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HYPNOTIC ANALGESIA IN PERSONS WITH DISABILITIES
201
make hypnotic-analgesia treatment more readily available to all
patients; if only 1% benefit, then it may be necessary to look elsewhere
for additional treatment options for chronic pain in persons with
disabilities. On the other hand, if a substantial subset of patients were
shown to respond to hypnotic analgesia at any one time, this would
support the need to increase the availability (and perhaps insurance
coverage) for this treatment.
A second question concerns the predictors of hypnotic-analgesia treat-
ment response. If patients who do not respond to hypnotic-analgesia
treatment can be identified before treatment begins or early in treatment,
they could be screened out of treatment, thus saving their time and
resources. Possible predictors of treatment outcome that deserve addi-
tional testing include general hypnotizability (Patterson & Jensen, 2003),
treatment-outcome expectancies (Kirsch, 1985), good initial response (i.e.,
a decrease in pain intensity during the first treatment session), the concen-
tration of treatment (i.e., administered on a daily basis versus over a
longer period of time), and specific diagnosis (e.g., SCI, amputation, MS).
General hypnotizability has been associated to a moderate extent
with treatment response to hypnotic analgesia (see review by Patterson &
Jensen, 2003). Fewer studies have examined the association between
treatment-outcome expectancy and treatment response, although those
performed suggest that this association is also in the moderate range
(e.g.,
r
= .27 to .35; Spinhoven & ter Kuile, 2000 ter Kuile et al., 1995).
Although this level of association indicates that pretreatment knowl-
edge of hypnotizability and/or treatment-outcome expectancy would
provide the clinician with some information regarding possible
responsiveness to treatment, it does not provide strong enough predic-
tive power to justify excluding patients from treatment on the basis of
these factors alone. Such moderate levels of correlation suggest that
some participants with low pretreatment hypnotizability or treatment-
outcome expectancy scores may still benefit from treatment. Because
we cannot assume that the strength of the associations found in previous
research with different pain populations will necessarily generalize,
there remains a need to examine these associations in samples with
disabilities and chronic pain.
To our knowledge, the utility of variables such as initial response to
treatment, intensity of treatment, and disability diagnosis as predictors
of treatment outcome in clinical hypnosis for chronic pain have yet to
be examined. Associations between these predictors and treatment
outcome could have important clinical implications. If patients who
show little or no response to suggestions for analgesia in the first ses-
sion ultimately do not benefit from the full course of treatment, then
this early treatment response could be used as a means of screening
out patients from further treatment. If patients who receive treatment
in a time-intensive manner (e.g., daily) ultimately do better than