Recurrent Abdominal Pain in Children: Summary Evidence From 3 Systematic Reviews of Treatment Effectiveness.

OBJECTIVES: Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. METHODS: We carried out a systematic review of randomised controlled trials (RCTs) in eleven databases and 2 trials registries from inception to June 2016. An update search was run in November 2017. All screening was performed by 2 independent reviewers. Included studies were appraised using the Cochrane risk of bias tool and the evidence assessed using GRADE. We included any dietary, pharmacological or psychosocial intervention for RAP, defined by Apley or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria, in children and adolescents. RESULTS: We included 55 RCTs, involving 3572 children with RAP (21 dietary, 15 pharmacological, 19 psychosocial, and 1 multiarm). We found probiotic diets, cognitive-behavioural therapy (CBT) and hypnotherapy were reported to reduce pain in the short-term and there is some evidence of medium term effectiveness. There was insufficient evidence of effectiveness for all other dietary interventions and psychosocial therapies. There was no robust evidence of effectiveness for pharmacological interventions. CONCLUSIONS: Overall the evidence base for treatment decisions is poor. These data suggest that probiotics, CBT, and hypnotherapy could be considered as part of holistic management of children with RAP. The evidence regarding relative effectiveness of different strains of probiotics is currently insufficient to guide clinical practice. The lack of evidence of effectiveness for any drug suggests that there is little justification for their use outside of well-conducted clinical trials. There is an urgent need for high-quality RCTs to provide evidence to guide management of this common condition.

[Description of current hypnosis practice in French university hospitals]. / État des lieux des pratiques actuelles de l'hypnose au sein des centres hospitaliers universitaires français.

Hypnosis is very fashionable as an entertainment through TV shows searching for new sensational experiences. What about its practice in the medical world? The aim of this article is to answer to this question. Therefore, we contacted every French University Hospital of each region to find out if hypnosis was practiced for the care of pain (hypnoanalgesia), for chirurgical procedures (hypnosedation) and in adult psychiatry care units (hypnotherapy). For this last practice, we also questioned the type of indications. All 30 of the French University Hospitals had replied by November 2015. Hypnoanalgesia is practiced by all and two-thirds offer hypnosedation. Hypnotherapy is practiced by 40 % of the University Hospitals, 91,7 % for anxiety disorders, 66,7 % for psychotraumatic care and 25 % for mood disorders. Therefore, hypnosis seems to have found its place in the care of pain and as an anesthetic to replace standard procedures. However, the use of hypnotherapy in psychiatry is less frequent, indications for its use being variable and not very consensual.

Preliminary study of relationships between hypnotic susceptibility and personality disorder functioning styles in healthy volunteers and personality disorder patients.

BACKGROUND: Hypnotic susceptibility is one of the stable characteristics of individuals, but not closely related to the personality traits such as those measured by the five-factor model in the general population. Whether it is related to the personality disorder functioning styles remains unanswered. METHODS: In 77 patients with personality disorders and 154 healthy volunteers, we administered the Stanford Hypnotic Susceptibility Scale: Form C (SHSSC) and the Parker Personality Measure (PERM) tests. RESULTS: Patients with personality disorders showed higher passing rates on SHSSC Dream and Posthypnotic Amnesia items. No significant correlation was found in healthy volunteers. In the patients however, SHSSC Taste hallucination (ß=0.26) and Anosmia to Ammonia (ß=-0.23) were significantly correlated with the PERM Borderline style; SHSSC Posthypnotic Amnesia was correlated with the PERM Schizoid style (ß=0.25) but negatively the PERM Narcissistic style (ß=-0.23). CONCLUSIONS: Our results provide limited evidence that could help to understand the abnormal cognitions in personality disorders, such as their hallucination and memory distortions.

Hypnosis and hemispheric asymmetry.

Participants of low and high hypnotic susceptibility were tested on a temporal order judgement task, both with and without hypnosis. Judgements were made of the order of presentation of light flashes appearing in first one hemi-field then the other. There were differences in the inter-stimulus intervals required accurately to report the order, depending upon which hemi-field led. This asymmetry was most marked in hypnotically susceptible participants and reversed when they were hypnotized. This implies not only that brain activity changes in hypnosis, but also that there is a difference in brain function between people of low and high hypnotic susceptibility. The latter exhibited a faster-acting left hemisphere in the waking state, but faster right when hypnotized.

Preoperative hypnosis for pain management after arthroscopic repair of anterior cruciate ligament.

BACKGROUND: The practice of hypnoanalgesia in orthopedics is rare and the literature is poor. AIM: The purpose of this pilot study was to verify the efficacy of hypnosis for the management of postoperative analgesia after arthroscopic repair of anterior cruciate ligament. METHODS: This was a prospective clinical trial over a period of 6 months (March - August 2015) including 25 patients scheduled for arthroscopic repair of anterior cruciate ligament under spinal anesthesia. All these patients had preoperative hypnosis in addition to the standard multimodal analgesia protocol (group H) and were compared to historical group (group S) who received only a standard multimodal analgesia protocol. RESULTS: Pain scores were significantly lower for the hypnosis group during the first 48 hours postoperatively (p = 0,006). The total dose of morphine at 48 hours was: 13,6 mg (95% CI [4,58; 22,62]) in the group H and 10,2 mg (95% CI [1,64 ; 18,76]) in group S with no statistically significant difference (p = 0,178) Conclusion: Results of this pilot study in orthopedic surgery suggested that hypnosis reduced postoperative pain scores as demonstrated in other surgeries.

A NATIONAL SURVEY OF CLINICAL HYPNOSIS VIEWS AND EXPERIENCES OF THE ADULT POPULATION IN THE UNITED STATES.

A nationwide, demographically balanced Internet survey of 1000 adults (500 females, 500 males, mean age 49.5, range 18-88 years) was conducted to assess views and experiences of clinical hypnosis in the United States population. Participants were unaware when enrolling in the survey that hypnosis was the subject matter. Key findings included that most reported a positive (38.6%) or neutral (48.4%) view of clinical hypnosis, with only 12.8% expressing a negative view; 7.6% of respondents had undergone hypnosis treatment, and 63.1% reported some resulting benefit; 54.9% of individuals who had never undergone hypnosis treatment indicated that they would consider seeking such treatment; 45.6% of all respondents thought there was moderate or strong scientific evidence supporting hypnosis as a real phenomenon; 77.8% identified one or more areas where they thought clinical hypnosis had substantial practical utility, and 44.8% estimated themselves to be at least moderately hypnotizable.

Hypnosis reduces preoperative anxiety in adult patients.

In this study we examined the effect of hypnosis on preoperative anxiety. Subjects were randomized into 3 groups, a hypnosis group (n = 26) who received suggestions of well-being; an attention-control group (n = 26) who received attentive listening and support without any specific hypnotic suggestions and a "standard of care" control group (n = 24). Anxiety was measured pre- and postintervention as well as on entrance to the operating rooms. We found that patients in the hypnosis group were significantly less anxious postintervention as compared with patients in the attention-control group and the control group (31 +/- 8 versus 37 +/- 9 versus 41 +/- 11, analysis of variance, P = 0.008). Moreover, on entrance to the operating rooms, the hypnosis group reported a significant decrease of 56% in their anxiety level whereas the attention-control group reported an increase of 10% in anxiety and the control group reported an increase of 47% in their anxiety (P = 0.001). In conclusion, we found that hypnosis significantly alleviates preoperative anxiety. Future studies are indicated to examine the effects of preoperative hypnosis on postoperative outcomes.

[Use of hypnosis in radiotherapy as an alternative to general anesthesia in pediatric radiation oncology]. / Radiothérapie des enfants de moins de cinq ans : peut-on limiter les anesthésies itératives par les rituels et l'hypnose ?

BACKGROUND: General anesthesia (GA) is often needed for radiotherapy (RT) in young children. This study aimed to evaluate the place of the rituals and/or hypnosis in pediatric in a reference center in pediatric radiation oncology in Rhône-Alpes Auvergne. METHODS: This observational study retrospectively collected data on AG in children<5 years treated by RT in Leon-Berard regional center, Lyon, France between 2003 and 2014. Two-time periods, before and after 2008 have been compared, the second one introducing accompaniment methods such as hypnosis systematically. Explanatory analyses of AG were performed using logistic regression. RESULTS: One hundred and thirty-two children benefited from RT in that period and were included (70 patients until 2008, 62 after 2008). Fifty-three percent were irradiated under GA. There was significant reduction (P<0.1) in the use of GA after 2008. The use of GA was not significantly associated with the RT techniques. The patients more likely to undergo RT without GA were the oldest and the patients treated for abdominal lesions (P<0.01). DISCUSSION: The study confirms that rituals and hypnosis can be used instead of GA in about half of patients under 5 years, even also with high-technicity RT requiring optimal immobilization.

Use of Hypnotic Techniques in Children and Adolescents with Chronic Pain: Do the Ages of Patients or Years of Practice and Theoretical Orientation of Clinicians Matter?

Hypnosis is known to be effective in the treatment of pediatric pain. To better understand which strategies might be most useful, more knowledge is needed regarding the strategies that are actually used by experienced clinicians and the factors that influence their use. To address this knowledge gap, 35 health care professionals completed an online survey on the use of hypnosis in the management of pediatric chronic pain. The findings indicate that clinicians vary their use of hypnotic strategies primarily as a function of a patient's age but not as a function of theoretical orientation or amount of experience. The findings may be useful for guiding clinicians in their selection of strategies and suggestions when working with children with pain.

The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women.

OBJECTIVES: This manuscript presents a preliminary examination of the characteristics of women who choose intrapartum hypnosis for pain management. DESIGN: Cross-sectional analysis of 2445 women (31-36 years) from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), employing Fisher exact tests. SETTING: Australia. MAIN OUTCOME MEASURES: Use of intrapartum hypnosis, or hypnobirthing, for pain management during labour and birth. RESULTS: Women using hypnobirthing were more likely to have consulted with an acupuncturist or naturopath, or attended yoga/meditation classes during pregnancy (p<0.0001). Use of CM products such as herbal medicines, aromatherapy oils, homoeopathy, herbal teas or flower essences (p<0.001) was also more common amongst these women. Women choosing hypnotherapy for intrapartum pain management less commonly identified as feeling safer knowing that an obstetrician is providing their care (p<0.001), and were more likely to labour in a birth centre or in a community centre (i.e. at home). CONCLUSIONS: This analysis provides preliminary analysis into an as yet unexamined topic in contemporary maternity health service utilisation. The findings from this analysis may be useful for maternity health professionals and policy makers when responding to the needs of women choosing to use hypnotherapy for intrapartum pain management.

The Efficacy, Safety and Applications of Medical Hypnosis.

BACKGROUND: The efficacy and safety of hypnotic techniques in somatic medicine, known as medical hypnosis, have not been supported to date by adequate scientific evidence. METHODS: We systematically reviewed meta-analyses of randomized controlled trials (RCTs) of medical hypnosis. Relevant publications (January 2005 to June 2015) were sought in the Cochrane databases CDSR and DARE, and in PubMed. Meta-analyses involving at least 400 patients were included in the present analysis. Their methodological quality was assessed with AMSTAR (A Measurement Tool to Assess Systematic Reviews). An additional search was carried out in the CENTRAL and PubMed databases for RCTs of waking suggestion (therapeutic suggestion without formal trance induction) in somatic medicine. RESULTS: Out of the 391 publications retrieved, five were reports of metaanalyses that met our inclusion criteria. One of these meta-analyses was of high methodological quality; three were of moderate quality, and one was of poor quality. Hypnosis was superior to controls with respect to the reduction of pain and emotional stress during medical interventions (34 RCTs, 2597 patients) as well as the reduction of irritable bowel symptoms (8 RCTs, 464 patients). Two meta-analyses revealed no differences between hypnosis and control treatment with respect to the side effects and safety of treatment. The effect size of hypnosis on emotional stress during medical interventions was low in one meta-analysis, moderate in one, and high in one. The effect size on pain during medical interventions was low. Five RCTs indicated that waking suggestion is effective in medical procedures. CONCLUSION: Medical hypnosis is a safe and effective complementary technique for use in medical procedures and in the treatment of irritable bowel syndrome. Waking suggestions can be a component of effective doctor-patient communication in routine clinical situations.

Studentized maximum root procedures for coherent analyses of two-factor fixed-effects designs.

The authors provide generalizations of R. J. Boik's (1993) studentized maximum root (SMR) procedure that allow for simultaneous inference on families of product contrasts including simple effect contrasts and differences among simple effect contrasts in coherent analyses of data from 2-factor fixed-effects designs. Unlike the F-based simultaneous test procedures (STPs) proposed by M. A. Betz and K. R. Gabriel (1978) for coherent analyses allowing for inferences on all factorial contrasts, SMR STPs are designed for analyses where each contrast of interest is a product contrast, which is usually the case in analyses of data from factorial experiments. When both factors have more than 2 levels, SMR STPs always provide more power and precision than F STPs for inferences on product contrasts.

Mexican norms for the Stanford Hypnotic Susceptibility Scale, Form C.

Normative data for the Mexican adaptation of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) are presented. Twenty-seven raters administered the scale to 513 Mexican volunteers. Score distribution, item analysis, and reliability of the SHSS:C are presented and compared to other international norming studies. The findings show that the Mexican adaptation of the SHSS:C has psychometric properties essentially comparable to those of the Dutch, German, Italian, and United States reference samples. However, the elevated sample mean suggests Mexicans may have an elevated ability to engage in hypnotic behavior, thus they would likely be especially good candidates for hypnotherapeutic interventions that would better the health options currently available.

The use of a multimodal image, the apple technique, to facilitate clinical hypnosis: a brief communication.

A 1- to 3-minute exercise involving imagination (of an apple) and ideomotor ideation (hand levitation) is a simple, benign technique that is useful for illustrating to patients the nature of imagery and hypnosis. It avoids power struggles and allows a reasonable approximation of the patient's capacity for imagery and hypnotic responsiveness, without emphasizing the use of a hypnotic procedure. When administered to 35 college students, the hand levitation component of this exercise correlated with the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1963) (r = .66, p less than .001) and with the Stanford Hypnotic Clinical Scale: Adult (Morgan & J. R. Hilgard, 1975, 1978/79) (r = .60, p less than .001).

The Stanford Hypnotic Susceptibility Scale, Form C: normative data of a Dutch student sample.

Norms for the Dutch language version of the Standford Hypnotic Susceptibility Scale, Form C (SHSS:C; Weitzenhoffer & Hilgard, 1962) are presented. These norms are based upon a sample of 135 students at a Dutch university. Generally, the psychometric properties of the Dutch version of the SHSS:C are similar to other language versions. However, the mean score was somewhat lower than that found in the original norming studies at Stanford University.