Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis

Abstract

Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, [95% confidence intervals]) for pain intensity (0-100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: -8.2 [-11.8, -1.9]; medical procedures/surgical pain: -6.9 [-10.4, -3.3]; burn wound care: -8.8 [-13.8, -3.9]). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (-11.5 [-19.7, 3.3]) but not postsurgery pain (-2.0 [-7.8, 3.7]). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (-2 [-3.7, -0.3]). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (-13.2, [-22.5, -3.8]). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted.

Keywords: Acute pain; Adjunct; Chronic pain; Hypnosis; Procedural pain; Systematic review.

Figure 1.

PRIMSA Flow Chart. PRISMA flowchart of search and study selection process.

Figure 2.

Risk of bias of included studies. Graph showing the percentage of included studies with low, unclear, and high risk of bias for each risk of bias assessment criteria. For the criteria “completeness of reporting UC", this only includes those studies that used usual care as their primary intervention. FU, follow-up; UC, usual care.

Figure 3.

Meta-analysis of adjunctive hypnosis for usual care. Forest plots demonstrating the mean difference in post-intervention pain intensity scores for usual care plus hypnosis vs usual care alone for chronic pain, acute pain from procedures and surgery, and acute pain from wound care (burns, physical trauma). Hyp, hypnosis; No control, studies in which only usual care was provided, with no additional time or attentional control for hypnosis; VR, virtual reality; UC, usual care.

Figure 4.

Meta-analysis for adjunctive hypnosis for psychological interventions. Forest plot demonstrating the mean difference in postintervention pain intensity scores for psychological interventions plus hypnosis vs psychological interventions alone for chronic pain. Hyp, hypnosis; Int., intervention; No control, studies in which only usual care was provided, with no additional time or attentional control for hypnosis; Psych., psychological.

Figure 5.

Meta-analysis for adjunctive hypnosis for education interventions. Forest plot demonstrating the mean difference in post-intervention pain intensity scores for education interventions plus hypnosis vs education interventions alone for chronic pain and for acute pain from procedures and surgery. Cog, cognitive control comparison; Hyp, hypnosis; Mind, Mindfulness control comparison; No control, studies in which only education was provided, with no additional time or attentional control for hypnosis.

Figure 6.

Meta-analysis for adjunctive hypnosis for pharmacological interventions. Forest plot demonstrating the mean difference in post-intervention pain intensity scores for pharmacological interventions plus hypnosis vs pharmacological interventions alone for chronic pain. Hyp, hypnosis; No control, studies in which only the pharmacological intervention was provided, with no additional time or attentional control for hypnosis.

Figure 7.

Pooled effects for only those studies using time and attention controls for hypnosis in the primary intervention group: (A) usual care; (B) psychological interventions; (C) education. Forest plot demonstrating the mean difference in postintervention pain intensity scores for usual care plus hypnosis vs usual care alone on pain intensity for chronic pain, acute pain from procedures and surgery, and acute pain from wound care (burns, physical trauma) when only studies that include a time and attention control in the primary intervention are included (A). Forest plot demonstrating the mean difference in postintervention pain intensity scores for psychological interventions plus hypnosis vs psychological interventions alone on pain intensity for chronic pain, when only studies that include a time and attention control in the primary intervention are included (B). Forest plot demonstrating the mean difference in postintervention pain intensity scores for education plus hypnosis vs education alone on pain intensity for acute pain from surgery and procedures when only studies that include a time and attention control in the primary intervention are included (C). Hyp, hypnosis; Int, intervention; Psych, psychological; UC, usual care.