[Integrative medicine: what's new in 2023]. / Médecine intégrative : ce qui a changé en 2023.

To illustrate the news of 2023 in integrative medicine, the authors summarized four particularly relevant studies. The first highlights one of the foundational principles of integrative medicine, describing the importance of respecting patient preference in the choice of a therapeutic approach, promoting their «empowerment¼. The second article proposes methodological recommendations to improve the scientific value of studies assessing the efficacy and mechanisms of non-pharmacological approaches. Finally, the last two articles are randomized studies designed to either demonstrate the feasibility and effect of hypnosis in geriatrics, or evaluate the efficacy of a several combined complementary approaches for cancer-related fatigue.

Dans cette nouvelle édition consacrée aux nouveautés en médecine intégrative, les auteurs ont choisi de résumer quatre études particulièrement pertinentes parmi les articles publiés en 2023. La première souligne l'un des principes fondateurs de la médecine intégrative en décrivant l'importance du respect de la préférence du patient dans le choix d'une approche thérapeutique, favorisant leur « empowerment ¼. La deuxième propose des recommandations méthodologiques afin d'améliorer la valeur scientifique des études de l'efficacité et des mécanismes d'approches non pharmacologiques. Enfin, les deux dernières sont des études randomisées visant à démontrer, d'une part, la faisablité et l'effet de l'hypnose en gériatrie et, d'autre part, l'efficacité d'une combinaison d'approches complémentaires pour lutter contre la fatigue liée au cancer.

Hypnosis in the operating room: are anesthesiology teams interested and well-informed?

BACKGROUND: Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff. DESIGN: A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively. RESULTS: Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training. CONCLUSION: Overall, anesthesia providers' attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.

[Integrative medicine: what's new in 2022]. / Médecine intégrative : ce qui a changé en 2022.

To illustrate the news of 2022, we present first a scientific article on mindfulness: a meta-analysis shows both preventive and therapeutic effects for the pediatric population. A second scientific article is summarized: it investigated acupuncture in an obstetrical context, demonstrating its effectiveness on post-caesarean pain and on functional capacity, by improving early mobilization. Hence, these approaches have an increasing level of scientific evidence in these given fields, calling for a clinical implementation. Finally, we offer a practical summary concerning the prescription of cannabis, especially useful following the abolishment of the obligatory FOPH authorization as of August 1, 2022. Nevertheless, we underline that the evidence for cannabinoids being effective remains weak in most indications.

En termes de nouveautés 2022, nous présentons en premier lieu un article scientifique traitant de la pleine conscience : une méta-analyse montre des effets tant préventifs que thérapeutiques pour la population pédiatrique. Le deuxième article scientifique présenté traite de l'acupuncture dans un contexte obstétrical, démontrant son efficacité sur la douleur postcésarienne et sur la capacité fonctionnelle, en améliorant la mobilisation précoce. Ces deux approches bénéficient donc d'un niveau de preuve scientifique croissant appelant à une implantation clinique. Finalement, nous offrons un résumé pratique concernant la prescription de cannabis, tout particulièrement utile suite à la levée de l'obligation d'autorisation de l'OFSP dès le 1er août 2022. Néanmoins, nous soulignons que les preuves restent faibles concernant l'efficacité des cannabinoïdes dans la plupart des indications.

[Integrative medicine: scientific literature in 2021]. / Médecine integrative - Littérature scientifique en 2021.

To illustrate the novelties in integrative and complementary medicine in 2021, the authors present a selection of six articles. One of them is specifically related to COVID-19. The other articles deal with themes that are always relevant and where complementary approaches represent a real added value. Two articles focus on low back pain, a common problem in primary care medicine. The others examine acupuncture in the oncological context, the use of therapeutic suggestions in an operative context, and Tai Chi. The authors thus provide an overview of the range of possible complementary therapeutic approaches that are increasingly supported by evidence, inviting them to be better integrated into clinical practice.

Pour illustrer les nouveautés en médecine intégrative et complémentaire en 2021, les auteur·e·s présentent une sélection de six articles. L'un s'intéresse plus spécifiquement au Covid-19. Les autres touchent des thématiques qui restent toujours d'actualité et où des approches complémentaires peuvent représenter une réelle plus-value. Deux articles ont pour thème les lombalgies, problématique courante en médecine de premier recours. Les autres examinent l'acupuncture dans le contexte oncologique, l'utilisation de suggestions thérapeutiques dans un contexte opératoire, et le Tai Chi. Les auteur·e·s donnent ainsi un aperçu de l'éventail d'approches thérapeutiques complémentaires possibles et de plus en plus soutenues par la science, invitant à les intégrer de mieux en mieux dans la pratique clinique.

Impact of hypnosis on psychophysiological measures: A scoping literature review.

Exploring psychophysiological changes during hypnosis can help to better understand the nature and extent of the hypnotic phenomenon by characterizing its influence on the autonomic nervous system (ANS), in addition to its central brain effects. Hypnosis is thought to induce a relaxation response, yet studies using objective psychophysiological measures alongside hypnosis protocols show various results. We review this literature and clarify the effects of hypnosis on psychophysiological indices of ANS activity and more specifically of the stress/relaxation response, such as heart rate variability and electrodermal activity. Studies reporting psychophysical measures during hypnosis were identified by a series of Pubmed searches. Data was extracted with an interest for the influence of hypnotizability and effects of specific suggestions or tasks on the findings. We found 49 studies comprising 1315 participants, 45 concerning healthy volunteers and only 4 on patients. Sixteen compared high vs. low hypnotizable people; 30 measured heart rate, 18 measured heart rate variability, 25 electrodermal activity, and 23 respiratory signals as well as other physiological parameters. Globally, results converge to show reductions in sympathetic responses and/or increases in parasympathetic tone under hypnosis. Several methodological limitations are underscored, such as older studies (N = 16) using manual analyses, small sample sizes (<30, N = 31), as well as uncontrolled multiple comparisons. Nevertheless, we confirm that hypnosis leads to a physiological relaxation response and highlight promising avenues for this research. Suggestions are made for guiding future work in this field.

[Scientific literature on integrative medicine in 2020]. / Littérature scientifique concernant la médecine intégrative en 202.

Scientific research in integrative medicine has undergone significant development in recent years. Several studies published in 2020 focus on the management of chronic pain. Hypnosis has been shown to be as effective in analgesia as cognitive-behavioral therapy and therapeutic education. A study on chronic low back pain showed lower health care costs for patients using complementary medicine. Furthermore, the hypothesis of super responders to acupuncture treatment does not seem to be confirmed. Yoga could be a useful approach in the prevention of migraines. With respect to the management of COVID-19, the addition of traditional Chinese medicine to conventional treatments could reduce a number of symptoms and the length of hospital stays, although the quality of data is limited.

La recherche en médecine intégrative connaît un développement important depuis quelques années. Plusieurs études publiées en 2020 concernent la prise en charge de la douleur chronique. L'hypnose s'est montrée aussi efficace contre la douleur que la thérapie cognitivo-comportementale et l'éducation thérapeutique. Une étude sur les lombalgies chroniques a indiqué des dépenses de santé plus basses pour les patients recourant aux médecines complémentaires. Par ailleurs, l'hypothèse de super-répondeurs à un traitement d'acupuncture ne semble pas se confirmer. Le yoga pourrait être une approche utile dans la prévention des migraines. En ce qui concerne la prise en charge du Covid-19, l'ajout de la médecine traditionnelle chinoise pourrait diminuer certains symptômes et la durée des hospitalisations, bien que la qualité des données reste limitée.

A test of positive suggestions about side effects as a way of enhancing the analgesic response to NSAIDs.

Side effects are frequent in pharmacological pain management, potentially preceding analgesia and limiting drug tolerability. Discussing side effects is part of informed consent, yet can favor nocebo effects. This study aimed to test whether a positive suggestion regarding side effects, which could act as reminders of the medication having been absorbed, might favor analgesia in a clinical interaction model. Sixty-six healthy males participated in a study "to validate pupillometry as an objective measure of analgesia". Participants were unknowingly randomized double-blind to positive vs control information about side effects embedded in a video regarding the study drugs. Sequences of moderately painful heat stimuli applied before and after treatment with diclofenac and atropine served to evaluate analgesia. Atropine was deceptively presented as a co-analgesic, but used to induce side effects. Adverse events (AE) were collected with the General Assessment of Side Effects (GASE) questionnaire prior to the second induced pain sequence. Debriefing fully informed participants regarding the purpose of the study and showed them the two videos.The combination of medication led to significant analgesia, without a between-group difference. Positive information about side effects increased the attribution of AE to the treatment compared to the control information. The total GASE score was correlated with analgesia, i.e., the more AEs reported, the stronger the analgesia. Interestingly, there was a significant between-groups difference on this correlation: the GASE score and analgesia correlated only in the positive information group. This provides evidence for a selective link between AEs and pain relief in the group who received the suggestion that AEs could be taken as a sign "that help was on the way". During debriefing, 65% of participants said they would prefer to receive the positive message in a clinical context. Although the present results cannot be translated immediately to clinical pain conditions, they do indicate the importance of testing this type of modulation in a clinical context.