Clinical hypnosis offers a non-pharmacological approach to managing chronic pain after cancer treatment.
The majority of patients with cancer will experience pain at some point, and 39% experience chronic pain after completing treatment. Since most drugs do not completely rid patients of pain and can come with negative adverse events (AEs) non-pharmacologic interventions are needed, explained Linda Eaton, PhD, RN, AOCN.
According to research conducted by Eaton and colleagues, clinical hypnosis may be a promising way to treat pain.
“We know pharmacotherapy is our main therapy for managing pain. This is usually opioids and comes with significant adverse events,” said Eaton while presenting her findings1 at Oncology Nursing Society (ONS) 44th Annual Congress. “Mind-body interventions such as hypnosis provide cancer survivors with skills to use in managing their pain.”
The researchers recruited 40 cancer survivors being treated at a National Cancer Institute-designated cancer center who had chronic pain to test the feasibility, acceptability, and preliminary efficacy of hypnosis. Participants were randomly assigned to receive either the hypnosis (n=21 patients) or be put on the waitlist (n=19 patients). Those in the intervention group received digitally recorded, nurse-derived hypnosis that they listened to every day on an MP3 player for the first 4 weeks of the study. Each session had a different recording. For the waitlist, however, the same recording was used each time.
The majority of participants (35%; n=14) had a hematologic cancer, with breast cancer (27.5%; n=11) being the secon most common diagnosis. Seven patients (17.5%) had a diagnosis classified as "other," 12.5% of patients (n=5) had gynecologic cancers, and 7.5% (n=3) were survivors of sarcoma.
The most frequently reported cause of pain was radiation (20%; n=8), followed by multimodal (17.5%; n=7), chemotherapy (12.5%; n=5), surgery (12.5%; n=5), hormonal (2.5%; n=1), and the rest reported their cause of pain as “unknown.”
Eaton hoped that by using the MP3 recording instead of live hypnosis, the intervention would be more feasible.
“Hypnosis is rarely used in clinical care because of the cost and the need to meet with someone who is trained in clinical hypnosis,” she said. “Nurses can easily create this intervention, and patients can use it in any time, thus overcoming the barriers of cost and timing.”
Data—which included PROMIS measures and a demographic questionnaire—were recorded at baseline, week 4, and week 8 of the study. Ninety-five percent of participants on the intervention arm completed the 4-week measures, and 75% kept up with hypnosis for 8 weeks.
At baseline, individuals on the intervention group reported an average pain intensity score of 6.6 out of 10, while the waitlist had an average of 6.9. After 4 weeks, the hypnosis group saw a pain intensity decrease to an average of 6.0, while the waitlist only dropped to 6.7.
One patient on the waitlist reported that the hypnosis intervention made them feel anxious. “Anxiety is a rare side effect for hypnosis. So, when this person told me they were experiencing anxiety, I suggested that they stop,” Eaton said.
Overall, the intervention was well-received, with survivors reporting that it was helpful for relaxation, calmness, and/or better sleep. One participant commented, “… it doesn’t make the pain go away completely, but it relaxed me a little bit to focus on something other than the pain.”
Although hypnosis may offer patients a low-cost and non-pharmacologic intervention to pain, the researchers noted that more research still needs to be done.
“I decided it was worthwhile to continue looking at this intervention,” Eaton said, mentioning that a randomized controlled trial is now enrolling, that will not only evaluate the effects of clinical hypnosis on factors such as pain and anxiety, but it will also use EEG scans to see how the intervention affects survivors’ brains.
“I hope to be back here in a couple of years and say, ‘Yes. This is an efficacious intervention.’”
Eaton L, Beck S, Jensen, N. Hypnosis for Pain Relief With Cancer Survivors. Presented at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA. Abstract 5477.