The therapist as a travelling companion to the chronically ill: Hypnosis and cancer related symptoms.

The complex interaction of pain, other symptoms and suffering in cancer patients requires a treatment approach that integrates psychological as well as pharmacological interventions. The supplementation of a pharmacological pain treatment concept based on WHO-guidelines by the use of self hypnosis was examined in a controlled clinical follow up study: 61 of 342 patients with cancer related pain referred to the Interdisciplinary Pain Unit of Munich University Clinic were included. In a cross-over design they were randomly assigned to two different successions of treatments after a 2-week period of establishing optimal medication: either AB (A: using self- hypnosis and analgesics, followed by B: pharmacological treatment alone, 4 weeks each) or BA (B: continuing pharmacological treatment alone and then A: using additional self-hypnosis). Patients themselves evaluated therapeutic effectiveness with the help of visual analogue scales (VAS) in a 'pain diary' for a total of 10 weeks. On account of a carryover-effect caused by the beneficial effects of self-hypnosis the 'cross-over' did not show statistical significance. Using a parallel design we found a statistically significant reduction of pain and suffering after the first four weeks for treatment A (with self-hypnosis) in comparison to treatment B (without self-hypnosis). The utilization of hypnosis requires an intensive subjective exchange over a period of time between the patient and the therapist, who embark as travelling companions on a journey through uncharted territory. Three case reports serve as an example for three different 'time windows' of this travelling companionship of therapists and patients: short term/crisis intervention, cooperation for several weeks/coping enhancement, and long term/psychotherapy.