Chronic pain refers to pain that persists for more than 6 months1 and as a condition in itself rather than a symptom2. We estimated that one in four Canadians had chronic pain2. This equates to 7.63 million people aged over 15 years old in 20193. In addition to the suffering and emotional distress for those affected1, there are many direct (e.g., medication) and indirect (e.g., reduced productivity) monetary costs associated with the chronic pain. According to the Canadian Pain Task Force (2020), these costs in Canada total $38.3 to $40.4 billion in 2019. Chronic pain is complex to treat and accessibility to treatment, including multidisciplinary interventions, is low2. For example, in Quebec, pain clinics are overwhelmed with demands, with an average wait of five years4. This suggests that care for chronic pain sufferers through specific interventions (i.e., preventive, or rapid intervention) should be widely considered.

In chronic pain treatment, although opioid use is common, it is not without adverse effects5. Potential harms include the development of opioid use disorders, overdoses, and deaths5. Consequently, it is desirable to reduce dependence on drug treatments in favor of protocols that focus on non-pharmacological approaches. Among established options for non-pharmacological interventions in chronic pain management, the literature has identified mindfulness meditation and acceptance therapy as effective treatments6,7. These effective treatments encourage the patient to focus on the present moment6 as well as to accept painful bodily sensations7. Another type of intervention that aligns with non-pharmacological treatments that is distinct from the two previously mentioned is hypnosis. Suggestion and dissociation techniques, used in hypnotic treatments, allow for longer-term effects than other interventions1.

Studies have primarily focused on the analgesic effects of hypnosis in the treatment of chronic pain with hypnosis8,9. To this end, a literature review using hypnosis as a treatment identified significant reductions in pain (hypnoanalgesia) in people with multiple chronic pain conditions (e.g., low back, cancer, fibromyalgia, arthritis)1. In the 13 studies reviewed, interventions using hypnosis were generally more effective than conventional treatment (e.g., physical therapy) and the effects lasted several months1. However, there are other estimable and important effects of the use of hypnosis for patients with chronic pain. Among the most notable effects are reduced anxiety, improved sleep and improved quality of life8. Therefore, using techniques associated with these targets would be beneficial in the development of an intervention for chronic pain involving hypnosis.

Another aspect of interest in a program using hypnosis is the ability to have an autonomous practice. Self-hypnosis, a practice in which one reaches the hypnotic trance state by oneself, facilitates this. Moreover, it allows one to benefit from the effects of hypnosis over a longer period10. Training is often done by providing instructions for self-hypnosis and recorded hypnosis sessions10. However, it is important to note that many questions remain regarding the practice of self-hypnosis. Indeed, the importance and best ways of providing instructions for practicing self-hypnosis have not been clarified by scientific studies1. Also, the frequency necessary for this practice to be optimal in its effectiveness remains unknown1. In short, several dimensions of self-hypnosis need to be further explored to optimize this practice.

A self-hypnosis training program has been tested in oncology to answer these questions. This program aimed to implement an intervention to improve breast cancer patients’ quality of life11. Cognitive-behavioral techniques and self-hypnosis training were used during 15 × 2 hours sessions to increase anxiety regulation and manage other physical symptoms such as nausea, hot flashes, and pain. The results of this study conducted with 159 participants (77 in the control group) showed a significant decrease in post-practice anxiety and following exposure to anxiety triggers that was accompanied by a lowering of heart rate at anxiety-provoking moments of the task11. Better daily anxiety regulation was reported compared to the control group, which had clinical support based on experience sharing with a peer group and a therapist, as well as a greater decrease in psychological distress associated with fear of cancer recurrence11. With its efficacy documented, this pilot study conducted in medical oncology can serve as a benchmark. Thus, it has been used as the foundation for a new self-hypnosis training program that aims to improve self-hypnosis training practices in a chronic pain setting.

HYlaDO (Hypnosis of pain in French, HYpnose de la DOuleur) is a new self-hypnosis training program for chronic pain management. This study aimed to 1) define the design of HYlaDO, and 2) assess it by gathering patients’ feedback and recommendations for improvement. Patients’ feedback allowed for the intervention program's refinement as well as to continue the program transfer by moving to future phases of development.