The secret to beating chronic back pain could be a drug-free therapy that quiets the neural connections that govern pain signals and perception.
Roughly 18,000 spinal cord injuries occur in the US each year, and about 300,000 Americans currently live with one.
Meanwhile, 31 million Americans suffer from low back pain at any given time, including 39 percent of adults report back pain within the past three months. Together, these conditions contribute to the 60 million Americans living with chronic pain.
Standard back pain treatments like NSAIDs and acetaminophen can cause stomach bleeding, kidney damage or liver injury with prolonged use, while opioids carry serious risks of addiction, overdose and death. Muscle relaxants and gabapentinoids also pose risks of dependence and withdrawal.
But now, researchers at the University of Washington have discovered that hypnosis can help people manage their pain, as well as reduce their perception that their pain will never end, which exacerbates the discomfort.
This is not the cartoonish hypnosis of a swinging pocket watch. Clinical hypnosis involves guiding patients into a relaxed state where the brain becomes more receptive to suggestions that change thoughts and beliefs about pain.
Researchers recruited patients who experienced a back injury about 15 years prior and were still experiencing pain. As part of the study, they underwent hypnotic therapy sessions for 12 weeks.
By week six, their average pain score dropped from 5.9 to 4.7, a decrease of 1.2 points. By 12 weeks, it edged down further to 4.5.
Patients with back injuries from 15 years prior received 12 weeks of hypnotic therapy — a far safer alternative to addictive opioids. By week six, their average pain score dropped from 6 to 4.8. By week 12, it fell further to 4.5 (stock)
‘Hypnosis helps patients be more open to ideas about changing their thinking and internalizing those ideas, so they become automatic,” first author Dr Charles Bombardier, a UW Medicine psychologist and professor of rehabilitation medicine said in a statement.
‘A lot of psychological interventions wear off,’ Bombardier said. ‘But in this case the effect had actually increased at 12 weeks — six weeks after treatment had stopped.’
To test hypnosis, researchers recruited 127 adults nationwide with moderate-to-severe pain.
Half were randomly assigned to receive a six-week program called hypnotic cognitive therapy (HYP-CT), while the other half continued their usual care.
Usual care could have included medications such as opioids, anti-seizure drugs, NSAIDs such as ibuprofen, antidepressants or cannabinoids, though the study did not track dosages or frequencies.
Nearly three-quarters of participants were already using prescription pain medications at the start of the trial.
The experimental therapy itself was practical and accessible. A psychologist delivered six one-hour hypnosis sessions entirely over the phone or via Zoom, so participants did not need to travel.
The approach combined two ideas, including cognitive therapy, which helps shift unhelpful thoughts about pain, and hypnosis, which uses focused relaxation to open the mind to new suggestions.
People in the hypnosis (HYP-CT) group had significantly larger pain reductions than those in usual care at six weeks and the gap widened by twelve weeks. Pain dropped 1.2 points at six weeks and 1.5 at twelve weeks in the therapy group
Dr M Elena Mendoza, coauthor and research associate professor, said: ‘We identified both helpful and unhelpful thoughts but focused on reassuring thoughts that help alleviate their pain and enhance coping. Then we reinforced those in the hypnosis sessions.’
Each session was recorded and participants were asked to practice self-hypnosis on their own every day. To measure their main target, average pain intensity, the researchers did not rely on memory.
Instead, they called participants four separate times over one week to get a reliable zero to 10 pain rating, then repeated the process at six weeks and again at 12 weeks.
At the start of the study, published in the journal Neurology, participants rated their average pain at an average of 5.9 out of 10. Six weeks later, the group that underwent HYP-CT reported a drop in their pain by 1.2 points.
Another six weeks later, the HYP-CT group’s pain dropped a further 0.2 points for a total pain reduction of 1.47 points from baseline.
The usual care group’s pain only dropped by 0.65 points after 12 weeks of therapy and follow-up – indicating there was a clinically meaningful advantage for the hypnosis group.
Hypnosis therapy worked best for pure neuropathic pain — the burning, shock-like pain common after spinal cord injury.
In that subgroup, pain dropped nearly 1.8 points more than usual care. For those with mixed pain types, the effect was much smaller and not statistically significant.
In 2023, the most recent data available, 24 percent of adults had chronic pain and 8.5 percent had high-impact chronic pain. Rates for both were higher in women (25.4 percent and 9.6 percent) than in men (23.2 percent and 7.3 percent)
This suggested to researchers that HYP-CT may be particularly well-suited for central neuropathic pain, a notoriously difficult condition to treat
Mendoza added: ‘Pain affects almost every aspect of these patients’ lives, so it was great to see that after just six sessions conducted over six weeks, they were able to make so much progress.’
When the spinal cord is injured, the physical damage triggers a signal sent up the spinal cord to the brain. The injury creates the signal but its the brain that brings on the pain.
That signal is just raw data. It has no feeling attached to it until the brain interprets it. The brain decides whether that signal means ‘ignore this,’ ‘that’s an itch,’ or ‘that’s excruciating pain.’
In chronic pain, especially after spinal cord injury, the original injury may have healed or the nerve pathways may be permanently damaged. Yet the brain continues to generate the experience of pain on its own.
The brain’s pain circuits become stuck in an overactive, hypervigilant state, interpreting weak or scrambled signals as intense suffering.
If the brain generates pain, the brain can also learn to turn it down, which is what hypnotic cognitive therapy does.
It retrains the brain’s interpretation of signals, which is why a psychological treatment can reduce physical pain even when the underlying injury remains unchanged.
Each year, about 18,000 Americans suffer a spinal cord injury. Roughly 300,000 are currently living with one, adding to the 60 million Americans who live with chronic pain (stock)
The benefits of hypnosis were not limited to pain alone. Depression scores improved significantly more in the therapy group, dropping by about 2.2 points on average on a standard scale, while usual care patients saw almost no change.
Sleep disturbances also got better due to hypnosis therapy and, by 12 weeks, pain interference – how much pain got in the way of daily life – had improved more with therapy as well.
Patient satisfaction was similarly positive. At 12 weeks, 90 percent of therapy recipients said they were satisfied or very satisfied with the treatment.
About one in three reported their pain was ‘much improved’ and nearly half said their pain had decreased to a meaningful extent.
Adverse effects were rare, mild and temporary. A few people felt dizzy, hot or briefly more aware of their pain during relaxation.
Overall, the researchers concluded, six sessions of therapy delivered entirely by phone or video can produce durable and clinically meaningful benefits for hard-to-treat pain. The study proved relief lasted at least 12 weeks.
Dr Mark P Jensen, senior author and professor of rehabilitation medicine, said: ‘Not only did the study show that this treatment is effective, but unlike most medications used for pain, it is a treatment with many positive side effects, like improved sleep and a greater sense of self-control.
‘I think that, based on the evidence, including the side-effect profile, this is the first treatment that people with chronic pain should be offered.’
