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Hypnotic cognitive therapy reduces pain intensity in adults with spinal cord injuryRemote hypnosis therapy shows modest pain relief for adults with spinal cord injury

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Key Takeaway
Consider remote hypnotic cognitive therapy as a potential adjunct for SCI-related pain, but note modest effect sizes.

In a randomized controlled trial, 127 community-residing adults with spinal cord injury (SCI) and moderate-to-severe chronic pain received either hypnotic cognitive therapy (HYP-CT) or usual care. HYP-CT consisted of 6 weekly 60-minute sessions delivered remotely by a psychologist via telephone or Zoom, plus daily self-hypnosis practice using session recordings. The comparator was usual care, where participants continued current treatments or sought additional pain treatments.

The primary outcome was average pain intensity assessed on a 0-10 scale. At 6 weeks, average pain intensity decreased more in the HYP-CT group compared with usual care (mean difference -0.55, 95% CI -1.04 to -0.06). This benefit was maintained at 12 weeks (mean difference -0.79, 95% CI -1.28 to -0.29). Depression also declined significantly more in the HYP-CT group at both time points, though specific effect sizes were not reported.

Safety and tolerability data were not reported. The study provides Class III evidence, and the effect sizes, while statistically significant, are modest. Replication studies are needed. For clinicians, this suggests HYP-CT delivered remotely may be a feasible adjunctive treatment option for chronic pain in this population, though its clinical meaningfulness requires further evaluation.

Researchers tested whether a remote therapy combining hypnosis and cognitive techniques could help adults with spinal cord injury manage their chronic pain. The study involved 127 people living in their communities who had moderate-to-severe pain for many years. They received either six weekly therapy sessions by phone or video call, plus daily self-hypnosis practice, or continued with their usual care.

After six weeks, people who received the hypnotic therapy reported slightly less pain than those who continued with usual care. The pain relief was still present at the 12-week follow-up. The therapy also appeared to help with depression symptoms.

The study did not report any safety concerns, but it's important to note that the pain reduction was modest—about half a point to three-quarters of a point on a 10-point pain scale. This was a relatively small study classified as providing preliminary evidence. Readers should understand that while these results are promising, more research is needed before this approach becomes a standard treatment option.

What this means for you:
Remote hypnosis therapy showed modest pain relief in a small study of adults with spinal cord injury, but more research is needed.

Study Details

Study typeRct
Sample sizen = 64
EvidenceLevel 2
Follow-up1.4 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND AND OBJECTIVES: Chronic pain is highly prevalent, disabling, and difficult to treat in people with spinal cord injury (SCI). Our objective was to determine whether hypnotic cognitive therapy (HYP-CT) significantly reduces average pain intensity. METHODS: This single-blind, randomized, parallel-group trial investigated the efficacy of HYP-CT in treating moderate-to-severe chronic pain in community-residing adults with SCI. Participants were recruited nationwide through SCI organizations and randomized 1:1 to HYP-CT vs usual care (UC). We used computerized permuted block randomization with variable block sizes and stratified by sex and worst pain type. HYP-CT was delivered by a psychologist over the telephone or through Zoom and consisted of 6 weekly 60-minute sessions plus instructions to practice self-hypnosis daily independently by listening to session recordings. Controls were encouraged to continue current treatments or seek additional pain treatments. The primary outcome was average pain intensity assessed 4 times per week on a 0-10 numerical rating scale and averaged. The primary end point was at 6 weeks after randomization, with a follow-up assessment at 12 weeks. All outcomes were assessed through structured telephone interviews performed by blinded assessors. RESULTS: A total of 127 participants were randomized to HYP-CT (n = 64) vs UC (n = 63). Forty-eight percent were treated over the telephone and 52% through Zoom. The group was 42% female, had a mean age of 51.3 years (15.4 years after SCI), and had a mean baseline pain intensity of 5.93. The worst pain was neuropathic in 57% of cases. The primary outcome, average pain intensity, decreased more in the HYP-CT group compared with UC controls at 6 (-0.55, 95% CI -1.04 to -0.06) and 12 (-0.79, 95% CI -1.28 to -0.29) weeks. Depression declined significantly more in the HYP-CT vs UC groups at 6 and 12 weeks. Planned exploratory analyses suggested that the effect of HYP-CT on pain intensity was similar when delivered over the telephone vs through Zoom, and that pain intensity decreased more in those with all neuropathic pain vs those with mixed pain at 12 weeks. DISCUSSION: The study suggests that HYP-CT is an effective adjunctive treatment for SCI-related pain. Replication studies are needed. TRIAL REGISTRATION INFORMATION: The study was registered on ClinicalTrials.gov (NCT03857672) on February 28, 2019 and study enrollment commenced on April 24, 2019. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that, in patients with SCI, HYP-CT improves average pain intensity at 6 weeks compared with UC.
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