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MARK P. JENSEN ET AL.
with acquired amputation than in patients with SCI or MS. If system-
atic and consistent differences are found in the response rates of
patients with different diagnoses, then further study of the reasons for
these differences might provide important clues concerning the mech-
anisms of hypnotic analgesia. For example, it is possible that sensory
loss, which is likely to be greater in those with MS and SCI, may have
some impact on the efficacy of hypnotic analgesia.
Treatment-outcome expectancies assessed after, but not before, the
first session were significantly associated with treatment outcome. This
finding is difficult to interpret, especially given the fact that change in
pain intensity during the first treatment session was not associated with
treatment outcome, effectively ruling out the possibility that patients
altered their expectancy of outcome based solely on the impact of one
session of hypnotic-analgesia treatment on their pain experience. If the
significant association between postsession treatment-outcome expect-
ancy and treatment outcome proves to be reliable, then it suggests that
there may be something else about experience with hypnosis (perhaps
the patients’ own sense of what might be possible with hypnosis) that
improves a patient’s ability to predict success. In any case, this finding
does provide limited support for a potential role for expectancy in
explaining, at least in part, the effects of hypnotic analgesia (Kirsch, 1985).
Limitations
There are a number of limitations of the current study. First, although
there was a no-treatment baseline period, there was no control condi-
tion in this study. That means that nonspecific (placebo) effects cannot
be ruled out as explaining some, or even all, of the treatment effects
found. There is a need for hypnotic-analgesia clinical outcome research
that includes appropriate control conditions (that can control, for
example, for therapist attention, patient expectancy and motivation,
and other nonspecific treatment factors) to help determine the specific
effects of hypnotic-analgesia treatment, distinct from its nonspecific
effects (Chambless & Hollon, 1998).
As already discussed, the standardized, script-driven intervention
used in this study only approximates usual clinical care. In most clini-
cal situations, there is much more flexibility and tailoring of the induc-
tions and hypnotic suggestions. Moreover, it is typical in the treatment
of chronic pain conditions to provide patients with at least one tape of
the induction and (tailored) suggestions to facilitate home practice
(e.g., Barber, 2004; Jensen and Barber, 2000). These components of
treatment were missing from the current study due to our efforts to
standardize the intervention. Moreover, although all of the clinicians
who participated in this trial have experience in the treatment of
chronic pain, two of the clinicians have had (MPJ, JR) less than 10 years
experience using hypnotic interventions, and two others (JE, MH)