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Leads of Clinical Health Psychology submission of 14 October 2021

PE1873/D: Provide hypnotherapy for the treatment of mental health, psychosomatic disorders and chronic pain. 

This response has been prepared on behalf of the Leads of Clinical Health Psychology, a group comprised of professional leads for Clinical Health Psychology services from across health boards in Scotland. The remit of the group is to improve the psychological well-being of people with physical health problems in Scotland, including those with chronic pain.  Psychological interventions are: based on sound evidence; delivered safely by competent practitioners who meet the minimum rigorous standards set by relevant governing bodies (including the Health Care Professions Council); applied to meet the unique needs of the individual.

Psychological management of chronic pain typically involves a thorough understanding of the cause, maintainers and protective factors associated with the psychological experiences. Psychological interventions are applied flexibly according to the outcomes of this assessment and in active collaboration with the person seeking treatment. 

Regarding the petition, we note the petitioner’s reference to the years-long history of interventions such as hypnosis; this is not adequate to recommend that it and similar approaches should be used in the modern NHS to safely meet the needs of people with chronic pain.   

There is little evidence for the use of either hypnotherapy or acupuncture in providing long term improvements in pain or quality of life. SIGN 136 concluded no good quality evidence was identified to evaluate the efficacy of hypnotherapy, and acupuncture was only to be considered for short term relief in specific situations (chronic lower back pain & osteoarthritis). Likewise, NICE Guideline 193 noted that evidence for hypnosis as applied to chronic primary pain

‘was based on one small study, showed no clinically important difference in quality of life between hypnosis and usual care. Evidence showed no difference in psychological distress at the earlier time point and a mixture of no difference and a benefit of hypnosis with some uncertainty at the later time point. There was no difference in sleep at the earlier time point and a benefit of hypnosis to sleep and pain reduction after 3 months.’ 

The NICE committee concluded: 

• there was a lack of evidence of the benefit of hypnosis in the management of chronic pain
• that the evidence available was ‘low to very low quality’
• a recommendation for or against hypnosis could not be made. 

In addition, the committee decided against making a research recommendation as ‘the results of the evidence available were not promising enough to warrant further research.’ 

Regarding acupuncture, a Complimentary and Alternative Medicine, the NICE guideline concluded that a brief single course of acupuncture could be recommended but that no evidence was found to inform a recommendation for repeat courses. 

There is, therefore, inadequate evidence to support the use of hypnosis or acupuncture in the management of chronic pain in the NHS.  Furthermore, there is a risk that interventions such as these, where the person seeking treatment does not play an active role, can serve to keep many in an unhelpful cycle of short-term pain alleviation. Even where successful, these often need repeated over long periods of time and prevent the empowerment of those with lived experience being supported to understand their condition how to manage it successfully in the longer term.   

To conclude, the Leads of Clinical Health Psychology are unable to support the proposals put forward in this petition.