Hypnotic relaxation results in elevated thresholds of sensory detection but not of pain detection

Sybille Kramer, Rolf Zims, Michael Simang, Linda Rüger, Dominik Irnich, Sybille Kramer, Rolf Zims, Michael Simang, Linda Rüger, Dominik Irnich

Abstract

Background: Many studies show an effectiveness of hypnotic analgesia. It has been discussed whether the analgesic effect is mainly caused by the relaxation that is concomitant to hypnosis. This study was designed to evaluate the effects of hypnotic relaxation suggestion on different somatosensory detection and pain thresholds.

Methods: Quantitative sensory testing (QST) measurements were performed before and during hypnosis in twenty-three healthy subjects on the dorsum of the right hand. Paired t-test was used to compare threshold changes. The influence of hypnotic susceptibility was evaluated by calculating correlation coefficients for threshold changes and hypnotic susceptibility (Harvard group scale).

Results: During hypnosis significantly changed somatosensory thresholds (reduced function) were observed for the following sensory detection thresholds: Cold Detection Threshold (CDT), Warm Detection Threshold (WDT), Thermal Sensory Limen (TSL) and Mechanical Detection Threshold (MDT). The only unchanged sensory detection threshold was Vibration Detection Threshold (VDT). No significant changes were observed for the determined pain detection thresholds (Cold Pain Thresholds, Heat Pain Thresholds, Mechanical Pain Sensitivity, Dynamic Mechanical Allodynia, Wind-up Ratio and Pressure Pain Threshold). No correlation of hypnotic susceptibility and threshold changes were detected.

Conclusion: Hypnotic relaxation without a specific analgesic suggestion results in thermal and mechanical detection, but not pain threshold changes. We thus conclude that a relaxation suggestion has no genuine effect on sensory pain thresholds.

Trial registration: ClinicalTrials.gov, Identifier: NCT02261155 (9th October 2014).

Figures

Figure 1
Figure 1
Quantitative sensory testing (QST) thresholds before and during hypnosis. *indicates statistical significance.
Figure 2
Figure 2
Distribution of the significantly changed somatosensory thresholds during hypnosis dependent on the hypnotic susceptibility level (achieved points in the Harvard Group Scale Test). No correlation of the hypnotizability to the threshold changes was observed.

References

    1. Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007;8(4):359–375. doi: 10.1111/j.1526-4637.2007.00312.x.
    1. Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage. 2000;20(5):374–387. doi: 10.1016/S0885-3924(00)00190-1.
    1. Bernardy K, Fuber N, Klose P, Hauser W. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome–a systematic review and meta-analysis of controlled trials. BMC Musculoskelet Disord. 2011;12:133. doi: 10.1186/1471-2474-12-133.
    1. Carlson LE, Bultz BD. Mind-body interventions in oncology. Curr Treat Options Oncol. 2008;9(2–3):127–134. doi: 10.1007/s11864-008-0064-2.
    1. Wetering EJ, Lemmens KM, Nieboer AP, Huijsman R. Cognitive and behavioral interventions for the management of chronic neuropathic pain in adults–a systematic review. Eur J Pain. 2010;14(7):670–681. doi: 10.1016/j.ejpain.2009.11.010.
    1. Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related side effects. Semin Clin Neuropsychiatry. 2003;8(4):253–275.
    1. 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. doi: 10.1053/eujp.2001.0263.
    1. Zacenteriae R, Bjerring P. Laser-induced pain-related brain potentials and sensory pain ratings in high and low hypnotizable subjects during hypnotic suggestions of relaxation, dissociated imagery, focused analgesia, and placebo. Int J Clin Exp Hypn. 1994;42(1):56–80. doi: 10.1080/00207149408409341.
    1. Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychol Bull. 2003;129(4):495–521. doi: 10.1037/0033-2909.129.4.495.
    1. 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. doi: 10.1016/0304-3959(94)00134-Z.
    1. Castel A, Perez M, Sala J, Padrol A, Rull M. Effect of hypnotic suggestion on fibromyalgic pain: comparison between hypnosis and relaxation. Eur J Pain. 2007;11(4):463–468. doi: 10.1016/j.ejpain.2006.06.006.
    1. Zacenteriae R, Andersen OK, Bjerring P, Jorgensen 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. doi: 10.1016/S1090-3801(98)90043-X.
    1. Facco E, Pasquali S, Zanette G, Casiglia E. Hypnosis as sole anaesthesia for skin tumour removal in a patient with multiple chemical sensitivity. Anaesthesia. 2013;68(9):961–965. doi: 10.1111/anae.12251.
    1. Carli G, Manzoni D, Santarcangelo EL. Hypnotizability-related integration of perception and action. Cogn Neuropsychol. 2008;25(7–8):1065–1076. doi: 10.1080/02643290801913712.
    1. Benhaiem JM, Attal N, Chauvin M, Brasseur L, Bouhassira D. Local and remote effects of hypnotic suggestions of analgesia. Pain. 2001;89(2–3):167–173. doi: 10.1016/S0304-3959(00)00359-6.
    1. Rainville P, Carrier B, Hofbauer RK, Bushnell MC, Duncan GH. Dissociation of sensory and affective dimensions of pain using hypnotic modulation. Pain. 1999;82(2):159–171. doi: 10.1016/S0304-3959(99)00048-2.
    1. 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. doi: 10.1016/j.brainresbull.2010.03.003.
    1. Houle M, McGrath PA, Moran G, Garrett OJ. The efficacy of hypnosis- and relaxation-induced analgesia on two dimensions of pain for cold pressor and electrical tooth pulp stimulation. Pain. 1988;33(2):241–251. doi: 10.1016/0304-3959(88)90096-6.
    1. Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner 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):231–243. doi: 10.1016/j.pain.2006.01.041.
    1. Rolke R, Magerl W, Campbell KA, Schalber C, Caspari S, Birklein F, Treede RD. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10(1):77–88. doi: 10.1016/j.ejpain.2005.02.003.
    1. Bongartz W. German norms for the Harvard Group Scale of Hypnotic Susceptibility. Form A. Int J ClinExp Hypn. 1985;33(2):131–139. doi: 10.1080/00207148508406643.
    1. Ziegler EA, Magerl W, Meyer RA, Treede RD. Secondary hyperalgesia to punctate mechanical stimuli. Central sensitization to A-fibre nociceptor input. Brain. 1999;122(Pt 12):2245–2257. doi: 10.1093/brain/122.12.2245.
    1. Greenspan JD, McGillis SL. Stimulus features relevant to the perception of sharpness and mechanically evoked cutaneous pain. Somatosens Mot Res. 1991;8(2):137–147. doi: 10.3109/08990229109144738.
    1. Slugg RM, Meyer RA, Campbell JN. Response of cutaneous A- and C-fiber nociceptors in the monkey to controlled-force stimuli. J Neurophysiol. 2000;83(4):2179–2191.
    1. Vickers AJ, Altman DG. Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001;323(7321):1123–1124. doi: 10.1136/bmj.323.7321.1123.
    1. Arendt-Nielsen L, Yarnitsky D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. J Pain. 2009;10(6):556–572. doi: 10.1016/j.jpain.2009.02.002.
    1. De Pascalis V, Magurano MR, Bellusci A. Pain perception, somatosensory event-related potentials and skin conductance responses to painful stimuli in high, mid, and low hypnotizable subjects: effects of differential pain reduction strategies. Pain. 1999;83(3):499–508. doi: 10.1016/S0304-3959(99)00157-8.
    1. Langlade A, Jussiau C, Lamonerie L, Marret E, Bonnet F. Hypnosis increases heat detection and heat pain thresholds in healthy volunteers. Reg Anesth Pain Med. 2002;27(1):43–46.
    1. Dahlgren LA, Kurtz RM, Strube MJ, Malone MD. Differential effects of hypnotic suggestion on multiple dimensions of pain. J Pain Symptom Manage. 1995;10(6):464–470. doi: 10.1016/0885-3924(95)00055-4.
    1. Roy M, Lebuis A, Peretz I, Rainville P. The modulation of pain by attention and emotion: a dissociation of perceptual and spinal nociceptive processes. Eur J Pain. 2011;15(6):641.e1-10.
    1. Ezra Y, Gotkine M, Goldman S, Adahan HM, Ben-Hur T. Hypnotic Relaxation Vs Amitriptyline for Tension-Type Headache: Let the Patient Choose. Headache. 2012;52(5):785–791. doi: 10.1111/j.1526-4610.2011.02055.x.
    1. Sharav Y, Tal M. Focused analgesia and generalized relaxation produce differential hypnotic analgesia in response to ascending stimulus intensity. Int J Psychophysiol. 2004;52(2):187–196. doi: 10.1016/j.ijpsycho.2003.10.001.
    1. Sharav Y, Tal M. Focused hypnotic analgesia: local and remote effects. Pain. 2006;124(3):280–286. doi: 10.1016/j.pain.2006.04.016.
    1. Santarcangelo EL, Paoletti G, Chiavacci I, Palombo C, Carli G, Varanini M. Cognitive modulation of psychophysical, respiratory and autonomic responses to cold pressor test. PLoS One. 2013;8(10):e75023. doi: 10.1371/journal.pone.0075023.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere