A self-hypnosis training program has been developed based on the experience of the
program developed in medical oncology (phase I). The aim of this project is to analyze
the self-hypnosis practice of chronic pain patients, and to evaluate the training program
provided in pain management clinics, by means of qualitative research interviews. It is
therefore situated at level Ib of the ORBIT model: Program refinement. Through this
study, the investigators also wish to evaluate the effects of the intervention on users.
In this context, the investigators hypothesize that patients who practice self-hypnosis
show an improvement in their quality of life and a reduction in anxiety and pain levels.
At this level, there are two objectives :
To assess the effect of hypnosis intervention on change in 24h pain between T0
(pre-intervention) and T3 (3-month follow-up).
To assess the effects of hypnosis intervention on (i) change in 24h pain between T0
and T4 (6-month follow-up), (ii) changes from T0 in measures of the functional
impact of pain, (iii) changes from T0 in anxiety-depression scores and (iv) changes
from T0 in quality of life.
Methods
Intervention : Self-hypnosis training Based on the exercises from the oncology pilot
project, the investigators redefined a program applicable to the pain clinic (phase I
ORBIT). To do so, the investigators maintained the stress and pain management exercises
and removed the exercises relating to the management of secondary symptoms of cancer
treatment. This new self-hypnosis training program is based on four complementary
exercises: two on stress management and two on pain perception. Each exercise is
organized according to the same hypnotic framework: induction, deepening, hypnotic work,
post-hypnotic suggestions and return to the waking state. Each exercise is derived from
the oncology study and has been enhanced by protocols drawn from the experience of other
hypnotherapists.
The first exercise involves letting go of the emotions and stress associated with the
painful condition, using the rucksack technique: a metaphor enabling the patient to empty
an imaginary bag that is heavy and preventing him or her from moving forward. The weight
of the bag represents the negative emotions, losses and pain that weigh down the
patient's daily life. The second exercise focuses on the notion of acceptance, in the
same way as cognitive-behavioral acceptance therapies. Suggestions and metaphors used in
the work include the ideas of doing nothing, letting oneself be carried away and
meditating in a pleasant place. The third exercise uses visualization techniques to
modify pain. The modification concerns the form and intensity of the pain. Finally, the
fourth exercise is derived from Rossi's protocol, which proposes mobilizing the patient's
resources through levitation and catalepsy techniques. This technique focuses on the body
and aims to restore confidence in the body in people with pain.
Participants: Sixty participants from pain clinic of our institution will be included in
these research. They will be randomized in the two group of our study : hypnosis Vs
Psychoeducation/CBT.
Procedures: Five measurement times will be used: T1-Start of research project; T2 -
Mi-intervention, T3 - End of intervention, T4 - 3 months follow up, T5 - 6 months follow
up. At each of these times, participants will complete self-administered questionnaires
(pain, anxiety-depression and quality of life). The investigators will also collect a
self-hypnosis practice diary, which the patient will complete during the course of the
study: each week, the patient will note each practice in his or her diary, indicating the
time and duration of the practice.
Measures: 24 h pain will be measured using the NRS from 0 to 10 (0 = no pain, 10 = the
most horrible pain participants can imagine). The functional impact of pain will be
measured using the Brief Pain Inventory (BPI). This 9-item scale assesses (1) the
presence of pain, (2) the location of the pain, (3) the most intense pain, (4) the least
intense pain, (5) the pain felt in general, (6) the pain felt at the moment on a NRS of 0
to 10. It also documents (7) the treatments used and (8) the relief provided over the
last 24 hours. Item (9) concerns a subscale that documents the extent to which pain has
interfered with 7 different activity and response domains (e.g., general activity, mood,
relationships with others) over the last 24 hours, using an NRS from 0 to 10 (0 = pain
does not interfere with this activity, 10 = pain interferes completely).
Anxiety-depression will be assessed using the Hospital anxiety and depression scale
(HADS). This scale was developed for general practice patients and comprises 2 subscales
of 7 items each, measuring anxiety and depression respectively. Each item is scored
between 0 and 3. The score of each subscale is obtained by summing the scores of the 7
items, with a total score thus ranging from 0 to 21. The scale has been translated and
validated in French.
Quality of life will be assessed by the SF-36 (36-Item Short Form Survey), which
comprises 36 questions covering eight health domains: (1) Limitations in physical
activities due to health problems; (2) Limitations in social activities due to physical
or emotional problems; (3) Limitations in usual activities due to physical health
problems; (4) Body pain; (5) General mental health (psychological distress and
well-being); (6) Limitations in usual activities due to emotional problems; (7) Vitality
(energy and fatigue); (8) General perception of health. The scores for the various
domains are converted and pooled using a scoring key, to obtain a total score indicating
a range of quality of life from low to high. Two component scores can also be tallied: a
summary of the physical component and a summary of the mental component. Secondary
measures concern hypnosis practice. The level of practice will be collected from the
logbook. Participants will also be asked to self-assess their perceived levels of
relaxation using a VAS-10 scale (0 = "not at all relaxed"; 10 = "very relaxed") before
and after practice.
Analyses: Primary and secondary outcome measures will be compared across the three time
points using repeated measures ANOVAs, and effect sizes will be calculated to document
changes associated with the intervention. The investigators will also conduct
correlations between self-hypnosis practice and scores on the measures taken. The
investigators expect to see relationships between significant levels of practice and
improvements in quality of life, and reductions in anxiety and pain levels.
