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< E G H M N P S T

Hypnosis for Fibromyalgia: Clinical Challenges and Therapeutic Perspectives (2026)

Giuseppe De Benedittis

Department of Neurosurgery, University of Milan, Italy

Correspondence:  giuseppe.debenedittis@unimi.it

Keywords: Fibromyalgia syndrome, pain, hypnosis, central sensitization, psychosocial factors, adverse childhood experiences

 

Fibromyalgia syndrome (FMS) is a complex and debilitating functional pain disorder. It is clinically defined by persistent, widespread musculoskeletal pain lasting three months or longer, accompanied by tenderness across multiple body regions, typically defined as at least four of five body regions, spanning three or four quadrants (Wolfe et al., 2011).

Beyond physical pain, patients frequently experience fatigue, nonrestorative sleep, cognitive dysfunction (fibrofog), morning stiffness, and comorbid psychological distress, such as anxiety and depression. Other conditions, such as irritable bowel syndrome or chronic pelvic pain, are also common, all of which contribute to an overall decline in quality of life (De Benedittis, 2023).

The prevalence of FMS is approximately 2% to 5% in the general population, with studies often indicating that 80–90% of diagnosed cases are female (Häuser & De Benedittis, 2024).

Although the exact pathogenesis of FMS remains poorly understood, researchers have largely shifted focus away from peripheral musculoskeletal abnormalities, increasingly pointing to a central dysfunctional pain syndrome. Central sensitization is believed to be a primary driver associated with hyperexcitability within the central nervous system. Furthermore, recent studies suggest that these functional changes may be accompanied by structural brain changes and neurocognitive impairment, providing further evidence of a complex, centralized neurological mechanism (De Benedittis, 2023).

Fibromyalgia pain is considered the representative, or “paradigmatic,” form of nociplastic pain, a type of chronic pain arising from altered central nervous system (CNS) function rather than direct tissue damage or inflammation (Fitzcharles et al., 2021).

Beyond biology, psychosocial factors are critical in the onset, exacerbation, and progression of FMS into a chronic state. There is a robust body of evidence linking Adverse Childhood Experiences (ACE) (e.g., abuse) to the development of FMS (De Benedittis, 2023). Furthermore, FMS and Post-Traumatic Stress Disorder (PTSD) appear closely linked, sharing similar physiological and neuroanatomical profiles (Nardi et al., 2020). Exposure to persistent or intense stress during developmental years can profoundly alter brain structure and function, leaving an “indelible imprint” that may predispose individuals to both FMS and PTSD in adulthood (Van der Kolk, 2003). Evidence indicates that exposure to Adverse Childhood Experiences (ACE) may manifest as a delayed form of PTSD through somatization, which can ultimately contribute to the clinical development of FMS in adulthood (De Benedittis, 2023).

Managing FMS remains challenging due to the syndrome’s frequent resistance to standard treatment regimens. Most evidence-based clinical guidelines advocate for a multimodal and multidisciplinary approach to managing fibromyalgia syndrome (FMS). A comprehensive strategy typically includes patient education, pharmacological interventions, physical exercise, and psychological therapies. Current recommendations emphasize a shift in approach, advocating for nonpharmacological interventions as the first-line treatment for FMS (MacFarlane et al., 2017). In this context, hypnosis has emerged as a promising, evidence-based adjunct. It is particularly noted for its excellent safety profile, presenting minimal risk of adverse effects compared to traditional pharmacotherapy (Milling et al., 2021).

Hypnosis serves as a versatile tool for addressing the wide array of symptoms characteristic of FMS through two main approaches (De Benedittis, 2023):

  1. Symptom-Oriented Hypnosis: Directly targets the reduction of physical and psychological symptoms, including chronic pain, fatigue, sleep disturbances, anxiety, and depression.
  2. Psychodynamic Hypnotherapy: Focuses on identifying and resolving the underlying emotional conflicts and past traumas that may contribute to the maintenance or exacerbation of the syndrome.

A typical therapeutic session for FMS follows a structured progression to maximize efficacy:

  1. Induction: The therapist utilizes techniques, such as eye fixation, to guide the patient into a state of focused attention and deep relaxation.
  2. Deepening: Multisensory imagery and progressive relaxation are employed to anchor the patient more securely within the hypnotic state.
  3. Therapeutic Suggestions: Tailored cognitive interventions are provided. A common focus is dissociation, where the patient is encouraged to detach from the pain, reinforcing the perspective that the condition is distinct from their identity.
  4. Guided Imagery: The therapist leads the patient through visualizations of soothing, restorative environments, such as swimming in a calm, tranquil pool, to modulate the nervous system.
  5. Respiratory Regulation: Techniques emphasizing slow, deep, diaphragmatic breathing are taught to actively reduce sympathetic nervous system arousal, thereby lowering stress and anxiety levels.

Hypnoanalytical treatments have demonstrated significant efficacy for highly hypnotizable individuals who have a history of abuse or PTSD. Through techniques such as age regression, therapists can guide patients to uncover, revisit, and process deeply rooted traumas and psychological conflicts.

Recent evidence underscores that the most effective protocol involves combining professional hypnotherapy with consistent daily self-hypnosis practice. When integrated with standard medical care, this adjunct approach can significantly improve pain control and overall quality of life.

While hypnosis is a promising treatment, achieving positive outcomes typically requires long-term commitment. In many cases, pain relief has been observed to improve progressively over the duration of the treatment. To solidify these findings, further high-quality research is required, specifically focusing on larger, longitudinal study designs and formal cost-effectiveness analyses.

References

De Benedittis, G. (2023). The challenge of fibromyalgia efficacy of hypnosis in alleviating the invisible pain: A narrative review. International Journal of Clinical and Experimental Hypnosis, 71(4), 276-296. https://doi.org/10.1080/00207144.2023.2247443

Fitzcharles, M. A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021). Nociplastic pain: Towards an understanding of prevalent pain conditions. Lancet, 397(10289), 2098–2110.  https://doi.org/10.1016/S0140-6736(21)00392-5

Häuser, W., & De Benedittis, G. (2024). Hypnosis and fibromyalgia syndrome. In J. Linden, G. De Benedittis, K. Varga, & L. Sugarman (Eds.),. The International Handbook of Clinical Hypnosis. Routledge.

MacFarlane, G. J., Kronisch, C., Dean, L. E., Atzeni, F., Häuser, W., Fluß, E., Choy, E., Kosek, E., Amris, K., Branco, J., Dincer, F., Leino-Arjas, P., Longley, K., McCarthy, G. M., Makri, S., Perrot, S., Sarzi-Puttini, P., Taylor, A., & Jones, G. T. (2017). EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases, 76(2), 318–328. https://doi.org/10.1136/annrheumdis-2016-209724

Milling, L. S., Valentine, K. E., LoStimolo, L. M., Nett, A. M., & McCarley, H. S. (2021). Hypnosis and the alleviation of clinical pain: A comprehensive meta-analysis. International Journal of Clinical and Experimental Hypnosis, 69(3), 297–322. https://doi.org/10.1080/00207144.2021.1920330

Nardi, A. E., Karam, E. G., & Carta, M. G. (2020). Fibromyalgia patients should always be screened for post-traumatic stress disorder. Expert Review of Neurotherapeutics, 20(9), 891–893. https://doi.org/10.1080/14737175.2020.1794824

Van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics of North America, 12(2), 293–317, ix. https://doi.org/10.1016/s1056-4993(03)00003-8

Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. Journal of Rheumatology, 38(6), 1113–1122. https://doi.org/10.3899/jrheum.100594