source: The Journal of Pain

year: 2018

authors: S. Martin, R. Bhatt, L. Payne, L. Seidman, T. Coates, L. Zeltzer

Pain is the most common symptom in sickle cell disease (SCD) and individuals with SCD exhibit pain hypersensitivity. Hypnosis can have beneficial effects on pain modulation, but it is unknown whether pain-related anxiety—a cognitive-affective factor also associated with pain modulation—attenuates the effects of hypnosis in individuals with SCD.  

This study examined if pain-related anxiety alters the effects of hypnosis on laboratory pain responsivity in adults with and without SCD. The sample included 14 adults with SCD and 14 race-matched healthy controls. Participants completed the Pain Anxiety Symptoms Scale (PASS-20) at baseline. Pain tolerance (°C), threshold (°C), and intensity (0–100) were collected during a standardized thermal pain protocol before and during a hypnosis session.

Change in pain outcomes indicated participants’ responses to hypnosis. Nonparametric tests were used and a median split determined within group levels of pain-related anxiety. Pain-related anxiety did not significantly differ across SCD and non-SCD groups, and was not associated with pre-hypnosis pain tolerance or threshold in either group. In adults with SCD who had lower levels of pain-related anxiety, pain tolerance increased 5.68°C during hypnosis compared to 1.97°C in those with high anxiety (Z = -1.98, p < .05). The effect on pain threshold approached significance (1.97°C vs. -.38°C, Z = -1.85, p = .06). There was no effect of pain-related anxiety on change in pain responsivity in healthy controls.

Results partially align with other pain anxiety research and suggest that higher pain-related anxiety may be particularly important to consider in individuals with SCD as it may attenuate pain modulatory effects of hypnosis. Further, in individuals with higher pain-related anxiety, a single hypnosis session may be insufficient to reduce modulatory effects of anxiety on pain responsivity. Thus, examination of long-term treatment effects in a larger sample is needed to confirm underlying mechanisms affecting hypnosis treatment responses in individuals SCD.

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