THE ROLE OF CLINICAL HYPNOSIS AND SELF-HYPNOSIS TO RELIEF PAIN AND ANXIETY IN SEVERE CHRONIC ILLNESSES AND IN PALLIATIVE CARE A LONG TERM FOLLOW-UP OF TREATMENT IN A PROSPECTIVE OBSERVATIONAL NON-RANDOMIZED CONTROLLED STUDY

ABSTRACT Introduction: Patients with severe chronic diseases and advanced cancer in Palliative care, have a complex array of physical and psychosocial needs that can arise early in the course of illness. We solicited the thoughts of patients who participated in a non-randomized trial of early integration in palliative care of clinical hypnosis, versus standard pharmacological care, regarding an early palliative care group therapy. Materials and Methods: This is a nonrandomized prospective trial. We studied fifty patients: 25 in a group therapy with the hypnosis intervention as adjuvant therapy to medicines, 25 in a control group, who received only a pharmacological intervention. Evaluations with VAS for pain and HAMA scale for anxiety were conducted for a long-term follow-up, after one year and two years, and analyzed using VAS scale for pain, and Hamilton Anxiety Scale for anxiety. Results: Fifty subjects 14 men and 36 women participated to the study. The patients suffered from 3 main types of severe advanced chronic disease: rheumatic (n=21), neurologic (n=16) and cancer (n=13). Sixteen of them (32%) were administered with opioids for pain control. Half of the patients (n=25) were assigned to the group administered with the self-hypnotic protocol (hypnosis group), while the remaining 25 followed the conventional pain therapies (control group). The VAS score at baseline was similar between the hypnosis and the control group (mean ± standard deviation, sd: 78 ± 16 and 77 ± 14, respectively). After 1 year follow-up, we observed a significant decrease of pain and anxiety in the group-hypnosis compared to the control-group: the group- hypnosis had a decrease of 7 points in the Hamilton anxiety score and a decrease of 16 points in the VAS score compared to the group that had not the hypnotic treatment. Only the 16% of the patients treated with hypnosis had to increase opioids, but the 52% of the control group, had to increase opioids. Who practice hypnosis has a less risk of 60% to have to increase the opioids therapy, compared with the control group. After 2 years, we have a total of 13 drop-out in the 2 groups: 7 drop-out in the hypnosis group and 6 drop-out in the control group. The decrease of the pain (VAS) was most important with the patient of the group hypnosis than in the control group (p=0.0001). The Hamilton score is decreased in group-hypnosis from 32.6 at baseline to 22.9 and 17.1 . In the control group anxiety it is the same at baseline (29.8), after 1 year (26.1) and after 2 years (28.5). ANOVA shows that the difference between the two groups is statistically significant (p<0.0001). After 1 and 2 years follow-up subjects in the hypnosis group were at lower risk of increasing the pharmacological treatment with opioids for pain control. Conclusions After 1 year and 2 years follow-up, subjects administered with the hypnosis therapy had a greater reduction in pain and in anxiety and the use of opioids, compared with the group that used only conventional pharmacological therapy.