TOPLINE:

Hypnotic cognitive therapy, which combines cognitive behavioral therapy with clinical hypnosis, was linked to a significantly greater reduction in pain intensity and depressive symptom scores than usual care in adults with moderate-to-severe chronic pain after spinal cord injury (SCI), a new study showed.

METHODOLOGY:

• A single-blind, randomized, parallel-group trial conducted in 2019-2021 included more than 100 US adults (mean age, 51 years; 58% men; 79% White individuals) with moderate-to-severe chronic pain after SCI (mean years since injury, 15). All were randomly assigned to receive six weekly sessions of hypnotic cognitive therapy delivered by a clinical psychologist via telephone or video call (n = 64) or usual care (n = 63).
• The primary outcome was average pain intensity over the previous 24 hours, as measured on a 0-10 numerical rating scale (NRS) at baseline, 6 weeks, and 12 weeks. Mean baseline score was 5.9.
• Secondary outcomes included depression severity on the Patient Health Questionnaire-Nine, the seven-item Brief Pain Interference Scale, the Patient Global Assessment of Treatment Satisfaction scale, and the Patient Global Impression of Improvement scale.

TAKEAWAY:

• Reduction in average pain intensity was significantly greater for hypnotic cognitive therapy than for usual care at 6 weeks (mean difference [MD], -0.55; P = .03) and 12 weeks (MD, -0.79; P = .002), as was depression severity (MDs, -2.55 and -1.81, respectively; P = .001 and .02).
• The effect of hypnotic cognitive therapy on pain intensity at 12 weeks was greater for those with neuropathic pain only (MD, -1.79) than for those with mixed pain (MD, -0.24).
• Overall satisfaction with the treatment; changes in pain intensity, the ability to manage pain, and the interference of pain with activities; and the importance of any change in pain at 12 weeks were significantly improved in the hypnotic therapy group compared with the usual care group (P < .001 for all).
• Exploratory analyses showed that pain intensity scores did not differ significantly between telephone or video call delivery.

IN PRACTICE:

Hypnotic cognitive therapy “may be an effective adjunctive treatment for SCI-related pain,” the investigators wrote.

“The fact that [it] is safe, brief, highly manualized and can be delivered over the telephone or through Zoom makes it an attractive option for further research and implementation in SCI or other patient populations affected by pain, including central neuropathic pain,” they added.

SOURCE:

This study was led by Charles H. Bombardier, PhD, University of Washington, Seattle. It was published online on March 26 in Neurology.

LIMITATIONS:

Usual care was the control condition instead of an active or placebo control and the planned sample size was not achieved, which could have indicated a biased sample. The intervention was also delivered by a single experienced clinical psychologist, which may have limited the generalizability of the findings. Additionally, the assessment of effects was limited to 12 weeks.

DISCLOSURES:

This study was funded by the Craig H. Neilsen Foundation. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.