In more than 30 years in oncology nursing, Linda Eaton has seen many cancer patients in pain. And the primary treatment for chronic pain is often opioid-based prescriptions. Now she’s researching an alternative approach to pain management that cancer survivors might use by themselves.
Eaton, an assistant professor in the University of Washington Bothell’s School of Nursing & Health Studies, hopes to scientifically establish the effectiveness of hypnosis recordings in managing chronic pain in cancer survivors. Listeners could use the recordings when and where they wish.
She’s now in the middle of a three-year project funded by a $450,000 grant from the National Institute of Nursing Research. When it’s concluded next year, the research will have involved 100 cancer survivors from the Seattle Cancer Care Alliance and the University of Illinois Cancer Center in Chicago. Eaton has a study coordinator at each location.
Chronic pain affects nearly 40% of the 18 million cancer survivors in the United States, Eaton said. Survivors who are no longer receiving active treatment may have pain from the disease itself or surgery, radiation, chemotherapy or other therapies.
Clinical hypnosis is already known to be effective in relieving pain. Eaton thinks listening to hypnosis audio-recordings at home may be similar in effectiveness to an office visit with a hypnotherapist.
“These suggestions support using the mind to promote well-being and physical function,” said Eaton, who has been at UW Bothell since 2018. In addition to conducting this research, this autumn she is teaching Critical Reading and Information Literacy in Nursing.
The recordings begin with familiar relaxation techniques — deep breathing, untensing different parts of the body one at a time, thinking about feeling comfortable and clearing the mind. Once a person is in a very deep state of relaxation with focused attention, the hypnosis recordings make suggestions to facilitate greater control over pain. Some examples are seeing your feelings of pain floating away or picturing a dimmer switch and turning it down.
There’s practically no risk. Listeners are still in control of themselves and not required to follow the suggestions.
“I think this could really work for people,” Eaton said. “A lot of people are saying no to medication because of what we see in the media about opioid addiction.”
Would-be participants are asked to rank their pain on a scale of zero to 10, with zero being no pain and 10 the worst pain imaginable. People who report at least a four — a moderate level of cancer-related pain — are selected to be part of the study.
Listen, relax, repeat
The study includes four different hypnosis audios, each about 15 minutes long. Participants listen to each one, once a day for three days. After those first 12 days, participants can listen to whichever recording they prefer for the rest of the month-long study. For comparison, some of the participants are randomly selected to listen to relaxation-only recordings. They are similar but without the hypnotic suggestions.
The scripts for the hypnosis recordings were developed by one of Eaton’s three mentors, Mark Jensen, a professor of rehabilitation medicine at the University of Washington in Seattle who studies psychosocial pain treatments. The recordings were made at UW Bothell and voiced by Bryce Figuero, the reserves lead at the library, and his wife, Rhonda. Study participants have a choice of listening to the male or female voice.
At three points during the month, participants are asked to report their pain from zero to 10 and complete questionnaires.
Because relaxation is known to be beneficial, Eaton expects both groups to report reduced pain, but she’s looking to see if hypnosis is significantly better than relaxation alone.
Seeking scientific proof
Eaton hopes to follow up with a study in which participants undergo an EEG while listening to a recording “so we can see if brain activity is different for the people who respond to hypnosis intervention compared to those who may not respond.”
Eaton wants to be able to tell cancer survivors that she can recommend something for their pain that’s based on science.
“We want our care to be evidence-based,” she said. "That’s why we conduct research."
The research, Efficacy and Mechanistic Testing of a Self-Management Intervention for Managing Chronic Pain with Cancer Survivors, is funded through the National Institutes of Health (1K23NR017208-01A1). Eaton’s primary mentor is Ardith Doorenbos, a professor in the Department of Biobehavioral Health Science at the College of Nursing, University of Illinois, Chicago. Co-mentors are Margaret Heitkemper, professor and chair of the Department of Biobehavioral Nursing and Health Informatics in the UW School of Nursing, and Mark P. Jensen, a professor in the UW Department of Rehabilitation Medicine.