Page 24 - JCBP-3-3

Journal of Clinical and
Basic Psychosomatics Utilizing hypnosis to cope with fibromyalgia

While ACE is a crucial factor in clinical practice,
patients may not readily acknowledge traumatic events
that could contribute to the development of FMS. This
may be due to a tendency to minimize or suppress such
experiences or due to alexithymia, a personality trait that
hinders the verbalization of emotions and understanding
of the connection between emotional events and physical
distress. 13
Consciously, only a small fraction of patients may
report traumatic events linked to the disease. This may
be attributed to difficulties in elaborating on traumatic
experiences. In a study by De Almeida-Marques et al., 32
30
women at a primary care center were interviewed twice,
once in a waking state and once under hypnosis, to explore Figure 1. Putative mechanisms of FMS. Childhood/adolescence abuse
might induce PTSD with delayed somatization (in a significant proportion
traumatic life events. Remarkably, patients reported of patients), eventually leading to FMS.
9.8 times more traumatic life events in the hypnotic state Abbreviations: FMS: Fibromyalgia syndrome; PTSD: Post-traumatic
compared to the waking state. This suggests that hypnosis stress disorder.
may facilitate access to dissociated or repressed memories,
potentially allowing for the restructuring of traumatic of the condition, can enhance the efficacy of medication
experiences. and improve overall treatment outcomes. 7
13
De Benedittis investigated the potential link between Cognitive-behavioral therapy (CBT) is the most
FMS, PTSD, and abuse, aiming to determine if ACEs acted commonly used psychological intervention for FMS,
as early stressors that predispose individuals to FMS and employed either alone or in combination with medication
delayed, somatized PTSD. Comparing 38 FMS patients and other psychological interventions such as imagery
6
with 38 NS-CLBP patients, the study found that FMS or hypnosis. A comprehensive review of 224 trials
patients reported significantly more ACEs on the ACE found high-quality evidence supporting the short-term
scale. Moreover, FMS patients exhibited higher rates effectiveness of CBT for pain relief in FMS patients. 33
31
of physical, sexual, and emotional abuse, and to a lesser The effectiveness and long-term benefits of psychological
extent, neglect. FMS patients also scored higher on the treatments for FMS remain uncertain due to inconsistent
post-traumatic severity symptom scale compared to the findings and potential methodological limitations in
32
NS-CLBP group. These findings suggest that childhood/ studies. Systematic reviews have yielded mixed results
4
adolescent abuse may lead to a delayed manifestation of regarding the efficacy of various treatment modalities.
PTSD through somatization, ultimately contributing to the While some reviews have found insufficient evidence
development of FMS (Figure 1). for non-pharmacological treatments, others reported
34
benefits from psychotherapy and relaxation/biofeedback
4. Management of FMS for pain, depression, and sleep. However, a review of CBT
35
Most evidence-based guidelines recommend a multimodal for FMS found no significant effects on pain, fatigue, or
36
and multidisciplinary approach to managing FMS. This sleep. An analysis of 25 systematic reviews by Lauche
includes education, medication, physical exercise, and et al. revealed consistently positive outcomes for a range
37
cognitive-behavioral or acceptance-based therapies. of complementary and alternative medicine therapies for
A personalized approach tailored to the patient’s specific FMS, including tai chi, yoga, meditation, mindfulness,
symptoms, level of disability, and comorbidities is hypnosis, EMG biofeedback, and balneotherapy/
recommended to effectively address the patient’s needs. 1,6 hydrotherapy. A recent meta-analysis by Williams et al.
38
Pharmacological treatments for FMS include tricyclic involving 59 studies and over 5000 participants found that
antidepressants, anticonvulsants (e.g., pregabalin), and CBT has small to very small beneficial effects on pain,
serotonin-norepinephrine reuptake inhibitors (e.g., disability, and distress in chronic pain, with evidence
duloxetine and milnacipran). Although medications are quality of evidence mostly rated as moderate, except for
often part of the treatment plan, non-medical factors disability, which was rated as low quality.
play a crucial role in managing FMS. In fact, 90% of In summary, the limited quality of evidence and
individuals with FMS utilize complementary medicine. methodological flaws in these reviews hinder the ability
7
This approach, which addresses the psychological aspects to draw definitive conclusions regarding the efficacy and

Volume 3 Issue 3 (2025) 18 doi: 10.36922/jcbp.4796