Integration of Hypnosis with Acupuncture: Possible Benefits and Case Examples

American Journal of Clinical Hypnosis,  Apr 2005  by Samuels, Noah

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Acupuncture treatment uses ultrafine needles which are inserted into specified points on the skin (acupoints). Acupuncture can help alleviate pain and inflammation, possibly through the increased release of pituitary beta-endorphins and ACTH. Hypnosis can also help alleviate pain syndromes, and may have centrally mediated immunomodulatory effects. The use of these 2 treatments simultaneously may potentially assist and augment the effects of each another. Two case reports where both treatments are used together are presented: One showing how hypnosis can help in the treatment of painful acupoints, the other how the response to acupuncture may be augmented by hypnosis in the treatment of headache. Controlled trials of this combined treatment are warranted.

Keywords: ACTH, Acupuncture, endorphins, hypnosis, immune, pain

The ancient Chinese treatment of acupuncture, during which thin needles (diameter 0.15-0.30mm) are inserted in specific points on the skin ("acupoints"), focuses on a holistic, energy-based approach to patients, as opposed to the disease-oriented approach of Western conventional medicine. Traditional Chinese Medicine (TCM) teaches that treatment with acupuncture can influence and harmonize imbalances and promote general well-being. Hundreds of acupoints are located along series of theoretical tracts located on the skin ("meridians") that are believed to influence the internal organs. In spite of a plethora of medical publications in the field of acupuncture research, acupuncture remains an enigmatic treatment option to many in the medical profession.

Though some researchers feel that the effects of acupuncture are no more than the result of autosuggestion (Kroger, 1972), acupuncture does result in both local and systemic physiological effects, such as the increased release of pituitary betaendorphins, which may partially explain its analgesic effect. Acupuncture also increases pituitary release of ACTH with concomitant increase in serum cortisol levels, which explains in part the analgesic as well as anti-inflammatory effects of this treatment (Malizia, Andreucci, Paolucci, Crescenzi, Fabbri, & Fraioli, 1979). In 1998, the National Institutes of Health (NIH) Consensus Development Panel on Acupuncture concluded that acupuncture is an effective treatment for ailments such as chemotherapy-related nausea and vomiting, as well as postoperative surgical and dental pain, and may be useful as an adjunct treatment for a variety of illnesses (National Institutes of Health, 1998). The British Medical Association has also recognized acupuncture as an effective treatment for many medical conditions (Silvert, 2000).

Hypnosis is also an effective treatment for many ailments (Astin, Shapiro, Eisenberg, & Forys, 2003), and is recognized by both the American and British medical establishments. Studies have found hypnosis to be an effective treatment modality for chronic pain (National Institutes of Health, 1996), including the severe pain experienced by cancer patients (Kellerman, Zeltzer, Ellenberg, & Dash, 1983). Hypnosis has been shown to selectively and somatotropically alter pain sensation in highly susceptible subjects (Benhaiem, Attal, Chauvin, Brasseur, & Bouhassira, 2001), interfering with the interaction between prefrontal gamma activity on EEC and the subjective experience of pain (Croft, William, Haenschel, & Gruzelier, 2002). Hypnosis can also alleviate many immune-mediated dermatological conditions such as dermatitis and psoriasis (Shenefelt, 2000), possibly through centrally-mediated immunomodulatory effects: for example, the inhibition of the immediate-type hypersensitivity response (Black, 1963).

There is a paucity of research on the combined use of hypnosis with acupuncture treatment. Studies comparing the benefits of each modality individually have found hypnosis to be more effective than acupuncture for analgesia (Dunninger 1998) with acupuncture significantly more effective in raising overall body pain thresholds (thermal), though just below significance for pain tolerance (Stewart, Thomson, & Oswald, 1977). In one study, 25 patients suffering from head and neck pain were treated with acupuncture and then, following a washout period, hypnosis. Those with acute pain benefited most from acupuncture, whereas those with psychogenic pain were more likely to benefit from hypnosis (Lu, Lu, & Kleinman 2001). In another study, 16 men suffering from non-organic sexual dysfunction were treated with acupuncture and 15 with hypnosis, with 29 serving as controls. Both acupuncture and hypnosis were found to be more effective than placebo, though this difference was only statistically significant with respect to hypnosis (Aydin et al., 1997).

A treatment regimen combining both acupuncture and hypnosis was evaluated in a Phase I study of children (ages 6-18 years) suffering from chronic pain (Zeltzer, Tsao, Stelling, Powers, Levy, & Waterhouse, 2002). All patients (n - 28; no control group) underwent six weekly sessions consisting of individually tailored acupuncture treatment together with a 20-minute hypnosis session conducted while needles were in place (all patients received both treatments). Both parents and children were satisfied with the combined treatment, and a significant decrease in pain and pain-related interference in functioning was observed, with children's anticipatory anxiety declining significantly across treatment sessions.