International Journal of Medical Science and Pharmaceutical Research

Background: Hypnosis has been investigated as a non-pharmacological intervention for fibromyalgia for several decades. Early systematic reviews and meta-analyses suggested potentially meaningful effects on pain, but the evidence was limited by small sample sizes, substantial heterogeneity, methodological weaknesses, and insufficient assessment of the multidimensional manifestations of fibromyalgia. Since the last fibromyalgia-specific meta-analysis, additional randomized controlled trials have provided new evidence regarding pain and other clinically relevant outcomes.

Objective: To critically review the evolution of evidence on hypnosis for fibromyalgia, contrasting findings from earlier systematic reviews and meta-analyses with contemporary randomized controlled trials and assessing whether more recent evidence has meaningfully changed the clinical interpretation of hypnosis in this condition.

Methods: A structured narrative review was conducted integrating historical evidence from fibromyalgia-specific systematic reviews and meta-analyses with contemporary clinical studies published after the search period of the most recent disease-specific meta-analysis. Particular attention was given to pain intensity and interference, fatigue, sleep, psychological symptoms, fibromyalgia impact, quality of life, durability of treatment effects, treatment delivery, safety, and methodological quality. Evidence from broader chronic musculoskeletal and neuropathic pain populations was considered separately as supportive contextual evidence.

Results: Early meta-analytic evidence demonstrated a significant but heterogeneous analgesic effect of hypnosis/guided imagery, while the certainty of evidence remained low. The 2017 meta-analysis subsequently identified benefits for pain response, mean pain intensity, psychological distress, coping, and sleep, but continued to highlight methodological limitations, imprecision, and heterogeneity. More recent randomized trials have strengthened and broadened this therapeutic signal, reporting improvements in pain intensity and interference, fatigue, sleep quality, anxiety, depression, catastrophizing, fibromyalgia impact, and selected quality-of-life domains. Several benefits persisted during follow-up. Contemporary studies have also demonstrated the feasibility of therapist-delivered, self-administered, and audio-assisted hypnosis. Nevertheless, sample sizes remain modest, populations are predominantly female, intervention protocols are heterogeneous, and optimal treatment dose and delivery remain uncertain.

Conclusions: Contemporary randomized evidence strengthens the earlier signal that hypnosis may provide clinically relevant benefits for fibromyalgia and suggests effects extending beyond analgesia to several interconnected symptom domains. However, current evidence remains insufficient to support hypnosis as a stand-alone treatment. Hypnosis may be considered a promising adjunct within individualized, multimodal fibromyalgia management. Larger, adequately powered and methodologically rigorous trials using standardized protocols, clinically meaningful outcomes, systematic safety assessment, and longer follow-up are needed to define its therapeutic role and identify patients most likely to benefit.