The purpose of this article is to provide a concise summary of the scientific literature in the form of a narrative review to highlight areas where the use of clinical hypnosis is supported by scientific evidence in dentistry. A literature review was carried out to identify relevant peer-reviewed articles on PubMed, written in French or in English, with time limitation from 2000 to May 2023, and updated in December 2024. Articles had to be systematic reviews or meta-analysis linked with the management of dental anxiety and acute dental pain, as well as chronic orofacial pain. Twelve articles were selected for analysis, with 8 on dental anxiety, 3 on temporomandibular disorders, and 1 on burning mouth syndrome. Several literature reviews and meta-analyses published on the subject support the use of hypnosis in several clinical contexts, including local anesthesia, dental extraction and dental anxiety in adults and children. Evidence is also presented to improve the condition of patients suffering from pain associated with temporomandibular disorders. However, the literature remains somewhat fragmented because of the diversity of hypnosis techniques applied, and the different dental procedures or conditions explored. Hypnosis can have a considerable impact in the management of dental anxiety and acute dental pain. It also seems promising for the management of orofacial pain, but further research would be necessary. This research highlights that the available evidence is sufficient to encourage the integration of evidence-based hypnosis training to improve the management of acute stress and pain in dental practice.

Objectives: To conduct a systematic review on the use of hypnosis in the treatment of orofacial pain. Methods: The search was performed on February 2021 and updated in July 2024 in the following databases: MEDLINE via PUBMED, Virtual Health Library (VHL), Web of Science, Cochrane Library, Embase, Clinical Trials, ISRCTN Registry, Psycinfo, Open Grey, Google Scholar, and Brazilian Digital Library of Theses and Dissertations (BDTD). The descriptors referring to Orofacial Pain and hypnosis were used to select clinical trials on the use of hypnosis in the treatment of Orofacial Pain, in English, Spanish, Portuguese, French, and Italian, without restriction on date and place of publication. In a first stage, two independent, trained, and calibrated reviewers classified the abstracts and then the full texts. The data were extracted, and the risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Of the 642 references identified, 6 studies-published between 1986 and 2010-were included in the review, with 232 patients reported. Hypnosis was mainly used in cases of chronic pain associated with temporomandibular disorders (TMDs), compared with relaxation sessions, acupuncture, occlusal splint, minimal treatment, or no interference. Hypnotherapy was applied in different ways, either exclusively by professionals or by means of self-hypnosis in a complementary or exclusive manner. All studies showed statistical significance for the effect of the intervention (hypnotherapy). The overall RoB2 consisted of three studies with high risk of bias and three studies with some concern. Conclusions: Although there were clinical studies on the subject and they had methodological flaws, hypnotherapy (induction and/or self-hypnosis) appears to be a promising strategy for the treatment of orofacial pain, especially TMDs. There is, therefore, a need for new randomized clinical studies with adequate methodological standards to confirm the findings.

Temporomandibular disorders (TMD) are common. They affect abilities for carrying out daily tasks and influence different psychological aspects. In addition to standard treatment, psychological treatments have been suggested. The aim was to investigate the effects of psychological treatments on patients with painful TMD in a short- and long-term perspective.

An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and Web of Science for randomized clinical trials (RCTs) reporting psychological interventions for TMD. Registered beforehand in PROSPERO (CRD42022320106). In total, 18 RCTs were included; six RCTs that could be used in the meta-analysis, and all 18 RCTs were used in the narrative synthesis. Risk of bias was assessed by the Cochrane's tool for assessing risk of bias and certainty of evidence by GRADE.

The narrative synthesis indicates that psychological treatment options seem equivalent to standard treatment for painful TMD. The meta-analysis showed that a combination of psychological treatment and standard treatment and manual treatment (very low-quality evidence) are significantly better in pain reduction than just counselling and standard treatments of TMD.

This study indicates that psychological treatments seem to reduce pain intensity in individuals with painful TMD, and that the effect seems to be equally good as standard treatment. However, a combination of psychological treatments and standard treatments seems to have an even better effect. This indicates that psychological treatments are promising as an additional treatment approach for painful TMDs.

Temporomandibular disorders (TMDs) are a group of musculoskeletal disorders affecting the jaw. They are frequently associated with pain that can be difficult to manage and may become persistent (chronic). Psychological therapies aim to support people with TMDs to manage their pain, leading to reduced pain, disability and distress.

To assess the effects of psychological therapies in people (aged 12 years and over) with painful TMD lasting 3 months or longer.

Cochrane Oral Health's Information Specialist searched six bibliographic databases up to 21 October 2021 and used additional search methods to identify published, unpublished and ongoing studies.

We included randomised controlled trials (RCTs) of any psychological therapy (e.g. cognitive behaviour therapy (CBT), behaviour therapy (BT), acceptance and commitment therapy (ACT), mindfulness) for the management of painful TMD. We compared these against control or alternative treatment (e.g. oral appliance, medication, physiotherapy).

We used standard methodological procedures expected by Cochrane. We reported outcome data immediately after treatment and at the longest available follow-up. We used the Cochrane RoB 1 tool to assess the risk of bias in included studies. Two review authors independently assessed each included study for any risk of bias in sequence generation, allocation concealment, blinding of outcome assessors, incomplete outcome data, selective reporting of outcomes, and other issues. We judged the certainty of the evidence for each key comparison and outcome as high, moderate, low or very low according to GRADE criteria.

We identified 22 RCTs (2001 participants), carried out between 1967 and 2021. We were able to include 12 of these studies in meta-analyses. The risk of bias was high across studies, and we judged the certainty of the evidence to be low to very low overall; further research may change the findings. Our key outcomes of interest were: pain intensity, disability caused by pain, adverse events and psychological distress. Treatments varied in length, with the shortest being 4 weeks. The follow-up time ranged from 3 months to 12 months. Most studies evaluated CBT.   At treatment completion, there was no evidence of a benefit of CBT on pain intensity when measured against alternative treatment (standardised mean difference (SMD) 0.03, confidence interval (CI) -0.21 to 0.28; P = 0.79; 5 studies, 509 participants) or control (SMD -0.09, CI -0.30 to 0.12; P = 0.41; 6 studies, 577 participants). At follow-up, there was evidence of a small benefit of CBT for reducing pain intensity compared to alternative treatment (SMD -0.29, 95% CI -0.50 to -0.08; 5 studies, 475 participants) and control (SMD -0.30, CI -0.51 to -0.09; 6 studies, 639 participants). At treatment completion, there was no evidence of a difference in disability outcomes (interference in activities caused by pain) between CBT and alternative treatment (SMD 0.15, CI -0.40 to 0.10; P = 0.25; 3 studies, 245 participants), or between CBT and control/usual care (SMD 0.02, CI -0.21 to 0.24; P = 0.88; 3 studies, 315 participants). Nor was there evidence of a difference at follow-up (CBT versus alternative treatment: SMD -0.15, CI -0.42 to 0.12; 3 studies, 245 participants; CBT versus control: SMD 0.01 CI - 0.61 to 0.64; 2 studies, 240 participants). There were very few data on adverse events. From the data available, adverse effects associated with psychological treatment tended to be minor and to occur less often than in alternative treatment groups. There were, however, insufficient data available to draw firm conclusions. CBT showed a small benefit in terms of reducing psychological distress at treatment completion compared to alternative treatment (SMD -0.32, 95% CI -0.50 to -0.15; 6 studies, 553 participants), which was maintained at follow-up (SMD -0.32, 95% CI -0.51 to -0.13; 6 studies, 516 participants). For CBT versus control, only one study reported results for distress and did not find evidence of a difference between groups at treatment completion (mean difference (MD) 2.36, 95% CI -1.17 to 5.89; 101 participants) or follow-up (MD -1.02, 95% CI -4.02 to 1.98; 101 participants). We assessed the certainty of the evidence to be low or very low for all comparisons and outcomes. The data were insufficient to draw any reliable conclusions about psychological therapies other than CBT.

We found mixed evidence for the effects of psychological therapies on painful temporomandibular disorders (TMDs). There is low-certainty evidence that CBT may reduce pain intensity more than alternative treatments or control when measured at longest follow-up,  but not at treatment completion. There is low-certainty evidence that CBT may be better than alternative treatments, but not control, for reducing psychological distress at treatment completion and follow-up. There is low-certainty evidence that CBT may not be better than other treatments or control for pain disability outcomes.  There is insufficient evidence to draw conclusions about alternative psychological therapeutic approaches, and there are insufficient data to be clear about adverse effects that may be associated with psychological therapies for painful TMD.  Overall, we found insufficient evidence on which to base a reliable judgement about the efficacy of psychological therapies for painful TMD. Further research is needed to determine whether or not psychological therapies are effective, the most effective type of therapy and delivery method, and how it can best be targeted. In particular, high-quality RCTs conducted in primary care and community settings are required, which evaluate a range of psychological approaches against alternative treatments or usual care, involve both adults and adolescents, and collect measures of pain intensity, pain disability and psychological distress until at least 12 months post-treatment.

Many medical conditions are claimed to benefit when hypnosis is incorporated into their treatment. For some conditions, the claims are largely anecdotal, but the treatment of pain stands out in two ways. First, there is a strong body of evidence that hypnosis can produce clinically useful analgesic effects. Second, since innocuous pain can be induced in the laboratory, the process can be explored rigorously. This idea assumes that experimentally induced pain and clinical pain behave identically. We describe using experimentally induced pain in patients already suffering from temporomandibular disorders. Scanning results indicate that the pain and its amelioration are the same in the two circumstances. Moreover, the absence of any impact upon a nociceptive trigemino-facial reflex implies that the impact of hypnosis is purely cortical. Finally, we address the observation that clinical success correlates poorly with hypnotic susceptibility scores. It is proposed that a painful experimental situation induces anxiety. This, like hypnosis, has been associated with an emphasis on right hemisphere activity. Thus, clinical anxiety may render a person more responsive to hypnosis than would be indicated by a susceptibility test delivered in stress-free circumstances.

The effects of hypnosis on acute pain have been discussed recently, resulting in increased attention in the dental/maxillofacial field offering new perspectives, especially in emergency situations, trauma, or acute inflammatory situations where conventional pharmaceuticals are contraindicated due to allergies or intolerance reactions.

To systematically evaluate and assess the effects of hypnosis on acute dental/facial pain relief. Randomized controlled trials, cohort studies, controlled clinical trials, cross-sectional studies, evaluation, and validation studies, following the PRISMA guidelines, of human subjects of all ages were included.

Five electronic databases (Cochrane, Embase, MEDLINE via PubMed, LILACS, Scopus) were screened for studies published between 1989 - 2021. A NIH quality-assessment-tool was performed.

27 papers have been included and a meta-analysis was performed. Hypnosis has been reported to reduce intraoperative and postoperative pain as well as the use of analgesics in various dental procedures such as tooth extraction. Highly hypnotizable subjects generally respond better to hypnosis. Different hypnosis techniques were used for pain relief and relaxation. The studies show a large heterogeneity.

Although there are only a small number of studies on the subject so far, evidence can be confirmed for the effects of hypnosis on acute pain relief in dental/maxillofacial area. Despite the promising results, further research is needed.

Hypnosis offers a possible alternative to conventional pain medications for acute dental and maxillofacial pain, especially in cases of allergies or contraindications; it can be easily applied by a trained practitioner.

Numerous treatment modalities have been attempted for masticatory muscle pain in patients with temporomandibular disorders (TMD). To compare the treatment efficacy of more than 2 competing treatments, a network meta-analysis (NMA) was conducted.

This study was reported with reference to the extended Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting of systematic reviews incorporating network meta-analyses. Medline via Pubmed, Embase via OVID, and Cochrane Library Central were searched (up to February 11, 2019). Axis I protocol of Diagnostic Criteria or Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD, RDC/TMD) were chosen as diagnostic standards. The PICOS (Problem/patient, Intervention, Comparison, Outcome, Study design) method was used to screen trials under eligibility criteria. And the NMA was performed with mvmeta commands in Stata (StataCorp, Tex).

Of 766 studies searched, 12 randomized clinical trials (RCTs) were finally included. Nineteen different therapies were found and further categorized into 9 treatment modalities. The general heterogeneity was not found among included trials. But predictive intervals (PrIs) were conspicuously wider than confidential intervals (CIs) of all pairwise comparisons, indicating that heterogeneity may exist between studies. Complementary therapy showed the greatest probability (42.7%) to be the best intervention. It also had the highest mean rank (2.3) in the rankogram and the biggest value of surface under the cumulative ranking (SUCRA, 84.1%).

Based on the limited evidence of available trials, complementary therapy seemed to be slightly more effective than remaining treatment modalities for pain reduction in TMD patients with masticatory muscle pain. High-quality randomized controlled trials are expected to validate the findings.

Studies of brain-plasticity changes in hypnosis using functional magnetic resonance imaging (fMRI), positron-emission-tomography (PET) and electroencephalography (EEG) were reviewed. The authors found evidence in those studies that hypnosis is a powerful and successful method for inhibiting the reaction of the fear circuitry structures. Limitations of the studies were critically discussed, and implications for future research were made. The authors are currently using a portable fNIRS apparatus to integrate the scanning device into real life situations in medical practice. Their aim is to disentangle the neuronal mechanisms and physiological correlates in patients with severe fear of medical treatments when directly confronted with anxiety-provoking stimuli and to assess the effects of a brief hypnosis. Drawing on evidence from several technological modalities, neuroimaging and physiological studies pave the road to a better scientific understanding of neural mechanisms of hypnosis.

The aim of this systematic review (SR) was to answer the following question: "In adult patients with temporomandibular disorder (TMD)-related pain, what is the placebo or nocebo effect of different therapies?"

A SR was performed with randomised clinical placebo-controlled trials on diagnosed painful TMD studies from five main databases and from three grey literature. Studies included must have sample older than 18 years, with painful TMD, which diagnosis was done by Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD).

Out of 770 articles obtained, 42 met the inclusion criteria for qualitative and 26 for quantitative analysis. Meta-analysis indicated mean variation on pain intensity for placebo therapy was higher on laser acupuncture with 45.5 mm point reduction, followed by avocado soya bean extract with 36 mm and amitriptyline 25 mg with 25.2 mm. Laser showed a 29% of placebo effect, as well medicine with 19% and other therapies with 26%. Possible nocebo effect of 8% pain increase was found for intra-articular injection of Ultracain.

Based on the available data, the placebo response could play a major effect on TMD pain management and may be responsible from 10% to 75% of pain relief. Laser acupuncture, avocado soya bean and amitriptyline promoted the higher placebo effect. Possible nocebo effect was found only for Ultracain injection with 8%.

Clinicians could apply such evidence to optimise pain management and judgement about treatment efficacy, and researches may find it useful when designing their investigations.

Pain is common in patients with multiple sclerosis. This study evaluated self-hypnosis for pain control in that population. A randomized clinical trial was conducted on 60 patients, who were assigned to either a control group or to a self-hypnosis group, in which patients performed self-hypnosis at least 10 times a day. All patients were trained to score the perceived pain twice daily on a numerical rating scale and also reported the quality of pain with the McGill Pain questionnaire. Repeated-measures analysis showed a significant difference between the groups; pain was lower in the self-hypnosis group but was not maintained after 4 weeks. Self-hypnosis could effectively decrease the intensity and could modify quality of pain in female patients with multiple sclerosis.

It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams.

To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases.

A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions.

The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache.

Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.

The purpose of this study was to examine the associations of complementary and alternative medicine (CAM) use with mammogram and Pap test rates and functional disabilities (FDs).

Cross-sectional study.

Data were derived from the 2012 National Health Interview Survey (n=6576).

FDs was defined as physical and/or social limitations. The weighted logistic regression models were performed using SAS software. Study covariates were age, race, education, marital status, usual source of care, and insurance.

Of 6576 women, a majority were Caucasian (87%), with GED or less (40%), married (50%), having usual source of care (96%) and health insurance (91%), and with FDs (56%). The results indicated that some CAM practices were negatively associated with increased mammogram and Pap test rates while other CAM practices were positively associated. The results indicated that CAM practices that contribute to musculoskeletal problems such as acupuncture and massage were associated with the increased mammogram and Pap test rates. Contrary, women who used chiropractic manipulation, biofeedback, guided imagery, and energy hearing therapy were less likely to obtain cancer screenings regularly regardless of having FDs.

The use of several CAM therapies was more likely to be associated with mammogram and Pap test frequency, indicating that the CAM use may be associated with better screening rates due to the improvement of musculoskeletal problems. It is important to determine how each CAM therapy improves secondary health conditions in clinical trials to increase cancer screening rates for women with FDs.

Pain-related temporomandibular disorder (TMD) is one of the top three most common chronic pain conditions, along with headaches and back pain. TMD has complex pathophysiology and significant associations with a variety of other chronic pain conditions, eg fibromyalgia, irritable bowel syndrome and migraine. Chronic TMD is associated with a negative impact upon quality of life and high levels of healthcare utility. It is important that clinicians are able to diagnose TMD correctly, provide appropriate management in keeping with current evidence-based practice, and identify when to refer patients to specialist care. The presence of risk factors, eg anxiety, depression, pain-related disability and chronic pain conditions elsewhere in the body, may help to identify which TMD patients require referral for multidisciplinary management. TMD should be managed using a holistic approach, incorporating patient education and encouragement towards self-management. TMD care pathways should consider using the three'pillars'of pain management: physical therapies, pharmacotherapy and clinical psychology.

Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management.

A systematic review was conducted, using Samueli Institute's Rapid Evidence Assessment of the Literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities.

Following key database searches, 146 randomized controlled trials were included in the review, 18 of which directly compared ACT-CIM approaches with one another.

This article summarizes the current evidence, quality, effectiveness, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with a high incidence in the general population. The diagnosis of IBS is mainly based on exclusion of other intestinal conditions through the absence of inflammatory markers and specific antigens. The current pharmacological treatment approaches available focus on reducing symptom severity while often limiting quality of life because of significant side effects. This has led to an effectiveness gap for IBS patients that seek further relief to increase their quality of life. Complementary and alternative medicines (CAM) have been associated with a higher degree of symptom management and quality of life in IBS patients. Over the past decade, a number of important clinical trials have shown that specific herbal therapies (peppermint oil and Iberogast(®)), hypnotherapy, cognitive behavior therapy, acupuncture, and yoga present with improved treatment outcomes in IBS patients. We propose an integrative approach to treating the diverse symptoms of IBS by combining the benefits of and need for pharmacotherapy with known CAM therapies to provide IBS patients with the best treatment outcome achievable. Initial steps in this direction are already being considered with an increasing number of practitioners recommending CAM therapies to their patients if pharmacotherapy alone does not alleviate symptoms sufficiently.

This randomized control trial studied the effect of hypnosis on dysmenorrhea. Fifty eligible nursing students were randomly divided into 2 groups according to baseline pain scores. One group was given hypnosis and the other given medications for pain relief for 3 menstrual cycles, followed by 3 cycles without any treatment. They were evaluated for functional restriction of activity on a 3-point scale. There was significant improvement in quality of life after the third cycle in both groups compared to baseline. The effect of hypnosis and medications on quality of life was similar in both groups at the third and sixth cycles.