 267 participants, met the inclusion criteria. Interventions included tai chi, qigong, and yoga. Collectively, these studies suggest that specific mind-body practices may help alleviate pain and enhance physical function in adults suffering from osteoarthritis of the knee. However, sample sizes are small, rigorous investigations are few, and the potential benefits of several mind-body therapies have not yet been systematically tested. Additional high-quality studies are needed to clarify the effects of specific mind-body therapies on standardized measures of pain, physical function, and related indices in persons with osteoarthritis of the knee, and to investigate possible underlying mechanisms.

Curr Rheumatol Rev. 2009 Nov 1;5(4):204-211. Selfe TK, Innes KE. Department of Community Health, West Virginia University School of Medicine, Morgantown, WV, USA.

Mind-body therapies for the management of pain.



This paper reviews the evidence for mind-body therapies (eg, relaxation, meditation, imagery, cognitive-behavioral therapy) in the treatment of pain-related medical conditions and suggests directions for future research in these areas. Based on evidence from randomized controlled trials and in many cases, systematic reviews of the literature, the following recommendations can be made: 1) multi-component mind-body approaches that include some combination of stress management, coping skills training, cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain; 2) multimodal mind-body approaches such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be an effective adjunct in the management of rheumatoid and osteoarthritis; 3) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or stand alone therapy for recurrent tension headache; 4) an array of mind-body therapies (eg, imagery, hypnosis, relaxation) when employed pre-surgically, can improve recovery time and reduce pain following surgical procedures; 5) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures.

Clin J Pain. 2004 Jan-Feb;20(1):27-32. Astin JA. California Pacific Medical Center Research Institute, San Francisco, CA, USA. john@integrativearts.com

Virtual reality and pain management: current trends and future directions.



Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a onpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. While the exact neurobiological mechanisms behind VR's action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance.

Pain Manag. 2011 Mar;1(2):147-157. Li A, Montaño Z, Chen VJ, Gold JI. Children's Hospital Los Angeles, Departments of Anesthesiology Critical Care Medicine & Radiology, 4650 West Sunset Boulevard, MS#12, Los Angeles, CA 90027, USA.

Hypnotherapeutic treatment approaches in children and adolescents suffering from functional...



Full title: Hypnotherapeutic treatment approaches in children and adolescents suffering from functional abdominal pain.

Functional abdominal pain significantly impairs day-to-day function. It is one of the most frequent somatic complaints among children and adolescents. For most of those affected, despite some indication of their possible presence, physiological factors fail to explain the symptoms adequately. The increased level of psychological symptoms suggests that the focus should be on behavioural and psychological aspects. Brief hypnotherapeutic treatment methods show encouraging results. A review of the current literature; potential mechanisms of effective intervention and their practical applicability are discussed.

Prax Kinderpsychol Kinderpsychiatr. 2011;60(5):386-400. Gulewitsch MD, Schlarb AA. Universität Tübingen, Fachbereich Psychologie.

Efficacy of hypnosis/guided imagery in fibromyalgia syndrome--a systematic review and meta-analysis



BACKGROUND: Recent systematic reviews on psychological therapies of fibromyalgia syndrome (FMS) did not consider hypnosis/guided imagery (H/GI). Therefore we performed a systematic review with meta-analysis of the efficacy of H/GI in FMS. METHODS: We screened ttp://ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO and SCOPUS (through December 2010). (Quasi-) randomized controlled trials (CTs) comparing H/GI with controls were analyzed. Outcomes were pain, sleep, fatigue, depressed mood and health-related quality of life (HRQOL). Effects were summarized using standardized mean differences (SMD). RESULTS: Six CTs with 239 subjects with a median of 9 (range 7-12) H/GI-sessions were analysed. The median number of patients in the H/GI groups was 20 (range 8-26). Three studies performed follow-ups. H/GI reduced pain compared to controls at final treatment (SMD -1.17 [95% CI -2.21, -0.13]; p = 0.03). H/GI did not reduce limitations of HRQOL at final treatment (SMD -0.90 [95% CI -2.55, 0.76]; p = 0.29) compared to controls. Effect sizes on fatigue, sleep and depressed mood at final treatment and follow-up and on pain and HRQOL at follow-up were not calculated because of limited data available. The significant effect on pain at final treatment was associated with low methodological and low treatment quality. CONCLUSION: Further studies with better treatment quality and adequate methodological quality assessing all key domains of FMS are necessary to clarify the efficacy of H/GI in FMS.

BMC Musculoskelet Disord. 2011 Jun 15;12:133. Bernardy K, Füber N, Klose P, Häuser W. Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital, Kirrberger Straße 100, D-66421 Homburg/Saar, Germany.

Efficacy of hypnosis/guided imagery in fibromyalgia syndrome...



Full Title: Efficacy of hypnosis/guided imagery in fibromyalgia syndrome - a systematic review and meta-analysis of controlled trials.

ABSTRACT:BACKGROUND: Recent systematic reviews on psychological therapies of fibromyalgia syndrome (FMS) did not consider hypnosis/guided imagery (H/GI). Therefore we performed a systematic review with meta-analysis of the efficacy of H/GI in FMS. METHODS: We screened http://ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO and SCOPUS (through December 2010). (Quasi-) randomized controlled trials (CTs) comparing H/GI with controls were analyzed. Outcomes were pain, sleep, fatigue, depressed mood and health-related quality of life (HRQOL). Effects were summarized using standardized mean differences (SMD). RESULTS: Six CTs with 239 subjects with a median of 9 (range 7-12) H/GI-sessions were analysed. The median number of patients in the H/GI groups was 20 (range 8-26). Three studies performed follow-ups. H/GI reduced pain compared to controls at final treatment (SMD -1.17 [95% CI -2.21, -0.13]; p = 0.03). H/GI did not reduce limitations of HRQOL at final treatment (SMD -0.90 [95% CI -2.55, 0.76]; p = 0.29) compared to controls. Effect sizes on fatigue, sleep and depressed mood at final treatment and follow-up and on pain and HRQOL at follow-up were not calculated because of limited data available. The significant effect on pain at final treatment was associated with low methodological and low treatment quality. CONCLUSION: Further studies with better treatment quality and adequate methodological quality assessing all key domains of FMS are necessary to clarify the efficacy of H/GI in FMS.

BMC Musculoskelet Disord. 2011 Jun 15;12:133. Bernardy K, Füber N, Klose P, Häuser W. Department of Internal Medicine I, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.de.

Efficacy of hypnosis/guided imagery in fibromyalgia syndrome...



ABSTRACT:BACKGROUND: Recent systematic reviews on psychological therapies of fibromyalgia syndrome (FMS) did not consider hypnosis/guided imagery (H/GI). Therefore we performed a systematic review with meta-analysis of the efficacy of H/GI in FMS. METHODS: We screened http://ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO and SCOPUS (through December 2010). (Quasi-) randomized controlled trials (CTs) comparing H/GI with controls were analyzed. Outcomes were pain, sleep, fatigue, depressed mood and health-related quality of life (HRQOL). Effects were summarized using standardized mean differences (SMD). RESULTS: Six CTs with 239 subjects with a median of 9 (range 7-12) H/GI-sessions were analysed. The median number of patients in the H/GI groups was 20 (range 8-26). Three studies performed follow-ups. H/GI reduced pain compared to controls at final treatment (SMD -1.17 [95% CI -2.21, -0.13]; p = 0.03). H/GI did not reduce limitations of HRQOL at final treatment (SMD -0.90 [95% CI -2.55, 0.76]; p = 0.29) compared to controls. Effect sizes on fatigue, sleep and depressed mood at final treatment and follow-up and on pain and HRQOL at follow-up were not calculated because of limited data available. The significant effect on pain at final treatment was associated with low methodological and low treatment quality. CONCLUSION: Further studies with better treatment quality and adequate methodological quality assessing all key domains of FMS are necessary to clarify the efficacy of H/GI in FMS.

BMC Musculoskelet Disord. 2011 Jun 15;12:133. Bernardy K, Füber N, Klose P, Häuser W. Department of Internal Medicine I, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.de.

EEG Biofeedback Treatment Improves Certain Attention and Somatic Symptoms in Fibromyalgia...



Full title: EEG Biofeedback Treatment Improves Certain Attention and Somatic Symptoms in Fibromyalgia: A Pilot Study.

Fibromyalgia (FMS) is a chronic, painful disorder often associated with measurable deficiencies in attention. Since EEG biofeedback (EEG-BF) has been used successfully to treat attention problems, we reasoned that this modality might be helpful in the treatment of attention problems in FMS. We also speculated that improvement in central nervous system (CNS) function might be accompanied by improvement in FMS somatic symptoms. We studied fifteen FMS patients with attention problems, demonstrated by visual and auditory continuous performance testing (CPT), while completing 40 or more EEG-BF sessions. Training consisted of a "SMR protocol" that augmented 12-15 Hz brainwaves (sensory motor rhythm; SMR), while simultaneously inhibiting 4-7 Hz brainwaves (theta) and 22-30 Hz brainwaves (high beta). Serial measurements of pain, fatigue, psychological distress, morning stiffness, and tenderness were also obtained. Sixty-three FMS patients who received standard medical care, but who did not receive EEG-BF, served as controls. Visual, but not auditory, attention improved significantly (P < 0.008). EEG-BF treated subjects also showed improvement in tenderness, pain and fatigue. Somatic symptoms did not change significantly in controls. Visual attention parameters and certain somatic features of FMS appear to improve with an EEG-BF SMR protocol. EEG-BF training in FMS deserves further study.

Appl Psychophysiol Biofeedback. 2011 Jun 9. Caro XJ, Winter EF. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA, xjcaro@earthlink.net.

An overview of systematic reviews of complementary and alternative medicine for fibromyalgia.



Fibromyalgia (FM) is a chronic pain condition which is difficult to diagnose and to treat. Most individuals suffering from FM use a variety of complementary or alternative medicine (CAM) interventions to treat and manage their symptoms. The aim of this overview was to critically evaluate all systematic reviews of single CAM interventions for the treatment of FM. Five systematic reviews met the inclusion criteria, evaluating the effectiveness of homoeopathy, chiropractic, acupuncture, hydrotherapy and massage. The reviews found some evidence of beneficial effects arising from acupuncture, homoeopathy, hydrotherapy and massage, whilst no evidence for therapeutic effects from chiropractic interventions for the treatment of FM symptoms was found. The implications of these findings and future directions for the application of CAM in chronic pain conditions, as well as for CAM research, are discussed.

Clin Rheumatol. 2011 May 26. Terry R, Perry R, Ernst E. Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter,UK, rohini.terry@pms.ac.uk.

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