The National Institutes of Health is supporting clinical trials of complementary and alternative medicine, which includes hypnosis. To determine whether hypnosis has a role in present-day medicine, this review evaluates relevant clinical trials involving hypnosis.  ....studies using PET (positron emission tomography) support the occurrence of distinct changes in the brain with hypnosis. By using electroencephalography, changes were seen during hypnosis that could not be evoked by waking imagination.

CLINICAL TRIALS OF HYPNOSIS

ANESTHESIA FOR PAIN RELIEF
Hypnosis with direct suggestions for pain relief produced significant pain relief compared with placebo...and gave the best results of all the treatments.

ANESTHESIA FOR SURGERY
A 1999 review of more than 1650 surgical cases using hypnosis combined with other methods for conscious sedation promoted the safety and patient comfort afforded by hypnosis....The authors concluded that hypnosis prevents pharmacological unconsciousness, allows patient participation, and may allow a faster recovery and a shorter hospital stay...Other studies support the multiple benefits of hypnosis as an adjunct to conscious sedation for many types of surgery.

DERMATOLOGY
Hypnosis has been used successfully for other (than warts) conditions. Patients with atopic dermatitis noted decreased pruritus, scratching, sleep disturbance, and tension after treatment with hypnosis. In many patients, improvements persisted at follow-up evaluations up to 18 months later. A review of the use of hypnosis in dermatology supports its value for many skin conditions not believed to be under conscious control.

GASTROENTEROLOGY
Hypnosis for irritable bowel syndrome (IBS) has been studied extensively...all patients in the hypnosis group had significant improvements...with no relapses at 3-month follow-up.

The positive results with hypnosis for IBS have been confirmed in several other trials. It was concluded that "in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work." Use of audiotapes for self-hypnosis at home, used in many IBS studies, was considered important for success. Patients with peptic ulcer disease have benefited from hypnosis.

HYPERTENSION
In 1 study of 44 patients, the hypnosis group had a significant decrease in blood pressure compared with the control group. At 6 months, the hypnosis group had mean decreases...below their baseline blood pressures.

NEUROLOGY
Hypnosis has been used successfully for treatment of headaches. Patients with chronic...tension headaches were assigned randomly to hypnosis or a control group. The hypnosis group had a significant reduction in the number, duration, and intensity of headaches. Instruction in self-hypnosis produced significant benefit for tension headaches...

OBSTETRICS
Hypnosis as anesthesia for childbirth has a long, successful history supported by several trials.

The hypnosis group reported less discomfort and shortened labor. At delivery, the hypnosis group had a significant decrease in complications, fewer surgical interventions, and a shorter hospital stay.

ONCOLOGY
Chemotherapy often is associated with nausea and vomiting. Hypnosis has been studied for reducing these and other adverse effects.

Hypnosis has been used successfully in other areas of oncology. Patients undergoing bone marrow transplantation treated with hypnosis experienced significantly less oral pain than control patients. Patients with metastatic breast cancer benefited from self-hypnosis and from participation in group support....benefited with significantly less pain and an increased duration of survival. An untapped potential for hypnosis for cancer treatment is the reported ability to alter regional blood flow, which offers the prospect of increasing the delivery of chemotherapy to a tumor or reducing blood flow to it.

OTORHINOLARYNGOLOGY
Patients with chronic tinnitus treated with hypnosis improved significantly in 7 of 10 disturbing symptoms compared with a group treated with masking techniques or supportive measures.... These results support the findings from other trials.

PULMONARY MEDICINE
Several trials have evaluated hypnosis for asthma. A study of 55 patients with asthma noted that patients assigned randomly to the hypnosis group used bronchodilators less frequently and experienced less wheezing than controls.... A large multicenter trial of patients with asthma reported a significant decrease in the number of treatment failures and a larger number of patients deemed "much improved" by independent assessment in the group taught self-hypnosis. A retrospective study of asthmatic patients reported similar benefit, with 54% of patients treated with hypnosis having an "excellent" result and 21% becoming symptom free and discontinuing medication.

Decreased rates of hospital admissions, length of stay, and use of corticosteroids were attained with hypnotherapy during the year of study in patients with refractory asthma who served as their own controls.

A few cases have been reported of success with hypnosis in weaning dependent patients from ventilators. The report indicates a potential benefit of hypnosis when other techniques have failed.

Numerous studies have reported various techniques and outcomes in the use of hypnosis for SMOKING CESSATION, many with beneficial results. A 1970 study used a single 12-hour group session for volunteer smokers who had unsuccessfully tried other methods of smoking cessation. The program achieved an 88% 1-year abstention rate.

In a 1992 meta-analysis of 633 smoking-cessation studies involving almost 72,000 participants, hypnosis was the most successful cessation method...

A 2000 review of 59 studies using various techniques for smoking cessation indicated that,...several showed a greater than 50% success rate, with 3 studies (200 participants total) documenting 12-month abstention rates of 63% to 88%. In another report, an experienced practitioner of hypnosis reviewed his experience and techniques with 4355 patients, citing an 81% success rate for smoking cessation.

RHEUMATOLOGY
Patients with refractory fibromyalgia (mean duration, 8.5 years) who were randomly assigned to receive hypnosis obtained significant improvement compared with those assigned randomly to physical therapy alone. Benefits included improvements in morning fatigue... sleep ... muscle pain... overall assessment... and use of pain medications, with results persisting for at least 6 months.

SURGERY
More recently, it has been emphasized again that health care personnel should be aware that patients under anesthesia have unconscious auditory perception and tend to interpret comments negatively. The report also stressed that, along with the potential deleterious effects of this awareness, came the opportunity for using "semantics of positive suggestion" (emphasizing comfort, safety, and success) that should be "an integral part" of surgical and obstetrical care. It appears appropriate to consider the use of suggestions for patients in the perioperative period as a part of the practice of hypnosis.

Postoperative hypnosis demonstrated significant...recall of material from the audiotape (as well as events during surgery) that was not recalled consciously.

Preoperative hypnosis is less controversial than the idea of awareness during anesthesia, with benefit noted in many trials. Significant benefits include less anxiety and decreased blood pressure...reduced blood loss...enhanced postoperative well-being...improved intestinal motility...shorter hospital stay...reduced postoperative nausea and vomiting...and reduced need for analgesics.

A 1991 review of clinical trials using hypnosis, suggestion, or relaxation in the care of surgical patients found that 89% of the trials showed that these techniques produced a positive outcome in facilitating physical or psychological recovery from surgery. Hypnosis as an adjunct to surgery was believed to be "successful for the majority of individuals," with benefits such as decreased pain, anxiety, nausea, and recovery time.

UROLOGY
The medical literature from the 1960s indicated a strong potential for the use of hypnosis for impotence, and support for this assertion has come from recent clinical trials. A review of the personal experience and techniques of an experienced practitioner cited an 88% success rate using hypnosis for impotence in almost 3000 patients. Review of developments in hypnosis reported its efficacy in augmenting other treatment methods for sexual dysfunction and its potential for exploring contributing psychological conflicts.

In a trial of hypnosis for chronic (mean, 7 years) urinary incontinence, 50 women served as their own controls. At 1 month, 58% were symptom-free and another 28% were improved, with cystometric testing at 3 months objectively confirming the benefits.

CONCLUSION
The acceptance of hypnosis as a mode of treatment in medicine is increasing as a result of "careful, methodical, empirical work of many research pioneers.” Many important trials reviewed here have helped to establish the role of hypnosis in contemporary medicine. These trials have established the utility and efficacy of hypnosis for several medical conditions, either alone or as part of the treatment regimen. Through greater awareness and acceptance of hypnosis, additional training and research can be inspired in pursuit of improved techniques and new areas of potential benefit.