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draw general conclusions (Ellis & Spanos, 1994), although some more standardised (according to
a manual) procedures have been reported (Liossi & Hatira, 2003).
Until recently much of the literature on the use of hypnosis in acute pain has been based on
studies with non‐RCT designs (Patterson & Jensen, 2003). However, recent papers have displayed
more experimental rigour.
Studies using hypnosis for pain control in both the laboratory and clinical settings (eight of the
eighteen studies included pain populations) indicated that hypnosis for pain had a moderate
to large effect size and provided substantial pain relief for 75% of laboratory and clinical
participants (Montgomery et al, 2000 Level I).
A review of hypnosis in clinical pain settings (including pain associated with invasive medical
procedures, burns wound care, labour and bone marrow aspiration) provided moderate
support for the use of hypnosis in the treatment of acute pain (Patterson & Jensen, 2003 Level I).
Eight of the nineteen studies showed hypnosis to be more effective on pain reports than no
treatment, standard care, or an attention control condition; three studies showed hypnosis to
be no better than such control conditions, and one study showed mixed results. Eight studies
compared hypnosis with other psychological interventions (cognitive‐behavioural
intervention, relaxation training, distraction, emotional support), and hypnosis was more
effective in reducing pain scores in four of the eight studies.
In relation to acute pain in cancer patients, some individual studies have found hypnosis to be
superior to other psychological interventions in reducing pain reports (eg Syrjala et al, 1992
Level II). In many of the hypnotic studies with cancer patients, the focus has been on acute
pain associated with procedures such as bone marrow aspiration, breast biopsy, or lumbar
puncture. In each case the findings have supported the use of hypnosis to reduce pain (eg Wall
& Womack, 1989 Level II; Liossi & Hatira, 1999 Level II; Montgomery et al, 2002 Level II). A systematic
review by Wild and Espie (Wild & Espie, 2004) of hypnosis in paediatric oncology pain concluded
the evidence was not consistent enough for general recommendations, but that hypnosis was
potentially useful.

8.1.3 Attentional techniques
A range of attention‐based strategies have been reported, from those involving distraction CHAPTER 8
from the pain through to attention to imagined scenes/sensations or to external stimuli such
as music, scenes or smells. Some techniques also involve deliberately attending to the pain,
but in ways intended to modify the threat value of pain (eg Logan et al, 1995 Level II).
Attempting to alter the patient’s emotional state, from stress or fear to comfort or peace,
is also a common feature of many of these techniques. Commonly, these techniques are used
in conjunction with relaxation methods and at times may be inseparable (Williams, 1996).
There is some evidence to support the benefit of some attentional techniques, often in
combination with relaxation, in acute postoperative pain (Raft et al, 1986 Level II; Daake &
Gueldner, 1989 Level II; Good et al, 1999 Level II). In childrenand adolescents, a systematic review
concluded that distraction is effective in needle‐related procedure‐related pain (Uman et al,
2006 Level I). A more recent comparison of two interventions, guided imagery and relaxation,
did not result in any difference in pain relief or analgesic use in elderly patients after colorectal
surgery (Haase et al, 2005 Level II).
Using thermal pain stimulation in volunteers and measuring pain‐related brain activity with
fMRI, both opioids and immersive virtual reality (VR) distraction led to reductions in pain
unpleasantness and pain‐related brain activity; the combination was more effective than
opioid alone (Hoffman et al, 2007 Level III‐2). VR distraction has also been reported to provide

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