Hypnosis and Fibromyalgia



I am not a physician and do not "treat" or "cure" fibromyalgia. As a hypnotist I use hypnotism to induce trance and deliver suggestions, which have been shown to provide significant relief from the symptoms of fibromyalgia. Any person suffering from chronic pain should consult a physician first before seeking hypnosis. I use hypnotism for chronic pain only with a referral from a qualified medical professional.


Fibromyalgia is a chronic disorder affecting over 5 million Americans, with 80-90% of those affected being women. Symptoms include widespread muscle pain, tenderness, painful trigger points, problems sleeping, fatigue, and depression. This article presents the scientific evidence that hypnosis is effective in providing relief from the symptoms of fibromyalgia. As this fact has become well established, the focus of research has shifted to the role of the brain, the comparison of hypnotic methods, and the effects of hypnosis when combined with other interventions. From the controlled studies on hypnosis and fibromyalgia, the hypnotist and hypnotherapist can draw conclusions concerning the best hypnotic approach and the likely results when using hypnosis for fibromyalgia.

Studies are conclusive
In the 1990s there were a number of studies on fibromyalgia and mind-based interventions, such as hypnosis, mindfulness meditation, and stress reduction exercises.[1] Generally, results have shown that psychological treatment is more effective than the conventional pharmacological approach, especially when hypnosis is added.[2] Hypnosis has proven so effective that German and Israeli guidelines for the treatment of fibromyalgia now include hypnosis.[3]

Two meta-analyses have assessed the effectiveness of hypnosis for fibromyalgia based on the combined results of multiple studies. One considered six separate studies with 239 subjects and concluded that hypnosis with guided imagery does reduce pain.[4] A more comprehensive meta-analysis considered the results of all known controlled studies and concluded that hypnotherapy and guided imagery are recommended.[5]

The findings that hypnosis reduces fibromyalgia symptoms are supported by the observation that cerebral blood flow in patients with fibromyalgia changes during hypnotic analgesia, compared to the waking state. Studies indicate the involvement of multiple areas in the brain and suggest an interplay between the cortical and subcortical brain structures.[6]

Length of treatment
Treatment protocols in these studies are based on experimental design, rather than evaluations of the individual patients. Nevertheless, it may be helpful to know the length of treatment used. In the largest meta-analysis, patients had a median of nine hypnosis sessions.[7] In one study fibromyalgia patients saw a significant decrease in physical and mental discomfort with 12 weeks of hypnotherapy and a follow up at 24 weeks.[8] In another, the patients experienced better overall change and significant improvement of sleep with five sessions over two months, and were also encouraged to practice self-hypnosis.[9]

Which symptoms are affected most?
Hypnosis does reduce strong feelings of physical and psychic pain from fibromyalgia.[10] Using hypnosis, fibromyalgia patients have also experienced significant improvements of sleep[11] and less fatigue on awakening.[12] There is less evidence that hypnosis reduces the general fatigue and depression that can accompany fibromyalgia. In one study hypnosis reduced pain but did not significantly improve the patient’s perceived quality of life as it relates to health.[13] This may suggest that the hypnotist should focus specifically on the reduction of pain, better sleep, and less fatigue on awakening, instead of the patient’s perception of quality of life, general fatigue, or depression.

While hypnotherapy patients did show significantly better outcomes with regard to overall pain, the pain response to manual pressure remained the same.[14] This may be communicated to the patient in order to establish reasonable expectations, lest the patient attempt to test the effectiveness of hypnosis by pressing upon tender areas.

Comparison of hypnotic approaches
Studies on hypnosis and fibromyalgia indicate that certain methods of hypnosis work best.

Relaxation exercises help fibromyalgia patients, but hypnotic trance is distinct from mere rest and has been found particularly effective. Fibromyalgia patients in hypnosis experienced less pain during hypnosis than patients at rest.[15] One study showed that the Ericksonian hypnosis method of analog marking (giving verbal or nonverbal cues to emphasize certain words) was more effective than Schultz’s Autogenic Training method, which is a self-directed form of relaxation with autosuggestion.[16]

Suggestions alone (without a hypnotic induction) can significantly reduce pain, but patients report greater reduction of pain and claim greater control over their pain when suggestions follow a hypnotic induction.[17] Suggestions of analgesia have a greater effect than suggestions of relaxation. In fact, the effect of hypnotic induction followed by suggestions of relaxation was no greater than the effect of relaxation alone.[18]

When working with someone who suffers from chronic pain, it is important to remember that there is more to hypnotic analgesia than direct commands for diminished pain or increased comfort. The scientific study of pain makes a distinction between two components of pain, the sensory component and the suffering component. Sensory pain is the perceptual response to irritation or injury; suffering is the reaction that follows such pain.[19] When the suffering is removed, the sensory aspect tends to become tolerable or may even disappear.[20] Suggestions to relieve the suffering component of pain may be directed, for example, at alleviating the subject’s non-acceptance or fear of the condition, separating sensory from suffering and quality of life, or placing a time limit on suffering. Where appropriate, suggestions may also be directed at releasing self-destructive feelings like guilt and resentment, and addressing any secondary benefit that the subject might gain from the condition or the limitations that it may place on carrying out the responsibilities of life.

Hypnosis and other interventions
Recognizing the effectiveness of both cognitive behavioral training (CBT) and hypnosis for treating fibromyalgia, several studies have investigated the combined effects of CBT and hypnosis. It has been found that psychological treatment provides greater relief from symptoms than conventional pharmacological treatment only, especially when hypnosis is added.[21] A 2012 study of 93 patients with fibromyalgia concluded that hypnosis enhanced the effectiveness of CBT to show greater improvements than drug intervention in terms of pain, catastrophizing, psychological distress, functionality, and sleep.[22]

Summary
Hypnosis for fibromyalgia should be considered as a way to alleviate symptoms. A hypnotist is not a physician and does not “treat” or “cure” fibromyalgia.
• Cognitive behavioral therapy is most effective when combined with hypnotherapy.
• Stress reduction and relaxation (in the form of Jacobson’s Progressive Relaxation technique, for example) can alleviate fibromyalgia symptoms. The hypnosis subject should be taught relaxation techniques and/or self hypnosis.
• Hypnotism in which a hypnotist or hypnotherapist induces trance and delivers suggestions (such as Ericksonian analog marking) is more effective than a self-directed approach (such as autogenic training).
• The trance state is particularly important and should be maximized.
• Suggestions should focus on the improvement of generalized pain, sleep, and fatigue.
• Suggestions for analgesia can address both the sensory and suffering components of pain.
• Experimental treatment designs generally employ weekly sessions for 2-3 months.
This approach learned from understanding hypnosis and fibromyalgia may also have application to other chronic pain disorders.


Sources:

[1] Lauche, R., Cramer, H., Häuser, W., Dobos, G., & Langhorst, J. (n.d.). A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome. Evidence-Based Complementary and Alternative Medicine, 1-13.

[2] Martínez-Valero, C., Castel, A., Capafons, A., Sala, J., Espejo, B., & Cardeña, E. (n.d.). Hypnotic Treatment Synergizes the Psychological Treatment of Fibromyalgia: A Pilot Study. American Journal of Clinical Hypnosis, 311-321.

[3] Ablin, J., Fitzcharles, M., Buskila, D., Shir, Y., Sommer, C., & Häuser, W. (n.d.). Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies. Evidence-Based Complementary and Alternative Medicine, 1-7.

[4] Bernardy, K., Füber, N., Klose, P., & Häuser, W. (n.d.). Efficacy of hypnosis/guided imagery in fibromyalgia syndrome - a systematic review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders BMC Musculoskelet Disord, 133-133.

[5] Thieme, K., Häuser, W., Batra, A., Bernardy, K., Felde, E., Gesmann, M., . . . Köllner, V. (2008). Psychotherapie bei Patienten mit Fibromyalgiesyndrom. Der Schmerz Schmerz, 295-302.

[6] Wik, G., Fischer, H., Bragée, B., Finer, B., & Fredrikson, M. (n.d.). Functional anatomy of hypnotic analgesia: A PET study of patients with fibromyalgia. European Journal of Pain, 7-12.

[7] Bernardy.

[8] Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, Hekster GB. Department of Rheumatology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J. Rheumatol. 1991 Jan;18(1):72-5.

[9] Picard, Jusseaume C, Boutet M, Dualé C, Mulliez A, Aublet-Cuvellier B. Hypnosis for management of fibromyalgia. Int J Clin Exp Hypn. 2013;61(1):111-23.

[10] Haanen.

[11] Picard.

[12] Haanen.

[13] Bernardy, K., Füber, N., Klose, P., & Häuser, W. (n.d.). Efficacy of hypnosis/guided imagery in fibromyalgia syndrome - a systematic review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders BMC Musculoskelet Disord, 133-133.

[14] Haanen.

[15] Wik.

[16] Rucco V, Feruglio C, Genco F, Mosanghini R. Servizio di Terapia Fisica, Ospedale di Medicina Fisica e Riabilitazione, Udine. Autogenic training versus Erickson's analogical technique in treatment of fibromyalgia syndrome. Riv Eur Sci Med Farmacol. 1995 Jan-Feb;17(1):41-50.

[17] Whalley MG, Oakley DA. Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis. Eur J Pain. 2009 May;13(5):542-50.

[18] Castel, A., Pérez, M., Sala, J., Padrol, A., & Rull, M. (n.d.). Effect of hypnotic suggestion on fibromyalgic pain: Comparison between hypnosis and relaxation. European Journal of Pain, 463-468.

[19] Hilgard, E., & Hilgard, J. (1975). Hypnosis in the relief of pain (pp. 27-28). Los Altos, Calif.: W. Kaufmann.

[20] Ewin DM, “Relieving suffering—and pain—with hypnosis” Geriatrics. 1978 Jun; 33 (6): 87-9.

[21] Martínez-Valero.

[22] Castel, A., Cascón, R., Padrol, A., Sala, J., & Rull, M. (n.d.). Multicomponent Cognitive-Behavioral Group Therapy With Hypnosis for the Treatment of Fibromyalgia: Long-Term Outcome. The Journal of Pain, 255-265.

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