Está en la página 1de 31

The Effects of "Hypnosis" on Pain

A Critical Review of Experimental and Clinical Findings

THEODORE XENOPHON BARBER, Ph.D.

Experimental and clinical studies concerned with the effects of "hypnotically-sug-


gested analgesia" in surgery, in labor, and in chronic pain are critically evaluated. The
review suggests that "hypnotic analgesia" at times produces not a reduction in pain
but an unwillingness to state directly to the hypnotist that pain was experienced or a
temporary "amnesia" for the pain experienced. In other instances, suggestions of pain
relief given under "hypnosis" produce some degree of diminution in anxiety and pain
as indicated by reduction in physiological responses to noxious stimuli and by reduc-
tion in requests for pain-relieving drugs. The data suggest that "the hypnotic trance
state" may be an extraneous variable in ameliorating pain experience in situations de-
scribed as "hypnosis;" the critical variables appear to include: (a) suggestions of pain
relief, which are (b) given in a close interpersonal setting.

A NUMBER OF INVESTIGATOHS34 contend notically-suggested analgesia"e.g., the


that "hypnotically-suggested analgesia" suggestions of analgesia, "the hypnotic
lessens or entirely prevents pain, while trance state," the close relationship be-
others82 are of the opinion that hypnotic tween patient and physicianwhich are
suggestions produce verbal denial of pain effective and which are superfluous to
experience without affecting pain and suf- producing "pain relief"?
fering. This paper critically evaluates the
effects of "hypnosis" on pain. Relevant
clinical and experimental studies are re- Denotations of Critical Terms
viewed to answer two questions: (1)
Does "hypnotically-suggested analgesia" The Term "Hypnosis"
refer to reduction of pain, to verbal de-
nial of the pain experienced, or to a com- When investigators report that "anal-
bination of both of these effects? (2) Of gesia" was produced under "hypnosis" or
the many independent and intervening in a "hypnotized" subject, they appear to
variables subsumed under the term "hyp- be saying in an abbreviated way that pain
and suffering were ameliorated in a sub-
From the Medfleld Foundation, Medfleld, ject who was selected as meeting criteria
Mass., and the Division of Psychiatry, Boston of "hypnotizability;" who was placed in
University School of Medicine, Boston, Mass. "a state of trance;" and who was given
The writing of this paper was made possible suggestions of pain relief by a prestigeful
by Research Grant MY+825 from the National
Institute of Mental Health, U.S.P.H.S. person with whom he had a close inter-
Received for publication Oct. 3,1962. personal relationship.17 This confound-
303
304 HYPNOSIS EFFECTS ON PAIN

ing of a number of independent and in- mistic, even cheerful, state of mind," and
tervening variables under the single term refused pain-relieving drugs. This ap-
"hypnosis" leads to serious problems. It parent lack of anxiety and suffering was
may be that one or two of these variables not due to shock, and it was not due to a
(e.g., suggestions of pain relief given in total "pain block;" the men were clear
a close interpersonal setting) are sufficient mentally and complained in a normal
to reduce pain and that the other vari- manner to rough handling of their
ables"the hypnotic trance state," the wounds or to inept venipunctures.
selection of subjects as "hypnotizable" Beecher compared the "reaction pattern"
are extraneous. In the following discus- of the wounded soldiers with the reac-
sion we shall at first use the word "hyp- tions shown by 150 male civilians who
nosis" as it is commonly used, to refer to had undergone major surgery. Although
all of these variables in combination. the postoperative patients were suffering
After we have reviewed clinical and ex- from less tissue trauma, only one-fifth of
perimental investigations concerned with these patients (as compared to two-thirds
"hypnotically-suggested analgesia," we of the soldiers) refused medication for re-
shafi turn again to the term "hypnosis" lief of pain. The striking difference in
and will place this concept under critical reaction to injury in the two groups was
analysis. apparently due to differences in the sig-
nificance of the wound. The soldier
viewed his wound as a good thing; it en-
The Term "Pain" abled him to leave the battlefield with
"Pain" is a multidimensional concept. honor. The civilian viewed his surgery
First, "pain" refers to an unpleasant sen- as a calamitous event. Beecher28 notes
sation which varies not only in intensity that "one cannot know whether in the
(from "mild" to "excruciating") but also above instances [of the wounded sol-
in quality (from the lancinating sensation diers] the pain sensation or the reaction
associated with trigeminal neuralgia, to to pain is blocked; however, since the
the burning sensation found in causalgia, conscious man badly wounded in warfare
to the deep, aching sensation of abdomi- often does not suffer at all from his great
nal cramps). Secondly, the term "pain" wound, yet is annoyed by, and suffers ap-
subsumes not only these various "sensa- parently normally from, a venipuncture,
tions of pain" but also a "reaction pat- one can conclude that the nervous sys-
tern" which is generally categorized by tem can transmit pain sensations but
such terms as "anxiety" or "concern over that somehow the reaction to them is
pain." Although these two components the altered element."
of the "pain experience" "sensation of
Hill et al.-" and Kornetsky86 have
pain," and "anxiety" or "reaction to pain"
are normally intimately interrelated, a presented evidence to support the hypoth-
series of studies, summarized below, sug- esis that pain relief following morphine
gests that they can be partly dissociated administration is closely related to "relief
under certain conditions. of anxiety" or "reduction in fear of pain."
Beecher28' ^ has presented cogent evi- Cattell,43 Beecher,28 and Barber11-12 have
dence that similar wounds which pre- reviewed other studies which suggest that
sumably produce similar "pain sensa- morphine and other opiates at times al-
tions" may give rise to strikingly different leviate suffering by minimizing "anxiety"
"reaction patterns." He studied 215 seri- and "concern over pain" without neces-
ously wounded soldiers in a combat zone sarily elevating the pain threshold or al-
hospital. Two-thirds of the men did not tering "awareness of pain." Data indicat-
show signs of suffering, were in an "opti- ing that placebos also at times ameliorate
PSYCHOSOMATIC MEDICINE
BARBER 305
"pain experience" by alleviating "anxi- reduction in pain and suffering but in an
ety" or "reaction to pain' have been re- apparent amnesia tor the pain and suffer-
viewed by Beecher-" and by Barber.11 ing experienced. In a number of investi-
Additional evidence that "the reaction gations37- 63'80-93-114> 128 the hypnotized
component" of the "pain experience" can patients cried, moaned, or showed signs
be at least partly dissociated from "pain of shock during surgery or parturition but
sensation" is found in the effects of such maintained afterwards that they had for-
surgical procedures as pretrontal leukoto- gotten the experience. For instance,
my and topectomy of Brodmann's areas Schultze-Rhonhofl!M reported that obstet-
9 and 10. These and other operations on ric patients who had received extensive
the frontal areas at times appear to amel- antenatal training in entering "deep
iorate intractable pain by alleviating trance" showed overt behavioral signs of
"anxiety," "worry," and "concern over pain during laborsome groaned, others
pain." 1 1 " 9 7 Leukotomized patients char- cried, others showed marked agitation
acteristically state that their pain is the but the patients maintained on awaken-
same, but it does not bother them any- ing that they were not aware of having
more. Investigators who have studied the suffered. This investigator interpreted his
effects of frontal operations appear to findings as indicating that hypnotic sug-
agree with Ostenasek's113 conclusion that gestions of pain relief rarely if ever pro-
"when the fear of pain is abolished, the duce a complete suppression of pain: "In
perception of pain is not intolerable." the majority of cases, the complete anal-
The above and other data11-12>132 sug- gesia which is claimed on awakening is
gest that in attempting to delineate the the result of the amnesia."
effects of "hypnotically-suggested anes- Raginsky124 refers to cases of minor
thesia or analgesia,"" it may be more rel- surgery performed under hypnosis in
evant to focus on the "reaction" compo- which the patients appeared "amnesic"
nent of the "pain experience" rather than immediately after surgery; however,
on "pain sensation per se." If "hypnotical- when hypnotized at a later date, the pa-
ly-suggested analgesia" relieves "anxiety" tients could " . . . usually recall the site of
or "concern over pain" but does not af- pain and describe accurately the pain ex-
fect pain as a sensation or exerts only an perienced at the time of the operation."
indirecT effect or a minor effect on pain Myers,112 Perchard,121 and Dorcus and
sensation, it can be said that it (1) affects Shaffer53 have also presented data indi-
a major component of the "pain experi- cating that "posthypnotic amnesia" for
ence" and (2) it may be exerting as much pain experienced during surgery or dur-
effect on "pain experience" as powerful ing parturition is temporary and easily re-
analgesics such as morphine.182 versible.
Other findings, recently reviewed in de-
"Hypnotic Analgesia," "Posthypnotic tail elsewhere,19 also indicate that "post-
Amnesia," and Denial of Pain hypnotic amnesia" is labile and superfi-
cial. Thesefindingsinclude the following:
A series of clinical reports indicates 1. With few if any exceptions, investi-
that suggestions of analgesia given under gators report that "amnesic hypnotic sub-
"hypnotic trance" at times result not in a jects recall the "forgotten" events if the
'Since "anesthesia" (insensibility to all stimu- hypnotist states, "Now you remember ."*
li) also includes "analgesia" (insensibility to Subjects who have been deeply hypno-
painful stimuli), studies concerned with relief of tized also recall the "forgotten" happen-
pain by hypnosis rarely made a distinction be-
tween these terms, and the terms will be used
ings when given implicit permission to
interchangeably in the present review. remember. Such tacit permission may be
VOL. XXV, NO. 4, 1963
306 HYPNOSIS EFFECTS O N PAIN

given by asking, "Do you remember?," the verbal reports of "good" hypnotic
with the intonation that the subject is subjects often appear to be closely cor-
permitted to remember;143 by giving a related with what the hypnotist leads the
"hint;"110 by instructing the subject to al- subject to believe he is expected to re-
low his hand to write automatically;110'144 p O r t 7, s, io, la, i is I f t h e hypnotist im-
and so forth. plies when interviewing the subject that
2. Experimental evidence indicates he should state that no pain was experi-
that "amnesic" hypnotic subjects recog- enced, the '"good" hypnotic subject may
nize the material which they claim not to comply on a verbal level even though
remember; this recognition is indicated pain was experienced. On the other hand,
by overt behaviore.g., avoidance of if the hypnotic subject is given a means of
"amnesic" material but not of similar con- stating what occurred without at the same
trol material8-144and by alterations in time directly contradicting the hypno-
pulse and respiration when presented tist's explicit suggestions and the hypno-
with the "forgotten" material but not tists's apparent desires and expectations,
when presented with comparable control he may give a different report. Kaplan*2
material.81 has presented an interesting case study
3. Experimental evidence indicates which can be interpreted along these
that "somnambulistic" subjects who show lines. A highly trained hypnotic subject
"complete amnesia" when interviewed by was placed in "a very deep trance" and
the hypnotist show very little if any ef- given two suggestions: that his left arm
fects of the "amnesia" when tested by in- was analgesic and insensitive and that his
uirect methods which do not depend on right hand would continuously perform
verbal reports, such as assessment of automatic writing. The "analgesic" left
practice effects or of retroactive inhibi- arm was pricked four times with a hypo-
tion effects.101'108' m dermic needle; when receiving this stim-
4. "Amnesic" hypnotic subjects charac- ulation, the subject's right hand wrote,
teristically make such statements as: '1 "Ouch, damn it, you're hurting me."
haven't any inclination to go back over After a minute or two, the subject asked
it;" "I do remember but I can't say;" "I the experimenter, "When are you going
know it but I can't think about itI know to begin," apparently having "forgotten"
what it is but I just kind of stop myself that he had received the painful stimuli.
before I think of it." 32146 These and Kaplan interpreted these findings as indi-
other remarks made by "amnesic" hyp- cating that hypnotic suggestions of anal-
notic subjects can be interpreted as sup- gesia produce " . . . an artificial repression
porting "... not a dissociation theory, but and/or denial of pain, but that at some
rather a motivational theory, a theory level pain is experiencedmoreover, ex-
that such amnesia is due to an unwilling- perienced as discomfort at that level."
ness to remember, an attempt to occupy The motivation for denial of pain is
oneself with other things than an effort to present in the hypnotic situation. The
recall."118 physician has invested time and energy
The above and other data19 suggest hypnotizing the patient and suggesting
that "posthypnotic amnesia for pain" may that pain will be relieved; expects and de-
be more labile and temporary than is at sires that his efforts will be successful;
times supposed and may be difficult to and by his words and manner communi-
differentiate from purposive denial of the cates his desires and expectations to the
pain experienced or from unwillingness to patient. The patient in turn has often
admit to the hypnotist that pain was ex- formed a close relationship with the
perienced. It should be noted here that physician-hypnotist and would like to
PSYCHOSOMATIC MEDICINE
BARBER 307
please him or at least not to disappoint Overt Behavioral Reactions as Criteria of
him. Furthermore, the patient is aware "Analgesia" or "Pain Relief
that if he states that he suffered, he is
implying that the physician's time and The data cited above suggest caution
energy were wasted and his efforts futile. in using the hypnotic patient's verbal re-
The situation is such that even though the port as given to the hypnotist as an index
patient may have suffered, it may be dif- of pain relief. Caution is also necessary
ficult or disturbing for him to state di- in using the hypnotic patient's lack of
rectly to the physician-hypnotist that he overt behavioral reactions to noxious
experienced pain and it may be less anx- stimulation as indicating that pain and
iety provoking to say that he did not suf- suffering have been abolished; as noted
fer. above, the hypnotic subject is often moti-
It should be noted that the motivation vated to please the hypnotist or to try not
to deny pain is not necessarily a function to disappoint the hypnotist and this may
of the patient's having been hypnotized. at times be sufficient for him to try to in-
Similar findings may be obtained in any hibit overt signs of pain such as moaning,
situation, hypnotic or nonhypnotic, in wincing, or restlessness.
which the physician invests time and ef- The findings presented by Javert and
fort attempting to support the patient and Hardy81 with respect to "natural child-
to ameliorate the patient's suffering. birth" may also apply to the patient un-
These conditions making for denial of dergoing labor under "hypnosis." The
pain appear to be present, for instance, subjects consisted of 26 untrained labor
in situations described as "natural child- patients and 5 patients who had been
birth." Mandy et al.102 have presented "trained" in "natural childbirth" by others
data indicating that the "natural child- (not by Javert or Hardy). During labor
birth" patient who reports to the physi- the untrained patients showed evidence
cian and to the physician's associates that of anxiety and pain, while the "natural
she was "delighted with natural child- childbirth" patients appeared relatively
birth" may state, when interviewed by an "serene." Between uterine contractions
independent observer, that her delivery both groups were asked to compare the
was more painful than she had antici- pain of labor with the pain produced by
pated or believed was necessary "but she application of radiant heat to the fore-
couldn't admit it to the house staff for limb. (These measurements were made
fear of disappointing them." in both groups prior to the administration
Carefully controlled studies are needed of analgesic or anesthetic drugs). The
in which patients who have ostensibly ex- "natural childbirth" patients did not dif-
perienced "hypnotic analgesia" are inter- fer from the untrained patients in esti-
viewed not only by the hypnotist but also mates of pain intensity; both groups rated
by a person who is not associated with the pain of labor as relatively severe and
"hypnosis" and to whom the patient is equal in maximal intensity to blister-pro-
willing to confide. It can be hypothe- ducing thermal stimulation. Javert and
sized from the data presented above that Hardy interpreted these findings as indi-
some hypnotic subjects who deny pain or cating that the regimen known as "natural
who appear to have amnesia for pain childbirth" produces a "satisfactory reac-
when questioned by the hypnotist will tion pattern" but has little if any effect
state that they experienced pain and that on the intensity of the pain experienced
they suffered when interviewed by a per- during labor.
son whom they trust and who is not as- An additional consideration should be
sociated with the "hypnosis." noted here: Velvovski et al.1S9 claims that
VOL. XXV, NO. 4, 1963
308 HYPNOSIS EFFECTS ON PAIN

from 7 to 14% of unselected patients in lished series of cases in which a statistical anal-
the Soviet Union give birth without medi- ysis would indicate that approximately 10 per
cations, without showing signs of pain, cent of the patients are aole to withstand a
anxiety, or suffering, and without receiv- surgical intervention with hypnoanesthesia as
ing any training or preparation. Are more a sole modality. Therefore, it is our conclusion
than 14% of unselected hypnotized pa- that the 10 per cent estimate is an often-re-
tit nts able to perform this feat? No data peated but unsubstantiated quantity and that
the true percentage of successful cases is much
are available to answer this question; re- below that figure.
ports concerned with the effects of hyp-
nosis in parturition are in all cases based The above data suggest two conclu-
on volunteers or selected patients. sions:
The proportion of selected hypnotic pa- 1. Caution is necessary in accepting the
tients able to deliver without medications hypnotic patient's verbal report or lack
and without exhibiting signs of suffering of overt behavioral reactions as valid in-
may not greatly exceed the 7 to 14% of dices that the patient did not suffer. The
unselected patients which Velvovski hypnotic situation is often structured in
claims can deliver in this way without such a manner that the patient is moti-
any training at all. Although some inves- vated to inhibit overt signs of pain and
tigators46107- 109 report that more than to deny pain experience.
one-third of selected hypnotic patients 2. The proportion of selected hypno-
are able to deliver without anodynes, tized patients who are able to undergo
others 4 ' 40 ' 14T find that no more than 14% labor or surgery without manifesting mo-
of patients who volunteer for hypnosis toric signs of pain and without receiving
training are able to deliver without medi- anodynes may not greatly exceed the pro-
caments and without showing gross signs portion of unselected patients who are
of pain. able to do the same thing without any
Similar considerations may apply in preparation at all. Careful controls are
surgery: The proportion of selected pa- needed to determine if the effects attribu-
tients who are able to undergo surgery ted to "hypnosis" are due to the selection
with "hypnoanesthesia" alone may not of patients.
greatly exceed the proportion of unse-
lected patients who were able to undergo
surgery in the preanesthetic period with- Physiological Indices of Anxiety
out manifesting signs of pain. Data pre- and Fain
sented by Trent,138 Leriche,98 Elliotson,58
and Chertok44 indicate that although The data presented above suggest that
some surgical patients, prior to the ad- an objective index of pain which is diffi-
vent of anesthetics, struggled and cult or impossible to affect voluntarily is
screamed, a small proportion of patients needed in studies concerned with "hyp-
"... bravely made no signs of suffering at notically-suggested analgesia." Unfortu-
all." Although it is often stated that at nately there appears to be no single in-
the present time approximately 10% of the dex and no combination of indices which
population is able to undergo surgery un- unequivocally indicate the presence or
der "hypnotic trance," Wallace and Cop- absence of pain and suffering. However,
polino141 note the following: a series of studies demonstrate that a sat-
isfactory, although not conclusive, objec-
tive index of anxiety and pain consists of
Our percentage of success in the complete an alteration in one or more systemic
substitution of hypnoanesthesia for chemoanes-
thesia has been less than the previously quoted physiological functions which are diffi-
10 per cent. There have not been any pub- cult to alter by voluntary effort.
PSYCHOSOMATIC MEDICINE
BARBER 309
In normal subjects painful stimulation ever, is not a major objection to the use of
almost always produces alterations in one autonomic indices to assess the effects of
or more of the following: blood pressure, "hypnotically-suggested analgesia." "Anx-
heart rate, respiration, digital vasomotor iety' or "concern over pain" appears to be
tone, skin resistance, and degree of tension a major component of the total pain ex-
in localized muscles.24' 2K-4- 48> Bfii 89'12W perience, and if ""hypnotic analgesia" re-
Although nonpainful stimuli at times also duces anxiety and concern over pain, it
produce alterations in these physiological can be said to exert an important effect
indices, they rarely produce the same de- on pain experience even if it does not
gree or the same pattern of alteration as significantly affect pain as a sensa-
painful stimuli.24'S9-92 There is also evi- tion. 11 ' 12> 28> 72> 76 ' 77> 88> 132
dence to indicate that morphine, meperi-
dine, nitrous oxide, and other analgesics
and anesthetics drastically reduce these Experimental Studies of
normally expected responses to noxious "Hypnotic Analgesia"
stimulation. The galvanic skin response
to painful stimulation is apparently mark- Dynes 5 6 monitored heart rate, respira-
edly reduced by morphine at low dose tory rate, and change in skin resistance in
levels (8 mg.) 3 and is apparently abol- response to pinch and pinprick in 7
ished by nitrous oxide anesthesia,38 by "trained somnambules" under control
meperidine (100 mg.), and by morphine conditions and after suggestions of anal-
at higher dose levels (20-100 mg.) .3 It al- gesia were given under trance. The nox-
so appears that morphine (8-16 mg.) ious stimulation produced an average in-
and codeine (32-64 mg.) reduce the vas- crease in respiratory rate of 3 cycles per
oconstriction response to noxious stimu- minute under the control condition and
lation to near the vanishing point129 and of 1 cycle per minute under the trance
that the elevation in blood pressure which condition. Heart rate showed a mean in-
normally follows painful stimulation is crease of 2& beats per minute under the
eliminated by anesthetic doses of barbitu- control condition and failed to show an
rates.08 increase under the trance condition. All
subjects showed galvanic skin responses
Before turning to experimental studies (GSR) of the same order of magnitude
which used physiological variables to as- under the control and trance conditions.
sess the effects of "hypnotically-suggested This study is open to at least one major
analgesia," two considerations should be criticism: The stimuli were always ad-
emphasized. (1) Subjects differ in their ministered first under the control condi-
physiological patterns of response to the tion and then under trance. As Shor 138
same noxious stimulus, and the same sub- has pointed out, since physiological reac-
ject may show different patterns of phys- tions to painful stimulation generally
iological response to different types of show a habituation or adaptation ef-
noxious stimuli.92 When physiological fect,48- 64> 74> 131 tending to decrease dur-
variables are used to assess "hypnotic an- ing a second and subsequent stimulations,
algesia," it is necessary to take inter- and the possibility was not excluded that a
intrasubject variability into account. (2) similar reduction in heart rate and respir-
Alterations in physiological variables atory rate might have been observed dur-
during painful stimulation appear to be ing the second stimulation if the subjects
more closely correlated with the "anxiety" had not been placed in "hypnotic trance"
or "reaction" component of the pain ex- and had not been given suggestions of
perience than with "pain sensation per analgesia. This experiment and the other
se "2i,w, 74,9, 127 xij i s consideration, how- experiments reviewed below were con-
VOL. XXV, NO. 4, 1963
310 HYPNOSIS EFFECTS O N PAIN

cerned primarily with the effects on pain uli TO, 75,84,142 However, Shor13- has re-
experience of explicit suggestions of anal- cently reanalyzed Sears' data and found
gesia given under "hypnotic trance." A that some of the computations were in-
number of studies34' wu-131>'1M> 145 also as- correct. Shor's analysis shows that respir-
sessed the effects of "hypnotic trance per atory depth, pulse variability, and pulse
se" on physiological responses to noxious amplitude were not significantly different
stimuli; these studies were unable to when the stimulus was applied under
demonstrate differences in autonomic re- trance to the "anesthetic" and control
activity to painful stimulation under a limbs. Facial flinch, respiratory variabili-
waking condition and a trance condition ty, and GSR differed significantly under
which did not include explicit suggestions the "anesthetic" and control conditions.
of analgesia. A further problem arose when the prob-
Sears130 employed facial flinch, respira- abilities for the waking control series
tory depth, respiratory variability, pulse were recomputed: Shor found that in this
amplitude, pulse variability, and GSR as series respiratory variability was not sig-
indices of pain. Seven carefully selected nificantly different before and after pain-
"deep-trance" subjects participated. The ful stimulation and was thus of question-
pain stimulus consisted of a sharp steel able adequacy as a criterion of physio-
point pressed against the calf of the leg logical response to painful stimulation.
for 1 sec. with a pressure of 20 oz. without In brief, Shor's careful reanalysis of Sears'
breaking the skin. This stimulus was first original data indicates that only 3 meas-
applied in a waking control series to de- ures instead of 6 as reported originally
termine which of the physiological varia- were significantly affected by hypnotical-
bles were reliable indices of pain. In a ly suggested analgesia. However, of these
subsequent hypnosis series the subjects three measures, one (respiratory varia-
were placed in deep trance, suggestions bility) was of questionable adequacy un-
of anesthesia were given for the left leg, der the conditions of the experiment as an
the right leg was employed as a control, index of response to painful stimulation
and the stimulus was applied alternately and another (facial flinch) is not a physi-
to the two legs. In a third series of experi- ological variable and is amenable to vol-
ments (voluntary inhibition), the sub- untary control. Sears' major finding, then,
jects were instructed to try to inhibit re- was that the GSR to painful stimulation
actions to the painful stimulus. was reduced by 22% under hypnotically
suggested analgesia. This mean reduc-
Sears presented the following findings tion in GSR was due to 4 of the 7 subjects;
with respect to the critical hypnosis se- the other 3 subjects showed a GSR of the
ries: When the painful stimulus was ap- same order of magnitude when the stimu-
plied to the "anesthetic" leg, the hypno- lus was applied to the "anesthetic" and
tized subjects showed significantly less control limbs.
facial flinch, respiratory depth, respira-
tory variability, pulse variability, and As mentioned above, Sears performed
GSR than when the stimulus was applied an additional series of experiments in
to the control leg. The amplitude of the which the same subjects were instructed
pulse did not differ significantly when the to try to inhibit all responses to the pain-
"anesthetic" and control limbs were stim- ful stimulus. In this voluntary inhibition
ulated. series significant physiological reactions
were found and the subjects showed fa-
Sears' findings have been generally in cial flinch. Sears interpreted these find-
terpreted as a convincing demonstration ings as indicating that "Voluntary inhibi-
of the effect of hypnotic analgesia on tion of reaction to pain does not present a
physiological reactions to painful stim-
PSYCHOSOMATIC MEDICINE
BARBER 311
picture even remotely resembling the the noxious stimuli. In the remaining 3
reaction under true hypnotic anesthesia." experiments, stimulation of the "anes-
However, the subjects' failure to inhibit thetic" limb produced less vasoconstric-
flinching renders this conclusion ques- tion than stimulation of the control limb,
tionable. In pilot studies Sears had found the reductions ranging from 36 to 40%.
that the flinch response to the stimulus Doupe et al. also recorded respiration and
could be inhibited "by most people with pulse in these experiments but did not
little difficulty." As Hull80 has pointed present the data obtained on these meas-
out, since the flinching response is nor- ures. They state only that "No significant
mally under voluntary control, it appears changes in pulse rate were recorded" and
possible that the "trained" hypnotic sub- "A slight alteration in respiratory rhythm
jects participating in the Sears experi- was caused by stimuli applied to either
ment did not actually try to suppress re- [the "anesthetic" or normal] side, but this
actions to pain when instructed to do so. tended to be greater when the normal
The Sears study thus appears to be open side was stimulated."
to the same criticism that applies to other Brown and Vogel38 compared physio-
studies in "hypnosis" which employed logical responses to noxious stimulation
"trained" hypnotic subjects "as their own under hypnotically suggested analgesia,
controls," namely, when a single group of waking-imagined analgesia, local anal-
"trained" hypnotic subjects is tested un- gesia produced by Novocain," and gen-
der both the experimental and the control eral anesthesia produced by nitrous oxide.
conditions, it is difficult to exclude the Three pain stimuli were used (lancet,
possibility that the subjects may pur- weighted thumbtack, and water at 49
posively give an inferior performance un- C ) ; three physiological measures were
der the control condition in order to com- monitored (GSR, pulse, and blood pres-
ply with what they correctly or incorrect- sure); and 3 carefully selected "deep-
ly surmise are the wishes or the expecta- trance" subjects participated. The authors
tions of the experimenter.17'133 presented the results in the form of raw
Doupe et al.&i studied the effect of hyp- data without statistical analysis. From
notically suggested analgesia on the vaso- these data they deduced the following
constriction response to painful stimula- general conclusions: (1) Waking-imag-
tion. Eight subjects were used, but data ined analgesia may be as effective as sug-
are presented only on 5 subjects. These 5 gestions of analgesia given under trance
subjects participated in 11 experiments. in reducing physiological responses to
After the subject was deeply hypnotized, noxious stimulation. (2) Nitrous oxide
digital vasodilatation was produced by anesthesia is totally dissimilar to hyp-
placing his legs in warm water. Sugges- notically suggested analgesia; nitrous
tions were then given that one arm was oxide anesthesia but not hypnotically sug-
insensitive and analgesic with the under- gested analgesia abolishes physiological
standing that the alternate arm would re- reactions to noxious stimulation. It is dif-
main normally sensitive. Pin-prick stimu- ficult to determine from the raw data pre-
lation (and, at times, ice stimulation) sented in the report if these general con-
was then applied alternately to the "anes- clusions are justified. However, a careful
thetic" and normal limbs. From 6 to 40 analysis of Brown and Vogel's data has
stimulations were applied to each limb in recently been performed by Shor,182 who
each experiment. Eight of the 11 experi- reports the following: (1) Physiological
ments failed to show a significant differ- responses to the noxious stimuli did not
ence between the "anesthetic" and nor- differ significantly under hypnotically
mal limbs in vasoconstriction response to Winthrop Laboratories, New York, N. Y.

VOL. XXV. NO. 4, 1963


312 HYPNOSIS EFFECTS ON PAIN

suggested, waking-imagined, and Novo- inhibition (voluntary suppression of re-


cain analgesia. Given the small number actions to pain n the hypnotic state);
of subjects and the variability of the data, and (5) hypnotically suggested anal-
it was not possible for statistically signifi- gesia. The experimental group ("som-
cant effects to emerge. (2) With respect nambulistic" hypnotic subjects) was hyp-
to the conclusion that nitrous oxide anes- notized under Conditions 2, 4, and 5; the
thesia is totally dissimilar to hypnotic controls (subjects insusceptible to hypno-
analgesia, it appears that this is valid for sis ) were instructed to pretend as if they
the galvanic skin response, but it is not were hypnotized under these three ex-
clear if it also applies to the pulse and perimental conditions. Shor presented
blood-pressure responses. The GSR to the following findings: (1) The experi-
noxious stimulation dropped out under mental group did not show significantly
nitrous oxide but not under hypnotic different physiological responses to the
analgesia. (3) With respect to the con- noxious stimuli under any of the five ex-
clusion that waking-imagined analgesia perimental conditions. (2) The control
may be as effective as hypnotically sug- group also failed to show significant dif-
gested analgesia in attenuating physio- ferences in physiological responses under
logical reactions to noxious stimulation, any of the experimental conditions. (3)
it appears that what is being said is that There appeared to be a trend (not signifi-
since neither waking-imagined nor hyp- cant) for over-all reactivity to be less un-
notically suggested analgesia had any der the waking inhibition condition. Shor
measurable effect, they both by default concluded that his data offered no sup-
had about equal effectiveness. port to the hypothesis that hypnotically
suggested analgesia has special effects on
In addition to performing reanalyses of physiological responses to painful stimuli
132
the data of previous experiments, Shor which are beyond the bounds of waking
also carried out an experimental study of volitional control.
his own. The experimental group con-
sisted of 8 "somnambulistic" subjects; the Since skin-resistance change (GSR) is
control group consisted of 8 subjects who easily monitored and is markedly respon-
had demonstrated in a series of prelimi- sive to painful and to anxiety-arousing
nary sessions that they were not suscepti- stimulation, it has been employed in an
ble to hypnosis. Prior to the experiment extensive series of studies concerned with
proper all subjects chose a level of electric the effects of "hypnotic analgesia." Five
shock which they found painful but early studies which used the GSR as the
which they were willing to tolerate with sole criterion of physiological response to
equanimity for an extended series of ex- pain reported contradictory findings.
periments. Each subject was then pre- Peiper,120 working with 4 subjects, Pri-
sented with his chosen level of electric deaux,123 with 4 subjects, and Levine,88
shock under 5 experimental conditions with 1 subject, reported that noxious stim-
while skin resistance, respiration, and ulation applied to a skin area for which
heart rate were recorded continuously on analgesia had been suggested under
a polygraph. The experimental condi- trance produced a normal GSR. Georgi,65
tions (counterbalanced to control for or- working with 3 subjects, and Moravc-
der effects) were as follows: (1) wake sik,111 with 1 subject, reported that hyp-
control (the effect of the wake state notic suggestions of analgesia reduced the
alone); (2) hypnotic control (the effect GSR to painful stimuli. In these early
of hypnosis alone); (3) wake inhibition studies the experimental procedures are
(voluntary suppression of reactions to not presented in detail, and the data are
pain in the waking state); (4) hypnotic not analyzed statistically. Two recent
PSYCHOSOMATIC MEDICINE
BARBER 313
studies, summarized below, were carried mal waking conditions, hypnotically-sug-
out more rigorously; here again, contra- gested analgesia, and waking stimulation
dictory results were obtained. of analgesia. Adaptation of the GSR to
West et al.us monitored skin resistance the noxious stimuli was controlled by
in an extensive series of repeated sessions employing different subjects under each
with 7 subjects. (A total of 45 experi- experimental condition. In pre-experi-
mental sessions was held, an average of mental sessions, 24 subjects were given a
more than 6 sessions per subject.) Each series of electric shocks, and a level of
experimental session included a waking shock was established which invariably
control condition followed by a hypnosis produced pain. The subjects were then
condition. Under the control condition randomly assigned to three experimental
each subject received a series of painful groups with 8 subjects (4 "somnambu-
stimuli of increasing intensity produced lists" and 4 "nonsomnambulists") in
by radiant heat applied to a forelimb; fol- each group. Group 1 received 4 elec
lowing these control trials, hypnosis was trie shocks at intervals of 1 min. un-
induced, suggestions were given that the der normal waking conditions. Group 2
limb was anesthetic, and the painful received the 4 electric shocks after sug-
stimuli were again presented in the same gestions of analgesia were given under
order. The mean GSR to the painful trance. Group 3 received the 4 shocks
stimuli was significantly reduced under after receiving instructions under waking
the hypnotic-analgesia condition for all conditions to act as if the shocks were
subjects, the reductions ranging from 26 nonpainful. The GSR to the shocks was
to &7%. West et al. note that the GSR was the same under the waking control condi-
at times reduced, even when ". . . there tion, the hypnotic analgesia condition,
was no alteration in pain perception, ac- and the waking acting condition. The
cording to subjective reports," and during "somnambulists" did not differ from the
the control periods a stimulus evoking re- "nonsomnambulists" under any of the ex-
ports of relatively severe pain at times perimental conditions. Sutcliffe's study
failed to produce a GSR. The findings also included three additional experimen-
thus appear to be consistent with earlier tal conditions designed to determine if
reports84 that the galvanic skin response hypnotically-hallucinated shock or wak-
to noxious stimulation may be more close- ing-acting as if receiving electric shock
ly related to the "threat-content" or "anxi- produce a CSR similar to that found
ety" aroused by a noxious stimulus rather when electric shock is actually received.
than to "pain perception per se." This study Hypnotically-hallucinated shock did not
appears to be open to one major criticism: produce a GSR comparable to that found
The control trials always preceded the during actual shock; waking-acting as if
hypnotic trials with 3 subjects and were receiving a shock produced a GSR of the
only "occasionally" reversed with the same order of magnitude as actual shock.
other 4 subjects; since the GSR to noxious Most of the experiments described
stimulation tends to decrease over a series above were limited in scope as follows:
48 T4 131
of trials, - > the effects of hyp- (1) The pain-producing stimulipin-
notically suggested analgesia may have prick, electric shock, or radiant heat ap-
been confounded with possible adapta- plied to a limb for no more than 3 sec
tion effects.132 In a recent experiment were of brief or momentary duration. (2)
which controlled adaptation effects, Sut- Pain reactivity under hypnotically sug-
cliffe184 presented contradictory findings. gested analgesia was compared with re-
activity under an uninstructed waking
Sutcliffe recorded the galvanic-skin re- condition. Although four of these experi-
sponse to noxious stimulation under nor-
VOL. XXV, NO. 4, 1963
314 HYPNOSIS EFFECTS ON PAIN

M M i:m U5
ments - - - found that suggestions ported that "aching pain" is elicited in
of analgesia given under "trance" were normal subjects by water near the freez-
more effective than no-instructions in re- ing point within 10-60 sec; if the stimulus
ducing physiological responses to noxious is not removed, pain continues for 2-4
stimulation of short duration, this does min. before adaptation sets in; and the
not demonstrate that "hypnotic trance" intensity of the pain experienced is close-
was a necessary condition in producing ly related to increments on such physio-
this effect. As Brown and Vogel38 hy- logical variables as heart rate, systolic and
pothesized, it may be possible to produce diastolic pressure, and respiratory vari-
a similar reduction in physiological reac- ability.) Subjects assigned to the un-
tivity to painful stimuli by instructing a instructed, control, and waking-imagina-
control group to try to imagine that a tion conditions were not hypnotized. Un-
noxious stimulus is nonpainful. Barber der the uninstructed and control condi-
and Hahn-4 recently presented a carefully tions the subjects were simply asked to
conducted experiment designed to test immerse the left hand in water: the unin-
this hypothesis. The Barber and Hahn ex- structed group immersed the hand in wa-
periment was performed as follows. ter near the freezing point (2C.) for 3
Prior to the experiment proper, a stand- min., and the control group immersed the
ardized suggestibility scale was adminis- hand in water at room temperature for
tered under nonhypnotic conditions to the same period of time. Subjects allo-
192 female students. The 48 most "sug- cated to the waking-imagined analgesia
gestible" subjects (ranking in the upper condition were instructed and motivated
quartile with respect to scores on the sug- for a 1-min. period to imagine a pleasant
gestibility scale) were selected to partici- situation when the noxious stimulus (wa-
pate in the critical experiment. These ter at 2C.) was applied ("... When your
selected subjects, who were homogeneous hand is in the water, try to imagine that
with respect to sex, age, social back- it is a very hot day, that the water feels
ground, and level of pre-existing sugges- pleasantly cool, and that your hand is re-
tibility, were allocated at random to one laxed and comfortable...").
of four experimental conditions (hyp- Soon after stimulation all subjects com-
notically suggested analgesia, uninstruct- pleted a questionnaire designed to assess
ed condition, control condition, and wak- subjective experiences. This question-
ing-imagined analgesia) with 12 subjects naire yielded the following findings: (1)
to each condition. Subjects assigned to the hypnosis and waking-imagination
the hypnosis condition were given a groups did not differ in subjective reports,
standardized 20-min. trance induction stating that, on the average, the stimulus
procedure followed by a series of tests to was experienced as uncomfortable but
assess suggestibility. All subjects in this not painful. (2) The hypnosis and wak-
group appeared to enter trance (i.e., ap- ing-imagination groups differed signifi-
peared drowsy and showed psychomotor cantly from the uninstructed group,
retardation and lack of spontaneity and which rated the stimulus as painful, and
initiative) and responded positively to from the control group, which rated the
the test suggestions. Suggestions were stimulus as not uncomfortable. Physio-
then given for a period of 1 min. to induce logical variables (heart rate, skin resist-
anesthesia of the left hand; following ance, forehead-muscle tension, and res-
these suggestions the hypnotized subject piration) monitored prior to and during
immersed the "anesthetic" hand in water stimulation were analyzed in terms of
near the freezing point (2CC.) for 3 min. Lacey's autonomic lability scores91 to con-
(Previous investigators29-59'9fl 149 had re- trol for differences in base (prestimulus)
PSYCHOSOMATIC MEDICINE
BARBER 315
levels of physiological functioning. This pin prick in three experiments but failed
analysis showed the following: (1) The to do so in eight experiments. Sears130
hypnosis and waking-imagination groups observed a 22% reduction in mean GSR
did not differ on any physiological re- to noxious stimuli under hypnotic anal-
sponse to the noxious stimulus. (2) As gesia. In Dynes'56 experiment, hypnotic-
compared to the uninstructed condition, ally suggested analgesia reduced the ex-
both hypnotically suggested analgesia pected increase in heart rate, and in res-
and waking-imagined analgesia were ef- piratory rate, by 2% beats per minute, and
fective in reducing muscle tension and by 2 cycles per minute, respectively. West
respiratory irregularities during the nox- et a/.145 observed a 26-67$ reduction in
ious stimulation. (3) Under hypnotical- galvanic-skin response to painful heat un-
ly suggested analgesia and waking-imag- der hypnotically suggested analgesia.
ined analgesia, muscle tension but not However, in the Dynes experiment and
respiratory irregularity was reduced to in the West et al. experiment, the hyp-
the low level found under the control con- notic trials almost always followed the
dition. (4) Heart rate and skin-resistance control trials, and it appears possible that
level during the period of noxious stimu- some of the observed reduction in auto-
lation did not differ under the hypnotic nomic reactivity associated with hypnotic
analgesia, waking-imagined analgesia, analgesia was produced by adaptation to
and uninstructed condition; under these the stimuli. Further, in the experiments
conditions subjects showed significantly presented by Dynes,58 Sears,130 Doupe
faster heart rate and signfiicantly lower et al.,5* and West et a?.,14"1 in which physi-
skin resistance than under the control ological reactivity was reduced under
condition. In brief, the Barber and Hahn hypnotic analgesia, the comparison was
experiment found that hypnotically sug- made with an uninstructed waking condi-
gested analgesia is effective in attenuat- tion. Barber and Hahn24 also found that
ing pain experience as indicated by sub- as compared to an uninstructed condition,
jective reports and by reduction in fore- hypnotically suggested analgesia reduced
head muscle tension and respiratory ir- some physiological responses to noxious
regularities; although pain experience is stimulation (muscle tension and irregular-
reduced under hypnotic analgesia, it is ities in respiration); however, these inves-
not abolished; and the experience of pain tigators also found that instructions giv-
appears to be as effectively mitigated by en under waking conditions to imagine a
waking-imagined analgesia as by hyp- pleasant situation when noxious stimula-
notically suggested analgesia. tion was applied were as effective as sug-
The findings reviewed above appear to gestions of analgesia given under hyp-
indicate that hypnotically suggested an- notic trance in producing these effects.
algesia at times has some effect on physi- A substantial number of "hypnotic-
ological reactions to noxious stimuli, but analgesic" subjects participating in the
this effect is by no means as drastic as is above experiments manifested gross phvs-
implied in previous reviews.70' "84> 142 iological responses to relatively "mild"
Brown and Vogel,38 Sutcliffe,134 and pain stimuli such as pin prick. This raises
Shor132 failed to reject the null hypothe- a crucial question: Does the "hypnotic
sis of no difference in autonomic re- analgesic" subject undergoing surgery
sponses to painful stimuli under hypnot- show autonomic responses indicative of
ically suggested analgesia and a waking anxiety or pain? In searching the litera-
control condition. Doupe et al.6* found ture, no studies were found which pre-
that hypnotically suggested analgesia re- sented data on a series of physiological
duced the vasoconstriction response to variables recorded continuously during

VOL. XXV. NO. 4, 1963


316 HYPNOSIS EFFECTS ON PAIN

surgery performed under "trance." A occasionally be reproduced by continuing


small number of surgical studies were the process, and then the sleeper remem-
found which presented a few discontinu- bers nothing; he has only been disturbed
ous pulse or blood-pressure measure- by a night-mare, of which on waking he
ments; these studies are reviewed below. retains no recollection" (pp.145-146).
In 1846, the governor of Bengal ap-
pointed a committee consisting of the
Surgery Under "Hypnotically Suggested
inspector-general of hospitals, three phy-
Analgesia" sicians, and three judges to investigate
Esdaile's claims.35 Esdaile removed scro-
Discussions concerned with the effec- tal tumors from 6 carefully selected pa-
tiveness of "hypnotically suggested anal- tients who had been placed in "mesmeric
gesia" in surgery2'39> 75>124> 13e generally trance" by "passes" made over the body
follow an outline as follows: It is first over a period of about 6-8 hr. (Three ad-
stated that the effectiveness of "hypnosis" ditional patients who were to undergo
is beyond dispute since Esdaile performed surgery before the committee were dis-
amputations and many other major oper- missed when it was found that they could
ations "painlessly" under "mesmeric not be mesmerized after repeated at-
trance" in India during the years 1845 to tempts extending up to 11 days.) The
1851; the authors then present a few sub- committee reported that during surgery
sequent cases of surgery preformed un- 3 of the 6 patients showed "convulsive
der "trance" and then conclude that "hyp- movements of the upper limbs, writhing
notic analgesia" produces a drastic reduc- of the body, distortions of the features,
tion in pain experience. The argument giving the face a hideous expression of
to support this contention almost always suppressed agony; the respiration became
relies heavily on Esdaile's series. heaving, with deep sighs." The other 3
Although Esdaile's cases are generally patients did not show gross signs of pain;
referred to as "painless" surgery per- however, 2 of these 3 showed marked
formed under "trance," a close look at elevations in pulse rate during the sur-
Esdaile's original report61 suggests that gery on the order of 40 beats per minute.
his operations may not have been free of
anxiety and pain. Esdaile did not claim In brief, it appears that some of Es-
that all or even a majority of his patients daile's surgical cases awakened from
remained quiet during surgery.103 Some "trance" and suffered and some remained
patients showed "disturbed trances" and in "trance" but showed either "a hideous
others awakened from "trance": "She expression of suppressed agony" or
moved and moaned" (p. 200); "He marked tachycardia. However, a certain
moved, as in an uneasy dream" (p. 204); number of Esdaile's surgical patients did
"About the middle of the operation he not show overt signs of pain and stated
gave a cry" (p. 222); "He awoke, and on awakening that they had not suffered.
cried out before the operation was fin- Although this is indeed remarkable, cau-
ished" (p. 232); "The man moved, and tion should be exercised in generalizing
cried out, before I had finished. . . . on from these cases. In the first place, the
being questioned he said that he had felt proportion of Esdaile's patients that fell
no pain" (pp. 145-146). Esdaile claimed into this category cannot be determined
that many of his operations were success- from the data presented in his report.
ful even though pain may have been ex- Secondly, if facilities had been available
perienced because the patients forgot the for recording blood pressure, pulse, skin
pain: ". . . the trance is sometimes com- resistance, and other autonomic variables
pletely broken by the knife, but it can continuously, it appears possible that
PSYCHOSOMATIC MEDICINE
BARBER 317
these patients may also have shown phys- Lee8x write that during the surgery the
iological reactions indicative of anxiety blood pressure varied from 125/85 to
and pain. Thirdly, it cannot be assumed 80/60 and pulse varied from 76 to 100.
that these patients would have moaned Taugher135 has presented 3 cases of sur-
or cried during the surgery if they had gery (tonsillectomy, curettage, and ce-
not been in "mesmeric trance;" although sarean section) performed under "trance."
many of Esdaile's nonmesmerized surgical Although the patients did not complain
patients cried and struggled, his report of pain, blood pressure and pulse showed
suggests that a few of his surgical patients marked variability; in the cesarean sec-
who could not be placed in "mesmeric tion, for instance, blood pressure varied
trance" did not show gross signs of pain from 140/90 to 80/20, and pulse rate
(pp. 214-215). varied from 86 to 120.
Following Esdaile's report, scattered Mason106 has presented a case of mas-
cases have been published of surgery per- toplasy performed under hypnotically
formed under "hypnosis."36-4T- 60 Typi- suggested analgesia. With the exception
cally these reports state that an operation of sodium amytal, administered the night
was performed under hypnotically sug- before surgery, no other medications were
gested analgesia, e.g., dental extraction, given. During the operation the entranced
avulsion of fingernail, incision of infected patient did not show noticeable signs of
digit,129 removal of cervicouterine tu- pain; on awakening, she appeared to be
mors,125 and the ". . . cooperation of the amnesic for any pain that may have been
patient was perfect, the operation was experienced. Mason writes that at some
painless and there was no post-operative point during the operationthe precise
pain"126 or the patient". .. woke up with- time is unspecifiedthe patient's ".. .pulse
out pain or any physiological disturb- rate stabilized at 96 and respiratory rate
ance."125 The procedures employed and at 24 per minute," with the implication
the patient's overt behavior and subjec- that these measures may have been un-
tive reports are not presented in detail, stable prior to this period.
and physiological measures monitored In other recent surgical cases the ef-
during the surgery are not reported. fects of hypnotically suggested analgesia
The few reports that present some phys- were confounded with the effects of seda-
iological data suggest the possibility that tive and analgesic drugs. Manner,105 for
the "hypnotic-analgesic" surgical patient instance, employed hypnosis in an exten-
may experience some degree of anxiety sive series of surgical cases (bunionecto-
and pain. Finer and Nylen62 presented a my, laminectomy, thyroidectomy, hemor-
successful case of excisions and skin grafts rhoidectomy), but substantial quantities
performed upon a severely burned pa- of analgesic agents (nitrous oxide, meper-
tient under 'Tiypnoanesthesia;" although idine, caudal block with lidocaine) were
the patient did not show overt motoric always used, no control cases are report-
signs of pain, blood pressure and pulse ed, and it is difficult to separate the effects
showed significant elevations. Kroger and of "hypnosis" from the effects of the drugs.
Kroger and DeLee 8788 employed "hyp- Tinterow137 has presented 7 cases of hyp-
notic analgesia" in the removal of breast notic surgery (cesarean section, bilateral
tumor, in subtotal thyroidectomy, in ex- vein ligation, vaginal hysterectomy, de-
cision biopsy for breast tumor, and in ce- bridements and skin grafts, hemorroid-
sarean section and hysterectomy; no phys- ectomy, appendectomy, and open-heart
iological data are presented with the ex- surgery); in most of these cases, secobar-
ception of the cesarean section and hys- bital, atropine sulfate, chlorpromazine,
terectomy; in this case, Kroger and De- and promethazine were administered
VOL. XXV, NO. 4, 1963
318 HYPNOSIS EFFECTS ON PAIN

singly or in combination. Similarly, pain. Such studies should meet the fol-
Owen-Flood114 presented a case of ap- lowing minimum requirements: (1) A
pendectomy performed under "hypnoan- series of physiological variablesblood
esthesia" in which the effects of "hypno- pressure, pulse, skin resistance, respira-
sis" were confounded with the effects of tionshould be recorded simultaneously
a regular dose of scopolamine and one- and continuously during surgery per-
half the routine dose of morphine. formed on two groups of subjects, one
In other surgical cases, hypnotic sug- group undergoing the surgery under hyp-
gestions of analgesia were sufficient to notically suggested analgesia and the
produce a satisfactory reaction pattern other under chemical anesthesia. (2) The
during part of the operation, but chemi- two groups should be matched as closely
cal agents were required before surgery as possible with respect to such back-
was completed. Anderson- reports that ground variables as age, sex, and social
an entranced subject showed little if any class and with respect to type of surgery.
overt signs of pain at the commencement (3) The data should be analyzed by ap-
of an abdominal exploration; however, propriate statistical techniques55'91 to
before the operation was completed, the take into account differences in physio-
patient ". . . practically broke his hyp- logical base levels under hypnotic anal-
notic trance," and thiopental was admin- gesia and chemical analgesia. The find-
istered. Butler39 presented similar find- ings reviewed above suggest that if these
ings concerning an abdominal explora- minimal requirements are included in
tion: As the fascia was being incised, the surgical studies, it will be found that
hypnotized patient showed signs of pain "hypnotic analgesic" subjects show sig-
and was given cyclopropane. nificantly greater physiological reactions
indicative of anxiety and pain than anes-
The above data suggest the possibility thetized subjects.
that surgery performed under "hypnotic
trance" may not be as painless and as free
from anxiety as has at times been sup- Reduction in Anodyne Requirements as
posed. Although highly selected subjects an Index of Pain Relief
were used in all of these studies, some
subjects showed physiological reactions Some patients in labor, some postoper-
which appear to be indicative of anxiety ative patients, and some terminal cancer
and pain, others "broke the trance," and patients who are given suggestions of
others required the assistance of chemical pain relief under "hypnotic trance" state
agents. These findings appear not to con- to the hypnotist that their pain has been
tradict Bernheim's30 contention that "hyp- reduced or abolished. Since the state-
notism only rarely succeeded as an anes- ments of the hypnotic subject, as given to
thetic, that absolute insensibility is the ex- the hypnotist, do not always correspond
ception among hypnotizable subjects, and to the true state of affairs,9 15< 1T a number
that the hypnotizing itself generally fails of investigators have focused on a reduc-
in persons disturbed by the expectations tion in the hypnotic patient's need for
oi an operation." The findings also do not anodynes as a somewhat more objective
contradict Moll's110 contention that "a and somewhat more reliable index of pain
complete analgesia is extremely rare in relief.
hypnosis, although authors, copying from August5 compared drug requirements
one another, assert that it is common." during labor of 850 trained hypnotic pa-
Additional studies are needed to delin- tients who had chosen "hypnosis" as the
eate more precisely the effects of hyp- preferred form of anesthesia and 150 con-
notically suggested analgesia on surgical trol patients who had refused hypnosis.
PSYCHOSOMATIC MEDICINE
BARBER 319
The control group received an average of laxation classes conducted by a physio-
53.7 mg. of meperidine (Demerol 9 ) and therapist. Gioup 3 (986 patients) re-
22.7 mg. of barbiturates (Seconalf or ceived the three instructional talks, the
NembutalJ); the hypnotic group re- visit to the labor wards, plus three train-
ceived, on the average, 30.3 mg. of me- ing sessions in hypnosis. In the hypnotic
peridine and 2.2 mg. of barbiturate. training sessions this group was given
Abramson and Heron1 compared narcot- practice in entering trance; practice in re-
ics requirements during labor of 100 hyp- sponding to suggestions of anesthesia;
notic patients and of 88 controls picked at suggestions that labor would be painless;
random from the hospital files. The hyp- and suggestions that amnesia would fol-
notic group had participated on the aver- low the labor. (Fifty-six per cent, 26!?,
age in 4 prelabor hypnotic training ses- and 18$ of the subjects in Group 3 were
sions, each session requiring a period of rated as "good," "moderately good," and
30 min.; the controls had been delivered "poor" hypnotic subjects, respectively.)
previously by other obstetricians and had There were no significant differences
not received antenatal training. The con- among the four groups (nonvolunteers,
trol group on the average received 123.6 Group 1, Group 2, and Group 3) in:
mg. of meperidine; the hypnotic group duration of labor; calmness, relaxation,
received an average of 103.5 mg. of me- and cooperation during labor; number of
peridine, a reduction of 16% patients judged to have had severe pain;
incidence of amnesia for labor; and pro-
The studies of August5 and Abramson portion of patients eager to have more
and Heron1 are open to a number of criti- children. There was a small difference in
cisms : (1) The hypnotic group consisted the amount of sedation requested during
of volunteers who may have represented labor: 40% of the hypnosis group and 32,
a selected group of patients who were 34, and 353? of Groups 1,2, and nonvolun-
likely to be more cooperative during la- teers, respectively, requested less than
bor. (2) The obstetricians gave more 100 mg. of meperidine. (The 403> figure
time and attention to the hypnotic pa- for the hypnotic group was increased to
tients than to the control patients. (3) 44$ in the subgroup rated as "good" hyp-
The hypnotic group was apparently given notic subjects.) Perchard concluded that
medication only on demand, while the "It would appear that no detectable bene-
control group received medicaments more fits were derived from the simple relaxa-
or less routinely. Perchard121 has carried tion exercises and that not more than a
out a large-scale study which attempted limited subjective benefit with slightly
to control some of these variables. A total reduced need for sedation resulted from
of 3083 primigravidas were observed, of the hypnosis."
whom 1703 did not volunteer for ante-
natal classes. The other 1380 primiparas, Papermaster et al.,us Bonilla et a/.,s*
who volunteered for classes, were as- and Laux95 assessed the effects of hyp-
signed to three experimental treatments notically suggested pain relief on narcot-
as follows. Group 1 (268 patients) re- ics requirements in postoperative cases.
ceived three instructional talks concern- Papermaster et al.116 worked with 33 un-
ing parturition plus a visit to the labor selected patients undergoing major ab-
wards. Group 2 (126 patients) was given dominal surgery. An attempt was made
the three instructional talks, plus a visit to hypnotize each patient 3 times, twice
to the labor wards, plus three physical re- prior to and once after surgery; during
the hypnosis sessions it was suggested that
Breon Laboratories, New York, N. Y. the area of incision would produce no
fEli Lilly and Company, Indianapolis, Ind. postoperative discomfort. A matched con-
JAbbott Laboratories, North Chicago, 111.
VOL. XXV, NO. 4, 1963
320 HYPNOSIS EFFECTS ON PAIN

tiol group, consisting oi 33 patients un- ative pain relief included: (1) number
dergoing similar surgery but not receiv- of requests for anodynes; (2) amount of
ing hypnosis training, was selected from drugs given; and (3) the charge nurse's
the hospital files. The hypnotic group re- evaluation of the amount of pain suffered.
quested and received an average of 4.21 The assessment period extended over 5
doses of meperidine (50 mg. per dose) days. During the first postoperative day
postoperatively as compared to 7.57 doses the number of requests for anodynes by
for the control group, a reduction in nar- the hypnosis group was 34 per cent less
cotics requirements of 45 per cent. The than for the control group. There were no
authors do not present data for the indi- significant differences between the two
vidual subjects, stating only that the groups on any of the criteria during the
range in doses of meperidine received remaining 4 days of the assessment peri-
varied from 0 to 44 and from 0 to 29 in od.
the control and hypnosis groups, respec- Butler,39 Cangello,41 and Perese122 as-
tively. sessed the effect of suggestions given un-
Bonilla et al.33 worked with 10 male pa- der "trance" on pain associated with ter-
tients undergoing uncomplicated arthrot- minal cancer. Butler found that after a
omy of the knee. Each patient partici- series of intensive trance sessions with 12
pated in from 1 to 4 30-min. hypnotic ses- selected hypnotizable cancer patients, 1
sions prior to surgery and received sug- patient showed a 503? reduction in narcot-
gestions that he would experience no post- ics requirements for a few days and
operative discomfort; in some instances, another showed a 100? reduction for 3
hypnotic sessions were also conducted in weeks. (Of the remaining 10 patients, 8
the postoperative period. This group was manifested subjective relief of pain dur-
compared on postoperative narcotics re- ing and, at times, for a brief period fol-
quirements with 40 preceding male pa- lowing the trance sessions.) Cangello41
tients undergoing uncomplicated arthrot- reported that after a series of intensive
omy for similar knee afflictions. The con- hypnotic sessions 18 of 31 selected cancer
trol group received an average of 360 mg. patients manifested from 25 to 100* re-
of meperidine postoperatively as com- duction in narcotics for a period extend-
pared to 275 mg. for the hypnosis group, ing from 2 days to 12 weeks. Perese122
a reduction of 24$. reported that "hypnosis" was "useful" in
It appears that in the Papermaster relieving pain in 2 of 16 cancer patients
et al.116 and Bonilla et al.as studies the and that with another 4 patients it dimin-
hypnotic group received medicaments ished narcotic requirements "slightly." In
only on demand while the control group these studies the physicians worked in-
was given medication routinely. Laux85 tensively with their hypnotic patients, and
presented an experimental study which a control group receiving a similar
controlled this factor. Forty veterans un- amount of attention was not used for com-
dergoing urological surgery were assigned parison. It is thus difficult to determine
either to an experimental hypnosis group to what extent the reported pain relief
(20 subjects) or to a nontreated control was due to the support the patients re-
group (20 subjects). The two groups were ceived from the physician and to what
matched with respect to type of surgery, extent it was due to other factors sub-
age, sex, and socioeconomic status. The sumed under the term "hypnosis." This
experimental subjects received sugges- factorthe support and attention received
tions intended to relieve postoperative by the patient from the physicianwill
pain in 3 presurgery and 1 postsurgery be discussed again below.
hypnosis sessions. Criteria for postoper- In summary, the studies reviewed
PSYCHOSOMATIC MEDICINE
BARBER 321
above appear to indicate that hypnotical- needle pricks and burns; suggestions to
ly suggested pain relief produces some induce hallucinatory pain;" suggestions
degree of reduction in anxiety and pain to remove the "hallucinatory pain;" and
in some patients undergoing surgery or posthypnotic suggestions that whenever
parturition and in some patients suffering pain arose in the waking state, it would
from postoperative pain or cancer pain. disappear immediately. The spinal-cord
However, these studies also suggest that cases showed a reduction in requests for
although pain experience is at times amel- anodynes and reported less pain, but none
iorated, it is only in very rare cases abol- were free from pain. The dysmenorrheics,
ished. A more precise statement of the ef- on the other hand, ". . . were relatively
fects of hypnotically suggested analgesia free from pain upon discontinuance of
in surgery, in labor, and in chronic pain therapy and have remained relatively
appears to be that when given suggestions free from pain for at least two years." The
of pain relief under "hypnotic trance," authors presented the following interpre-
some patients are able to endure what- tation of these findings:
ever degree of pain is present, are not
overly anxious, and do not seem to suffer We believe that dysmenorrhea is a condi-
to the degree expected when anxiety is tioned process brought about in the following
present. manner. Pain above threshold levels has been
present at some time during menstruation.
When the experience has once occurred, such
The Effects of "Hypnotic Suggestions" changes as extra-cellular edema, basal tem-
on "Functional" or "Conditioned" Pain perature change, muscle tonicity, vascular
changes, and breast change which were origi-
nally associated with the painful experience re-
Although it appears that hypnotic sug- instate the pain even in the absence of the or-
gestions rarely if ever abolish pain experi- ganic factors that originally brought it about
ence in conditions in which noxious stim- . . . In the dysmenorrheic, when we break the
ulation is continually presente.g., in sur- chain of expectancy and tension, we break
gery, in chronic painthis does not ex- down the conditioned process, whereas in the
clude the possibility that hypnotic sugges- spinal nerve injury cases we are not destroying
tions may at times eliminate some types of a conditioned process, but suppressing the pri-
pain, specifically, those types of pain which mary pain-arousing mechanism. This is held
in abeyance only insofar as the factors that
appear to be produced by a "condition- tend to focus the individual's attention on the
ing or learning process." Dorcus and pain is concerned and in that respect the pain
Kirkner52 have presented experimental may appear abated. It does not remain in-
findings which support this contention. hibited because the source is continually pres-
These investigators worked with two ent.
groups of selected patients: a group of 5
males suffering from pain associated with Dorcus and Kirkner's findings with re-
spinal-cord injuries and a group of 5 fe- spect to dysmenorrhea may be relevant
males suffering from chronic dysmen- to other "functional" painful conditions
orrhea. (No pathology could be found such as certain types of headaches or
in the latter group that could account for backaches. There is evidence to indicate
the chronic painful menstrual condition.) that some headaches are associated with
Each of the spinal-cord cases participated "emotional tension, anxiety, and conflict"
in approximately 16 hypnotic sessions; and with prolonged contraction of the
the dysmennorheics participated in from muscles of the head and neck, and that
1 to 5 hypnotic sessions. The method of alleviation of the "conflicts and anxieties"
treatment included: induction of hyp- and/or relief of the muscle hyperfunction
notic trance; suggestions of anesthesia to at times relieves the headache.1"1 There
VOL. XXV, NO. 4, 1963
322 HYPNOSIS EFFECTS O N PAIN

is also evidence to indicate that some trance." These two interrelated referents
backaches are associated with sustained of the term "hypnosis" can be further
contraction in the muscles of the back; specified as follows.
the sustained skeletal-muscle hyperfunc- 1. Investigators agree that a wide varie-
tion is one component of a more gener- ty of procedures can be classified as
alized pattern of response to "anxiety, "trance inductions." At the present time
hostility, and conflict;" and the backache such "induction procedures" generally in-
may be ameliorated by relieving either clude verbal suggestions of relaxation,
the "anxiety" or the muscular contrac- drowsiness, and sleep, and often also in-
tions.78 The findings presented by Dorcus clude some type of "physical stimulation"
and Kirkner,52 Wolff,151 and Holmes and such as the sound of a metronome or eye
Wolff78 suggest the hypothesis that some fixation on a "hypnodisk." However,
types of headaches and backaches can other types of "induction procedures,"
be effectively relieved by suggestions comprehensively described by Pattie119
(given with or without 'hypnotic and by Weitzenhoffer,143 have been used
trance") intended to eliminate the ten- in the past and are at times used now, in-
sion-anxiety-conflict pattern and the sus- cluding hyperventilation, compression of
tained muscle contractions in the neck or the carotid sinus, stimulation of "hypno-
back. Experiments are needed to test this genic zones," and use of "passes" or "hand
hypothesis. gestures." Although the administration
of one of these "induction procedures"
appears to be necessary to induce an in-
Significant Variables in "Hypnotic experienced subject to enter "the hyp-
Analgesia" notic trance," a consensus exists that after
a subject has had experience with or
The general conclusion indicated by "training" in "hypnosis," he may be in-
this review is that some degree of reduc- duced to enter "trance" by a drastically
tion in pain experience can at times be abbreviated "induction procedure" con-
produced by suggestions given under sisting of a prearranged signal or cue
"hypnosis." The question may now be word.
raised: Which of the many variables sub-
2. Numerous attempts have been made
sumed under the concept of "hypnosis"
to find physiological indices of "the state
are effective and which are irrelevant to
of trance" which is said to be produced
producing this effect? To answer this
when the "induction procedure" is "suc-
question, it is necessary first to specify
cessful." These attempts have failed to
the referents of the term "hypnosis."
yield an acceptable criterion15 and the
Although formal definitions of "hyp- presence of "the trance state" is inferred
nosis" and "hypnotized" differ widely, in from the subject's observable character-
practice the terms are used more or less istics and behaviors. These "trance char-
interchangeably and appear to derive acteristics" according to Erickson et al,90
meaning from a consensual frame of ref- include a loss in mobility, tonicity
erence; that is, when it is stated that sub- throughout the body, rigid facial expres-
jects were "hypnotized" or "placed in hyp- sion, and literalness in response. Other
nosis," it is implied that: (a) one of vari- investigators list similar indices. Pattie119
ous types of procedures that have been refers to ". .. passivity, a disinclination to
historically categorized as "trance induc- talk . . . a great degree of literal-minded-
tions" was administered and (b) the sub- ness, and a lack of spontaneity and initia-
jects manifested a number of character- tive." Weitzenhoffer143 notes that "There
istics which by consensus are presumed seems to be some agreement that hyp-
to signify the presence of "the hypnotic
PSYCHOSOMATIC MEDICINE
BARBER 323
4
notized individuals, even when behaving Barber and Hahn- found that waking
in a most natural manner, still show a control subjects instructed to imagine a
constriction of awareness, a characteristic pleasant situation during painful stimula-
lileral-mindedness, some psychomotor re- tion showed as much reduction in pain
tardation, and possibly a degree of auto- experience, as indicated by subjective re-
matism." Gill and Brenman68 similarly ports and by reduction in muscle tension
write that entranced subjects who have and respiratory irregularities, as "en-
been instructed to behave as if they are tranced" subjects given suggestions of an-
not hypnotized show ". . . momentary esthesia. Von Dedenroth140 has presented
lapses into somewhat stiff or frozen pos- a series of cases in which patients who
tural attitudes . . . an impression of a manifested the characteristics of "deep
slight slowing down of the pace of bodily trance" did not respond to suggestions of
movement . . . [and] a fleeting glazing pain relief, and patients who appeared at
of the eyes, the 'unseeing look' normally best to be "in a light hypnoidal state" and
found in reverie or in a Tjrown study.'" patients who insisted that they were not
It has often been assumed that "hyp- hypnotized at all, showed dramatic re-
notic trance," as inferred from the char- lief of stubborn headache or underwent
acteristics and behaviors described above, dentistry without analgesics or anes-
is crucial to producing "pain relief by thetics even though these agents had
suggestions. A series of recent investiga- been demanded consistently for prior
tions, summarized below, suggest that dental work. Von Dedenroth interpreted
this assumption is open to question. his data as indicating that "each instance
of hypnotherapy is dependent upon the
"The Hypnotic Trance" as a patient's inner responsiveness and the
Factor in "Hypnotic Analgesia" character and nature of his motivation
rather than upon trance level or depth."
The presence of "hypnotic trance" is Lea et a/.96 arrived at a similar conclu-
not sufficient to produce "analgesia" by sion in an investigation concerned with
suggestions. Esdaile61 presented cases of the effects of "hypnosis" on chronic pain:
patients manifesting many if not all of "We assumed that our success would de-
the characteristics of "deep trance" who pend upon the depth of hypnosis, but, to
"shrunk on the first incision" and showed our surprise, we found that this was not
normal responses to painful stimulation. necessarily the case. As a matter of fact,
Winkelstein and Levinson,148 Anderson,2 two of our best patients obtained only
Butler,39 Liebault100 and others also light to medium trances, and significant
found that some "deeply entranced" pa- responses were noted in even the very
tients did not respond positively to sug- lightest hypnoidal states." Along similar
gestions intended to produce pain relief. lines, Cangello41 found in a study of the
The crucial question, however, is not, Is effects of "hypnosis" on pain associated
"hypnotic trance" sufficient to produce with cancer that "an individual who en-
"analgesia" by suggestions?, but, Is "hyp- tered a deep trance might be unable to
notic trance" a necessary or an extraneous obtain relief of pain while another who
factor in producing this effect? Contrary was at best in a hypnoidal or light state
to what the early literature on "hypnosis" experienced complete pain relief." Laux95
might lead one to expect, recent studies presented comparable results in an exper-
indicate that subjects who are in "a very imental investigation on postoperative
light trance" and subjects who are not "in pain: "Some of those who appeared to be
trance" are often as responsive and at the most deeply hypnotized had marked
time more responsive to suggestions of pain, and some who showed little re-
pain relief than "deep-trance" subjects.
VOL. XXV, NO. 4, 1963
324 HYPNOSIS EFFECTS ON PAIN

sponse to the hypnosis had little pain and sis" was discontinued, but the physician
attributed their comfort to the effects of continued to give the same amount of
hypnosis." personal attention to the patient, the pa-
Comparable findings have been pre- tient continued to show pain relief.
sented in a series of recent studies em- Manner104 has also pointed to the atten-
ploying "hypnosis" in obstetrics. Mi- tion and support given to the patient as a
chael107 found that some patients who at significant variable, writing that "The
best attained only "a very light hypnotic realization that the anesthesiologist is
trance" underwent labor without medi- willing to invest time, effort, warmth and
cations and without manifesting overt understanding in an attempt of hypnosis
signs of pain while others who attained will give most patients added security and
" a deep trance" experienced severe pain trust in the physician and will result in
and required standard doses of narcot- decreased tension and anxiety." Lea et
ics. Winkelstein147 observed that "Some a/.96 reported similar observations in a
women, hypnotized only to the lightest study on chronic pain: "At times it was
degree managed their delivery success- hard to decide whether benefit was ac-
fully, while others, deep in the somnam- tually being derived from hypnosis itself
bulistic state were unable to cope with or such extraneous factors as the second-
the discomfort of labor." Similarly, ary gain a patient would derive from an
Mody109 noted no relationship in his sam- unusual amount of personal attention
ple of 20 selected patients between "the from the hypnotherapist."
depth of hypnosis" and the degree of pain Recent reports concerned with the ef-
experienced during parturition. fects of "hypnosis" on the pain of parturi-
The data cited above suggest that "the tion also emphasize the significance of in-
hypnotic trance state" may not be a criti- terpersonal factors. In a study with 200
cal factor in producing "pain relief" by obstetrical patients, Winkelstein147 found
suggestions. The data reviewed below that to produce some measure of pain re-
suggest that the critical factors in so- lief by suggestions, it was necessary for
called "hypnotic analgesia" may include: the physician to devote a great amount of
(a) suggestions of pain relief; which are time and attention to each patient. This
(b) given in a close interpersonal set- investigator de-emphasized the impor-
ting. tance of "the trance state" in producing
pain relief by suggestions, pointing to the
The Interpersonal Relationship following variables as crucial: (1) the
Butler39 attempted to relieve pain asso- suggestions themselves; (2) the mental
ciated with carcinoma in 12 selected pa- attitude of the patient toward pregnancy
tients who were able to attain "a medium and delivery; (3) the will to succeed; (4)
or deep trance." Each patient received the confidence of the patient in the pro-
suggestions of pain relief in a series of cedure as well as in the obstetrician; and
trance sessions held daily and at times (5) the patient-obstetrician rapport.
2-4 times per day. Ten of the 12 patients Chlifer46 had similarly observed that the
stated that their pain was reduced during effectiveness of suggestions of pain relief
and, at times, for a brief period following in labor is not correlated with "the depth
the hypnotic sessions; however, when of trance;" pain may be ameliorated by
"hypnosis" and the relationship between suggestions given to nontrance subjects;
patient and physician were terminated, and "the success of verbally induced anal-
the patients showed a return of the origi- gesia is closely related to the personality
nal pain syndrome. The significant find- of the subject and the relationship estab-
ing in these cases was that when "hypno- lished between the doctor and the par-
PSYCHOSOMATIC MEDICINE
BARBER 325
turient woman." After wide experience inof war hospital near Singapore. Anes-
thetic agents were not available, and
the use of "hypnosis" for relief of labor
pain, Kroger and Freed89 proffered the "hypnosis" was employed for surgery.
hypothesis that if a close relationship Two patients could not be "hypnotized;"
exists between patient and obstetrican, since the surgical procedures (incision for
about 10-15% of nonmedicated patients exploration of abscess cavity and extrac-
will be free of discomfort during labor tion of incisor) had to be performed with-
even though the hypnotic trance state isout drugs, Sampimon and Woodruff pro-
not induced. ceeded to operate after giving "the mere
The above studies suggest that the suggestion of anesthesia." To their sur-
critical factors in so-called "hypnotic prise they found that both patients were
analgesia" may include "suggestions of able to undergo the normally painful pro-
cedures without complaints and without
pain relief given in a close interpersonal
setting. The interpersonal variable has noticeable signs of pain. These investiga-
been emphasized above; the "suggestions tors write that "As a result of these cases
of pain relief" require further comment.two other patients were anesthetized by
suggestions only, without any attempt to
"Suggestions of Pain Relief as a induce true hypnosis, and both had teeth
14 20
Critical Factor in "Hypnotic Analgesia" removed painlessly." Other workers ' >
22,23,67,86,150 n a v e presented comparable
The effects of "suggestions of pain re- findings with respect to the effectiveness
lief per se" have at times been confound- of "direct suggestions" given without the
ed with the effects of "hypnotic trance." induction of "hypnotic trance."
In a number of studies 1 ' 5 ' 33 ' 113 the ex-
perimental group was placed "in hypnotic Similar findings have been presented in
trance" and then given suggestions to re- studies concerned with the effects of pla-
lieve pain; the control group was not cebos. Hardy et al.14 found that 2 sub-
placed "in trance" and was not given jects given an inactive drug with the sug-
pain-relieving suggestions. These studies gestion that it was a strong analgesic
failed to exclude the possibility that the showed elevations in pain threshold over
effective factor in ameliorating pain in 90% above the control levels; blisters were
the experimental group was not "the hyp- produced in these subjects without re-
notic trance" but "the suggestions of pain ports of pain. Beecher,26 Dodson and
relief per se;" if the control group had Bennett,51 and others79' 83>116 have pre-
been given suggestions of pain relief sented evidence indicating that about
without trance, it might also have shown one-third of postoperative patients re-
a reduction in pain experience. Support- ceive "satisfactory relief of pain when
ing evidence for this supposition is found inert agents are administered as pain-re-
in the Barber and Hahn2* experiment in lieving drugs. Laszlo and Spencer04
which a nontrance control group given found in a study with 300 cancer patients
instructions or "suggestions" intended to that "over 50 per cent of patients who had
ameliorate pain showed a similar reduc- received analgesics for long periods of
tion in pain experience as entranced sub- time could be adequately controlled by
jects given suggestions of anesthesia. placebo medication." Although few if
Sampimon and Woodruff1-6 have pre- any studies on the "placebo effect" re-
sented data indicating that direct sug- port detailed data concerning the rela-
gestions given without "hypnotic trance" tionship between patient and physician
are at times sufficient to alleviate pain. and the suggestions given to the patient,
In 1945 these investigators were working it appears likely that in some if not many
under primitive conditions in a prisoner of these studies the patients were given

VOL. XXV, NO. 4. 1963


326 HYPNOSIS EFFECTS ON PAIN

suggestions of pain relief in a close inter- ble opportunity to form a close relation-
personal setting. ship with him.
3. Both groups should be given similar
suggestions of pain relief, one group to
Indications for Further Research be given the suggestions under "trance"
and the other under nontrance conditions.
To determine the significance of "hyp- The data presented in this review sug-
notic trance" as a factor in relieving pain gest that if these critical variables are
by suggestions, additional experiments controlled, it will be difficult to reject the
are needed which control three critical null hypothesis of no difference in re-
variables noted above: (1) the selection sponse to suggestions of analgesia in non-
of subjects; (2) the interpersonal rela- entranced and "deeply entranced" sub-
tionship between subject and experi- jects.
menter; and (3) the suggestions of pain
relief per se. These experiments should Variables Intervening Between Sugges-
be conducted as follows: tions of Pain Relief and Reduction in
1. The effects of "hypnotic trance" Pain Response
should not be confounded with differ-
ences between subjects. In a number of A number of investigators have postu-
studies cited above,1' "33-115'132 subjects
lated that suggestions of analgesia are ef-
meeting criteria of "hypnotizability" were
fective in diminishing subjective and
assigned to the "trance" treatment, and physiological responses to pain if and
unselected subjects or nonhypnotizable when they lead the subject to stop think-
subjects were assigned to the control ing about or to stop attending to the pain.
treatment. The criterion used for select-Liebault100 hypothesized that the process
ing the experimental group, that the sub-of suggested analgesia can be described
jects were "hypnotizable," is difficult if
simply as the focusing of attention on
not impossible to differentiate from an in-
ideas other than those concerning pain.
terrelated implicit criterion, namely, that
Young152 presented a similar hypothesis:
the subjects were highly responsive to Pain relief produced by "hypnosis" or by
suggestions with or without "hypnotic suggestive procedures is due to a "taking
trance." If suggestible subjects are allo-
of an attitude and consequently refusing
cated to the "trance" treatment and less to feel the pain or even to take cognizance
suggestible subjects to the control treat-
of it." August5 postulated that "Hypno-
ment, it is impossible to determine if anesthesia results from directing attention
greater response to suggestions of pain away from pain response towards pleas-
relief in "entranced" subjects, as com- ant ideas." These hypotheses receive some
pared to control subjects, is due to their
support from a recent experimental
being in "trance" or to their being more study24 which found that the subjective
suggestible to begin with. To control this
and physiological responses to painful
factor, it is necessary that subjects be ran-
stimuli which characterize "hypnotic-
domly assigned to the "trance" and non- analgesic" subjects can be elicited from
trance treatments from an original groupcontrol subjects by instructions to think
of subjects who show a similar level of about and to imagine a pleasant situation
suggestibility.17' m when noxious stimulation is applied.
2. Subjects allocated to the "trance" The intervening variables in so-called
and nontrance treatments should be given "hypnotic analgesia" may be similar to
comparable time and attention by the ex- those which presumably operate in the
perimenter and should have a compara- placebo situation and in other nontrance
PSYCHOSOMATIC MEDICINE
BARBER 327
situations in which pain experience is sires that his efforts will be successful;
abated without medications. These inter- and communicates his desires to the pa-
vening variables have been summarized tient. The patient in turn has often formed
succinctly by Cattell:43 a close relationship with the physician-
The intensity of the sensation produced by hypnotist and does not want to disappoint
a painful stimulus is determined to a large ex- him. The situation is such that even
tent by circumstances which determine the though the patient may have suffered, it
attitude towards its cause. If there is no worry is at times difficult or disturbing for him
or other distressing implications regarding its to state directly to the physician that pain
source, pain is comparatively well tolerated, was experienced and it is less anxiety pro-
and during important occasions injuries ordi- voking to state that he did not suffer.
narily painful may escape notice. On the other 3. A series of experiments that moni-
hand, in the absence of distraction, particularly tored heart rate, skin resistance, respira-
if there is anxiety, the patient becomes preoc-
cupied with his condition, and pain is badly tion, blood pressure, and other physio-
tolerated. logical responses which are normally as-
It appears unnecessary to hypothesize sociated with painful stimulation found
additional intervening variables in so- that in some instances "hypnotically sug-
called "hypnotic analgesia." In any situa- gested analgesia" reduced some physio-
tion (hypnotic or nonhypnotic) in which logical responses to noxious stimuli and
anticipation or fear of pain is dispelled, in other instances physiological responses
and "anxiety" is reduced, and the subject were not affected. However, experiments
does not "attend to" or "think about" the which found reduced autonomic re-
painful stimulus, noxious stimulation is sponses to noxious stimuli under "hyp-
apparently experienced as less painful notic analgesia" compared reactivity un-
and less distressing than in situations in der the hypnotic condition with reactivity
which "anxiety" and "concern over pain" under an uninstructed waking condition.
are present.11'2H'71~73'76'77- 8-lli2 In a recent carefully controlled experi-
ment in which physiological reactions to
painful stimulation were compared under
Summary (a) "hypnotically suggested analgesia"
and (b) a waking condition in which sub-
1. In some instances, suggestions of jects were instructed to imagine a pleas-
pain relief given under "hypnotic trance" ant situation when noxious stimulation
appear to produce some degree of dimi- was applied, it was found that both con-
nution in pain experience as indicated by ditions were equally effective in reducing
reduction in physiological responses to subjective and physiological responses to
noxious stimuli and by reduction in re- painful stimulation.
quests for pain-relieving drugs. In other
instances, however, "hypnotically sug- 4. Studies concerned with surgery per-
gested analgesia" produces, not a reduc- formed under "hypnoanesthesia alone"
tion in pain experience, but an unwilling- rarely present any physiological data; the
ness to state directly to the hypnotist that small number of studies that presented a
pain was experienced and/or an apparent few pulse or blood pressure measure-
"amnesia" for the pain that was experi- ments suggest the possibility that "hyp-
enced. notic-analgesic" subjects undergoing sur-
2. The motivation for denial of pain is gery may show autonomic responses in-
present in the hypnotic situation. The dicative of anxiety and pain. In other
physician has invested time and energy studies concerned with surgery per-
hypnotizing the patient and suggesting formed under "hypnosis" the effect of
that pain will be relieved; expects and de- "hypnotically suggested analgesia" was

VOL. XXV, NO. 4. 1963


328 HYPNOSIS EFFECTS ON PAIN

confounded with the effects of sedative 3. ANDREWS, H. L. Skin resistance change


and analgesic drugs. and measurements of pain threshold. /.
Clin. Invest. 22:517,1943.
5. The data appear to indicate that in 4. ASIN, J. The utilization of hypnosis in
surgery, in chronic pain, and in other con- obstetrics. /. Amer. Soc. Psychosom.
ditions in which noxious stimulation is Dent. Med. 8:63, 1961.
continually present, pain experience is at 5. AUGUST, R. V. Hypnosis in Obstetrics.
times reduced but is rarely if ever abol- McGraw-Hill, New York, 1961.
ished by "hypnotically suggested anal- 6. BANISTER, H., and ZANGWILL, O. L.
gesia." However, the data also indicate Experimentally induced visual param-
that suggestions given under "hypnotic nesias. Brit. J. Psychol. 32:30,1941.
trance" (and possibly without "hypnotic 7. BARBER, T. X. Hypnosis as perceptual-
trance") may at times drastically reduce cognitive restructuring: I. Analysis of
or eliminate some painful conditions, concepts. /. Clin. Exp. Hypnosis 5:147,
such as dysmenorrhea and certain types 1957.
8. BARBER, T. X. Hypnosis as perceptual-
of headaches and backaches, which ap- cognitive restructuring: II. "Post"-hyp-
pear to be produced by a "conditioning or notic behavior. /. Clin. Exp. Hypnosis
learning process." 6:10, 1958.
6. This review suggests that the criti- 9. BARBER, T. X. Hypnosis as perceptual-
cal variables in so-called "hypnotic anal- cognitive restructuring: IV. "Negative
gesia" include: (a) suggestions of pain hallucinations." /. Psychol. 46:187,
1958.
relief, which are (b) given in a close in-
10. BARBER, T. X. The concept of "hyp-
terpersonal setting. Additional research
nosis." /. Psychol. 45.115, 1958.
is needed to determine if "the hypnotic 11. BARBER, T. X. Toward a theory of pain:
trance state" is also a relevant variable. Relief of chronic pain by prefrontal leu-
Further experiments should control: (a) cotomy, opiates, placebos, and hypnosis.
the preexisting level of suggestibility Psychol. BuU. 56:430, 1959.
among subjects assigned to the "trance" 12. BARBER, T. X. "Hypnosis," analgesia,
and control treatments; (b) the interper- and the placebo effect. J.A.M.A. 172:
sonal relationship between subject and 680, 1960.
experimenter; and (c) the suggestions of 13. BARBER, T. X. Antisocial and criminal
pain relief per se. The data reviewed sug- acts induced by "hypnosis": A review of
gest that if these variables are controlled, experimental and clinical findings.
it will be found that suggestions of pain A.M.A. Arch. Gen. Psychiat. 5:301,
relief given either to waking control sub- 1961.
14. BARBER, T. X. Experimental evidence
jects or to "deep-trance" subjects produce for a theory of hypnotic behavior: II.
a comparable reduction in pain experi- Experimental controls in hypnotic age-
ence. regression. Int. ]. Clin. Exp. Hypnosis
Medfield Foundation 9.181, 1961.
Medfield, Mass. 15. BARBER, T. X. Physiological effects of
"hypnosis." Psychol. Bull. 58.390,
1961.
References 16. BARBER, T. X. Hypnotic age regression:
A critical leview. Psychosom. Med. 24:
1. ABHAMSON, M., and HERON, W. T. An 286, 1962.
objective evaluation of hypnosis in ob- 17. BARBER, T. X. Experimental controls
stetrics. Amer. } . Obstet. Gynec. 59: and the phenomena of "hypnosis": A
1069, 1950. critique of hypnotic research methodol-
2. ANDERSON, M. N. Hypnosis in anes- ogy. /.Nerv.Ment. Dis. 134:493, 1962.
thesia. /. Med. Ass. Alabama 27:121, 18. BARBER, T. X. Toward a theory of
1957. "hypnotic" behavior: The "hypnotically-
PSYCHOSOMATIC MEDICINE
BARBER 329
induced dream." /. Nerv. Ment. Dis. 34. BRAID, J. Neurypnology. Churchill,
135:206, 1962. London, 1843.
19. BARBER, T. X. Toward a theory of hyp- 35. BRAID, J. Facts and observations as to
nosis: Posthypnotic behavior. A.M.A. the relative value of mesmeric and hyp-
Arch. Gen. Psychiat. 7:321, 1962. notic coma, and ethereal narcotism, for
20. BARBER, T. X., and CALVERLEY, D. S. the mitigation or entire prevention of
"Hypnotic behavior" as a function of pain during surgical operations. Med.
task motivation. /. Psychol. 54:363, Times 15:381, 16:10,1847.
1962. 36. BRAMWELL, J. M. Hypotism: Its His-
21. BARBER, T. X., and COULES, J. Electri- tory, Practice, and Theory. Julian Press,
cal skin conductance and galvanic skin New York, 1956, p. 106. (Original date
response during "hypnosis." Int. J. Clin. of publication: 1903).
Exp. Hypnosis 7:79,1959. 37. BROCA, P. Note sur une nouvelle
22. BARBER, T. X., and DEELEY, D. C. Ex- methode anesthesique. C. R. Acad. Sci.
perimental evidence for a theory of hyp- (Par.) 49:902,1859.
notic behavior: I. "Hypnotic color-blind- 38. BROWN, R. R., and VOGEL, V. H. Psy-
ness" without "hypnosis." Int. ]. Clin. chophysiological reactions following
Exp. Hypnosis 9:79,1961. painful stimuli under hypnotic analgesia,
23. BARBER, T. X., and GLASS, L. B. Sig- contrasted with gas anesthesia and No-
nificant factors in hypnotic behavior. /. vocain block. /. Appl. Psychol. 22:408,
Abnorm. Soc. Psychol 64:222, 1962. 1938.
24. BARBER, T. X., and HAHN, K. W., JR. 39. BUTLER, B. The use of hypnosis in the
Physiological and subjective responses care of the cancer patient. Cancer 7:1,
to pain-producing stimulation under 1954.
hypnotically-suggested and waking- 40. CALLAN, T. D. Can hypnosis be used
imagined analgesia. /. Abnorm. Soc. routinely in obstetrics? Rocky Mountain
Psychol., in press. Med. ]. 58:28,1961.
25. BEECHER, H. K. Pain in men wounded 41. CANGELLO, V. W. Hypnosis for the pa-
in battle. Ann. Surg. 123:96, 1946. tient with cancer. Amer. J. Clin. Hyp-
26. BEECHER, H. K. The powerful placebo. nosis 4:215, 1962.
J.A.M.A. 159:1602, 1955. 42. CANNON, W. B. Bodily Changes in
27. BEECHER, H. K. Relationship of sig- Pain, Hunger, Fear, and Rage. Apple-
nificance of wound to pain experienced. ton, New York, 1915.
].A.M.A. 161:1609,1956. 43. CATTELL, M. The action and use of
28. BEECHER, H. K. Measurement of Sub- analgesics. Res. Publ. Ass. Nerv. Ment.
jective Responses. Oxford Univ. Press, Dis. 23:365, 1943.
New York, 1959. 44. CHERTOK, L. Psychosomatic Methods
m Painless Childbirth. Pergamon, New
29. BENJAMIN, F. B. Effect of aspirin on
York, 1959, pp. 3-4.
suprathreshold pain in man. Science
128:303, 1958. 45. CHLIFER, R. I. Verbal analgesia in
childbirth. Psychoiherapia (Kharkov)
30. BERNHEIM, H. Suggestive Therapeu- 307, 1930 (Cited by Chertok").
tics. Associated Booksellers, Westport,
46. CLARK, R. N. Training method for
Conn., 1957, p. 116. (Original date of
childbirth utilizing hypnosis. Amer. J.
publication: 1887).
Obstet. Gynec. 72:1302, 1956.
31. BITTERMAN, M. E., and MARCUSE, F. 47. COCHRAN, J. L. The adaptability of
L. Autonomic responses in posthypnotic psychosomatic anesthesia for the per-
amnesia. /. Exp. Psychol. 35:248,1945. formance of intermediate surgery on
32. BLUM, G. S. A Model of the Mind. certain types of patients. Brit. } . Med.
Wiley, New York, 1961, p. 162. Hypnotism 7:26, 1955.
33. BONILLA, K. B., QUIGLEY, W. F., and 48. COHEN, L. H., and PATTERSON, M. Ef-
BOWERS, W. F. Experience with hyp- fects of pain on heart rate of normal and
nosis on a surgical service. Mdit. Med. schizophrenic individuals. /. Gen. Psy-
126:364, 1961. did. 16:273, 1937.
VOL. XXV, NO. 4, 1963
330 HYPNOSIS EFFECTS O N PAIN

49. COOPER, S. R., and POWLES, W. E. The 62. FINER, B. L., and NYLEN, B. O. Car-
psychosomatic approach in practice. diac arrest in the treatment of burns, and
McGifl Med. ]. 14:415, 1945. report on hypnosis as a substitute for
50. CRASILNECK, H. B., MCCRANIE, E. J., anesthesia. Plast. Reconstr. Surg. 27:49,
and JENKINS, M. T. Special indications 1961.
for hypnosis as a method of anesthesia. 63. FRANKE, U. Amnesie und Anaesthesie
JA.MA. 162.1606,1956. bei der Hypnosegeburt. Dtsch. Med.
51. DODSON, H. C , JR., and BENNETT, H. Wschr. 874, 1924. (Cited by Cher-
A. Relief of postoperative pain. Amer. tok")
Surg. 20:405, 1954. 64. FURER, M., and HARDY, J. D. The re-
52. DORCUS, R. M., and KIRKNER, F. J. The action to pain as determined by the
use of hypnosis in the suppression of in- galvanic skin response. Res. Publ. Ass.
tractable pain. /. Abnortn. Soc. Psychol. Nerv. Ment. Dis. 29:72, 1950.
43:237, 1948. 65. GEORGI, F. Beitrage zur Kenntnis des
53. DORCUS, R. M., and SHAFFER, G. W. psycho-galvanischen Phanomens. Arch.
Textbook of Abnormal Psychology, ed. Psychiat. 62:571, 1921.
3. Williams & Wilkins, Baltimore, 1945. 66. GILL, M. M., and BRENMAN, M. Hyp-
54. DOUPE, J., MILLER, W. R., and KEL- nosis and Related States. Internat. Univ.
LER, W. K. Vasomotor reactions in the Press, New York, 1959, pp. 38-39.
hypnotic state. /. Neurol. Psychiat. 2: 67. GLASS, L. B., and BARBER, T. X. A note
97, 1939. on hypnotic behavior, the definition of
55. DYKMAN, R. A., REESE, W. G., GAL- the situation and the placebo effect. /.
BRECHT, C. R., and THOMASSON, P. J. Nerv. Ment. Dis. 132:539, 1961.
Psychophysiological reactions to novel 68. GOETZL, F. R , BIEN, C. W., and Lu,
stimuli: Measurement, adaptation, and G. Changes in blood pressure in re-
relationship of psychological and physi- sponse to presumably painful stimuli.
ological variables in the normal human. /. Appl. Physiol. 4:161, 1951.
Ann. N.Y. Acad. Sci. 79:43, 1959. 69. GOLD, H. The effect of extracardiac
56. DYNES, J. B. An experimental study of pain on the heart. Res. Publ. Ass. Nerv.
hypnotic anesthesia. /. Abnorm. Soc. Ment. Dis. 23:345, 1943.
Psychol. 27:79,1932. 70. GORTON, B. E. The physiology of hyp-
57. DYNES, J. B., and POPPEN, J. L. Lobot- nosis. Psychiat. Quart. 23:317, 457,
omy for intractable pain. J.A.M.A. 140: 1949.
15, 1949. 71. HALL, K. R. L. Studies of cutaneous
58. ELLIOTSON, J. Numerous Cases of Sur- pain: A survey of research since 1940.
gical Operations Without Pain in The Brit. } . Psychol. 44:279, 1953.
Mesmeric State; With Remarks Upon 72. HALL, K. R. L., and STRIDE, E. The
the Opposition of Many Members of the varying response to pain in psychiatric
Royal Medical and Chirurgical Society disorders: A study in abnormal psychol-
and Others to tlie Reception of the In- ogy. Brit. ]. Med. Psychol. 27:48,1954.
estimable Blessings of Mesmerism. H. 73. HALL, K. R. L. Pain and suffering.
Bailliere, London, 1843, pp. 15-17. South African Med. J. 31:1227,1957.
59. ENGEL, B. T. Physiological correlates 74. HARDY, J. D., WOLFF, H. G., and
of pain and hunger. Doctoral disserta- GOODELL, H. Pain Sensations and Re-
tion, Univ. of California at Los Angeles, actions. Williams & Wilkins, Baltimore,
1956. 1952.
60. ERICKSON, M. H., HERSHMAN, S., and 75. HERON, W. T. Hypnosis as an anes-
SECTER, 1.1. The Practical Application thetic. Brit. J. Med. Hypnotism 6:20,
of Medical and Dental Hypnosis. Julian 1954-1955.
Press, New York, 1961, pp. 55-58. 76. HILL, H. E., KORNETSKY, C. H., FLAN-
61. ESDAILE, J. Hypnosis in Medicine and ARY, H. G., and W K L E R , A. Effects of
Surgery. Julian Press, New York, 1957. anxiety and morphine on discrimination
(Originally entitled Mesmerism in India of intensities of painful stimuli. /. Clin.
and published in 1850.) Invest. 31:473, 1952.
PSYCHOSOMATIC MEDICINE
BARBER 331
77. HILL, H. E., KORNETSKY, C. H., FLAN- 90.
KUNKLE, E. C. Phasic pains induced by
ARY, H. G., and WIKLEH, A. Studies on cold. / . Appl. Physiol. 1:811, 1949.
anxiety associated with anticipation of 91. LACEY, J. I. The evaluation of auto-
pain. I. Effects of morphine. A.M.A. nomic responses: Toward a general so-
Arch. Neurol. Psychiat. 67:612,1952. lution. Ann. N.Y. Acad. Sd. 67:123,
78. HOLMES, T. H., and WOLFF, H. G. 1956.
Life situations, emotions and backache. 92. LACEY, J. I. "Psychophysiological ap-
Res. Publ. Ass. Nerv. Ment. Dis. 29: proaches to the evaluation of psycho-
750,1950. therapeutic process and outcome," in
79. HOUDE, R. W., and WALLENSTEIN, S. Research in Psychotherapy, edited by
L. A method for evaluating analgesics E. A. Rubinstein and M. B. Parloff.
in patients with chronic pain. Drug. American Psychological Ass., Washing-
Addict. Narcot. Bull. App. F., 660, ton, D. C , 1959.
1953. 93. LAFONTAINE, C. L'Art de Magnetiser
80. HULL, C. L. Hypnosis and Suggestibili- ou le Magnetistne Animal, ed. 3. Bail-
ty: An Experimental Approach. Apple- liere, Paris, 1860.
ton-Century-Crofts, New York, 1933, p. 94. LASZLO, D., and SPENCER, H. Medical
252. problems in the management of cancer.
81. JAVEHT, C. T., and HARDY, J. D. Influ- Med. Clin. N. Amer. 37:869,1953.
ence of analgesics on pain intensity dur- 95. LAUX, R. An investigation of the anal-
ing labor (with a note on "natural child- gesic effects of hypnosis on postopeia-
birth"). Anesthesiology 12:189, 1951. tive pain resulting from urological sur-
82. KAPLAN, E. A. Hypnosis and pain. gery. Doctoral dissertation, Univ. of
A.M.A. Arch. Gen. Psychiat. 2.567, Southern Calif., 1953.
1960. 96. LEA, P. A., WARE, P. D., and MONROE,
83. KEATS, A. S. Postoperative pain: Re- R. R. The hypnotic control of intract-
search and treatment. /. Chron. Dis. 4: able pain. Amer. } . Clin. Hypnosis 3:3,
72, 1956. 1960.
84. KIRKNER, F. J. "Control of sensory and 97. LE BEAU, J. Experience with topeetomy
perceptive functions by hypnosis," in for the relief of intractable pain. /.
Neurosurg. 7:79, 1950.
Hypnosis and its Therapeutic Applica-
98. LERICHE, R. The Surgery of Pain. Wil-
tions, edited by R. M. Dorcus. McGraw-
liams & Wilkins, Baltimore, 1939, pp.
Hill, New York, 1956.
55-56.
85. KLOPP, K. K. Production of local anes-
99. LEVINE, M. Psychogalvanic reaction to
thesia using waking suggestion with the painful stimuli in hypnotic and hysteri-
child patient. Int. J. Clin. Exp. Hypno- cal anesthesia. Bull. Johns Hopkins
sis 9:59, 1961. Hosp. 46:331, 1930.
86. KORNETSKY, C. Effects of anxiety and 100. LIEBAULT, A. A. Anesthesie par sugges-
morphine in the anticipation and per- tion. /. Magnetisme 64, 1885. (Cited
ception of painful radiant heat stimuli. by Chertok")
/. Comp. Physiol. Psychol. 47:130, 101. LIFE, C. The effects of practice in the
1954. trance upon learning in the normal wak-
87. KROGER, W. S. "Introduction and sup- ing state. Bachelor's thesis, 1929 (Cited
plemental reports," in Hypnosis in Med- by Hull 80 ).
icine and Surgery, by J. Esdaile. Julian 102. MANDY, A. J., MANDY, T. E., FARKAS,
Press, New York, 1957. R., and SCHER, E. IS natural childbirth
88. KROGER, W. S., and D E L E E , S. T. Use natural? Psychosom. Med. 14:431,
of hypnoanesthesia for cesarean section 1952.
and hysterectomy. J.A.M.A. 163:442, 103. MARCUSE, F. L. Hypnosis in dentistry.
1957. Amer. J. Orthodont. Oral. Surg. 33:796,
89. KROGER, W. S., and FREED, S. C. Psy- 1947.
chosomatic Gynecology. Free Press, 104. MARMER, M. J. Hypnoanalgesia: The
Glencoe, 111., 1956, p. 130. use of hypnosis in conjunction with
VOL. XXV, NO. 4, 1963
332 HYPNOSIS EFFECTS ON PAIN

chemical anesthesia. Anesth. Analg. peutic Applications, edited by R. M.


(Cleve.) 36:27, 1957. Dorcus. McGraw-Hill, New York, 1956.
105. MAHMEH, M. J. Hypnosis in Anes- 120. PEIPER, A. Untersuchungen iiber den
thesiology. Thomas, Springfield, 111., galvanischen Hautreflex (psychogalvan-
1959. ischen Reflex) im Kindesalter. Jahrb.
106. MASON, A. A. Surgery under hypnosis. KmderheUkunde 107:139, 1924.
Anaesthesia 10:295, 1955. 121. PERCHARD, S. D. Hypnosis in obstetrics.
107. MICHAEL, A. M. Hypnosis in child- Proc. Royal Soc. Med. 53:458,1960.
birth. Brit. Med. ]. 1.734, 1952. 122. PERESE, D. M. HOW to manage pain in
108. MITCHELL, M. B. Retroactive inhibi- malignant disease. j.A.M.A. 175:75,
tion and hypnosis. /. Gen. Fsychol. 7: 1961.
343, 1932. 123. PRIDEAUX, E. The psychogalvanic re-
109. MODY, N. V. Report on twenty cases flex. Brain 43:50, 1920.
delivered under hypnotism. /. Obstet. 124. RAGINSKY, B. B. The use of hypnosis in
Gynec. India 10:3, 1960. anesthesiology. J. Pers. 1:340, 1951.
110. MOLL, A. The Study of Hypnosis. 125. ROSE, A. G. The use of hypnosis as an
Julian Press, New York, 1958, pp. 105, anaesthetic, analgesic, and amnesic
125, 248. (Original date of publica- agent in gynaecology. Brit. J. Med.
tion: 1889.) Hypnotism 5.17, 1953.
111. MORAVCSIX, E. E. Experimente iiber 126. SAMPIMON, R. L. H., and WOODRUFF,
das psychogalvanische Reflexphanomen. M. F. A. Some observations concerning
/. Psychol. Neurol. 18:186,1912. the use of hypnosis as a substitute for
112. MYERS, F. W. H. Human Personality anesthesia. Med. } . Australia 1:393,
and its Survival of Bodily Death, vol. 1, 1946.
Longmans, Green, New York, 1954, p. 127. SATTLER, D. G. Absence of local sign
181. (Original date of publication: in visceral reactions to painful stimula-
1903.) tion. Res. Publ. Ass. Nerv. Ment. Dis.
113. OSTENASEK, F. J. Prefrontal lobotomy 23.143,1943.
for the relief of intractable pain. Johns 128. SCHULTZE-RHONHOF, F. Der hyp-
Hopkins Hosp. Bull. 83:229, 1948. notische Geburtsdammerschlaf. ZW.
114. OWEN-FLOOD, A. "Hypnosis in anaes- Gyndk. 247, 1922. (Cited by Cher-
thesiology," in Hypnosis in Modern tok")
Medicine, edited by J. M. Schneck, 129. SCHWARTZ, A. M., SATA, W. K., and
Thomas, Springfield, 111., 1959. LASZLO, D. Studies on pain. Science
115. PAPERMASTER, A. A., DOBERNECK, R. 111:310, 1950.
C , BONELLO, F. J., GRIFFEN, W. O., 130. SEARS, R. R. Experimental study of
JR., and WANGENSTEEN, O. H. Hypno- hypnotic anesthesia. J. Exp. Psychol.
sis in surgery: II. Pain. Amer. } . Clin. 15:1, 1932.
Hypnosis 2:220, 1960. 131. SEWARD, J. P., and SEWARD, G. H. The
116. PAPPER, E. M., BRODIE, B. B., and effect of repetition on reaction to electric
ROVENSTINE, E. A. Postoperative pain; shock. Arch. Psychol. #168, 1934.
its use in comparative evaluation of 132. SHOR, R. Explorations in hypnosis: A
analgesics. Surgery 32:107, 1952. theoretical and experimental study.
117. PATTEN, E. F. Does post-hypnotic Doctoral dissertation, Brandeis Univ.,
amnesia apply to practice effects? / . 1959.
Gen. Psychol. 7:196,1932. 133. SUTCLIFFE, J. P. "Credulous" and
118. PATTIE, F. A. "Theories of hypnosis," "sceptical" views of hypnotic phenom-
in Hypnosis and its Therapeutic Appli- ena: A review of certain evidence and
cations, edited by R. M. Dorcus. Mc- methodology. Int. J. Clin. Exp. Hyp-
Graw-Hill, New York, 1956, p. 8. nosis 8:73, 1960.
119. PATTIE, F. A. "Methods of induction, 134. SUTCLIFFE, J. P. "Credulous" and
susceptibility of subjects, and criteria of "skeptical" views of hypnotic phenom-
hypnosis," in Hypnosis and its Thera- ena: Experiments on esthesia, halluci-
PSYCHOSOMATIC MEDICINE
BARBER 333
nation, and delusion. /. Abnorm. Soc. J. D. Effects of hypnotic suggestion on
Psychol. 62.189,1961. pain perception and galvanic skin re-
135. TAUGHER, V. J. Hypno-anesthesia. sponse. A.Af.A. Arch. Neurol. Psychiat.
Wisconsin Med. } . 57:95,1958. 68:549, 1952.
136. TINTEROW, M. M. The use of hypno- 146. WHITE, R. W. A preface to the theory
analgesia in the relief of intractable of hypnotism. /. Ahnorm. Soc. Psychol.
pain. Amer. Surg. 26:30, 1960. 36:477, 1941.
137. TINTEROW, M. M. The use of hypnotic 147. WINKELSTEIN, L. B. Routine hypnosis
anesthesia for major surgical procedures. for obstetrical delivery: An evaluation
Amer. Surg. 26:732,1960. of hypnosuggestion in 200 consecutive
138. TRENT, J. C. Surgical anesthesia, 1846- cases. Amer. J. Obstet. Cynec. 76.152,
1946. J. Hist. Med. 1:505, 1946. 1958.
139. VELVOVSKI, I. Z., PLATONOV, K. I., 148. WINKELSTEIN, L. B., and LEVINSON, J.
PLOTITCHER, V. A., and CHOUGOM, E. Fulminating pre-eclampsia with Ce-
A. Psychoprophylactic. Leningrad, Med- sarean section performed under hypno-
guiz, 1954. (Cited by Chertok44) sis. Amer. J. Obstet. Cynec. 78:420,
140. VON DEDENROTH, T. E. A. Trance 1959.
depths: An independent variable in ther- 149. WOLF, S., and HARDY, J. D. Studies on
apeutic results. Amer. J. Clin. Hypno- pain: Observations on pain due to local
sis 4:174,1962. cooling and on factors involved in the
141. WALLACE, G., and COPPOLINO, C. A. "cold pressor" response. /. Clin. Invest.
Hypnosis in anesthesiology. New York 20:521, 1941.
J. Med. 60:3258,1960. 150. WOLFE, L. S. "Hypnosis in anesthesiol-
142. WEITZENHOFFER, A. M. Hypnotism: ogy," in Techniques of Hypnotherapy,
An Objective Study in Suggestibility. edited by L. M. LeCron. Julian Press,
John Wiley, New York, 1953. New York, 1961.
143. WEITZENHOFFER, A. M. General Tech- 151. WOLFF, H. G. Headache and Other
niques of Hypnotism. New York, Grune, Head Pain. Oxford Univ. Press, New
1957, p. 347. York, 1948.
144. WELLS, W. R. The extent and duration 152. YOUNG, P. C. An experimental study of
of post-hypnotic amnesia. /. Psychol. 2: mental and physical functions in the nor-
137, 1940. mal and hypnotic state. Amer. J. Psy-
145. WEST, L. J., NIELL, K. C , and HARDY, chol. 37:345,1926.

VOL. XXV, NO. 4, 1963