Original ResearchDefinition and refinement of HYlaDO, a self-hypnosis training program for chronic pain management: A qualitative exploratory study
Introduction
Chronic pain refers to pain that persists for more than 6 months1 and as a condition in itself rather than a symptom.2 We estimated that one in four Canadians had chronic pain.2 This equates to 7.63 million people aged over 15 years old in 2019.3 In addition to the suffering and emotional distress for those affected,1 there are many direct (e.g., medication) and indirect (e.g., reduced productivity) monetary costs associated with the chronic pain. According to the Canadian Pain Task Force (2020), these costs in Canada total $38.3 to $40.4 billion in 2019. Chronic pain is complex to treat and accessibility to treatment, including multidisciplinary interventions, is low.2 For example, in Quebec, pain clinics are overwhelmed with demands, with an average wait of five years.4 This suggests that care for chronic pain sufferers through specific interventions (i.e., preventive, or rapid intervention) should be widely considered.
In chronic pain treatment, although opioid use is common, it is not without adverse effects.5 Potential harms include the development of opioid use disorders, overdoses, and deaths.5 Consequently, it is desirable to reduce dependence on drug treatments in favor of protocols that focus on non-pharmacological approaches. Among established options for non-pharmacological interventions in chronic pain management, the literature has identified mindfulness meditation and acceptance therapy as effective treatments.6,7 These effective treatments encourage the patient to focus on the present moment6 as well as to accept painful bodily sensations.7 Another type of intervention that aligns with non-pharmacological treatments that is distinct from the two previously mentioned is hypnosis. Suggestion and dissociation techniques, used in hypnotic treatments, allow for longer-term effects than other interventions.1
Studies have primarily focused on the analgesic effects of hypnosis in the treatment of chronic pain with hypnosis.8,9 To this end, a literature review using hypnosis as a treatment identified significant reductions in pain (hypnoanalgesia) in people with multiple chronic pain conditions (e.g., low back, cancer, fibromyalgia, arthritis).1 In the 13 studies reviewed, interventions using hypnosis were generally more effective than conventional treatment (e.g., physical therapy) and the effects lasted several months.1 However, there are other estimable and important effects of the use of hypnosis for patients with chronic pain. Among the most notable effects are reduced anxiety, improved sleep and improved quality of life.8 Therefore, using techniques associated with these targets would be beneficial in the development of an intervention for chronic pain involving hypnosis.
Another aspect of interest in a program using hypnosis is the ability to have an autonomous practice. Self-hypnosis, a practice in which one reaches the hypnotic trance state by oneself, facilitates this. Moreover, it allows one to benefit from the effects of hypnosis over a longer period.10 Training is often done by providing instructions for self-hypnosis and recorded hypnosis sessions.10 However, it is important to note that many questions remain regarding the practice of self-hypnosis. Indeed, the importance and best ways of providing instructions for practicing self-hypnosis have not been clarified by scientific studies.1 Also, the frequency necessary for this practice to be optimal in its effectiveness remains unknown.1 In short, several dimensions of self-hypnosis need to be further explored to optimize this practice.
A self-hypnosis training program has been tested in oncology to answer these questions. This program aimed to implement an intervention to improve breast cancer patients’ quality of life.11 Cognitive-behavioral techniques and self-hypnosis training were used during 15 × 2 h sessions to increase anxiety regulation and manage other physical symptoms such as nausea, hot flashes, and pain. The results of this study conducted with 159 participants (77 in the control group) showed a significant decrease in post-practice anxiety and following exposure to anxiety triggers that was accompanied by a lowering of heart rate at anxiety-provoking moments of the task.11 Better daily anxiety regulation was reported compared to the control group, which had clinical support based on experience sharing with a peer group and a therapist, as well as a greater decrease in psychological distress associated with fear of cancer recurrence.11 With its efficacy documented, this pilot study conducted in medical oncology can serve as a benchmark. Thus, it has been used as the foundation for a new self-hypnosis training program that aims to improve self-hypnosis training practices in a chronic pain setting.
HYlaDO (Hypnosis of pain in French, HYpnose de la DOuleur) is a new self-hypnosis training program for chronic pain management. This study aimed to (1) define the design of HYlaDO, and (2) assess it by gathering patients’ feedback and recommendations for improvement. Patients’ feedback allowed for the intervention program's refinement as well as to continue the program transfer by moving to future phases of development.
Section snippets
The ORBIT model
The Obesity-Related Behavioral Intervention Trials12 model provides a methodological framework to structure the development and evaluation of a new intervention program.13 This model has four distinct phases. Phase I consists of defining the program and includes two stages: definition of the design (Ia) which consists of establishing the scientific basis for a treatment and the specifics of that treatment (topics, progress milestones, treatment components, and investigation of behavioral
Participants
Out of the 20 participants invited, 15 participants agreed to participate and were included. Ten were women and 5 were men. The average age of the participants was 54.7 years. Three were single, 4 were divorced and/or separated, 4 were married, and 4 were in a relationship. Three participants had no children, 2 had one child, 5 had two children, 4 had three children, and one did not respond. Four participants had a high school education, 2 had a college education, 7 had a university education,
Discussion
This qualitative study aimed to collect the opinions and recommendations of people suffering from chronic pain on a self-hypnosis training program for pain management. The present study is a refinement and preliminary phase (phase Ib) of the ORBIT model. The results consist of six themes extracted from the verbatims of semi-structured interviews. Based on these results areas for improvement have been developed.
The first theme concerned the adequacy of the self-hypnosis training program. Most of
Conclusion
In conclusion, this study's results support the social validity of the “HYlaDO” program. Participants reported in their interviews that their main objectives such as pain reduction, better stress management, and easier sleep, were improved as a result of the program. Also, recommendations for improvements to the program design were made and could be implemented to improve the acceptability to patients suffering from chronic pain. This study is part of the Phase Ib of the ORBIT model. After the
Funding
Support for this research came from: Fonds de Recherche du Québec – Programme Engagement citoyen (recipients: David Ogez, Maryse Aubin).
Acknowledgments
The authors wish to thank all the patients who took part in this study and helped improve the HYlaDO program. Thank you to Jennifer Aramideh for his proofreading of the English version of this manuscript.
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