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Gut. 2007 November; 56(11): 1643.
PMCID: PMC2095665

Hypnotherapy for non‐cardiac chest pain: long‐term follow‐up

We have been researching the effects of hypnotherapy in gastroenterology for many years and recently reported in Gut1 that a course of 12 sessions of hypnotherapy seems to be beneficial in the treatment of non‐cardiac chest pain. In a study on 28 patients comparing the effects of either hypnotherapy or a similar duration of supportive listening combined with placebo medication (control group), the active treatment resulted in a much better outcome. Of the 15 patients randomised to hypnotherapy, 12 (80%) responded to treatment, as judged by either a complete or moderate improvement in their chest pain, compared with 3/13 (23%) controls (p = 0.008). A similar trend was observed for general wellbeing, which was regarded as a marker of quality of life, where 11 (73%) of the hypnotherapy patients improved compared with 3 (23%) controls (p = 0.023).

Unfortunately, it is impossible to undertake a double blind trial of a treatment such as hypnotherapy and the choice of control treatment is difficult as it is not possible to provide “sham” hypnotherapy. The only realistic alternative is to use some form of supportive treatment for a similar length of time and we have found that this, combined with placebo medication, provides a reasonably robust alternative. Obviously, this does not overcome any differences in expectation between the two treatments in the short term, but if the beneficial effects were sustained after hypnotherapy this would suggest that any observed improvement is indeed genuine. Furthermore, hypnotherapy would only be a viable option for more widespread use if the patients remained well over a long period of time without the need for continuing sessions

In our non‐cardiac chest pain study efficacy was only reported at the end of 17 weeks' treatment. We have now had the opportunity to follow up all members of this cohort of patients for at least 2 years (mean 2.8 years) after stopping treatment and would like to report these data. In the 15 patients who received hypnotherapy there has been further improvement, with 14 (93%) now classified as responders compared with 3/13 (23%) controls (p = 0.001) (fig 11).). The quality of life has also improved in 14 (93%) of the hypnotherapy group compared with 3 (23%) controls (p = 0.001) (fig 22).

figure gt132621.f1
Figure 1 Percentage of patients reporting a global improvement in chest pain with either hypnotherapy (n = 15) or supportive therapy (n = 13).
figure gt132621.f2
Figure 2 Percentage of patients reporting an improvement in quality of life with either hypnotherapy (n = 15) or supportive therapy (n = 13).

Thus not only do the beneficial effects of hypnotherapy for non‐cardiac chest pain persist for at least 2 years, but patients do seem to carry on improving once treatment has been completed. This outcome is in accord with our previous observations in irritable bowel syndrome2 and functional dyspepsia,3 where we have also reported long‐term benefit and a tendency for continued improvement after stopping treatment. All these results suggest that incorporating hypnotherapy into the provision of care for functional gastrointestinal disorders is worthy of serious consideration.4

References

1. Jones H, Cooper P, Miller V. et al Treatment of non‐cardiac chest pain: a controlled trial of hypnotherapy. Gut 2006. 551403–1408.1408 [PMC free article] [PubMed]
2. Gonsalkorale W M, Miller V, Afzal A. et al Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 2003. 521623–1629.1629 [PMC free article] [PubMed]
3. Calvert E L, Houghton L A, Cooper P. et al Long‐term improvement in functional dyspepsia using hypnotherapy. Gastroenterology 2002. 1231778–1785.1785 [PubMed]
4. Whorwell P J. Effective management of irritable bowel syndrome—the Manchester Model. Int J Clin Exp Hypn 2006. 5421–26.26 [PubMed]

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