Efficacy of a combination of hypnosis and transcutaneous electrical nerve stimulation for chronic non-cancer pain: A randomized controlled trial

Louise Tonye-Geoffroy, Stéphanie Mauboussin Carlos, Sophie Tuffet, Hélène Fromentin, Laurence Berard, Judith Leblanc, Françoise Laroche, Louise Tonye-Geoffroy, Stéphanie Mauboussin Carlos, Sophie Tuffet, Hélène Fromentin, Laurence Berard, Judith Leblanc, Françoise Laroche

Abstract

Background: Chronic non-cancer pain, which persists for at least three months, seriously affects quality of life. Chronic non-cancer pain patients are usually managed by a multidisciplinary team using pharmacological and non-pharmacological strategies. Nurses perform transcutaneous electrical nerve stimulation (TENS) and hypnosis, which are widely used in France for the treatment of chronic pain in pain departments.

Objective: To assess pain relief at three months, comparing a simultaneous combination of hypnosis and TENS (intervention) with TENS alone (control).

Design: Randomized controlled trial.

Methods: Patients aged 18-80 years, suffering from chronic peripheral neuropathic and/or nociceptive non-cancer pain were included (September 2013 to May 2017) and followed for six months. The primary outcome was the pain intensity difference (by visual analog scale score) between month 3 and baseline. The secondary outcomes, assessed at months 3 and 6, were SF36 score, analgesics consumption and number of TENS sessions performed at home (last seven days).

Results: Seventy-two patients were included, suffering from a combination of chronic non-cancer nociceptive and neuropathic pain, with a mean pain intensity of about sixty out of a hundred. The results show an important pain reduction (forty percent) in both groups at 3 months. No significant difference was observed between the control and intervention groups. Similarly, SF36 score, change in analgesic intake and patient compliance did not differ significantly between groups.

Conclusions: This is the first randomized controlled study showing a decrease of pain intensity and a high level of compliance with transcutaneous electrical nerve stimulation alone or associated to hypnosis. The combination does not seem to be more efficient than transcutaneous electrical nerve stimulation alone. Chronic non-cancer pain remains a major issue and a substantial proportion of patients do not appear to benefit from interventions.

Impact: This study increases our understanding of the combination of two non-pharmacological methods in chronic non-cancer pain patients. The combination of the two non-pharmacological strategies did not appear to be more efficient than one alone. Further research on non-pharmacological treatments targeting to patient's characteristics are needed to find appropriate strategies in patients with complex multidimensional pain conditions. Clinical Trial Number: NCT01944150 (Sept. 17, 2013).

Keywords: chronic non-cancer pain; hypnosis; nurse caring; transcutaneous electrical nerve stimulation.

Conflict of interest statement

None.

© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Study procedures. D, day; NB, patient notebook; PGIC, patients' global impression of change scale; SF36, 36‐item short‐form quality‐of‐life scale; T, Transcutaneous electrical nerve stimulation (TENS) session with the nurse; T + H, TENS and hypnosis session with the nurse; Ts, self‐administered TENS session; Ts + H, self‐administered TENS and hypnosis with the nurse; VAS, visual analog scale [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Flow diagram [Colour figure can be viewed at wileyonlinelibrary.com]

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