Hypnoanalgesia for procedural and chronic pain

1. Introduction

Version followed: two complementary clinical versions. (a) Chronic pain: the manualised self-hypnosis-training approach of Mark P. Jensen and David R. Patterson (University of Washington), as published in Jensen's Hypnosis for Chronic Pain Management: Therapist Guide (Oxford, Treatments That Work, 2011; used with a paired patient Workbook) and described in trial reports and reviews (Jensen et al. 2005 protocol as summarised by Elkins, Jensen & Patterson 2007; Jensen & Patterson 2014). Status of this source: the Therapist Guide's text is not reproduced or summarised here [uncertain]; its chapter structure (Part III running from patient assessment and preparation, through inductions and three suggestion chapters, to end-of-session posthypnotic suggestions and reorienting, then consolidation) is taken from Oxford Academic chapter pages and the publisher's table of contents and is used to order this guide. The book's wording and any session-by-session schedule it contains are NOT reproduced here [uncertain]. Group formats come from two Chronic Pain Skills Study protocols (Vanderbilt, PI L. McKernan; University of Washington/VA Puget Sound, PIs M. P. Jensen and R. M. Williams). (b) Procedural pain: Elvira Lang's adjunctive self-hypnotic relaxation for invasive procedures (Lang et al. 2000, Lancet; large-core breast-biopsy trial, Lang et al. 2006) and its later staff-training form, Comfort Talk® ("Rapport, Relaxation and Reframing"), plus evidence on positive versus warning-style procedural language. Lang's script wording is not reproduced here; its published elements (eye roll, deep breathing, floating, safe comfortable place, periodic check-ins, three responses to pain or anxiety) and five of the eight 'structured attention' behaviours are taken from a published report of the breast-biopsy trial. Problem handling (section 5) and several contraindications remain [synthesis].

Scope and medical frame (non-negotiable). Hypnoanalgesia is an adjunct within medical care. It is used only after the pain has been medically assessed and a diagnosis or working diagnosis made, alongside (never instead of) the analgesia, sedation, local anaesthesia, rehabilitation and investigations the medical team prescribes. It must never be used to mask an undiagnosed or changing pain, and it is not a treatment for cancer or any physical disease; where pain is disease-related (e.g. bone metastases, sickle cell disease), it addresses the pain experience only. [source: ISH Encyclopedia entry (Lang-Anderson & Bruhn 2025): hypnosis used as an adjunct with local anaesthesia/sedation; synthesis for the masking warning]

What it is. Clinical hypnosis for pain is a structured interaction in which the patient, after an induction that focuses attention and usually produces relaxation, is offered suggestions to change how pain is perceived (its intensity, its unpleasantness, its sensory quality, how much attention it receives) and how the patient sleeps, moves and copes. Jensen and Patterson favour defining hypnosis as a social interaction in which a person responds to suggestions for changes in perception, memory and voluntary action. In chronic pain the main deliverable is self-hypnosis skill that the patient uses daily and at need, supported by audio recordings. In procedural pain the deliverable is a brief in-procedure self-hypnotic relaxation plus consistently positive staff language, so that pain and anxiety do not escalate as the procedure goes on. [source: Jensen & Patterson 2014; Elkins, Jensen & Patterson 2007; ISH Encyclopedia]

How change is thought to happen (as the authors frame it). Suggestions can target separate pain dimensions (sensory intensity, unpleasantness, threat value, the ability to screen out discomfort and let in comfort), which imaging studies link to different brain areas, so wording is tailored to the dimension the patient struggles with. The induction itself may be analgesic: Jensen & Patterson note an EEG shift toward less beta and more alpha, similar to meditation and relaxation, and in an early case series (Jensen et al. 2000, 22 participants) most reported lower pain intensity and unpleasantness after the induction alone, with a specific analgesic suggestion lowering intensity further [source: SCIRE evidence table]. Outcome expectancy partly mediates benefit. Repeated self-practice, with posthypnotic suggestions that comfort will last after practice, is meant to produce both short relief (hours) and, for some patients, lasting reductions in average pain. In procedures, negative wording (warnings of stinging, hurting) is treated as a nocebo that can increase pain and anxiety, and rapport plus reframing is meant to prevent that. [source: Jensen & Patterson 2014; NCT03502655 protocol; Comfort Talk MRI protocol NCT02427737]

2. Framework

Hypnoanalgesia is a set of procedures rather than one branded therapy; the two versions have different frameworks. [source: Elkins, Jensen & Patterson 2007; Jensen & Patterson 2014; ISH Encyclopedia]

A. Chronic pain: self-hypnosis training course

Phase 0. Medical clearance and screening (before session 1). Goal: confirm the pain has been medically assessed, that no red-flag or untreated condition is being bypassed, and that the patient is suitable for (group or individual) hypnosis. In the Vanderbilt group protocol, the referring provider completes a referral form covering chronic pain status, pain intensity and suitability for a group; if not possible, the facilitator screens by phone. Inclusion there: pain ≥3 months, average pain ≥3/10 and worst ≥5/10 in the past week, pain ≥75% of the time. Move on when: medical assessment documented, screening passed, patient consents. [source: Vanderbilt protocol NCT03384953]
Phase 1. Education and expectation setting (session 1, often longer). Goal: explain hypnosis as focused attention and suggestion, correct misconceptions, set realistic hope (some patients gain lasting relief, some short relief lasting hours, most gain something such as better sleep or calm; no promise of pain relief). [source: Jensen & Patterson 2014; Vanderbilt protocol]
Phase 2. Skill-building sessions (core). Each session: review of home practice and goals → standard induction → ≥20 minutes of therapeutic suggestion → posthypnotic suggestions (comfort persisting; daily self-hypnosis becoming easy and automatic) → re-alerting → discussion → home practice assignment. Suggestions are added and tailored across sessions (pain intensity, unpleasantness, sensory change, imagined analgesia, relaxation, then sleep, activity, mood, coping). [source: Elkins, Jensen & Patterson 2007 (Jensen & Patterson 2006 recommendations; Jensen et al. 2005); Vanderbilt protocol]
Phase 3. Independence and maintenance (final sessions and after). Goal: patient practises first with recordings, then without, and uses brief self-hypnosis on demand. Most trial participants kept practising after treatment. [source: Jensen & Patterson 2014; Vanderbilt protocol]

How Jensen's Therapist Guide orders the work (from the publisher's table of contents, description and chapter abstracts; the chapter text itself is not summarised here [uncertain]). The publisher describes the book as distilling trial-tested techniques into research findings on pain, what hypnosis can do for pain, and step-by-step instructions for inductions and suggestions. Part I covers the biology and psychology of pain; Part II what hypnosis is and what it can do for pain; Part III the procedures: Ch. 5 Patient Assessment and Preparation; Ch. 6 Hypnosis for Chronic Pain Management: The Basics; Ch. 7 Hypnotic Inductions; Ch. 8 Suggestions for Pain and Symptom Management; Ch. 9 Suggestions for Thought, Attribution, and Mood Management; Ch. 10 Suggestions for Behavior, Activity, and Sleep Management; Ch. 11 End of the Session: Post-hypnotic Suggestions and Reorienting; Ch. 12 Summary and Consolidation. Back matter includes a pain evaluation form and an appendix of self-report measures (pain, pain beliefs and coping, clinical success). The guide is written for clinicians with or without prior hypnosis training and is meant to be used with the patient Workbook. This confirms the session anatomy used here (assessment and preparation → induction → suggestions drawn from pain/symptom, thought/mood and behaviour/activity/sleep menus → posthypnotic suggestions → reorienting), but not the book's own session count or allocation of content to sessions [uncertain]. [source: Oxford Academic chapter pages for Ch. 5, 6, 9, 10; Kinokuniya table of contents and description]

Dose and format. Minimum components named by Jensen and Patterson (as summarised by Dillworth & Jensen 2010): a standardised induction, pain-related suggestions, at least 20 minutes of hypnosis, four or more sessions, and home practice. Jensen & Patterson's recommendation (as cited in the 2007 review): 4–7 sessions for brief treatment, 8 or more for full treatment; their self-hypnosis trials used 10 sessions; Jensen et al. (2005) used 10 script-driven sessions. Group format: 8 sessions, 60–80 min (scheduled 90), 10–15 patients, two facilitators, workbook plus a recording of each session's induction and suggestions. Earlier trials used 4–12 weekly sessions (e.g. 8 weekly sessions for low back pain or osteoarthritis; five sessions for temporomandibular disorder; long-term tapering schedules in sickle cell disease). [source: Elkins, Jensen & Patterson 2007; Jensen & Patterson 2014; Vanderbilt protocol]

Further published formats. UW/VA Chronic Pain Skills Study (veterans): self-hypnosis training as one of three group treatments, eight weekly sessions of about 90 minutes, homework between sessions, pain and comfort rated before and after every session, a workbook plus audio recordings for participants treated by mail, group leaders drawn from existing credentialed clinic staff (e.g. psychologists, nurse practitioners) with a named fidelity supervisor. Hypnotic responsiveness was measured once before treatment (Modified Stanford Hypnotic Clinical Scale) for research purposes, not to select patients. Spinal cord injury trial (Jensen et al. 2009): 10 self-hypnosis training sessions delivered daily or weekly, compared with 10 sessions of EMG biofeedback relaxation; pain reduction was found only in participants with neuropathic pain. [source: NCT02653664 protocol; SCIRE evidence table]

Monitoring and criteria for progress. Responder definition used by the authors: ≥30% reduction in average pain intensity. Track average and worst pain (0–10), unpleasantness, sleep, activity, mood and home-practice logs each session. Decision points [synthesis]: if no short-term relief after 3–4 sessions, change suggestion type (e.g. from intensity to unpleasantness, from imagery to non-visual or acceptance suggestions) or broaden targets to sleep/mood/activity; if practice is not happening, solve practice barriers before adding content; end when the patient can self-induce reliably and has a maintenance plan. [source for responder definition: Jensen & Patterson 2014]

B. Procedural pain: adjunctive self-hypnotic relaxation

Before the day: whole-team training. In the Comfort Talk model, all staff (reception, technologists, nurses, physicians) learn advanced rapport, expectation-shaping and comforting language; a core group of licensed professionals learns to guide self-hypnotic relaxation. The MRI trial protocol used 2 × 8-hour live modules plus a 4-hour e-module, with an observed structured exam of staff behaviour (including counting negative suggestions). Lang's continuing-education outline for dental teams lists the same core skills: rapid rapport with distressed patients, preventing anxiety and pain from rising over the visit, recognising and avoiding negative suggestions, several ways to reframe distressing thoughts, reducing the impact of painful stimuli, and the principles of procedure hypnosis. [source: Comfort Talk MRI protocol NCT02427737; Hygienetown course page (outline only)]
At the start of the procedure: a standardised self-hypnotic relaxation script is read aloud by a trained care provider at procedure onset (Lang's trials: vascular/renal interventions, large-core breast biopsy under local anaesthesia, tumour embolisation), on top of standard sedation or local anaesthesia, which stays available on request. In the breast-biopsy trial the hypnosis group also received every 'structured (empathic) attention' behaviour (C1), anxiety was rated 0–10 at the start, every 10 minutes and at the end, and the method was presented as a technique patients can use on their own. See C4 for the script elements. [source: ISH Encyclopedia; Lang et al. 2000 abstract via Iowa repository; NCT00122369 registry summary; Cancer Network report of the breast-biopsy trial]
Throughout: positive, non-warning procedural language from every staff member; reframing of sensations; patient retains control (e.g. signals readiness). [source: NCT03502655 protocol; ISH Encyclopedia]
End: full re-alerting before the patient leaves; debrief [source: Comfort Talk MRI protocol for re-alerting; debrief = synthesis].
A short preoperative script has also been used before knee arthroplasty (Markovits et al. 2022, as cited in the ISH Encyclopedia entry) [uncertain: secondary, unverified].

One session per procedure; repeat procedures can reuse a cue the patient learned [synthesis].

3. Guiding principles

Adjunct, never substitute. Practical meaning: confirm medical assessment in writing, keep medication and sedation decisions with the medical team, and never ask a patient to forgo analgesia to "prove" hypnosis works. [source: ISH Encyclopedia (hypnosis alongside local anaesthesia/sedation); synthesis]
Never mask the unknown. Practical meaning: any new, changed, escalating or unexplained pain (or new neurological, bowel/bladder, systemic symptoms) goes back to the medical team before more hypnotic analgesia. [synthesis]
Hypnosis as a social, suggestion-based interaction. Practical meaning: demystify it; the patient stays in control and can open their eyes, move or speak at any time. [source: Jensen & Patterson 2014; synthesis for the control statement]
Target several pain dimensions, not only intensity. Practical meaning: ask what bothers the patient most (how strong, how distressing, how threatening, how much it grabs attention) and word suggestions for that dimension. [source: Jensen & Patterson 2014]
Treat the whole pain problem. Practical meaning: include suggestions for sleep, activity/exercise confidence, energy, mood, coping and acceptance, because many patients benefit there even without pain relief. [source: Jensen & Patterson 2014]
Self-hypnosis is the product. Practical meaning: every session ends with a practice plan; give recordings; move from recorded to unrecorded practice. [source: Jensen & Patterson 2014; Vanderbilt protocol; Elkins et al. 2007]
Realistic, hopeful expectancy. Practical meaning: describe the range of outcomes (lasting, short-lived, side benefits) without promising pain relief. [source: Jensen & Patterson 2014]
Hypnotizability is not a gatekeeper. Practical meaning: formal hypnotizability testing is rarely needed clinically; most patients benefit somewhat; adapt style (more relaxation and gentler imagery for lower responders). [source: Jensen & Patterson 2014; ISH Encyclopedia]
Tailor imagery; offer non-visual options. Practical meaning: not everyone likes or can form visual images; ask first and avoid imagery that may evoke unpleasant memories. [source: Jensen & Patterson 2014]
Words can hurt. Practical meaning: avoid warning-style language ("this will sting"); describe what the patient can notice or do in neutral-to-positive terms, without lying about the procedure. [source: NCT03502655 protocol; ISH Encyclopedia citing Varelmann et al. 2010]
Rapport, relaxation, reframing (procedural). Practical meaning: match the patient (e.g. come down to their level when they lie supine), help them help themselves rather than being merely "extra nice", reframe sensations. [source: Comfort Talk MRI protocol]
Patients in procedures may already be in a suggestible state. Practical meaning: everything said in the room acts as suggestion, so whole-team language matters. [source: ISH Encyclopedia citing Cheek 1962]
Work within competence and licence. Practical meaning: use hypnosis only for problems you are trained to treat without hypnosis, after specific clinical-hypnosis training (e.g. the Vanderbilt protocol required clinical competence or a 2-day training plus supervision). [source: Vanderbilt protocol; synthesis for the competence rule]
Not a memory-recovery tool. Practical meaning: suggestions are present- and future-focused; do not use hypnosis to search for a hidden cause of pain in the past. [synthesis]

4. Intervention inventory

All example wording below is the author's own illustrative paraphrase, not any founder's or manual's script. The sources name the components and their order; Jensen's (2011) manual is represented here only by its published chapter structure and abstracts, and Lang's script only by its published elements, not its wording [uncertain]. Part A covers preparation, induction and closing procedures common to both versions; Part B covers pain-specific suggestions (mainly chronic pain); Part C covers procedural-pain techniques.

Part A. Preparation, induction, deepening, closing

A1. Medical clearance and screening

Purpose / when: before any hypnoanalgesia; repeat whenever pain changes.
Steps: (1) Obtain the medical assessment and diagnosis/working diagnosis from the treating clinician; note current analgesia and planned investigations. (2) Screen for exclusions used in the Vanderbilt group protocol: cognitive impairment that would stop the patient following the session (including moderate-severe or unresolved brain injury); primary psychotic or major thought disorder in the past 5 years; active delusional/psychotic thinking; active suicidal ideation with intent; unstable or severe psychiatric or behavioural conditions or substance dependence in the past 6 months; acute distress; for groups, behaviour unsuitable for a group. [source: Vanderbilt protocol NCT03384953] The UW/VA protocol used near-identical criteria and added: severe cognitive impairment judged by a brief six-item cognitive screen; psychiatric hospitalisation in the past 5 years (except for suicidal or homicidal ideation or PTSD); very high daily opioid use (a research exclusion, not a clinical rule); clinicians could use discretion on the mental-health criteria. Patients were screened for suicidal ideation and psychosis before treatment. [source: NCT02653664 protocol] (3) Added cautions [synthesis]: severe dissociative disorders or frequent dissociation (use eyes-open, grounding-heavy, brief work or defer); untreated PTSD, especially where pain is tied to a traumatic injury (stabilise first, keep imagery present-focused, no regression); epilepsy with seizure triggers from relaxation or hyperventilation-like breathing (coordinate with neurologist); patients seeking hypnosis to avoid recommended investigation; litigation where memory content may later be questioned (avoid any memory-focused work). (4) Ask about prior experience of hypnosis, beliefs and fears, and imagery preferences (visual, auditory, bodily, none). (5) Record pain baseline (average, worst, unpleasantness, sleep, activity, mood). Jensen's Therapist Guide devotes a chapter (Ch. 5) to patient assessment and preparation, which opens with the purposes of the assessment, and supplies a pain evaluation form and an appendix of self-report measures of pain, pain-related beliefs and coping, and clinical success; their detailed content is not summarised here [uncertain]. [source: Oxford Academic Ch. 5 page; publisher's table of contents]
Example language (illustrative): "Before we use hypnosis I want to be sure your doctors have checked this pain. Hypnosis can turn the volume down on pain, so we only use it on pain that has been looked at properly."
Watch for: red flags (new, escalating, nocturnal or unexplained pain; new neurological deficits; fever, weight loss); pressure from the patient to skip medical review. Working when: documented clearance and an agreed treatment target.

A2. Education, consent and expectation setting

Purpose / when: session 1 (and briefly before any procedural script).
Steps: (1) Describe hypnosis as focused attention plus suggestion, a social interaction the patient takes part in, not something done to them. [source: Jensen & Patterson 2014] (2) Correct myths: no loss of control, the patient can hear, move, speak, and stop at any time; hypnosis does not make anyone do things against their will [synthesis]. (3) Set realistic hope: some get lasting relief, some relief for hours after practice, most get something (sleep, calm, less stress); no guarantee of pain relief. [source: Jensen & Patterson 2014] (4) Explain the plan (number of sessions, recordings, daily practice). (5) Obtain informed consent, including that hypnosis is an adjunct and medical treatment continues; document it [synthesis]. (6) Mention possible mild after-effects (brief grogginess, headache, emotion) and how they are handled [synthesis].
Example language (illustrative): "Think of this as training your attention. I'll guide you at first, then you'll learn to do it yourself with a recording, then without one."
Watch for: fear of losing control, religious objections, magical expectations; offer a brief taster with eyes open if anxious [synthesis]. Working when: patient can explain the rationale and agrees a practice plan.

A3. Eye-closure / eye-roll induction

Purpose / when: start of each hypnosis segment. Eye-closure inductions are reported in pain trials (e.g. Simon & Lewis 2000, TMD); the eye-roll variant appears in ASCH training materials and opens Lang's procedural script (eyes rolled upward, eyes closed, deep breathing, then a floating sensation). Jensen's Therapist Guide gives inductions their own chapter (Ch. 7), and the companion patient Workbook has a chapter that explains the purpose of the induction, which usually begins any hypnosis session, and provides three basic inductions; which three is not given here [uncertain]. [source: Oxford Academic Workbook chapter page] [source: Elkins, Jensen & Patterson 2007; ASCH eye-roll deepening document; Cancer Network report of Lang's breast-biopsy trial]
Steps (eye-roll, structure from ASCH material): (1) Patient sits supported. (2) Invite them to look upward as far as is comfortable, then let the lids close while taking a deep breath and holding it briefly. (3) On the out-breath, eyes relax behind closed lids and the patient imagines drifting or sinking down with a pleasant, welcoming feeling. (4) Move into deepening (A5). For a simple eye-closure version [synthesis]: fix the gaze on a spot, suggest the lids grow heavy, allow them to close when ready.
Example language (illustrative): "Let your eyes look up, as if at your eyebrows... take a full breath and hold it... now let the breath go, let your eyes close and relax, and let yourself settle down into the chair."
Watch for: contact lenses or eye discomfort (skip the upward gaze); anxious patients who prefer eyes open (use an eyes-open focus) [synthesis]. Working when: slower breathing, facial relaxation, stillness.

A4. Arm levitation induction

Purpose / when: an alternative induction that gives the patient visible evidence of response; used in a fibromyalgia trial (Haanen et al. 1991). Ideomotor suggestions (hands moving together, an arm rising) were also used in sickle cell disease (Dinges et al. 1997). [source: Elkins, Jensen & Patterson 2007]
Steps [structure is synthesis; sources name the technique only]: (1) Patient rests hands on thighs. (2) Suggest attention to sensations in one hand: lightness, tingling, small movements. (3) Suggest the hand and arm become lighter and begin to lift on their own, at their own pace. (4) Link rising with deepening comfort. (5) Suggest the hand returns to rest as comfort deepens further.
Example language (illustrative): "Notice whichever hand feels a little lighter... no need to make anything happen, just be curious whether it wants to lift, a little at a time."
Watch for: frustration if the arm doesn't move: frame any response (or none) as fine and move on; avoid with shoulder or arm pain [synthesis]. Working when: spontaneous, slightly jerky movement and absorption.

A5. Deepening

Purpose / when: after induction, to strengthen absorption and relaxation before therapeutic suggestions.
Steps (sequence from ASCH eye-roll/deepening material): (1) Increasing support: notice contact of body with chair and floor and let go into it. (2) Breath focus: observe natural breathing, letting each out-breath carry tension away. (3) Body scan: with each out-breath relax muscle groups from feet upward to face and jaw (progressive muscle relaxation suggestions were used in "hypnorelaxation" for TMD, Winocur et al. 2002). (4) Optional imagery: a calming light of the patient's chosen colour surrounding the body; waves of relaxation moving from head to toe in time with breathing. [source: ASCH document; Elkins, Jensen & Patterson 2007] Counting down is a common alternative [synthesis].
Example language (illustrative): "Each time you breathe out, let a little more weight sink into the chair... let that softness spread from your feet up to your calves..."
Watch for: relaxation-induced anxiety, intrusive images, or rising pain from attention to the body: switch to an external focus or open-eye grounding [synthesis]. Skip body-scan detail over the painful area if it amplifies pain [synthesis]. Working when: slower, deeper breathing; reduced muscle tone; delayed responses.

A6. Safe or comfortable place imagery

Purpose / when: after deepening, as a calming base and a place to which the patient can return; part of ASCH training material and (as a comfortable-place element) of procedural scripts [source: ASCH document; Cancer Network report of Lang's breast-biopsy trial for the safe, comfortable place element].
Steps: (1) Agree the place beforehand (real or imagined, chosen by the patient). (2) Invite the patient to imagine being there and to find one detail that signals safety. (3) Suggest that the longer they stay, the safer and more comfortable they feel. (4) Optionally anchor it to a cue (e.g. a word or a breath) for later use [synthesis].
Example language (illustrative): "Let yourself arrive at that place you chose... notice one thing there that tells you you're safe... and the longer you stay, the more settled you can feel."
Watch for: places linked to loss or trauma; distress means switch place or use non-visual focus. Jensen & Patterson warn against imagery that brings up unpleasant memories. [source: Jensen & Patterson 2014] Working when: visible calm; patient can return to the place in self-hypnosis.

A7. Time expansion

Purpose / when: near the end of the suggestion phase, so that a few minutes of comfort feel longer and the experience consolidates. [source: ASCH document]
Steps: (1) Suggest that the next minute or two of clock time can feel like a much longer stretch of comfortable time. (2) Allow silence. (3) Continue to posthypnotic suggestions.
Example language (illustrative): "In the next minute of clock time you can have all the time you need to enjoy this comfort."
Watch for: none specific; keep silence short with anxious patients [synthesis].

A8. Posthypnotic suggestions

Purpose / when: at the end of every chronic-pain session; Jensen & Patterson recommend suggestions that comfort lasts minutes to hours after practice, that pain reduction becomes "automatic", and that self-hypnosis practice becomes easier and routine. Jensen et al. (2005) gave a posthypnotic suggestion for daily self-hypnosis. A TMD protocol framed muscle tension as a cue for relaxation. Jensen's Therapist Guide treats posthypnotic suggestions and reorienting as the dedicated end-of-session step (Ch. 11; its content is not summarised here [uncertain]). Across the controlled trials reviewed by Dillworth & Jensen (2010), posthypnotic suggestions included a 'deep breath' cue, extended analgesia and encouragement to practise regularly; a TMD trial (Abrahamsen et al. 2009) also used pain as a cue to focus on good memories and muscle tension as a cue to relax. [source: Jensen & Patterson 2014; Elkins, Jensen & Patterson 2007; Dillworth & Jensen 2010; publisher's table of contents]
Steps: (1) Link a benefit to after-session time (comfort continues). (2) Link a cue to a response (e.g. noticing jaw tension cues release; a breath and a word cue a brief self-hypnosis). (3) Suggest practice becomes easy and natural. (4) Keep suggestions permissive and achievable.
Example language (illustrative): "And this comfort can stay with you for minutes and hours after you open your eyes... and whenever you notice your jaw tightening, that can be your reminder to let it soften."
Watch for: cues that occur too often or at unsafe times (e.g. not a cue tied to driving). Avoid suggesting the patient ignore pain signals [synthesis]. Working when: patient reports spontaneous use of the cue between sessions.

A9. Re-alerting

Purpose / when: end of every hypnosis segment; the Comfort Talk MRI protocol specifies re-orientation so patients are fully re-alerted. [source: Comfort Talk MRI protocol; ASCH document]
Steps: (1) Suggest the imagery fades, keeping whatever was useful. (2) Re-orient to the room, the chair's support, sounds, time. (3) Return to full alertness at the patient's own pace (or by counting up [synthesis]); eyes open = fully alert and refreshed. (4) Check orientation before the patient stands, drives or leaves [synthesis].
Example language (illustrative): "Let that place fade for now, bringing back what's useful... notice the chair, the sounds in the room... and when you're ready, open your eyes, alert and clear-headed."
Watch for: grogginess, dizziness, slow response: repeat re-alerting, have the patient stand slowly, wait before driving [synthesis].

A10. Debrief

Purpose / when: after each hypnosis segment. Group protocols include a post-exercise discussion. [source: Vanderbilt protocol]
Steps [synthesis]: ask what helped, what didn't, which images or words worked, pain ratings before and after (intensity and unpleasantness), any unpleasant experiences; adapt the next script accordingly.
Example language (illustrative): "What did you notice? Which part would you like more of next time, and which part should I drop?"
Watch for: unexpected emotion or memories; treat as present experience, contain, and plan; don't explore them hypnotically. Working when: next-session scripts become increasingly patient-specific.

Part B. Pain-specific suggestions and self-hypnosis training (chronic pain)

Jensen et al. (2005) gave five suggestions after induction, in this order: decreased pain, relaxation, imagined analgesia, decreased unpleasantness, replacement of pain with non-painful sensations. Jensen & Patterson recommend at least 20 minutes of suggestion per session. B1–B5 follow that set; B6–B16 are further suggestion types used in published trials or recommended by Jensen & Patterson. [source: Elkins, Jensen & Patterson 2007; Jensen & Patterson 2014] Jensen's Therapist Guide groups suggestions in three chapters: pain and symptom management, thought/attribution/mood, and behaviour/activity/sleep. Mapping the items below onto those chapters (roughly B1–B11, B14, B12–B13) is this guide's own [synthesis; chapter titles from Oxford Academic and Kinokuniya].

B1. Suggestions for decreased pain intensity

Purpose / when: core suggestion when the patient's main complaint is how strong the pain is.
Steps: (1) Agree the target area and the patient's own words for the pain. (2) After deepening, suggest the sensation can gradually turn down, become fainter or smaller. (3) Optionally use a control image the patient chooses (e.g. a dial or volume control) [synthesis: device images are common in practice but are not described in the sources cited]. (4) Link to posthypnotic continuation (A8).
Example language (illustrative): "You can let that sensation in your lower back become a little quieter... and a little quieter still, at whatever pace your body finds right."
Watch for: wording that promises complete absence (sets up failure); use "less", "easier". Working when: in-session drop in 0–10 rating; patient reproduces it at home.

B2. Relaxation suggestions

Purpose / when: every session; useful alone for low hypnotic responders, and for muscle-tension pain (TMD, fibromyalgia). [source: Elkins, Jensen & Patterson 2007; ISH Encyclopedia]
Steps: suggest progressive release of muscle groups, slower breathing, warmth and heaviness (autogenic-style statements were used by Appel & Bleiberg) [source: Elkins et al. 2007].
Example language (illustrative): "Your shoulders can let go a little more... your arms heavy and warm, resting."
Watch for: relaxation-induced anxiety (A5). Working when: lower muscle tension and arousal.

B3. Imagined analgesia (numbness, anaesthesia)

Purpose / when: when the patient can imagine numbness or an anaesthetic feeling; used by Jensen et al. (2005) and Simon & Lewis (2000) (analgesia/anaesthesia suggestions). [source: Elkins, Jensen & Patterson 2007]
Steps: (1) Ask about a time the patient felt numbness (e.g. cold, a dental anaesthetic) [synthesis]. (2) Suggest that numb, cool or insulated feeling gradually developing in the painful area. (3) Suggest it stays as long as useful and returns with self-hypnosis. Transferring numbness from the hand to the painful area ("glove" technique) is a commonly taught variant not described in the sources cited [synthesis].
Example language (illustrative): "Remember how a cold drink can make your fingers feel cool and a bit numb... let that cool, numb feeling settle into your knee."
Watch for: do not use over areas where the patient must notice injury signals (e.g. insensate feet, recent surgery wounds) without medical agreement [synthesis]. Working when: reports of numb or muted sensation.

B4. Decreased unpleasantness (affective) suggestions

Purpose / when: when the pain may stay the same strength but the distress, threat or bother is the problem; imaging shows different brain effects from intensity suggestions. [source: Jensen & Patterson 2014]
Steps: suggest the sensation can be there while bothering the patient less, matter less, feel less threatening, become just a sensation.
Example language (illustrative): "The sensation may still be there, and it can matter less and less... just a feeling your body has, nothing you need to fight."
Watch for: patients who hear this as "it's in your head": frame it as a different brain channel [synthesis]. Working when: unpleasantness rating falls more than intensity.

B5. Sensory substitution (replacing pain with non-painful sensations)

Purpose / when: for burning, stabbing, aching qualities the patient wants changed; used by Jensen et al. (2005). Related: Spiegel & Bloom (1983) taught patients to "filter out the hurt" by imagining competing sensations (warmth, coolness, tingling) in the painful area. [source: Elkins, Jensen & Patterson 2007]
Steps: (1) Ask what the pain feels like and what more tolerable sensation would be acceptable (e.g. burning → cool tingling). (2) Suggest the sensation gradually changing into that one.
Example language (illustrative): "That burning can start to change... perhaps cooler, perhaps more like a gentle tingling, a sensation that's easy to have."
Watch for: substitutes that are themselves unpleasant to the patient. Working when: patient describes a changed quality.

B6. Pain displacement

Purpose / when: when moving the sensation to a less troublesome area is acceptable; used by Spinhoven & Linssen (1989). [source: Elkins, Jensen & Patterson 2007]
Steps [synthesis for detail]: suggest the sensation gradually shifts, e.g. from the back to a fingertip, where it is small and easy to manage.
Example language (illustrative): "You might let some of that sensation travel down into your little finger, where it can be small and easy to set aside."
Watch for: confusion about real symptom location in later medical exams; tell the patient to report original pain honestly to their doctors [synthesis].

B7. Pain transformation imagery

Purpose / when: imagery-friendly patients; Spinhoven & Linssen used pain transformation; Jensen & Patterson give examples such as imagining a colour for pain or a soothing water image. [source: Elkins et al. 2007; Jensen & Patterson 2014]
Steps: (1) Ask the patient's image or colour for the pain and for comfort. (2) Suggest the pain image changing (red to soft blue; hot to cool water flowing over the area). (3) Let the patient guide the change.
Example language (illustrative): "Let that colour begin to soften and change towards the colour of comfort... spreading slowly through the whole area."
Watch for: non-visualisers (offer bodily or sound-based versions); imagery tied to bad memories. Working when: image shifts and sensation follows.

B8. Imaginative inattention and dissociative imagery

Purpose / when: redirecting attention away from pain; Spinhoven & Linssen used imaginative inattention; Elkins et al. (2004) used dissociative imagery for bone-metastasis pain (adjunct to oncological care only). Jensen & Patterson describe the ability to screen out discomfort and let in comfort as a target. [source: Elkins, Jensen & Patterson 2007; Jensen & Patterson 2014]
Steps: (1) Agree an absorbing scene or activity. (2) Suggest the patient becomes absorbed in it while body sensations fade into the background. (3) Optionally suggest the painful part can rest "over there" while the patient is elsewhere.
Example language (illustrative): "While your body rests here, comfortable, your mind can be walking that beach, feeling the sand and hearing the waves."
Watch for: dissociation-prone or traumatised patients: prefer attention-shifting with a present-moment anchor over strong body-detachment suggestions [synthesis]. Working when: patient reports time passing with less pain awareness.

B9. Observing pain from a distance / acceptance

Purpose / when: when control-focused suggestions provoke struggle; Jensen & Patterson suggest hypnosis may help patients observe pain from a distance and accept it, reducing suffering. [source: Jensen & Patterson 2014]
Steps [detail is synthesis]: suggest stepping back to watch sensations come and go, describing them with curiosity, letting them be without needing to change them.
Example language (illustrative): "Just notice the sensation, as if from a little further away... noticing it shift and change, without needing to do anything about it."
Watch for: patients who feel this means giving up; pair with activity goals. Working when: less catastrophising, more engagement despite pain.

B10. Future-oriented imagery

Purpose / when: building motivation and confidence; Spinhoven & Linssen used future-oriented imagery. [source: Elkins, Jensen & Patterson 2007]
Steps: suggest imagining a near-future day handled with more comfort and activity, in detail, then link back to today's practice.
Example language (illustrative): "Picture a morning a few weeks from now... you get up, and you notice how much more easily you move into your day."
Watch for: unrealistic images that set up disappointment; keep them modest. Working when: goals become concrete and acted on.

B11. Ego strengthening and positive mobility imagery

Purpose / when: low confidence, demoralisation; ego-strengthening suggestions were used in fibromyalgia (Haanen) and mixed pain (Melzack & Perry); Gay et al. (2002) used recall of a childhood memory of easy joint movement in osteoarthritis. [source: Elkins, Jensen & Patterson 2007]
Steps: suggest growing confidence, strength and capacity to cope; optionally invite a patient-chosen pleasant memory of moving freely as a resource.
Example language (illustrative): "You've already found ways through hard times... that strength is still there and can grow each day."
Watch for: keep remembered material as a pleasant resource the patient already knows about; never probe for unknown past events [synthesis].

B12. Sleep suggestions

Purpose / when: sleep disturbance (reported by roughly half to most chronic pain patients). [source: Jensen & Patterson 2014]
Steps: suggestions for falling asleep easily, returning to sleep after waking, waking rested; practise the recording at bedtime [synthesis for bedtime use].
Example language (illustrative): "Tonight, as your head touches the pillow, your body can remember this comfort and drift easily into sleep."
Watch for: sedating medications and daytime sleepiness; coordinate with prescriber [synthesis].

B13. Activity, exercise and energy suggestions

Purpose / when: fear of movement, fatigue, poor adherence to physiotherapy. [source: Jensen & Patterson 2014]
Steps: suggestions for confidence to start and keep up exercise or physiotherapy and to draw on inner energy when needed; align with the physiotherapist's plan; set no targets beyond those prescribed [synthesis].
Example language (illustrative): "As you walk to physio this week, you can feel steady and capable, finding the energy you need."
Watch for: suggestions that encourage overriding medical activity limits.

B14. Mood, coping and hypnotic cognitive therapy

Purpose / when: depression, anxiety, catastrophising. Jensen and colleagues piloted "hypnotic cognitive therapy" (cognitive restructuring delivered within hypnosis) in multiple sclerosis pain, with preliminary added benefit for pain, catastrophising and interference. Jensen's Therapist Guide has a chapter on suggestions for thought, attribution and mood management (Ch. 9); its detailed content is not summarised here [uncertain]. [source: Jensen & Patterson 2014; Oxford Academic Ch. 9 page] A later trial by Jensen and colleagues comparing hypnosis, cognitive therapy and hypnotic cognitive therapy is listed by IASP [uncertain: secondary, unverified].
Steps: (1) In the waking part of the session, identify the patient's catastrophic pain thought and a balanced alternative (standard CBT). (2) Within hypnosis, suggest the balanced thought arises automatically when pain flares. (3) Practise with recording.
Example language (illustrative): "When the pain flares, a calm thought can come to you: 'I've handled this before; it will ease.'"
Watch for: suicidal ideation or severe depression: assess and treat per standard risk practice, not by hypnosis alone. Working when: reduced catastrophising scores.

B15. Ideomotor work and individualised metaphors / self-suggestions

Purpose / when: to build a sense of response and personal tools; Dinges et al. (1997, sickle cell) used ideomotor suggestions and had patients develop individualised metaphors and self-suggestions; Simon & Lewis (2000) used limb catalepsy and metaphors. [source: Elkins, Jensen & Patterson 2007]
Steps [synthesis for detail]: (1) Brief ideomotor experience (hands drifting together). (2) Ask the patient for a metaphor for their pain easing (ice melting, a knot loosening). (3) Help them phrase short, positive, present-tense self-suggestions for home use.
Example language (illustrative): "What would it look like if this pain were loosening? ... Let's turn that into a phrase you can say to yourself."
Watch for: catalepsy suggestions near painful limbs (avoid) [synthesis].

B16. Self-hypnosis training, recordings and home practice

Purpose / when: throughout; the main vehicle of change. [source: Jensen & Patterson 2014; Vanderbilt protocol; Elkins et al. 2007]
Steps: (1) Record each session's induction and suggestions (or provide standardised recordings). (2) Assign daily practice; brief on-demand self-hypnosis for flares [synthesis for flare use]. (3) Patient logs practice; review each session. (4) Fade recordings: practise first with, then without them. (5) Teach a short self-induction (e.g. eye-roll + breath + cue word) [synthesis] and a closing self-re-alert.
Example language (illustrative): "This week, once a day with the recording, at a time you won't be interrupted. Next week we'll try one practice on your own."
Watch for: practising while driving or operating machinery (forbid) [synthesis]; non-adherence (see section 5). Working when: patient self-induces reliably and reports relief or side benefits.

B17. Group delivery

Purpose / when: services offering scalable chronic pain care. [source: Vanderbilt protocol]
Steps: 8 weekly sessions of 60–80 minutes; 10–15 participants; two facilitators; each session: home-practice review and goals → short standard induction → standardised suggestion script (pain, mood/optimism, relaxation, sleep, posthypnotic) → discussion → home practice; workbook and recordings; facilitators trained (2-day course plus feedback/consultation).
Example language (illustrative): "Let's start with how practice went this week. What got in the way, and what helped?"
Watch for: disruptive behaviour (protocol allows removal from the group); less tailoring than individual work, so collect individual feedback. Working when: practice logs complete; pain ratings and sleep improving.

Part C. Procedural pain (adjunct to sedation and local anaesthesia)

C1. Rapport and matching (whole team)

Purpose / when: from reception to discharge; the first R of Comfort Talk's "Rapport, Relaxation and Reframing". [source: Comfort Talk MRI protocol]
Steps: (1) Every staff member greets and orients the patient calmly. (2) Match the patient's position and pace (e.g. bend down towards a supine patient rather than talking down from above). (3) Use the patient's own words for their concerns. (4) Help the patient help themselves (give them tasks and choices) rather than only being "extra nice", which the protocol notes carries risk. [source: Comfort Talk MRI protocol] (5) Apply Lang's 'structured attention' behaviours. Her trial manual specified eight; published reports name five: listen attentively; avoid negative suggestions; give the patient a sense of control (e.g. offer help at any time); respond quickly to requests; encourage the patient by praising something they did well. The other three were not found [uncertain]. [source: Cancer Network report of Lang's breast-biopsy trial]
Example language (illustrative): "I'm going to sit down here so we can talk at the same level. What would help you most to feel comfortable today?"
Watch for: staff over-reassurance or hurry. Working when: patient engages, asks questions, breathing settles.

C2. Positive procedural language and nocebo avoidance (reframing)

Purpose / when: every procedural communication. Warning-style wording is hypothesised to act as a nocebo and raise pain and anxiety; ISH entry recommends avoiding negative suggestions and using positive ones, reframing, metaphor and imagination. Lang's attention manual illustrates the swap with check-in questions: ask "What are you experiencing?" rather than "How bad is your pain?" [source: NCT03502655 protocol; ISH Encyclopedia citing Varelmann et al. 2010; Cancer Network report of Lang's breast-biopsy trial]
Steps: (1) Describe what the patient may notice in neutral or comfortable terms (pressure, coolness, warmth, heaviness) rather than "sting", "burn", "hurt", "don't move". (2) Keep it truthful: say sensations may occur, describe their nature and duration. (3) Replace prohibitions with positive instructions ("keep your arm resting just like that"). (4) Give the patient a way to signal readiness or discomfort.
Example language (illustrative): "You may notice a cool feeling, then some pressure for a moment. Let your arm stay resting there, heavy and still."
Watch for: deception (never say "you won't feel anything" if they might); habitual negative phrases in staff. Comfort Talk audits count negative suggestions in observed staff behaviour. [source: Comfort Talk MRI protocol] Working when: fewer startle responses and pain behaviours.

C3. Brief suggestion during cannulation or injection (arm dissociation)

Purpose / when: single brief procedures (IV lines, injections). The NCT03502655 intervention suggested the arm may begin to feel numb, heavy or warm, "as if asleep", limited to the procedure, avoided explicit words like pain, sting or needle, and let the patient signal readiness by lifting a finger of the other hand. [source: NCT03502655 protocol]
Steps: (1) Brief rapport. (2) Suggest the arm may start to feel heavy, warm or a bit numb, as if it were resting, asleep, for just these few minutes. (3) Invite a readiness signal (finger lift on the other hand). (4) Proceed; keep talking softly. (5) Suggest normal feeling returns afterwards.
Example language (illustrative): "This arm can just rest, perhaps feeling heavy or warm, a bit like it's asleep for these few minutes. When you're ready, lift a finger on your other hand."
Watch for: patients who want to watch and be told exactly what happens; respect that preference [synthesis].

C4. In-procedure self-hypnotic relaxation script

Purpose / when: longer invasive procedures (vascular/renal interventions, biopsies, embolisation, MRI), read at onset of the procedure by a trained professional, alongside standard sedation available on request. In Lang's trials pain did not rise over time as with standard care; patients needed less medication and had more stable vital signs. [source: ISH Encyclopedia; Lang et al. 2000 abstract]
Steps (elements of Lang's standardised script as reported for the breast-biopsy trial; script wording not reproduced): (1) Brief consent and expectation: present it as a technique the patient can use for themselves [framing: source; wording: synthesis]. (2) Induction: ask the patient to roll the eyes upward, close them, and breathe deeply. (3) Invite concentration on a sensation of floating. (4) Guide the patient to imagine a safe, comfortable place. (5) Throughout the procedure, the provider periodically asks how the patient is feeling. (6) If the patient reports pain or anxiety, use one of three published responses: guide them back to the comfortable place; suggest adding coolness to the painful area; or shift attention to another part of the body. (7) Structured-attention behaviours (C1) and positive language (C2) continue throughout; medication on request is always honoured. (8) Re-alert fully at the end (A9) and debrief [re-alerting: Comfort Talk MRI protocol; debrief: synthesis]. [source: Cancer Network report of Lang et al. 2006 breast-biopsy trial; ISH Encyclopedia]
Example language (illustrative): "You can take yourself to that place you chose, and stay there while we do our work. If you need anything, just tell us; you're in charge of your comfort."
Watch for: high responders may vividly imagine the worst but can also reframe well; low responders may do better with less frightening imagery and more relaxation. [source: ISH Encyclopedia] Ensure analgesia/sedation are not withheld. Working when: stable vitals, steady pain ratings, fewer requests for drug rescue.

C5. Conversational hypnosis during care

Purpose / when: when there is no time or consent for a formal induction; ISH entry describes it as used by healthcare providers: verbal and non-verbal rapport, positive suggestion, reframing, metaphor, imagery. [source: ISH Encyclopedia]
Steps [synthesis for detail]: weave comfort suggestions into ordinary talk; use metaphors the patient offers; keep a calm rhythm; pair each procedural step with a positive statement.
Example language (illustrative): "You've been breathing so steadily... you can keep that easy rhythm going as we move to the next step."
Watch for: must remain transparent and consensual: tell the patient you are using comfort techniques; no covert hypnosis [synthesis].

C6. Training the team (Comfort Talk model)

Purpose / when: before implementing C1–C5 in a unit. [source: Comfort Talk MRI protocol]
Steps: all staff trained in rapport, expectation shaping and comforting language; licensed core staff trained to guide self-hypnotic relaxation; lecture, demonstration, small-group practice and micro-teaching; site-specific "suggestion cards"; observed structured skills assessment; local champions to sustain use.
Watch for: drift back to warning language; refresh training. Working when: audited negative-suggestion counts fall.

5. Handling problems

Problem handling is still mostly [synthesis]. Sourced responses exist only for pain or anxiety during a procedure (Lang's three script responses and structured-attention behaviours) and for screening exclusions; any troubleshooting advice in Jensen's Therapist Guide is not reflected here [uncertain]. Each item is tagged.

Pain changes, worsens or new symptoms appear. Stop hypnoanalgesia for that pain; refer back to the medical team before resuming. Never use suggestion to override a new pain. [synthesis]
No relief after several sessions. Expect uneven benefit: in Jensen's case series responder rates ranged 22–60% depending on condition, and in one study responders all had neuropathic pain. Shift targets (intensity → unpleasantness → acceptance), broaden to sleep/mood/activity (many patients still benefit there), check practice, and agree a review point to stop if there is no useful benefit. [source: Jensen & Patterson 2014; synthesis for steps]
Relief is real but brief. Present this as a recognised outcome; build on-demand brief self-hypnosis for flares and posthypnotic suggestions for lasting comfort. [source: Jensen & Patterson 2014]
"I can't be hypnotised" / low response. Hypnotizability relates weakly to clinical outcomes; reframe as attention training, use more relaxation and gentler imagery, eyes-open options, or conversational approaches. [source: Jensen & Patterson 2014; ISH Encyclopedia]
Dislikes or cannot form images. Use bodily, auditory or verbal suggestions; avoid imagery linked to unpleasant memories. [source: Jensen & Patterson 2014]
Fear of losing control / resistance. Re-explain, give control (patient sets pace, chooses imagery, can stop), start brief, use permissive language. Explore beliefs (religious, cultural, previous stage-show exposure). [synthesis]
Feels dismissed ("you think it's in my head"). Validate the pain as real and medically assessed; explain hypnosis works on how the nervous system processes real pain. [synthesis]
Non-adherence to home practice. Review logs each session (group protocol does this), problem-solve time and place, shorten practice, use the recording at bedtime, link practice to an existing routine, use posthypnotic suggestions that practice becomes easy. [source: Vanderbilt protocol; Jensen & Patterson 2014; synthesis for tactics]
Overwhelm, abreaction or intrusive memories during hypnosis. Shift to present-focused grounding: eyes open, name the room, feel the feet on the floor, slow exhale; re-alert fully; debrief; do not explore the memory in hypnosis; treat it as the patient's present experience; if trauma emerges, refer for trauma-focused assessment and stabilisation before resuming. [synthesis]
Dissociation or difficulty re-alerting. Repeat re-alerting with a clear count, use the patient's name, touch only if previously agreed, keep them seated until oriented, check before driving. Reduce depth and use eyes-open methods next time. [synthesis]
Mild after-effects (headache, dizziness, grogginess, emotion). Adverse effects in trials were rare (3 negative of 40 reported effects). Re-alert carefully, normalise, adjust next script. [source: Jensen & Patterson 2014; synthesis for responses]
Increased pain focus from body-scanning. Use external focus or attention-shifting instead of attention to the painful area. [synthesis]
Suicidal ideation or severe depression emerging. Standard risk assessment and safety planning; hypnosis is not the treatment of risk; active suicidal intent was an exclusion in the group protocol. [source: Vanderbilt protocol; synthesis]
Medication over-reliance or wish to stop analgesics. Changes are the prescriber's decision; hypnosis supports but does not replace medication plans. The group protocol excluded very high opioid doses. [source: Vanderbilt protocol; synthesis]
Group problems (disruption, comparison). Set ground rules; the protocol allows removing disruptive members from group delivery while keeping them in follow-up assessment; offer individual sessions. [source: Vanderbilt protocol]
Rupture (patient feels the treatment failed them or was oversold). Acknowledge, revisit expectations, ask what was useful, renegotiate goals. [synthesis]
Procedural: patient panics or reports pain mid-procedure. Respond quickly and acknowledge truthfully; give medication if requested (team decides). Within the script, Lang's published responses are to guide the patient back to their comfortable place, suggest adding coolness to the painful area, or redirect attention to another part of the body [source: Cancer Network report of Lang's breast-biopsy trial]. Use a readiness signal before continuing; never pressure a patient to tolerate pain [synthesis; ISH Encyclopedia for adjunct framing].
Procedural: staff use warning language. Brief, non-blaming feedback; suggestion cards; re-training; audit. [source: Comfort Talk MRI protocol]
Legal or forensic contexts. Avoid any memory-related suggestion; document consent and content. [synthesis]

Sources

Web sources:

Further web sources:

Books and papers cited (print sources; claims resting only on them are marked [uncertain]):

Jensen, M. P. (2011). Hypnosis for Chronic Pain Management: Therapist Guide. Oxford University Press.
Lang, E. V., Benotsch, E. G., Fick, L. J., et al. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet, 355, 1486–1490.
Lang, E. V. (2019). Comfort Talk®: From the waiting room to the treatment suite. Deutsche Zeitschrift für zahnärztliche Hypnose, 25, 22–24.
Varelmann, D., et al. (2010). Nocebo-induced hyperalgesia during local anesthetic injection. Anesthesia & Analgesia, 110, 868–870.
Markovits, J., et al. (2022). HYPNO-TKA randomized clinical trial. Regional Anesthesia & Pain Medicine.
Trials summarised via Elkins et al. (2007): Spiegel & Bloom 1983; Elkins et al. 2004; Spinhoven & Linssen 1989; Gay et al. 2002; Dinges et al. 1997; Simon & Lewis 2000; Winocur et al. 2002; Haanen et al. 1991; Jensen et al. 2005; Melzack & Perry 1975; Appel & Bleiberg 2005–2006.

Jensen, M. P. (2011). Hypnosis for Chronic Pain Management: Workbook. Oxford University Press.
Lang, E. V., et al. (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain, 126, 155–164 (elements as reported by Cancer Network).
Jensen, M. P., et al. (2009). Self-hypnosis training versus EMG biofeedback for chronic pain after spinal cord injury (via SCIRE table).
Jensen, M. P., et al. (2000). Hypnotic analgesia case series in spinal cord injury pain (via SCIRE table).

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