***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study was design ed in order to examine the effects of different types of hypnotic suggestion on hypnotic analgesia . Generalized relaxation and focused analgesia were induced in seven high-hypnotizable ( HH ) and eight low-hypnotizable ( LH ) subjects . Subjects were not aware to which group they belonged . The two groups did not differ in their expectation rates to achieve analgesia under hypnosis . Pain intensity and unpleasantness were rated on visual analogue scales in response to painful electrical stimuli , delivered in r and om order in five ascending intensities . Both focused analgesia and generalized relaxation decreased pain intensity significantly ( P < 0.01 ) . However , stimulus-intensity response curves differed under the two hypnotic conditions . As stimulus intensity became higher pain reduction was enhanced under focused analgesia , while a constant reduction occurred under generalized relaxation . The interaction between hypnotic state and stimulus intensity was significant for focused analgesia ( P < 0.05 ) but not for generalized relaxation ( P > 0.07 ) , difference became more pronounced when analyzed for HH subjects only ( P < 0.002 for analgesia , P > 0.10 for relaxation ) . Pain reduction was significantly higher in HH than in LH subjects under focused analgesia ( P < 0.02 ) but not under generalized relaxation ( P > 0.5 ) . We conclude that by utilizing two modes of hypnotic suggestions in response to ascending stimuli , we were able to discover two components of hypnotic analgesia . One shows a parallel shift in the stimulus-response function , has features similar to placebo and bears no clear relationship to hypnotic susceptibility . The other shows a slope change in the stimulus-response curve and has a positive relationship to hypnotic susceptibility Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive-behavioral psychotherapy .  This hypnotic enhancement effect was evaluated in the analogue treatment of pain .  Individuals scoring in the high ( n = 135 ) and low ( n = 150 ) ranges of hypnotic suggestibility were r and omly assigned to 1 of 6 conditions : Stress Inoculation Training , the same treatment provided hypnotically , nonhypnotic analgesia suggestions , hypnotic analgesia suggestions , a hypnotic induction treatment , or a control condition . The 5 analogue treatments reduced experimental pain more than the control condition , but were not different from one another . Under circumstances optimized to detect an enhancement effect , neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically Background Vaso-occlusive pain crises ( VOCs ) are the “ hallmark ” of sickle-cell disease ( SCD ) and can lead to sympathetic nervous system dysfunction . Increased sympathetic nervous system activation during VOCs and /or pain can result in vasoconstriction , which may increase the risk for subsequent VOCs and pain . Hypnosis is a neuromodulatory intervention that may attenuate vascular and pain responsiveness . Due to the lack of laboratory-controlled pain studies in patients with SCD and healthy controls , the specific effects of hypnosis on acute pain-associated vascular responses are unknown . The current study assessed the effects of hypnosis on peripheral blood flow , pain threshold , tolerance , and intensity in adults with and without SCD . Subjects and methods Fourteen patients with SCD and 14 healthy controls were included . Participants underwent three laboratory pain tasks before and during a 30-minute hypnosis session .  Peripheral blood flow , pain threshold , tolerance , and intensity before and during hypnosis were examined . Results A single 30-minute hypnosis session decreased pain intensity by a moderate amount in patients with SCD . Pain threshold and tolerance increased following hypnosis in the control group , but not in patients with SCD . Patients with SCD exhibited lower baseline peripheral blood flow and a greater increase in blood flow following hypnosis than controls . Conclusion Given that peripheral vasoconstriction plays a role in the development of VOC , current findings provide support for further laboratory and clinical investigations of the effects of cognitive – behavioral neuromodulatory interventions on pain responses and peripheral vascular flow in patients with SCD . Current results suggest that hypnosis may increase peripheral vasodilation during both the anticipation and experience of pain in patients with SCD . These findings indicate a need for further examination of the effects of hypnosis on pain and vascular responses utilizing a r and omized controlled trial design . Further evidence may help determine unique effects of hypnosis and potential benefits of integrating cognitive – behavioral neuromodulatory interventions into SCD treatment Background : Few studies have compared placebo and suggested pain reduction . Purpose : Hypnotic and nonhypnotic imaginative analgesia suggestions were compared against a placebo in reducing  experimental pain .  The mediator role of response expectancies and the moderator role of hypnotic and nonhypnotic imaginative suggestibility were evaluated . Methods : Sixty participants previously assessed for hypnotic and nonhypnotic imaginative suggestibility were assigned to one of two experimental conditions or a no-treatment control condition . In the “ placebo first ” condition , participants received placebo , followed by imaginative and then hypnotic analgesia suggestions . In the “ placebo last ” condition , participants received imaginative and then hypnotic suggestions , followed by placebo . Results : Imaginative and hypnotic suggestions did not differ significantly and were more effective than no treatment in reducing pain . The placebo was no different from the analgesia suggestions and was more effective than no treatment , but only when administered after the suggestions . Pain reduction was mediated by expectancy but was not significantly related to suggestibility or hypnotizability , the latter operationalized as hypnotic suggestibility with imaginative suggestibility statistically controlled . Conclusions : In the general population , nonhypnotic imaginative suggestions may be as effective as hypnotic suggestions in reducing pain . Response expectancies would seem to be an important mechanism of placebo and suggested pain reduction This study evaluates the effects of hypnotic analgesia and hypnosis on bilateral EEG activity recorded from frontal , central and posterior areas during three painful electrical stimulation conditions : waking , hypnosis/no-analgesia , hypnosis/analgesia . Eight high-hypnotizable and eight low-hypnotizable ( right h and ed ) subjects participated in the experiment . The following measures were obtained : pain and distress tolerance ratings ; EEG spectral amplitudes for the frequency b and s : delta ( 0.5 - 3.75 Hz ) , theta 1 ( 4 - 5.75 Hz ) , theta 2 ( 6 - 7.75 Hz ) , alpha 1 ( 8 - 9.75 Hz ) , alpha 2 ( 10 - 12.75 Hz ) , beta 1 ( 13 - 15.75 Hz ) , beta 2 ( 16 - 31.75 Hz ) , total b and ( 0.5 - 31.75 Hz ) , ' 40-Hz ' ( 36 - 44 Hz ) ; cardiac interbeat interval ( ms ) ; mid-frequency and high-frequency peaks from power spectral analysis of heart period variability . During hypnosis/analgesia , high hypnotizable subjects displayed significant reductions in pain and distress scores compared to hypnosis/no-analgesia and waking conditions . In each experimental condition these subjects displayed significant lower total and beta 1 amplitudes compared to low hypnotizables . High hypnotizables , on central and posterior recording sites , during both hypnosis/analgesia and hypnosis/no-analgesia conditions also showed total and delta EEG amplitude reductions in both hemispheres and a theta 1 amplitude reduction in the left hemisphere . However , for total , delta and beta 1 b and s in the hypnosis/analgesia condition the amplitude reduction was more pronounced in the right hemisphere as shown by hemispheric asymmetry in favor of the left hemisphere . Low hypnotizables , on posterior recording sites , displayed a delta amplitude reduction during hypnosis/no-analgesia and hypnosis/analgesia conditions . These subjects also showed , for all recording sites , a reduction in theta 1 amplitude during hypnosis/no-analgesia compared to the waking condition . Lows , however , failed in evidencing amplitude differences between hypnosis/no-analgesia and hypnosis/analgesia conditions . During hypnotic analgesia the hemispheric asymmetry found in high hypnotizables was parallel to a significant reduction in the spectral mid-frequency peak of heart period variability which indicated a decrease in the level of sympathetic activity . In contrast , during hypnosis/no-analgesia the EEG amplitude reduction was not paralleled by a decrease in sympathetic activity BACKGROUND Breast cancer surgery is associated with side effects , including postsurgical pain , nausea , and fatigue . We carried out a r and omized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective . METHODS We r and omly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy ( mean age 48.5 years ) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening ( attention control ) . Patients were not blinded to group assignment . Intraoperative anesthesia use ( i.e. , of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam ) was assessed . Patient-reported pain and other side effects as measured on a visual analog scale ( 0 - 100 ) were assessed at discharge , as was use of analgesics in the recovery room . Institutional costs and time in the operating room were assessed via chart review . RESULTS Patients in the hypnosis group required less propofol ( means = 64.01 versus 96.64 microg ; difference = 32.63 ; 95 % confidence interval [ CI ] = 3.95 to 61.30 ) and lidocaine ( means = 24.23 versus 31.09 mL ; difference = 6.86 ; 95 % CI = 3.05 to 10.68 ) than patients in the control group . Patients in the hypnosis group also reported less pain intensity ( means = 22.43 versus 47.83 ; difference = 25.40 ; 95 % CI = 17.56 to 33.25 ) , pain unpleasantness ( means = 21.19 versus 39.05 ; difference = 17.86 ; 95 % CI = 9.92 to 25.80 ) , nausea ( means = 6.57 versus 25.49 ; difference = 18.92 ; 95 % CI = 12.98 to 24.87 ) , fatigue ( means = 29.47 versus 54.20 ; difference = 24.73 ; 95 % CI = 16.64 to 32.83 ) , discomfort ( means = 23.01 versus 43.20 ; difference = 20.19 ; 95 % CI = 12.36 to 28.02 ) , and emotional upset ( means = 8.67 versus 33.46 ; difference = 24.79 ; 95 % CI = 18.56 to 31.03 ) . No statistically significant differences were seen in the use of fentanyl , midazolam , or recovery room analgesics .  Institutional costs for surgical breast cancer procedures were $ 8561 per patient at Mount Sinai School of Medicine . Patients in the hypnosis group cost the institution $ 772.71 less per patient than those in the control group ( 95 % CI = 75.10 to 1469.89 ) , mainly due to reduced surgical time . CONCLUSIONS Hypnosis was superior to attention control regarding propofol and lidocaine use ; pain , nausea , fatigue , discomfort , and emotional upset at discharge ; and institutional cost . Overall , the present data support the use of hypnosis with breast cancer surgery patients Abstract The rate , intensity , and selectivity of hypnotic focused analgesia ( HFA ) were tested with dental pulp stimulation . Thirty-one healthy subjects were hypnotized , and hypnotic suggestions were given for anesthesia of the right m and ibular arch . A posthypnotic suggestion of persisting analgesia was also given . The pain threshold of the first premolar was bilaterally measured before , during , and after hypnosis using a pulp tester . During hypnosis , the pain threshold increased significantly ( p < .0001 ) for both sides . The posthypnotic right pain threshold was also significantly ( p < .0015 ) higher than in the basal condition Background and Objectives Hypnosis has been reported to induce analgesia and to facilitate anesthesia . To date , hypnotic-induced analgesia has had little explanation and it has even been question ed . The current study was thus design ed to investigate the effect of hypnotic suggestion on thermal-detection thresholds , heat pain , and heat-pain tolerance thresholds . Methods In 15 healthy volunteers , enrolled in a r and omized cross-over study , thermal thresholds were investigated in 2 sequences of measurements , under waking and hypnotic states , using a thermal stimulator .  Results Heat detection and heat-pain thresholds were increased under hypnosis ( from 34.3 ± .9 ° C to 36.0 ± 2.9 ° C and 45.0 ± 3.7 ° C to 46.7 ± 2.7 ° C , respectively , P < .05 ) , whereas heat-pain tolerance and cold-detection thresholds were not statistically changed . Conclusion These results indicate that hypnosis may partly impair the detection of Aδ and C fibers stimulation , potentially explaining its analgesic effect Previous research by Stam and Spanos suggests that if waking analgesia 
    Output:
    
Effectiveness was dependent upon hypnotic suggestibility and use of analgesic imagery .
Efficacy was strongly influenced by hypnotic suggestibility and use of direct analgesic suggestion .
Minimal benefits were found for low suggestibles .
These findings suggest that hypnotic intervention can deliver meaningful pain relief for most people and therefore may be an effective and safe alternative to pharmaceutical intervention .