Is hypnotherapy an effective treatment for patients with recurrent chest pain but no evidence of reflux or heart disease?

Hypnotherapy improves short-term symptoms and well-being in patients with noncardiac, nonreflux chest pain. Whether this persists over the long term is unknown. (LOE = 1b-)

Jones H, Cooper P, Miller V, Brooks N, Whorwell PJ. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut 2006;55:1403-1408.  [PMID:16627548]

Randomized controlled trial (single-blinded)

Government

Concealed

Outpatient (specialty)

Patients commonly return for evaluation of recurrent chest pain despite a previous evaluation that showed no evidence of heart disease or acid reflux. In this small but very well designed study, the researchers identified 28 patients with chest pain at least once a week who had a normal coronary catheterization, normal 24-hour esophageal pH monitoring, normal gastroscopy (if performed), and no response to a proton pump inhibitor (if taken). The patients were randomized to receive either hypnotherapy or supportive therapy as a control intervention. Patients initially met with their counselor or hypnotherapist weekly for 9 weeks, then every other week for 4 weeks, and then had a final visit 4 weeks later; sessions were 30 minutes long. Patients receiving supportive therapy also were given a placebo tablet to make the control intervention more convincing. The mean age of patients was 57 years, and analysis was by intention to treat. The primary outcomes were a global assessment of well-being (asking patients whether they felt completely better, moderately better, slightly better, no change, slightly worse, moderately worse, or much worse) and the score on a 100-point visual analog scale for chest pain. The hypnotherapy group improved significantly more than the control group for both outcomes. Regarding chest pain, 12 of 15 treated patients reported at least a 10-point improvement compared with 3 of 13 in the control group (80% vs 23%; P = .008). Similarly, 11 of 15 hypnotherapy patients reported improvement in global well-being compared with only 3 of 13 in the control group (73% vs 23%; P = .023).