Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis

Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, 95% confidence intervals) for pain intensity (0-100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: -8.2 -11.8, -1.9; medical procedures/surgical pain: -6.9 -10.4, -3.3; burn wound care: -8.8 -13.8, -3.9). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (-11.5 -19.7, 3.3) but not postsurgery pain (-2.0 -7.8, 3.7). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (-2 -3.7, -0.3). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (-13.2, -22.5, -3.8). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted.