Publications
APS Bulletin • Volume 7, Number 2, March/April 1997
Resource Review
John D. Loeser, MD, Department Editor
Hypnosis and Suggestion in the Treatment of Pain: A Clinical Guide
Reviewed by Russell Hawkins, PhD
J. Barber, W.W. Norton, New York, 1996, $45, 413 pages, ISBN 0-393-70216-2
This book should be required reading for all newcomers to the application of hypnosis to pain control, and it deserves to be read by even the most experienced clinicians.
The first of the book's three sections, "Orientation to Basic Issues," is particularly valuable to newcomers. It includes summaries of medical and psychological evaluations of the pain patient which, although brief, include appropriate references to more detailed treatments of the subject.
For the experienced hypnosis clinician or researcher, the first section is frustrating because it mentions several important areas without providing the depth of discussion warranted. One example is the inadequate treatment of the controversy regarding the relationship between measured hypnotizability and therapeutic outcome. A second is the claim that relaxation per se is generally not useful for treating pain; this claim, which might well be justified, deserves more than a passing reference, given that relaxation training is commonly advocated for pain. A third example concerns self-hypnosis. While interest in learning self-hypnosis and willingness to use it are described as "a valuable index of the patient's motivation for actively participating in recovery," it is also claimed that most patients are resistant to self-hypnosis (p. 94). Given this conflict, greater attention to self-hypnosis training approaches would have been desirable.
The second section reviews syndromes of special interest (i.e., cancer pain, headache, dental pain, painful medical procedures, and burn pain). Interesting and useful case studies are supplied to illustrate advice or treatment approaches. The headache chapter provides treatment suggestions but lacks sufficient emphasis on data from controlled studies, which would be useful to convince practitioners and skeptics alike of the benefits to be expected. The dental pain chapter fails to clarify or disentangle adequately an apparent confusion between placebo and hypnotic responses. Bejenke's chapter on painful medical procedures provides a particularly good example of how to integrate hypnotic style into routine medicine (i.e., without focusing on an induction). There is sufficient detail to supply guidance to newcomers.
Patterson's chapter on burns is the only chapter that sufficiently stresses the absence of controlled outcome studies. He notes that many claims of success with hypnotic analgesia remain at the level of anecdote and case study (they may have validity, but the necessity remains to demonstrate validity by favorable outcome studies). Patterson states, "The results [for the hypnotic treatment of burn pain] are not nearly as dramatic as those reported in the early clinical literature" (p. 277). This realistic assessment contrasts with the claim in the chapter on headaches that every one of the author's migraine patients had benefited from hypnosis treatment (p. 161). This result may have had more to do with sample size or other issues than to with remarkable capacity of hypnosis to relieve migraines.
Section 3 covers, in a particularly compassionate manner, the pain problems of children and elderly people. The chapter on treatment failures is an unusual ending to the book. It rectifies a tendency toward overly optimistic treatment expectations elsewhere in the text.
The use of case studies is both a strength and a weakness. Reliance on case studies rather than on clinical trials means that the art of treatment is emphasized more than the science. I would have preferred to see more emphasis on outcome studies and the inclusion of more of the experimental literature (as in, for example, Hilgard and Hilgard's classic text, Hypnosis in the Relief of Pain). The strength of the case studies is in showing just how potent hypnosis may be on occasion and in providing guidance and ideas for other clinicians. Despite the foregoing quibbles with the content, I recommend that anyone with a serious or even a passing interest in the hypnotic treatment of pain should buy this well-written book.
Russell Hawkins, PhD, is a clinical psychologist in the Pain Management Unit at Flinders Medical Center in Adelaide, South Australia, Australia.