Anxiety and depressive disorders in patients with primary painful bladder syndrome. Part 2. Modern treatment approaches

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

This article presents modern approaches to the treatment of comorbid anxiety and depressive disorders in patients with primary painful bladder syndrome. The pharmacotherapy options and various non-pharmacological methods (psychotherapy, cognitive-behavioral therapy, hypnotherapy) for managing these conditions are detailed. It is noted that treatment targeting only the physical component of chronic pelvic pain is often ineffective. To achieve the desired outcome in some patients, it is also necessary to address cognitive, emotional, and behavioral factors associated with pain syndrome.

Full Text

INTRODUCTION

Primary bladder pain syndrome (PBPS) is one of the most common causes of chronic pelvic pain. The condition is characterized by pain or discomfort in the bladder region, with exacerbation during bladder filling, in the absence of infection or another urinary tract involvement [1, 2]. PBPS is 5–10 times more prevalent in women than in men and frequently results in dysuria [3]. The medical and social importance of PBPS is due to its high prevalence, significant negative impact on the quality of life, long periods of disability and often invalidity of such patients, as well as the significant costs of long-term treatment, which is often lifelong [2, 4, 5].

COMORBID ANXIETY AND DEPRESSIVE DISORDERS IN PATIENTS WITH PRIMARY BLADDER PAIN SYNDROME

The goal of treatment for PBPS is to reduce and, if possible, eliminate pain and dysuria, ultimately improving the patient’s quality of life [1, 2, 4]. Treatment options for PBPS are diverse and include behavioral, physical, and pharmacological therapies, as well as minimally invasive and non-malignant surgical procedures [2, 4, 6–8]. However, despite the variety of treatment approaches, their efficacy is often inadequate, with a significant number of patients with PBPS failing to achieve not only pain relief, but also a reduction in pain severity. These circumstances contribute to the low level of adherence of such patients to medical recommendations and frequent consultations with different specialists. It has been found that patients with PBPS have a very high frequency of combined (comorbid) psychiatric disorders, including depression, anxiety disorders, and social phobias [9–11]. Moreover, there is a direct correlation between the severity of affective disorders and pain intensity [12–14].

In recent years, there is increasing evidence of the contribution of somatoform disorders and associated affective disorders to the persistence of clinical manifestations of PBPS when standard therapy is prescribed [9, 15, 16]. This highlights the need to prescribe appropriate drug and non-drug therapy when the somatoform origin of PBPS is identified. Management of these patients should be based on the biopsychosocial concept of chronic pelvic pain syndrome (CPPS), in which pain is the result of a dynamic interaction of biological, psychological, and sociocultural factors [17]. The involvement of these factors may vary at different stages of the disease progression. Comorbid emotional disorders (primarily anxiety and depressive disorders) that influence the strategy of drug therapy account for a significant specific weight [18]. Psychological and social components are predominant in somatoform disorders. In this regard, PBPS treatment targeting only the physical component is often ineffective. To achieve success, it is necessary to address not only physiological processes, but also cognitive, emotional, and behavioral factors associated with the pain syndrome [19].

Pharmacotherapy

According to Haase et al. [20] and Zhuo et al. [21], there is a significant decrease in monoamine neurotransmitters in depression and anxiety disorders, which affects both pain and mood regulation in the central nervous system. As chronic pain persists, alterations in monoaminergic transmission become more pronounced and contribute significantly to the sensitization and maintenance of pain, leading to dysfunction of modulatory pathways, decreased inhibition and/or increased pain signals, forming a vicious cycle [22]. Taking into account the clinical and neurobiological overlap between affective disorders and chronic pain conditions, psychopharmacotherapeutic agents are actively used in the treatment of patients with PBPS. Tricyclic antidepressants (e.g., amitriptyline, clomipramine, and imipramine) and new-generation antidepressants, i.e., selective serotonin reuptake inhibitors (SSRIs; e.g., sertraline, fluoxetine, and others), are widely used. Serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g., venlafaxine, duloxetine) are a class of antidepressants that have been demonstrated to potentiate the functioning of the antinociceptive system [23–26]. Duloxetine, a drug included in many international clinical guidelines for the treatment of chronic pain, is especially relevant in this context. Its antialgic effect is associated with its effect on central sensitization, which is mediated through noradrenergic neurotransmission. The limited affinity of SSRIs and SNRIs for muscarinic, histamine, and alpha1-adrenoreceptors, in conjunction with their minimal impact on monoamine oxidase, contributes to a reduction in adverse effects and an enhancement of their safety profile compared with tricyclic antidepressants. Tranquilizers belonging to the benzodiazepine derivatives group are prescribed for patients exhibiting a combination of anxiety and somatic symptom disorders. In recent years, the antiepileptic agents (e.g., gabapentin and pregabalin) have been used to target the neuropathic mechanism of CPPS [27–30]. A potential risk associated with the use of these drugs is the possibility of addiction [22]. As noted by Servais et al. [31], pregabalin abuse in individuals with CPPS is associated with an elevated risk of chemical addiction. In this regard, the importance of collecting a comprehensive and structured medical history to identify risk factors for addiction, including alcohol and/or other substance abuse and comorbid psychiatric disorders, is evident [32].

Psychotherapy

Taking into account the important role of psychological mechanisms in the development of CPPS, the main component of personalized therapy is the use of psychotherapeutic interventions [17, 19]. The most commonly used cognitive-behavioral psychotherapies include various relaxation and meditation techniques, biofeedback therapy (BFT), and the recently developed acceptance and commitment therapy (ACT).

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is a widely used approach to the treatment of various conditions associated with chronic pain [33]. This psychotherapeutic method was initially developed for the treatment of depression; however, it has been adapted for psychiatric disorders and chronic pain conditions since then [34]. CBT is a focused psychological therapy that teaches patients to recognize the impact of their own thoughts and behavior on their pain and functioning, and how to change it. CBT techniques in the treatment of chronic pain include training to identify the relationships between thoughts, emotions, behavior, and the development of physical symptoms; cognitive restructuring and reframing; relaxation techniques to minimize autonomic arousal; stepping and pacing; sleep hygiene; problem-solving strategies; coping and interpersonal skills. There is emerging evidence for the effectiveness of online CBT for chronic pain syndromes using mobile and digital technologies [35–37]. As indicated by Mazzolenis et al. [38], the introduction of artificial intelligence and virtual reality technologies in cognitive therapy for chronic pain seems promising.

Similar to the treatment of genitourinary dysfunction, BFT with parallel electromyography is actively used in the treatment of CPPS [39–41]. This technique is based on a modified system of pelvic floor muscle exercises. The therapeutic and diagnostic hardware used in this procedure includes computerized BFT complexes that facilitate the measurement, reception, and processing of electromyographic signals from the patient during muscle contraction. Furthermore, these complexes enable the supervision of exercise performance by providing feedback in verbal (sound) and/or visual (video) formats [41]. In a comparative study by Cornel et al. [40], 33 patients with diagnosed chronic prostatitis/CPPS were enrolled in the BFT treatment program. According to the results, the mean National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) changed from 23.6 (range: 11–34) at baseline to 11.4 (range: 1–25) after treatment (p < 0.001). The mean pelvic floor muscle tone was 4.9 (range: 2.0–10.0) at diagnosis and decreased to 1.7 (range: 0.5–2.8) after treatment (p < 0.001).

ACT focuses on observing thoughts and feelings as they are, without trying to change them, and on behavior that is consistent with values and important life goals. This approach has shown promising results in trials of integrated treatment for chronic pain [42–45]. The data from a meta-analysis of 21 randomized controlled trials by Ye et al. [44] showed a large effect size three months after ACT for individuals with chronic pain. The basic premise of the method as applied to chronic pain is that while pain causes physical discomfort, it is the struggle with pain that causes suffering. In ACT, the sensation of pain itself is regarded as an unconditioned reflex that serves the function of warning the individual of danger or tissue damage, and the sensation of pain is critical for survival.

Hypnotherapy

Although hypnotherapy has not been extensively studied for its efficacy in patients with PBPS, it has been used extensively for pain syndromes [46, 47]. There is evidence that hypnotherapy is an effective approach compared with other non-physical approaches, such as CBT [48, 49]. Thompson et al. [49] conducted a meta-analysis of the data on quantitative assessment of the efficacy of hypnosis for pain reduction and to identify the factors that influence the efficacy of hypnotherapy. A systematic search was conducted in six databases (i.e., PubMed, EMBASE, PsycINFO, CINAHL, CENTRAL, and Web of Science) to identify studies that compared the effects of hypnotic interventions on pain severity, threshold sensitivity, and pain tolerance. The selected studies utilized the models of experimentally induced pain in healthy controls. The researchers identified 85 papers that met the selection criteria, predominantly cross-sectional studies, with a total sample size of 3632 participants (n = 2892 for the study group, n = 2646 for the control group). A subsequent random-effect meta-analysis revealed the analgesic effects of hypnosis for all types of pain (confidence interval: 0.54–0.76, p < 0.001). The efficacy of hypnosis was strongly influenced by hypnotic suggestibility and the use of direct suggestion for pain relief. Specifically, the study found that individuals with high and moderate hypnotizability experienced optimal pain relief through the use of direct analgesic suggestion in hypnosis, demonstrating 42% (p < 0.001) and 29% (p < 0.001) clinically significant reductions in pain, respectively [49].

Hypnosis for chronic pain usually involves induction with suggestions for relaxation and comfort. Post-hypnotic suggestion is designed to continue pain reduction after the session, or to help the patient easily and quickly achieve comfort through anchoring. In addition, techniques such as gauntlet anesthesia, dissociation, indirect suggestion for pain relief, or scattered suggestion are used. The amnesia phenomenon is used to desensitize the patient to forget the pain, even temporarily.

CONCLUSION

The postulate of multifactorial pathogenesis of PBPS is accepted by the scientific community. The importance of psychogenic causes in the development of urogenital pain syndrome is undisputed. Comorbid anxiety and depressive disorders in patients with CPPS require special therapeutic approaches. In this regard, a psychotherapist or psychiatrist must be included in a multidisciplinary team of specialists involved in the treatment of such patients. The possibilities of modern pharmacotherapy and a variety of non-drug methods allow for the effective treatment of these disorders.

ADDITIONAL INFO

Authors’ contribution. All authors made a substantial contribution to the conception of the study, acquisition, analysis, interpretation of data for the work, drafting and revising the article, final approval of the version to be published and agree to be accountable for all aspects of the study. Personal contribution of each author: T.A. Karavaeva, A.V. Vasileva, I.V. Kuzmin, M.N. Slesarevskaya, D.A. Starunskaya — search and analysis of literary data, editing the text of the manuscript; D.S. Radionov — search and analysis of literary data, writing the text of the manuscript.

Funding source. The study was carried out within the framework of the state assignment of the V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology for 2024–2026 (XSOZ 2024 0014).

Competing interests. The authors declare that they have no competing interests.

×

About the authors

Tatiana A. Karavaeva

V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; Saint Petersburg State University; St. Petersburg State Pediatric Medical University; N.N. Petrov National Medical Research Center of Oncology

Email: tania_kar@mail.ru
ORCID iD: 0000-0002-8798-3702
SPIN-code: 4799-4121

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg; Saint Petersburg

Anna V. Vasileva

V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; North-Western State Medical University named after I.I. Mechnikov

Email: annavdoc@yahoo.com
ORCID iD: 0000-0002-5116-836X
SPIN-code: 2406-9046

MD, Dr. Sc. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Igor V. Kuzmin

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: kuzminigor@mail.ru
ORCID iD: 0000-0002-7724-7832
SPIN-code: 2684-4070
https://www.1spbgmu.ru/ru/obrazovanie/kafedry/106-glavnaya/3828-igor-valentinovich-kuzmin

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Margarita N. Slesarevskaya

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: mns-1971@yandex.ru
ORCID iD: 0000-0002-4911-6018
SPIN-code: 9602-7775

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Dmitrii S. Radionov

V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology

Author for correspondence.
Email: dumradik@mail.ru
ORCID iD: 0000-0001-9020-3271
SPIN-code: 3247-3178
Russian Federation, Saint Petersburg

Diana A. Starunskaya

V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology

Email: dianastarunskaya@gmail.com
ORCID iD: 0000-0001-8653-8183
SPIN-code: 1478-0297
Russian Federation, Saint Petersburg

References

  1. Engeler D, Baranowski AP, Bergmans B, et al. EAU guidelines on chronic pelvic pain. European Association of Urology Guideline. 2024. Available from: https://uroweb.org/guidelines/chronic-pelvic-pain
  2. Homma Y, Akiyama Y, Tomoe H, et al. Clinical guidelines for interstitial cystitis/bladder pain syndrome. Int J Urol. 2020;27(7): 578–589. doi: 10.1111/iju.14234
  3. Slesarevskaya MN, Ignashov YuA, Kuzmin IV, Al-Shukri SKh. Persistent dysuria in women: etiological diagnosis and treatment. Urological Reports (St. Petersburg). 2021;11(3):195–204. EDN: BDUFWQ doi: 10.17816/uroved81948
  4. Clemens JQ, Erickson DR, Varela NP, Lai HH. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022;208(1):34–42. doi: 10.1097/JU.0000000000002756
  5. Slesarevskaya MN, Ignashov YuA, Kuzmin IV. Current approaches to the diagnostic of bladder pain syndrome. Urological Reports (St. Petersburg). 2017;7(2):25–30. EDN: YUCBMP doi: 10.17816/uroved7225-3
  6. Juliebø-Jones P, Hjelle KM, Mohn J, et al. Management of bladder pain syndrome (BPS): a practical guide. Adv Urol. 2022;2022:7149467. doi: 10.1155/2022/7149467
  7. Zaitsev AV, Sharov MN, Ibragimov RA, et al. Painful bladder syndrome / interstitial cystitis: modern approaches to diagnosis and treatment. Vrach Skoroi Pomoshchi. 2018;(8):16–26. (In Russ.) EDN: YLJJWX
  8. Al-Shukri SH, Kuzmin IV, Slesarevskaya MN, Ignashov YuA. Bladder hydrodistension in the treatment of patients with interstitial cystitis/painful bladder syndrome. Urologiia. 2018;(1):26–29. EDN: YRSGPY doi: 10.18565/urology.2018.1.26-29
  9. Riegel B, Bruenahl CA, Ahyai S, et al. Assessing psychological factors, social aspects, and psychiatric co-morbidity associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men — a systematic review. J Psychosom Res. 2014;77(5):333–350. doi: 10.1016/j.jpsychores.2014.09.012
  10. Brünahl C, Dybowski C, Albrecht R, et al. Mental disorders in patients with chronic pelvic pain syndrome (CPPS). J Psychosom Res. 2017;98:19–26. doi: 10.1016/j.jpsychores
  11. Fedorova AI, Vykhodtsev SV, Tregubenko IA. Pathogenetic features of psychosomatic disorders of the urogenital sphere of men and women. Psychiatry (Moscow). 2022;20(S3(2)):112–113. EDN: QAEKJG
  12. Thompson EL, Broadbent J, Fuller-Tyszkiewicz M, et al. A network analysis of the links between chronic pain symptoms and affective disorder symptoms. Int J Behav Med. 2019;26(1):59–68. doi: 10.1007/s12529-018-9754-8
  13. Slesarevskaya MN, Kuzmin IV, Ignashov YuA Features of symptomatology and psychoemotional status in women with chronic pelvic pain syndrome. Urological Reports (St. Petersburg). 2015;5(3): 16–19. EDN: VHUCAT doi: 10.17816/uroved5316-19
  14. Wi D, Park C, Ransom JC, et al. A network analysis of pain intensity and pain-related measures of physical, emotional, and social functioning in US military service members with chronic pain. Pain Med. 2024;25(3):231–238. doi: 10.1093/pm/pnad148
  15. Kryuchkova MN, Soldatkin VA. Chronic pelvic pain syndrome: psychopathological aspects. Urology Herald. 2017;5(1):52–63. EDN: YHGGNN doi: 10.21886/2306-6424-2017-5-1-52-63
  16. Karavaeva TA, Vasilieva AV, Kuzmin IV, et al. Anxiety and depressive disorders in patients with primary painful bladder syndrome. Part 1: symptoms and clinical progression. Urological Reports (St. Petersburg). 2024;14(3):331–342. EDN: JEBVHE doi: 10.17816/uroved635373
  17. Sandler MD, Ledesma B, Thomas J, et al. Biopsychosocial approach to male chronic pelvic pain syndrome: recent treatments and trials. Sex Med Rev. 2023;12(1):59–66. doi: 10.1093/sxmrev/qead038
  18. Coelho DRA, Gersten M, Jimenez AS, et al. Treating neuropathic pain and comorbid affective disorders: preclinical and clinical evidence. Pain Pract. 2024;24(7):937–955. doi: 10.1111/papr.13370
  19. Vasilieva AV, Karavaeva TA, Neznanov NG. Psychotherapy in somatic medicine. In: Psychotherapy: National Guide. Vasilieva AV, Karavaeva TA, Neznanov NG, editors. Moscow: GEOTAR-Media; 2023. P. 928–938. (In Russ.)
  20. Haase J, Brown E. Integrating the monoamine, neurotrophin, and cytokine hypotheses of depression — a central role for the serotonin transporter? Pharmacol Ther. 2015;147:1–11. doi: 10.1016/j.pharmthera.2014.10.002
  21. Zhuo M. Neural mechanisms underlying anxiety-chronic pain interactions. Trends Neurosci. 2016;39(3):136–145. doi: 10.1016/j.tins.2016.01.006
  22. Hebert SV, Green MA, Mashaw SA, et al. Assessing risk factors and comorbidities in the treatment of chronic pain: a narrative review. Curr Pain Headache Rep. 2024;28(6):525–534. doi: 10.1007/s11916-024-01249-z
  23. Foster HE Jr, Hanno PM, Nickel JC, et al. Effect of amitriptyline on symptoms in treatment-naive patients with interstitial cystitis/painful bladder syndrome. J Urol. 2010;183(5):1853–1858. doi: 10.1016/j.juro.2009.12.106
  24. Van Ophoven A, Hertle L. The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observational study. J Urol. 2007;177(2):552–555. doi: 10.1016/j.juro.2006.09.055
  25. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain: a Cochrane review. J Neurol Neurosurg Psychiatry. 2010;81(12): 1372–1373. doi: 10.1136/jnnp.2008.144964
  26. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy or chronic pain. Cochrane Database Syst Rev. 2009;4: CD007115. doi: 10.1002/14651858.CD007115.pub2
  27. Aktar N, Moudud A, Chen T, et al. Recent advances in pharmacological interventions of chronic prostatitis/chronic pelvic pain syndrome. Curr Pharm Des. 2021;27(25):2861–2871. doi: 10.2174/1381612827666210322125054
  28. Moore RA, Straube S, Wiffen PJ, et al. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009;3: CD007076. doi: 10.1002/14651858.CD007076.pub2
  29. Franco JVA, Turk T, Jung JH, et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int. 2020;125(4):490–496. doi: 10.1111/bju.14988
  30. Allaire C, Yong PJ, Bajzak K, Jarrell J, et al. Guideline No. 445: Management of chronic pelvic pain. J Obstet Gynaecol Can. 2024;46(1):102283. doi: 10.1016/j.jogc.2023.102283
  31. Servais L, Huberland V, Richelle L. Misuse of pregabalin: a qualitative study from a patient’s perspective. BMC Public Health. 2023;23(1):1339. doi: 10.1186/s12889-023-16051-6
  32. Radionov DS, Karavaeva TA, Vasilieva FV, et al. Peculiarities of alcohol abuse by individuals with neurotic spectrum anxiety disorders. Clinical aspects and issues of psychotherapy. Journal of Addiction Problems. 2023;35(3):27–50. EDN: AQBTRS
  33. Urits I, Callan J, Moore WC, et al. Cognitive behavioral therapy for the treatment of chronic pelvic pain. Best Pract Res Clin Anaesthesiol. 2020;34(3):409–426. doi: 10.1016/j.bpa.2020.08.001
  34. Sanabria-Mazo JP, Colomer-Carbonell A, Fernández-Vázquez Ó, et al. A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress. Front Psychol. 2023;14:1200685. doi: 10.3389/fpsyg.2023.1200685
  35. Martinson A, Johanson K, Wong S. Examining the efficacy of a brief cognitive-behavioral therapy for chronic pain (Brief CBT-CP) group delivered via VA Video Connect (VVC) among older adult veterans. Clin Gerontol. 2024;47(1):122–135. doi: 10.1080/07317115.2023.2186303
  36. Zambelli Z, Halstead EJ, Fidalgo AR, et al. Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single-arm feasibility study. Front Psychol. 2024;14:1266368. doi: 10.3389/fpsyg.2023.1266368
  37. Moreno-Ligero M, Moral-Munoz JA, Salazar A, et al. mHealth intervention for improving pain, quality of life, and functional disability in patients with chronic pain: systematic review. JMIR Mhealth Uhealth. 2023;11:e40844. doi: 10.2196/40844
  38. Mazzolenis MV, Mourra GN, Moreau S, et al. The role of virtual reality and artificial intelligence in cognitive pain therapy: a narrative review. Curr Pain Headache Rep. 2024. doi: 10.1007/s11916-024-01270-2
  39. Wagner B, Steiner M, Huber DFX, et al. The effect of biofeedback interventions on pain, overall symptoms, quality of life, and physiological parameters in patients with pelvic pain: a systematic review. Wien Klin Wochenschr. 2022;134(Suppl 1):11–48. doi: 10.1007/s00508-021-01827-w
  40. Cornel EB, van Haarst EP, Schaarsberg RW, et al. The effect of biofeedback physical therapy in men with chronic pelvic pain syndrome type III. Eur Urol. 2005;5:607–611. doi: 10.1016/j.eururo.2004.12.014
  41. Borrego-Jimenez PS, Flores-Fraile J, Padilla-Fernández BY, et al. Improvement in quality of life with pelvic floor muscle training and biofeedback in patients with painful bladder syndrome/interstitial cystitis. J Clin Med. 2021;10(4):862. doi: 10.3390/jcm10040862
  42. Trindade IA, Guiomar R, Carvalho SA. Efficacy of online-based acceptance and commitment therapy for chronic pain: a systematic review and meta-analysis. J Pain. 2021;22(11):1328–1342. doi: 10.1016/j.jpain.2021.04.003
  43. McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014;2:178–187. doi: 10.1037/a0035623
  44. Ye L, Li Y, Deng Q, et al. Acceptance and commitment therapy for patients with chronic pain: a systematic review and meta-analysis on psychological outcomes and quality of life. PLoS One. 2024;19(6): e0301226. doi: 10.1371/journal.pone.0301226
  45. Herbert MS, Dochat C, Wooldridge JS, et al. Technology-supported acceptance and commitment therapy for chronic health conditions: a systematic review and meta-analysis. Behav Res Ther. 2022;148:103995. doi: 10.1016/j.brat.2021
  46. Langlois P, Perrochon A, David R, et al. Hypnosis to manage musculoskeletal and neuropathic chronic pain: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2022;135:104591. doi: 10.1016/j.neubiorev.2022.104591
  47. Caron-Trahan R, Jusseaux AE, Aubin M, et al. Practicing self-hypnosis to reduce chronic pain: a qualitative exploratory study of HYlaDO. Br J Pain. 2024;18(1):28–41. doi: 10.1177/20494637231200324
  48. Adachi T, Fujino H, Nakae A, et al. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions. Int J Clin Exp Hypn. 2014;62(1):1–28. doi: 10.1080/00207144.2013.841471
  49. Thompson T, Terhune DB, Oram C, et al. The effectiveness of hypnosis for pain relief: a systematic review and meta-analysis of 85 controlled experimental trials. Neurosci Biobehav Rev. 2019;99:298–310. doi: 10.1016/j.neubiorev.2019.02.013

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 89281 от 21.04.2025.