The use of hypnosis to improve pain management during voluntary interruption of pregnancy: an open randomized preliminary study. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Hypnosis to facilitate uncomplicated birth. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Massage or music for pain relief in labour: a pilot randomised placebo controlled trial. Hypnosis in the management of persistent idiopathic orofacial pain--clinical and psychosocial findings. Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients. Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: a randomised controlled trial. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations.
This report describes an open randomized study that aims to determine whether a brief hypnotic intervention during first-trimester surgical abortion reduces requests for pain medication.
                Thirty women undergoing first-trimester surgical abortion at the family planning clinics of a large hospital in Quebec City were randomized into a control group that received standard care and a hypnosis group that received, in addition to standard care, an intervention of hypnosis, including analgesia suggestions 20 min before and throughout the surgical procedure. Patients in both groups were given the option to control their pain with nitrous oxide (N(2)O) sedation administered through a nose mask as often and for as long as they wanted during the procedure. N(2)O sedation as the primary outcome was assessed at each step of the procedure. The patient's self-reported anxiety and pain were also assessed during the procedure as secondary outcomes.
                Thirty-six percent of patients in the hypnosis group requested N(2)O sedation during the procedure versus 87% in the control group (p<.01). No differences between the groups were found in reports of pain and anxiety during the procedure.
                These results suggest that hypnosis can be integrated into standard care and reduces the need for N(2)O in patients undergoing first-trimester surgical abortion. This reduction in N(2)O consumption did not lead to significant changes in pain or anxiety, and a larger sample size is required to assess the possible effects of hypnosis on those variables. The benefits of hypnotic analgesia as an adjunct to childbirth education were studied in 60 nulliparous women. Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task. Half of the Ss in each group received a hypnotic induction at the beginning of each session; the remaining control Ss received relaxation and breathing exercises typically used in childbirth education. Both hypnotic Ss and highly susceptible Ss reported reduced pain. Hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries than control Ss' births. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other 3 groups. We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study. Prior research by the author showed that psychosocial factors distinguished complicated from uncomplicated birth outcome. The purpose of this study was to determine if prenatal hypnosis could facilitate uncomplicated birth. Following a psychosocial assessment, 520 pregnant women in their first or second trimester of pregnancy were randomized to receiving prenatal hypnosis or attention-only groups. The author provided all of the hypnosis in a manner similar to that taught by David Cheek. The goal was to reduce fear of birth and parenthood; to reduce anxiety; to reduce stress; to identify specific fears that might complicate the labor process (addressing them whenever possible); and to prepare women for the experience of labor. The attention-only group was matched to a no-contact comparison group. Women receiving prenatal hypnosis had significantly better outcomes than women who did not. Further assessment suggested that hypnosis worked by preventing negative emotional factors from leading to an complicated birth outcome. Attention only was associated with minimal differences in outcome over the no-contact group. The routine prenatal use of hypnosis could improve obstetric outcome. To determine the effect of breathing techniques and nurse-administered massage on the pain perception of pregnant woman during labour.
                The present study was conducted among pregnant women (75% primiparous) admitted to the SSK Bakirkoy Women and Children's Hospital (Istanbul, Turkey) between January 1, and September 1, 2000. The patients were in their 38th to 42nd week of pregnancy, not at high risk and expected to have normal vaginal delivery. They were selected from volunteers by nonrandom sampling.
                The present study involved 40 cases, with 20 in the experimental group and 20 in the control group. Data were obtained through the visual analogue scale, inspection form, observation form and postnatal interview form. The study investigators provided information about labour, breathing techniques and massage to the pregnant women assigned to the experimental group at the beginning of labour (latent phase). A study investigator also accompanied them during labour. These women received nurse-administered massage and were encouraged to breathe and perform self-administered massage. They were also instructed to change their positions and to relax.
                Study results demonstrated that nursing support and patient-directed education concerning labour and nonpharmacological pain control methods (eg, breathing and cutaneous stimulation techniques) were effective in reducing the perception of pain by pregnant women (when provided in the latent labour phase before delivery), leading to a more satisfactory birth experience. Research on massage therapy for maternal pain and anxiety in labour is currently limited to four small trials. Each used different massage techniques, at different frequencies and durations, and relaxation techniques were included in three trials. Given the need to investigate massage interventions that complement maternal neurophysiological adaptations to labour and birth pain(s), we designed a pilot randomised controlled trial (RCT) to test the effects of a massage programme practised during physiological changes in pain threshold, from late pregnancy to birth, on women's reported pain, measured by a visual analogue scale (VAS) at 90 min following birth. To control for the potential bias of the possible effects of support offered within preparation for the intervention group, the study included 3 arms--intervention (massage programme with relaxation techniques), placebo (music with relaxation techniques) and control (usual care). The placebo offered a non-pharmacological coping strategy, to ensure that use of massage was the only difference between intervention and placebo groups. There was a trend towards slightly lower mean pain scores in the intervention group but these differences were not statistically significant. No differences were found in use of pharmacological analgesia, need for augmentation or mode of delivery. There was a trend towards more positive views of labour preparedness and sense of control in the intervention and placebo groups, compared with the control group. These findings suggest that regular massage with relaxation techniques from late pregnancy to birth is an acceptable coping strategy that merits a large trial with sufficient power to detect differences in reported pain as a primary outcome measure. This controlled and patient blinded study tested the effect of hypnosis on persistent idiopathic orofacial pain (PIOP) in terms of clinical and psychosocial findings. Forty-one PIOP were randomized to active hypnotic intervention or simple relaxation as control for five individual 1-h sessions. Primary outcome was average pain intensity scored three times daily in a pain diary using visual analogue scale (VAS). Secondary outcome measures were pain quality assessed by McGill pain questionnaire (MPQ), psychological symptoms assessed by symptom check list (SCL), quality of life assessed by SF36, sleep quality, and consumption of analgesic. Data were compared between groups before and after treatment using ANOVA models and paired t-tests. The change in VAS pain scores from baseline to the last treatment (t4) was (33.1+/-7.4%) in the hypnosis group and (3.2+/-5.4%) in the control group (P<0.03). In the hypnosis group, highly hypnotic susceptible patients had greater decreases in VAS pain scores (55.0+/-12.3%) when compared to less susceptible patients (17.9+/-6.7%) (P<0.02). After the last treatment there were also statistically significant differences between groups in perceived pain area (MPQ) and the use of weak analgesics (P<0.03). There were no statistically significant changes in SCL or SF36 scores from baseline to t4. In conclusion, hypnosis seems to offer clinically relevant pain relief in PIOP, particularly in highly susceptible patients. However, stress coping skills and unresolved psychological problems need to be included in a comprehensive management plan in order also to address psychological symptoms and quality of life. This prospective controlled trial investigated the efficacy of a manual-based clinical hypnosis intervention in alleviating pain in 80 pediatric cancer patients (6-16 years of age) undergoing regular lumbar punctures. Patients were randomly assigned to 1 of 4 groups: direct hypnosis with standard medical treatment, indirect hypnosis with standard medical treatment, attention control with standard medical treatment, and standard medical treatment alone. Patients in the hypnosis groups reported less pain and anxiety and were rated as demonstrating less behavioral distress than those in the control groups. Direct and indirect suggestions were equally effective, and the level of hypnotizability was significantly associated with treatment benefit in the hypnosis groups. Therapeutic benefit degraded when patients were switched to self-hypnosis. The study indicates that hypnosis is effective in preparing pediatric oncology patients for lumbar puncture, but the presence of the therapist may be critical. To assess the effect of psychosocial support on labour outcomes.
                A randomised control trial conducted at the University College Hospital Ibadan, Nigeria, from November 2006 to 30 March 2007. Women with anticipated vaginal delivery were recruited and randomised at the antenatal clinic. The experimental group had companionship in addition to routine care throughout labour until two hours after delivery, while the controls had only routine care. The primary outcome measure was caesarean section rate. Others included duration of active phase, pain score, time of breast-feeding initiation and description of labour experience. Multivariable analyses were used to adjust for potential confounders. The level of statistical significance was set at 5%.
                Of the 632 recruited, 585 were eventually studied: 293 and 292 were in experimental and control groups, respectively. Husbands constituted about two-thirds of the companions. Women in the control group were about five times more likely to deliver by caesarean section (95% confidence interval (CI) 1.98-12.05), had significantly longer duration of active phase (P < 0.001), higher pain scores (P = 0.011) and longer interval between delivery and initiation of breast-feeding (P < 0.001). However, those in experimental group had a more satisfying labour experience (odds ratio 3.3 95% CI 2.15-5.04).
                Women with companionship had better labour outcomes compared to those without. It is desirable to adopt this practice in our health-care settings as an alternative strategy to provide comparable quality services to would-be mothers in labour. A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.
There are still only a small number of studies assessing the use of hypnosis for labour and childbirth. Although the intervention shows some promise, further research is needed before recommendations can be made regarding its clinical usefulness for pain management in maternity care.