What if arthritis sufferers could take an immersive walk through a forest filled with soothing birdsong and then, with some help from hypnosis, come to experience their pain as separate from their body – and expel it?
That’s the goal of research led by David Ogez, a professor in the Department of Anesthesiology and Pain Medicine at Université de Montréal and a clinical researcher at the Maisonneuve-Rosemont Hospital Research Centre.
Together with postdoctoral researcher Valentyn Fournier, Ogez is testing an approach that combines medical hypnosis and virtual reality (VR) to help seniors manage chronic arthritis pain in the hands, a common and debilitating condition.
Their research was published online last month in BMJ Open.
“Chronic pain is a major public-health issue that affects about one in five people in Canada and as many as one in three over the age of 60,” said Ogez. “It significantly impacts quality of life, mobility and mental health. But apart from pharmacological treatments, solutions are few.”
The problem lies in the limitations of drug treatments, including the risk of addiction to painkillers. This led Ogez and his team to explore complementary, non-invasive methods to help patients better manage their pain.
A powerful duo
Medical hypnosis is already recognized as an effective pain management tool, particularly in palliative care and post-operative settings. It relies on hypnotic suggestion—guided phrases that help patients alter their sensory and emotional perception of pain.
For example, patients may be asked to imagine submerging their sore hand in cold water, or be guided through controlled breathing techniques to synchronize their heartbeat and breathing to induce relaxation.
Ogez’s team wanted to take it one step further by combining the power of hypnosis with immersive virtual experiences.
Wearing a headset, the patient is transported to a Quebec landscape—a forest, mountains, a beach—accompanied by music and the sounds of nature. Developed in Quebec, this application was originally designed to give end-of-life patients the opportunity to “visit” places they never had the chance to see in real life.
Pairing hypnosis and VR makes it possible to visualize and manipulate pain, allowing patients to reclaim control of their bodies and their pain, research has shown.
One intervention being tested is the “magic hand.” In virtual reality, patients look at their hand and put little sparkles on the painful area to alleviate the pain. Another intervention involves guiding patients to “objectify” their pain: to make it visible on their hand and then remove it.
“The pain is still there, but…”
The researchers are also interested in the physiological mechanisms responsible for the pain relief provided by these techniques, which may resemble those associated with mindfulness.
One hypothesis is that VR distracts the brain. By intensely engaging vision, hearing and concentration, VR redirects mental resources that would otherwise be mobilized by pain. Hypnosis then reinforces this diversion of attention by guiding the patient toward pleasant sensations and gradual relief.
Neuroscience research has shown that these techniques modulate the activity of the anterior cingulate cortex and primary somatosensory cortex, two brain regions involved in the emotional and perceptual processing of pain.
“The pain is still there, but its unpleasantness and intensity are reduced,” explained Ogez.
Exposure to nature also provides psychological benefits. “Nature refreshes attention, directing the mind away from negative stimuli and restoring our ability to focus on positive ones,” said Fournier.
Promising preliminary results
Beyond the immediate calming or distracting effects of a treatment session combining hypnosis and VR, the new research aims to help patients develop self-hypnosis skills they can use at home.
The team is also working on developing a neurofeedback tool that patients can use to track and regulate their brain activity in real time in order to help them modulate their physiological responses during immersive VR experiences.
While the study is presently in the randomized clinical trial phase, the preliminary feedback from participants is encouraging, said Ogez.
“We’re seeing good patient satisfaction, although we mustn’t confuse satisfaction with effectiveness,” he cautioned. “Still, we’re hopeful, since pain is partly a subjective experience.”
