Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220059-en
Brazilian Journal of Pain
Original Article

Effects of specific hypnotic suggestions on mechanical and thermal sensitivity of healthy volunteers: randomized and double-blind study

Efeito de sugestões hipnóticas específicas sobre a nocicepção mecânica e térmica em voluntários saudáveis: estudo randomizado e duplo-cego

Victória Regina da Silva Oliveira; Inaeh de Paula Oliveira; Beatriz Magalhães Eng; Manoel Jacobsen Teixeira; Fabio Puentes; Camila Squarzoni Dale

http://dx.doi.org/10.5935/2595-0118.20220059-en BrJP, vol.5, n4, p.320-331, 2022
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Abstract

BACKGROUND AND OBJECTIVES: Hypnotic suggestions for hypoalgesia or analgesia are efficient for relieving different pain conditions, presenting few or no side effects. However, little is known about its direct effect on the modulation of peripheral nociception. The goal of this study was to evaluate the mechanical and thermal response after specific hypnotic suggestions in healthy volunteers.
METHODS: This is a randomized double-blinded controlled trial that aimed to evaluate both mechanical and thermal nociception after specific hypnotic suggestions in healthy volunteers. For this, twenty-seven participants were enrolled, according to the following eligibility criteria: age between 18-65 years and absence of pain complaints or psychological disorders. After signed Free Informed Consent Term (FICT) the participants were divided by a computer-generated randomization in three groups: sham group (no induction of hypnosis), hypnosis-induced pain group and hypnosis-induced analgesia group. Susceptibility to hypnosis was assessed through the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility and outcomes included evaluation of questionnaires (Hospital Anxiety and Depression Scale and Short Form Brief Pain Inventory) as well as the examination of mechanical and thermal nociception through the Quantitative Sensory Testing (QST), a tool widely used to investigate somatosensory sensitivity by assessing functions of small A-δ and C nerve sensory fibers, before and after specific hypnotic suggestion for pain and analgesia made by a qualified hypnotherapist.
RESULTS: Data demonstrated that specific hypnotic suggestions induced significant changes in mechanical and thermal sensitivity. The pain group revealed an increase in mechanical hyperalgesia and allodynia, while the analgesia group increased pain thresholds to thermal stimulations, being conditioned to withstand temperature changes after hypnosis, demonstrating a modulatory effect for both pain and analgesia sensations in healthy volunteers.
CONCLUSION: The evidence presented in this study supports the use of the hypnosis technique as an auxiliary tool in clinical practice.
HIGHLIGHTS
• Specific hypnotic suggestions can modulate peripheral nociception in healthy subjects.
• Data show a modulatory effect for both pain and analgesia sensations.
• Hypnosis can be considered a feasible technique for the clinical pain management.

Keywords

Analgesia, Hypnosis, Pain, Quantitative sensory test.

Resumo

JUSTIFICATIVA E OBJETIVOS: Sugestões hipnóticas de hipoalgesia ou analgesia são eficientes para aliviar diferentes quadros álgicos, apresentando poucos ou nenhum efeito colateral. No entanto, pouco se sabe sobre seu efeito direto na modulação da nocicepção periférica. O objetivo deste estudo foi avaliar a resposta mecânica e térmica após sugestões hipnóticas específicas em voluntários saudáveis.
MÉTODOS: Este é um estudo randomizado e duplo-cego que visou avaliar a nocicepção mecânica e térmica após sugestões hipnóticas específicas em voluntários saudáveis. Para isso, vinte e sete participantes foram selecionados, de acordo com os seguintes critérios de elegibilidade: idade entre 18 e 65 anos e ausência de distúrbios psicológicos e de queixas de dor. Após a assinatura do Termo de Consentimento Livre e Esclarecido (TCLE), os participantes foram divididos por randomização gerada por computador em três grupos: grupo sham (sem indução de hipnose), grupo dor induzida por hipnose e grupo analgesia induzida por hipnose. A suscetibilidade à hipnose foi avaliada através da escala Waterloo-Stanford Group C (WSGC) de suscetibilidade hipnótica e os resultados incluíram a avaliação de questionários (Escala Hospitalar de Ansiedade e Depressão e Inventário Breve de Dor), bem como o exame de nocicepção mecânica e térmica através do Teste Sensorial Quantitativo (QST), uma ferramenta amplamente utilizada para investigar a sensibilidade somatossensorial por meio da avaliação das funções das fibras sensoriais finas dos nervos A-δ e C, antes e após sugestão hipnótica específica para dor e analgesia aplicada por um hipnoterapeuta qualificado. 
RESULTADOS: Os dados mostraram que as sugestões hipnóticas específicas induziram mudanças significativas na sensibilidade mecânica e térmica dos indivíduos. O grupo dor revelou aumento da hiperalgesia mecânica e da alodinia, enquanto o grupo analgesia aumentou os limiares de dor por estímulos térmicos, sendo condicionado a suportar mudanças de temperatura após a hipnose, demonstrando efeito modulador tanto para as sensações de dor quanto de analgesia em voluntários saudáveis. 
CONCLUSÃO: As evidências apresentadas neste estudo sustentam o uso da técnica de hipnose como ferramenta auxiliar na prática clínica.
DESTAQUES
• Sugestões hipnóticas específicas podem modular a nocicepção periférica em sujeitos saudáveis. 
• Os dados mostram um efeito modulador tanto para as sensações de dor quanto de analgesia. 
• A hipnose pode ser considerada uma técnica viável para o manejo clínico da dor.

Palavras-chave

Analgesia, Dor, Hipnose, Teste quantitativo sensorial.

References

1 Facco E, Casiglia E, Zanette G, Testoni I. On the way of liberation from suffering and pain: role of hypnosis in palliative care. Ann Palliat Med. 2018;7(1):63-74.

2 Jensen M P, Patterson DR. Hypnotic approaches for chronic pain management: clinical implications of recent research findings. Am Psychol. 2014;69(2):167-77.

3 Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007;8(4):359-75.

4 Bernardy K, Füber N, Klose P, Häuser W. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome--a systematic review and meta-analysis of controlled trials. BMC Musculoskelet Disord. 2011;15;12:133.

5 Wetering EJ, Lemmens KM, Nieboer A P, Huijsman R. Cognitive and behavioral interventions for the management of chronic neuropathic pain in adults--a systematic review. Eur J Pain. 2010;14(7):670-81.

6 Tompson T, Terhune DB, Oram C, Sharangparni J, Rouf R, Solmi M, Veronese N, Stubbs B. The effectiveness of hypnosis for pain relief: A systematic review and meta-a-nalysis of 85 controlled experimental trials. Neurosci Biobehav Rev. 2019;99:298-310.

7 Milling LS, Valentine KE, LoStimolo LM, Nett AM, McCarley HS. Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis. Int J Clin Exp Hypn. 2021;69(3):297-322.

8 Cardeña E. The phenomenology of deep hypnosis: quiescent and physically active. Int J Clin Exp Hypn. 2005;53(1):37-59.

9 Cardeña E, Jönsson P, Terhune DB, Marcusson-Clavertz D. The neurophenomenology of neutral hypnosis. Cortex. 2013;49(2):375-85.

10 Kiernan BD, Dane JR, Phillips LH, Price DD. Hypnotic analgesia reduces R-III nociceptive reflex: further evidence concerning the multifactorial nature of hypnotic analgesia. Pain. 1995;60(1):39-47.

11 Castel A, Pérez M, Sala J, Padrol A, Rull M. Effect of hypnotic suggestion on fbromyalgic pain: comparison between hypnosis and relaxation. Eur J Pain. 2007;11(4):463-8.

12 Zachariae R, Andersen OK, Bjerring P, Jørgensen MM, Arendt-Nielsen L. Effects of an opioid antagonist on pain intensity and withdrawal reflexes during induction of hypnotic analgesia in high- and low-hypnotizable volunteers. Eur J Pain. 1998;2(1):25-34.

13 Facco E, Pasquali S, Zanette G, Casiglia E. (2013). Hypnosis as sole anaesthesia for skin tumour removal in a patient with multiple chemical sensitivity. Anaesthesia. 2013;68(9):961-5.

14 Provençal SC, Bond S, Rizkallah E, El-Baalbaki G. Hypnosis for burn wound care pain and anxiety: A systematic review and meta-analysis. Burns. 2018;44(8):1870-81.

15 Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. Hypnosis for pain management during labour and childbirth. Cochrane Database Syst Rev. 2016;(5):CD009356.

16 Bongartz W. German norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A. Int J Clin Exp Hypn. 1985;33(2):131-9.

17 Bowers KS. Waterloo-Stanford Group Scale of Hypnotic Susceptibility, Form C: manual and response booklet. Int J Clin Exp Hypn. 1998;46(3):250-68.

18 Carli G, Manzoni D, Santarcangelo EL. Hypnotizability-related integration of perception and action. Cognitive Neuropsychology. 2008;25(7-8):1065-76.

19 Benhaiem JM, Attal N, Chauvin M, Brasseur L, Bouhassira D. Local and remote effects of hypnotic suggestions of analgesia. Pain. 2001;89(2-3):167-73.

20 Paoletti G, Varanini M, Balocchi R, Morizzo C, Palombo C, Santarcangelo EL. Cardiovascular and respiratory correlates of deep nociceptive stimulation, suggestions for analgesia, pain imagery and cognitive load as a function of hypnotizability. Brain Res Bull. 2010;82(1-2):65-73.

21 Gay MC, Philippot P, Luminet O. Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation. Eur J Pain. 2002;6(1):1-16.

22 Arendt-Nielsen L, Yarnitsky D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. J Pain. 2009;10(6):556-72.

23 Siviero M, Teixeira MJ, de Siqueira JT, Siqueira SR. Somesthetic, gustatory, olfactory function and salivary fow in patients with neuropathic trigeminal pain. Oral Dis. 2010;16(5):482-7.

24 Saunders JB, Aasland OG, Babor T F, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993;88(6):791-804.

25 Castro MM, Quarantini L, Batista-Neves S, Kraychete DC, Daltro C, Miranda-Scippa A. Validity of the hospital anxiety and depression scale in patients with chronic pain. Rev Bras Anestesiol. 2006;56(5):470-7.

26 Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2011;19(4):505-11.

27 Patterson DR, Jensen M P. Hypnosis and clinical pain. Psychol Bull. 2003;129(4):495-521.

28 Rolke R, Baron R, Maier C, Tölle TR, Treede -DR, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihöfner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123(3):231-43.

29 Mücke M, Cuhls H, Radbruch L, Baron R, Maier C, Tölle T, Treede RD, Rolke R. Quantitative sensory testing (QST). English version. Schmerz. 2021;35(Suppl 3)153-60.

30 de Melo DM, Barbosa AJ. (2015). O uso do Mini-Exame do Estado Mental em pesquisas com idosos no Brasil: uma revisão sistemática. Cien Saude Colet. 2015;20(12):3865-76.

31 Velasco R, Videla S, Villoria J, Ortiz E, Navarro X, Bruna J. Reliability and accuracy of quantitative sensory testing for oxaliplatin-induced neurotoxicity. Acta Neurol Scand. 2015;131(5):282-9.

32 Nash MR, Barnier AJ. (Eds.) The Oxford Handbook of Hypnosis: Theory, Research and Practice. New York: Oxford University Press. Reviewed by Eric K. Willmarth, PhD, Saybrook Graduate School and Research Center, San Francisco, CA. 2008.

33 Conversa G, Facco E, Leoni MLG, Buonocore M, Bagnasco R, Angelini L, Demartini L, Spiegel D. Quantitative Sensory Testing (QST) Estimation of regional cutaneous thermal sensitivity during waking state, neutral hypnosis, and temperature specific suggestions. Int J Clin Exp Hypn. 2019;67(3):364-81.

34 Caratelli E, Menzocchi M, Carli G, Fontani G, Santarcangelo E. Is high hypnotizability a trouble in balance control? Eur J Appl Physiol. 2010;108(1):201-6.

35 Menzocchi M, Paoletti G, Carli G, Scattina E, Manzoni D, Santarcangelo EL. Hypnotizability -related effects of vestibular impairment on posture and locomotion. Int J Clin Exp Hypn. 2010;58(3):329-44.

36 Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg. 2002;94(6):1639-45.

37 Vanhaudenhuyse A, Boly M, Balteau E, Schnakers C, Moonen G, Luxen A, Lamy M, Degueldre C, Brichant J F, Maquet P, Laureys S, Faymonville ME. Pain and non-pain processing during hypnosis: a thulium-YAG event-related fMRI study. Neuroimage. 2009;47(3):1047-54.

38 Brunoni AR, Mofa AH, Fregni F, Palm U, Padberg F, Blumberger DM, Daskalakis ZJ, Bennabi D, Haffen E, Alonzo A, Loo CK. Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. Br J Psychiatry. 2016;208(6):522-31.

39 Kramer S, Zims R, Simang M, Rüger L, Irnich D. Hypnotic relaxation results in elevated thresholds of sensory detection but not of pain detection. BMC Complement Altern Med. Dec 2014;15;14:496.

40 Derbyshire S W, Whalley MG, Stenger VA, Oakley DA. Cerebral activation during hypnotically induced and imagined pain. Neuroimage. 2004;23(1):392-401.

41 Jiang H, White M P, Greicius MD, Waelde LC, Spiegel D. Brain activity and functional connectivity associated with hypnosis. Cereb Cortex. 2017;27(8):4083-93.

42 Baad-Hansen L, Abrahamsen R, Zachariae R, List T, Svensson P. Somatosensory sensitivity in patients with persistent idiopathic orofacial pain is associated with pain relief from hypnosis and relaxation. Clin J Pain. 2013;29(6):518-26.
 

Submitted date:
08/22/2022

Accepted date:
11/14/2022

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