Effects of Hypnosis vs Mindfulness Meditation vs Education on Chronic Pain Intensity and Secondary Outcomes in Veterans: A Randomized Clinical Trial

Training in hypnosis (HYP) and mindfulness meditation (MM) produced lasting improvements in chronic pain for veterans, while an active education control (ED) did not. Veterans (N=328) were randomly assigned to eight sessions of HYP, MM, or ED. All three groups showed immediate posttreatment benefits in average pain intensity and secondary outcomes. However, at 3- and 6-month follow-ups, HYP led to greater decreases in pain intensity, pain interference, and depressive symptoms compared to ED, and MM led to greater decreases in pain intensity and pain interference at 6 months compared to ED. No significant differences between HYP and MM were found at any time point.

Study at a glance

Abstract

Effective, rigorously evaluated nonpharmacological treatments for chronic pain are needed. This study compared the effectiveness of training in hypnosis (HYP) and mindfulness meditation (MM) to an active education control (ED). Veterans (N=328) were randomly assigned to 8 manualized, group-based, in-person sessions of HYP (n = 110), MM (n = 108), or ED (n = 110). Primary (average pain intensity; API) and secondary outcomes were assessed at pretreatment, posttreatment, and 3- and 6-months posttreatment. Treatment effects were evaluated using linear regression, a generalized estimating equation approach, or a Fisher exact test, depending on the variable. There were no significant omnibus between-group differences in pre- to posttreatment change in API, however pre- to posttreatment improvements in API and several secondary variables were seen for participants in all three conditions. Participation in MM resulted in greater decreases in API and pain interference at 6-months posttreatment relative to ED. Participation in HYP resulted in greater decreases in API, pain interference, and depressive symptoms at 3- and 6-months posttreatment compared to ED. No significant differences on outcomes between HYP and MM were detected at any time point. This study suggests that all three interventions provide posttreatment benefits on a range of outcomes, but the benefits of HYP and MM continue beyond the end of treatment, while the improvements associated with ED dissipate over time. Future research is needed to determine whether the between-group differences that emerged posttreatment are reliable, whether there are benefits of combining treatments, and to explore moderating and mediating factors. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02653664