Hypnosis combined with pain education for chronic low back pain: a randomized controlled trial

Introduction: The combination between pain education (PE) with clinical hypnosis (CH) has not yet been investigated in patients with chronic non-specific low back pain. Objectives: To investigate the effectiveness of PE combined with CH at reducing pain intensity and disability in patients with chronic non-specific low back pain. Method: A total of 100 patients with chronic non-specific low back pain were randomized to receive either (1) PE or (2) PE plus CH. Outcomes were collected by a blinded assessor at 2 weeks and 3 months after randomization. The primary outcomes were average and worst pain intensity (11-point Numerical Rating Scale), and disability (24-item Roland Morris Disabilty Questionnaire) at 2 weeks. Statistical analyses were conducted using intention-to-treat principles. Results: Patients who received PE added to CH reported larger improvements in worst pain intensity (mean difference = 1.35 points, 95% confidence interval [CI] = 0.32 to 2.37) and disability (mean difference = 2.34 points, 95% CI = 0.06 to 4.61) but not average pain intensity (mean difference = 0.67 point, 95% CI = -0.27 to 1.62) at 2 weeks. The combination of PE and CH evidenced larger improvements in: (1) worst pain intensity (mean difference = 1.32 points, 95% CI = 0.29 to 2.34), (2) catastrophizing (mean difference = 5.30 points, 95% CI = 1.20 to 9.41) at 3 months; and (3) global perceived benefits at 2 weeks (mean difference = -1.98 points 95% CI = -3.21 to -0.75). No adverse effects were observed. Conclusion: This is the first trial showing that hypnosis can be positively combined with education to improve pain intensity, disability, perceived benefits and catastrophizing in patients with chronic non-specific low back pain. This study provides another option for the management of chronic low back pain that is low cost and can be offered in groups. Clinical hypnosis added to pain education could be offered to patients who are on waiting lists for physiotherapy treatment. This trial was prospectively registered at clinicaltrials.gov: NCT02638753 Keywords: Education; Hypnosis; Low Back Pain