Effects of perioperative clinical hypnosis on heart rate variability in patients undergoing oncologic surgery: secondary outcomes of a randomized controlled trial.

Introduction: Clinical hypnosis has been proposed for post-surgical pain management for its potential vagal-mediated anti-inflammatory properties. Evidence is needed to understand its effectiveness for post-surgical recovery. Iin this secondary outcome study, it was hypothesized that surgical oncology patients randomized to receive perioperative clinical hypnosis (CH) would demonstrate greater heart-rate variability (HRV) during rest and relaxation at a 1-month post-surgery assessment compared to a treatment-as-usual group (TAU). Methods: After REB approval, trial registration and informed consent, 92 participants were randomized to receive CH (n = 45) or TAU (n = 47). CH participants received a CH session before surgery and during post-surgical in-hospital stay HRV was assessed during rest (5 min) and relaxation (10 min) before and 1-month after surgery. Pain intensity was obtained using a 0-10 numeric rating scale pre and post 1-week and 1-month post surgery. Results: One month after surgery, HRV was significantly higher in CH group (n = 29) during rest and relaxation (both p < 0.05, d = 0.73) than TAU group (n = 28). By contrast, rest and relaxation HRV decreased from pre- to 1-month post-surgery for the TAU (both p < 0.001, d > 0.48) but not the CH group. Pain intensity increased from pre-surgery to 1-week post-surgery (p < 0.001, d = 0.50), and decreased from 1-week to 1-month post-surgery (p = 0.005, d = 0.21) for all participants. Discussion: The results suggest that hypnosis prevents the deleterious effects of surgery on HRV by preserving pre-operative vagal activity. These findings underscore the potential of clinical hypnosis in mitigating the adverse effects of surgery on autonomic function and may have significant implications for enhancing post-surgical recovery and pain management strategies. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT03730350).

A Randomized Controlled Trial of Clinical Hypnosis as an Opioid-Sparing Adjunct Treatment for Pain Relief in Adults Undergoing Major Oncologic Surgery.

Clinical hypnosis is an effective strategy for managing acute pain in the surgical setting. However, the opioid sparing effects of clinical hypnosis are not as well understood. This pre-registered (NCT03730350) randomized, controlled trial (RCT) examined the impact of clinical hypnosis, pre- and post-surgery, on opioid consumption during hospitalization as well as on measures of pain intensity, pain interference, depressed mood, anxiety, sleep, and pain catastrophizing. Participants (M = 57.6 years; SD = 10.9) awaiting oncologic surgery were randomized to treatment-as-usual (n = 47) or hypnosis (n = 45). Intent-to-treat analyses were conducted using linear mixed effects modeling. A significant Group × Time interaction, F(6, 323.34) = 3.32, p = 0.003, indicated an opioid sparing effect of clinical hypnosis during the acute postoperative period. Hypnosis also protected against increases in pain catastrophizing at one-week after surgery, F (1, 75.26) = 4.04, p = 0.048. A perioperative clinical hypnosis intervention had a sparing effect on opioid consumption in-hospital after major oncologic surgery. These findings extend the efficacy of clinical hypnosis as an adjunct tool for perioperative pain management.

Painful reminders: Involvement of the autobiographical memory system in pediatric postsurgical pain and the transition to chronicity.

Memory biases for previous pain experiences are known to be strong predictors of postsurgical pain outcomes in children. Until recently, much research on the subject in youth has assessed the sensory and affective components of recall using single-item self-report pain ratings. However, a newly emerging focus in the field has been on the episodic specificity of autobiographical pain memories. Still in its infancy, cross-sectional work has identified the presence of various memory biases in adults living with chronic pain, one of which concerns the lack of spatiotemporal specificity. Moreover, a recent prospective longitudinal study found that adults scheduled for major surgery who produced fewer specific pain memories before surgery were at greater risk of developing chronic postsurgical pain up to 12 months later. The present review draws on this research to highlight the timely need for a similar line of investigation into autobiographical pain memories in pediatric surgical populations. We (1) provide an overview of the literature on children's pain memories and underscore the need for further research pertaining to memory specificity and related neurobiological factors in chronic pain and an overview of the (2) important role of parent (and sibling) psychosocial characteristics in influencing children's pain development, (3) cognitive mechanisms underlying overgeneral memory, and (4) interplay between memory and other psychological factors in its contributions to chronic pain and (5) conclude with a discussion of the implications this research has for novel interventions that target memory biases to attenuate, and possibly eliminate, the risk that acute pain after pediatric surgery becomes chronic.

Les biais de mémoire concernant les expériences douloureuses antérieures sont connus pour être de puissants prédicteurs de la douleur post-chirurgicale chez les enfants. Jusqu'à récemment, la plupart des études sur ce sujet menées auprés des jeunes évaluaient les composantes sensorielles et affectives du souvenir en utilisant des auto-évaluations de la douleur comportant un seul énoncé. Cependant, la spécificité épisodique des souvenirs autobiographiques de la douleur a récemment fait son apparition en tant que nouveau centre d'intérêt dans le domaine. Bien qu'ils en soient encore à leurs premiers balbutiements, des travaux transversaux ont déterminé que divers biais de mémoire étaient présents chez les adultes vivant avec la douleur chronique, dont l'un concerne le manque de spécificité spatiotemporelle. De plus, une étude longitudinale prospective récente a révélé que les adultes en attente d'une chirurgie majeure qui avaient moins de souvenirs spécifiques de la douleur avant la chirurgie étaient plus à risque de développer de la douleur post-chirurgicale chronique jusqu'à 12 mois plus tard. La présente étude s'appuie sur cette étude pour souligner la nécessité de mener des études similaires sur les souvenirs autobiographiques de la douleur au sein de la population chirurgicale pédiatrique. Nous (1) faisons un survol de la littérature sur les souvenirs de la douleur chez les enfants et soulignons la nécessité de poursuivre la recherche sur la spécificité de la mémoire et sur les facteurs neurobiologiques liés à la douleur chronique, ainsi qu'un survol (2) du rôle important des caractéristiques psychosociales des parents (et des fréres et sœurs) dans le développement de la douleur chez les enfants, (3) les mécanismes cognitifs qui sous-tendent la mémoire surgénérale et (4) l'interaction entre la mémoire et d'autres facteurs psychologiques qui contribue à la douleur chronique et (5) concluons par une discussions sur les implications de cette étude pour les interventions novatrices qui ciblent les biais de mémoire pour atténuer, et possiblement éliminer, le risque que la douleur aigue aprés une chirurgie pédiatrique devienne chronique.

Autobiographical memory predicts postsurgical pain up to 12 months after major surgery.

ABSTRACT: Recent cross-sectional studies have identified differences in autobiographical memory (AM) among individuals with chronic pain, but the temporal relationship between the 2 is unknown. Moreover, AM has yet to be studied in patients undergoing major surgery. This study addressed these gaps by conducting a prospective, longitudinal study of memory performance, postsurgical pain, and psychosocial factors in 97 adult participants scheduled for major surgery. Memories were evaluated using the Autobiographical Memory Test before and one month after surgery when participants were asked to recall personal events related to positive and pain-related word cues. Responses were coded for level of specificity, emotional valence, and surgery-related content. Questionnaires assessing presence/absence of pain and psychological functioning were administered before and at 1-, 3-, 6-, and 12-month follow-ups. Generalized estimating equations modelled pain at each postsurgical time point with memory variables as predictors. As hypothesized, higher numbers of specific pain memories recalled before surgery predicted lower odds of pain across all time points (OR = 0.58, 95% CI [0.37-0.91]). Participants who took longer to recall pain memories before surgery (OR = 2.65, 95% CI [1.31-5.37]) and those who produced more surgery-related content at the one-month assessment (OR = 1.31, 95% CI [1.02-1.68]) had greater odds of reporting postsurgical pain up to 12 months later. These findings indicate that presurgical AM biases are risk factors for development and maintenance of postsurgical pain. To the extent that these biases are causal, presurgical interventions that modify the quality and content of patients' memories may prove to be promising strategies in the prevention of chronic postsurgical pain.

Flexibility of cue use in the fox squirrel (Sciurus niger).

Recent work on captive flying squirrels has demonstrated a novel degree of flexibility in the use of different orientation cues. In the present study, we examine to what extent this flexibility is present in a free-ranging population of another tree squirrel species, the fox squirrel. We trained squirrels to a rewarded location within a square array of four feeders and then tested them on transformations of the array that either pitted two cue types against one cue type, the majority tests, or all cue types against each other, the forced-hierarchy test. In Experiment 1, squirrels reoriented to the two-cue-type location in all majority tests and to the location indicated by the visual features of the feeders in the forced-hierarchy test. This preference for visual features runs contrary to previous studies that report the use of spatial cues over visual features in food-storing species. In Experiments 2-5 we tested squirrels with different trial orders (Experiments 2 and 3), a different apparatus (Experiment 4) and at different times of the year (Experiment 5) to determine why these squirrels had chosen to orient using visual features in the first experiment. Like captive flying squirrels, free-ranging fox squirrels showed a large degree of flexibility in their use of cues. Furthermore, their cue use appeared to be sensitive both to changes in the test apparatus and the season in which we tested. Altogether our results suggest that the study of free-ranging animals over a variety of conditions is necessary for understanding spatial cognition.

Treatment with non-hypercalcemic analogs of 1,25-dihydroxyvitamin D3 increases responsiveness to 17beta-estradiol, dihydrotestosterone or raloxifene in primary human osteoblasts.

Pretreatment with 1 nM 1,25-dihydroxyvitamin D(3) (1,25), or non-hypercalcemic Vitamin D analogs, upregulated the response of creatine kinase (CK) to 17beta-estradiol (30 nM E(2)), raloxifene (3000 nM RAL) or dihydrotestosterone (300 nM DHT) in primary human bone cells. Previously, we reported that these osteoblast-like cells responded to gonadal steroids in a sex specific manner. Bone cells derived from pre-menopausal women showed greater stimulation of CK specific activity by E(2) than bone cells from post-menopausal women; in male-derived cells no age related difference was found. In this study, we treated cells derived from female or male bones, at different ages, with the side chain modified analogs of Vitamin D: CB 1093 (CB), EB 1089 (EB), MC 1288 (MC) and the demonstrably non-calcemic hybrid analog JK 1624 F2-2 (JKF), by daily addition of 1 nM, for 3 days. On day 4, cells were incubated with sex steroids for 4h and cell extracts were prepared. Pretreatment with JKF or CB significantly upregulated the response to 30 nM E(2) in all female-derived cells and to 300 nM DHT in mature male-derived cells. In cells from older males, only JKF caused augmentation of DHT action. Bone cells from pre- or post-menopausal females responded to 3000 nM RAL by increased CK activity to the same extent as to 30 nM E(2); however, RAL and E(2), when applied together, resulted in mutual annihilation of their agonist activities. Vitamin D analogs prevented the antagonistic effect of RAL in the presence of E(2), possibly due to increased numbers of ERs. Both estrogen receptors, alpha (ERalpha) and beta (ERbeta), were expressed in male- as well as in female-derived cells. However, only in female-derived cells were ERalpha and ERbeta upregulated by pretreatment with Vitamin D analogs. This study raises the possibility of testing combined Vitamin D analog and estrogen replacement treatment for post-menopausal women to prevent osteoporosis.