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HYPNOTIC ANALGESIA IN PERSONS WITH DISABILITIES
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unpleasantness, in particular, could be viewed as a simple cognitive-
behavioral intervention that provides important information about the
difference between pain intensity and pain affect. Repetition of this
information, even among patients who may not be able to respond to
traditional hypnotic suggestions, might conceivably help patients alter
their view of pain and its impact. Changes in pain attributions are
thought to influence the processing, and subsequent experience, of
pain (Sullivan et al., 2001). Thus, it is possible that high levels of hyp-
notizability may not have been necessary for participants to benefit
from some of the suggestions included in the treatment protocol. A
stronger association between hypnotizability and treatment outcome
might have been found had the hypnotic intervention included only
suggestions that require high levels of hypnotic ability.
Another possible explanation for the lack of significant association
between hypnotizability and treatment outcome may be related to the
method used to assess hypnotizability. It is possible that the 5-item
SHCS used in this study is inadequately valid for assessing the specific
hypnotic skills needed to respond to hypnotic analgesia. Future
research should study the association between this measure and other
measures of hypnotizability to determine their validity as predictors of
treatment outcome. It is also possible that any measure of hypnotiz-
ability, if administered only one time before treatment begins, might
also show weak associations with treatment outcome. In the current
study, hypnotizability was measured just once, before many of the
participants had experience with hypnosis. Some of the participants
might have been uncomfortable or anxious about the procedure, and
this could have inhibited their initial responses. Future research
should examine the ability of hypnotizability measures administered
on multiple occasions, perhaps both before and after treatment, to see
if more experience with hypnosis increases hypnotizability scores in
some participants and also increases the size of the association found
between those scores and treatment outcome.
The findings do raise the possibility that patients with amputation
might be more responsive to hypnotic-analgesia treatment than
patients with SCI or MS. However, this possibility must be considered
very tentative due to the fact that a statistically significant association
between diagnostic group and treatment outcome was not found and
the fact that the sample sizes in each diagnostic group were relatively
small. Future research, with a larger sample size, should look at this
association more carefully. If found to be statistically significant in
larger sample sizes, then it would appear that this is a patient popula-
tion for whom hypnosis holds particular promise. Further, this infor-
mation would be useful for helping future researchers power
hypnotic-analgesia clinical trials; fewer participants would likely be
needed to detect significant effects of hypnotic analgesia in patients