Background: Patients with severe chronic diseases and advanced cancer receiving palliative care, have a complex range of pain and anxiety that can arise early in the course of illness. We studied two groups of patients with severe chronic diseases who participated in a nonrandomized clinical trial of early integration of clinical hypnosis in palliative care versus standard pharmacological care. The purpose of this investigation was to evaluate whether a long-term intervention of 2 years with clinical hypnosis and self-hypnosis as an adjuvant therapy in chronic pain and anxiety, is more effective than pharmacological therapy alone.
Methods: The study was performed at the Center of Anesthesiology, Intensive Care and Pain Therapy at the University of Verona, Italy. The study population consisted of 50 patients, 25 in the hypnosis group and 25 in the control group. Fourteen men and 36 women participated in the study. Evaluations with Visual Analog Scale (VAS) for pain and Hamilton Anxiety Rating Scale (HAM-A) for anxiety and the evaluation of the use of opioids and analgesic medicines were conducted at baseline and for a long-term follow-up (after 1 and 2 years).
Results: The two groups were homogeneous in the distribution of sex, age, type and subtypes of diseases and use of opioids and analgesic medicines at baseline. The patients suffered from 3 main types of severe chronic diseases: rheumatic (n=21), neurologic (n=16) and oncologic (n=13). The VAS score at baseline was similar in both the hypnosis group and control group (mean ± standard deviation, SD: 78±16 and 77±14, respectively). The average VAS value for the hypnosis group decreased from 81.9±14.6 at baseline to 45.9±13.8 at 1-year follow-up, to 38.9±12.4 at 2-year follow-up. The average VAS value for the control group decreased from 78.5±14.8 at baseline, to 62.1±15.4 at 1-year follow-up, to 57.1±15.9 at 2-year follow-up. The variance analysis indicated that the decrease in perceived pain was more significant in the hypnosis group patients than in the control group, after 1- and 2-year follow-up (P=0.0001). The average HAM-A Hamilton anxiety score decreased from 32.6 at baseline to 22.9 and 17.1 respectively at 1-year and 2-year follow-up for the hypnosis group, but it remained almost the same in the control group (29.8, 26.1 and 28.5 at baseline, first and second year respectively). ANOVA showed that the difference between the two groups was statistically significant (P<0.0001). Univariate analysis showed a 4-times greater risk of increasing analgesic medicines and opioids in the control group (adj.IRR: 4.36; 95% CI: 1.59-12.0) after 2-year follow-up.
Conclusions: The patient group receiving hypnosis as an adjuvant therapy showed a statistically significant decrease in pain and anxiety and a significantly lower risk of increasing pharmacological pain treatment in a long term follow-up after 1 and 2 years compared to the control group. Clinical hypnosis can be considered an effective adjuvant therapy for pain and anxiety control in cancer as well as in severe chronic diseases for patients receiving palliative care.
Keywords: Clinical hypnosis; anxiety; pain; palliative care; self-hypnosis; severe chronic illnesses.