The Laurs of Hypnotic Communication and the "Lived in Imagination" Technique in Medical Practice.

This article describes two common hypnotic communication techniques that can be used in anesthesiology and more generally for a variety of medical applications. First, the LAURS (listening, acceptance, utilization, reframing, suggestion) hypnotic communication structure is detailed. This technique allows clinicians to rapidly build patient rapport and maximize the chance of a suggestion being realized. Second, the "Lived in Imagination" technique can be used to supplement a less than perfect local anesthesia technique or help provide analgesia or sedation to support a patient undergoing minor or even major surgical procedures. These techniques may allow for an adjunctive, seamless integration during standard clinical care.

Parental satisfaction of child's perioperative care.

BACKGROUND: Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child's hospital experience, parent satisfaction of their child's perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child's perioperative process. METHODS: Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21-item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction. RESULTS: Descriptive statistics and correlational analysis found that sedative-premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received. CONCLUSION: Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores.

[The non-pharmacological management of chronic pain]. / La prise en charge non médicamenteuse de la douleur chronique.

Pain management is not limited to the putting in place of pharmacological, surgical, physiotherapy or psychological strategies. Non-pharmacological therapies can also be proposed, notably in relation to chronic pain. Appreciated by patients and developed by caregivers, they require appropriate regulatory guidelines and specific training in order for them to be implemented safely.

Impact of a Hypnotically-Based Intervention on Pain and Fear in Women Undergoing Labor.

The purpose of this study was to evaluate the effects of a hypnotically-based intervention for pain and fear in women undergoing labor who are about to receive an epidural catheter. A group of 155 women received interventions that included either (a) patient rocking, gentle touching, and hypnotic communication or (b) patient rocking, gentle touching, and standard communication. The authors found that the hypnotic communication intervention was more effective than the standard communication intervention for reducing both pain intensity and fear. The results support the use of hypnotic communication just before and during epidural placement for women who are in labor and also indicate that additional research to evaluate the benefits and mechanism of this treatment is warranted.

Efficacy of Self-Hypnosis in Pain Management in Female Patients with Multiple Sclerosis.

Pain is common in patients with multiple sclerosis. This study evaluated self-hypnosis for pain control in that population. A randomized clinical trial was conducted on 60 patients, who were assigned to either a control group or to a self-hypnosis group, in which patients performed self-hypnosis at least 10 times a day. All patients were trained to score the perceived pain twice daily on a numerical rating scale and also reported the quality of pain with the McGill Pain questionnaire. Repeated-measures analysis showed a significant difference between the groups; pain was lower in the self-hypnosis group but was not maintained after 4 weeks. Self-hypnosis could effectively decrease the intensity and could modify quality of pain in female patients with multiple sclerosis.

Non-pharmacological interventions for assisting the induction of anaesthesia in children.

BACKGROUND: Induction of general anaesthesia can be distressing for children. Non-pharmacological methods for reducing anxiety and improving co-operation may avoid the adverse effects of preoperative sedation. OBJECTIVES: To assess the effects of non-pharmacological interventions in assisting induction of anaesthesia in children by reducing their anxiety, distress or increasing their co-operation. SEARCH METHODS: In this updated review we searched CENTRAL (the Cochrane Library 2012, Issue 12) and searched the following databases from inception to 15 January 2013: MEDLINE, EMBASE, PsycINFO and Web of Science. We reran the search in August 2014. We will deal with the single study found to be of interest when we next update the review. SELECTION CRITERIA: We included randomized controlled trials of a non-pharmacological intervention implemented on the day of surgery or anaesthesia. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted data and assessed risk of bias in trials. MAIN RESULTS: We included 28 trials (2681 children) investigating 17 interventions of interest; all trials were conducted in high-income countries. Overall we judged the trials to be at high risk of bias. Except for parental acupuncture (graded low), all other GRADE assessments of the primary outcomes of comparisons were very low, indicating a high degree of uncertainty about the overall findings. Parental presence: In five trials (557 children), parental presence at induction of anaesthesia did not reduce child anxiety compared with not having a parent present (standardized mean difference (SMD) 0.03, 95% confidence interval (CI) -0.14 to 0.20). In a further three trials (267 children) where we were unable to pool results, we found no clear differences in child anxiety, whether a parent was present or not. In a single trial, child anxiety showed no significant difference whether one or two parents were present, although parental anxiety was significantly reduced when both parents were present at the induction. Parental presence was significantly less effective than sedative premedication in reducing children's anxiety at induction in three trials with 254 children (we could not pool results). Child interventions (passive): When a video of the child's choice was played during induction, children were significantly less anxious than controls (median difference modified Yale Preoperative Anxiety Scale (mYPAS) 31.2, 95% CI 27.1 to 33.3) in a trial of 91 children. In another trial of 120 children, co-operation at induction did not differ significantly when a video fairytale was played before induction. Children exposed to low sensory stimulation were significantly less anxious than control children on introduction of the anaesthesia mask and more likely to be co-operative during induction in one trial of 70 children. Music therapy did not show a significant effect on children's anxiety in another trial of 51 children. Child interventions (mask introduction): We found no significant differences between a mask exposure intervention and control in a single trial of 103 children for child anxiety (risk ratio (RR) 0.59, 95% CI 0.31 to 1.11) although children did demonstrate significantly better co-operation in the mask exposure group (RR 1.27, 95% CI 1.06 to 1.51). Child interventions (interactive): In a three-arm trial of 168 children, preparation with interactive computer packages (in addition to parental presence) was more effective than verbal preparation, although differences between computer and cartoon preparation were not significant, and neither was cartoon preparation when compared with verbal preparation. Children given video games before induction were significantly less anxious at induction than those in the control group (mYPAS mean difference (MD) -9.80, 95% CI -19.42 to -0.18) and also when compared with children who were sedated with midazolam (mYPAS MD -12.20, 95% CI -21.82 to -2.58) in a trial of 112 children. When compared with parental presence only, clowns or clown doctors significantly lessened children's anxiety in the operating/induction room (mYPAS MD -24.41, 95% CI -38.43 to -10.48; random-effects, I² 75%) in three trials with a total of 133 children. However, we saw no significant differences in child anxiety in the operating room between clowns/clown doctors and sedative premedication (mYPAS MD -9.67, 95% CI -21.14 to 1.80, random-effects, I² 66%; 2 trials of 93 children). In a trial of hypnotherapy versus sedative premedication in 50 children, there were no significant differences in children's anxiety at induction (RR 0.59, 95% CI 0.33 to 1.04). Parental interventions: Children of parents having acupuncture compared with parental sham acupuncture were less anxious during induction (mYPAS MD -17, 95% CI -30.51 to -3.49) and were more co-operative (RR 1.59, 95% CI 1.01 to 2.53) in a single trial of 67 children. Two trials with 191 parents assessed the effects of parental video viewing but did not report any of the review's prespecified primary outcomes. AUTHORS' CONCLUSIONS: This review shows that the presence of parents during induction of general anaesthesia does not diminish their child's anxiety. Potentially promising non-pharmacological interventions such as parental acupuncture; clowns/clown doctors; playing videos of the child's choice during induction; low sensory stimulation; and hand-held video games need further investigation in larger studies.

Posthypnotic use of olfactory stimulus for pain management.

Chronic pain due to disease or injury persists even after interventions to alleviate these conditions. Opiates are not always effective for the patient and have undesirable side effects. Hypnosis has been shown to be an effective treatment and may be enhanced by the use of olfactory stimulation as a posthypnotic cue. The article details 2 case reports that demonstrate the possible benefits of olfactory stimulus as an adjunct to hypnosis for pain relief.

Non-pharmacological interventions for assisting the induction of anaesthesia in children.

BACKGROUND: Induction of general anaesthesia can be distressing for children. Non-pharmacological methods for reducing anxiety and improving co-operation may avoid the adverse effects of preoperative sedation. OBJECTIVES: To assess the effects of non-pharmacological interventions in assisting induction of anaesthesia in children by reducing their anxiety, distress or increasing their co-operation. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2009, Issue 1). We searched the following databases from inception to 14th December 2008: MEDLINE, PsycINFO, CINAHL, DISSERTATION ABSTRACTS, Web of Science and EMBASE. SELECTION CRITERIA: We included randomized controlled trials of a non-pharmacological intervention implemented on the day of surgery or anaesthesia. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed risk of bias in trials. MAIN RESULTS: We included 17 trials, all from developed countries, involving 1796 children, their parents or both. Eight trials assessed parental presence. None showed significant differences in anxiety or co-operation of children during induction, except for one where parental presence was significantly less effective than midazolam in reducing children's anxiety at induction. Six trials assessed interventions for children. Preparation with a computer package improved co-operation compared with parental presence (one trial). Children playing hand-held video games before induction were significantly less anxious than controls or premedicated children (one trial). Compared with controls, clown doctors reduced anxiety in children (modified Yale Preoperative Anxiety Scale (mYPAS): mean difference (MD) 30.75 95% CI 15.14 to 46.36; one trial). In children undergoing hypnosis, there was a nonsignificant trend towards reduced anxiety during induction (mYPAS < 24: risk ratio (RR) 0.59 95% CI 0.33 to 1.04 - 39% versus 68%: one trial) compared with midazolam. A low sensory environment improved children's co-operation at induction (RR 0.66, 95% CI 0.45 to 0.95; one trial) and no effect on children's anxiety was found for music therapy (one trial).Parental interventions were assessed in three trials. Children of parents having acupuncture compared with parental sham-acupuncture were less anxious during induction (mYPAS MD 17, 95% CI 3.49 to 30.51) and more children were co-operative (RR 0.63, 95% CI 0.4 to 0.99). Parental anxiety was also significantly reduced in this trial. In two trials, a video viewed preoperatively did not show effects on child or parental outcomes. AUTHORS' CONCLUSIONS: This review shows that the presence of parents during induction of general anaesthesia does not reduce their child's anxiety. Promising non-pharmacological interventions such as parental acupuncture; clown doctors; hypnotherapy; low sensory stimulation; and hand-held video games needs to be investigated further.

O diagnóstico psiquiátrico e a produção de vida em serviços de saúde mental / Hypnosis and pain: clinical origin and tradition

A Reforma Psiquiátrica objetiva desconstruir a relação de tutela e objetificação sustentada pelo saber/práticas psiquiátricas para com a loucura. Um dos pilares dessa relação é o diagnóstico psiquiátrico que produz efeitos importantes nas trajetórias vital e institucional dos portadores de transtornos mentais. Essa pesquisa objetivou conhecer os sentidos do diagnóstico psiquiátrico para usuários do Ambulatório de Saúde Mental na cidade de Natal/RN e os efeitos produzidos em suas vidas. Trabalhamos com observações e um roteiro semi-estruturado de entrevista. Identificamos variações na concepção do diagnóstico, alterações nas suas vidas em função do mesmo tais como a perda do trabalho, a dependência familiar, mudanças nas relações sociais, as quais são sustentadas pelo saberes médico e jurídico. Entendemos que as relações tutelares com a família e os serviços de saúde se estabelecem a partir do momento que o diagnóstico é atestado e a vida passa a ser norteada pela "existência" do transtorno mental.(AU)

The objective of the Psychiatric Reform is to deconstruct the tutelage relation and the objetivation produced by the psychiatric knowledge and practices regarding madness. One of the pillars of that relationship is the psychiatric diagnosis. This tool produces important life process effects, as well as institutional, amongst individuals that are diagnosed with Mental Disorders. The purpose of this work is to present a research study conducted with clients of the Mental Health Ambulatory Unit in the city of Natal, RN. The objective of the study was to identify the meanings of the psychiatric diagnoses of the clients and the effects they produce on their daily lives. Working with observations and with a semi-structured interview, we identified that the diagnosis concept varies amongst the clients and that the diagnosis alters their lives in ways such as loss of a job, family dependence and disruption of social relations, effects that are sustained by the medical and judicial knowledge. We understand that the tutelage relations with the family and the health services are established when the diagnosis is made and the life style is then oriented by the "existence" of the mental illness/disorder.(AU)

O diagnóstico psiquiátrico e a produção de vida em serviços de saúde mental / Hypnosis and pain: clinical origin and tradition

A Reforma Psiquiátrica objetiva desconstruir a relação de tutela e objetificação sustentada pelo saber/práticas psiquiátricas para com a loucura. Um dos pilares dessa relação é o diagnóstico psiquiátrico que produz efeitos importantes nas trajetórias vital e institucional dos portadores de transtornos mentais. Essa pesquisa objetivou conhecer os sentidos do diagnóstico psiquiátrico para usuários do Ambulatório de Saúde Mental na cidade de Natal/RN e os efeitos produzidos em suas vidas. Trabalhamos com observações e um roteiro semi-estruturado de entrevista. Identificamos variações na concepção do diagnóstico, alterações nas suas vidas em função do mesmo tais como a perda do trabalho, a dependência familiar, mudanças nas relações sociais, as quais são sustentadas pelo saberes médico e jurídico. Entendemos que as relações tutelares com a família e os serviços de saúde se estabelecem a partir do momento que o diagnóstico é atestado e a vida passa a ser norteada pela "existência" do transtorno mental.

The objective of the Psychiatric Reform is to deconstruct the tutelage relation and the objetivation produced by the psychiatric knowledge and practices regarding madness. One of the pillars of that relationship is the psychiatric diagnosis. This tool produces important life process effects, as well as institutional, amongst individuals that are diagnosed with Mental Disorders. The purpose of this work is to present a research study conducted with clients of the Mental Health Ambulatory Unit in the city of Natal, RN. The objective of the study was to identify the meanings of the psychiatric diagnoses of the clients and the effects they produce on their daily lives. Working with observations and with a semi-structured interview, we identified that the diagnosis concept varies amongst the clients and that the diagnosis alters their lives in ways such as loss of a job, family dependence and disruption of social relations, effects that are sustained by the medical and judicial knowledge. We understand that the tutelage relations with the family and the health services are established when the diagnosis is made and the life style is then oriented by the "existence" of the mental illness/disorder.

[Patient satisfaction after oral and maxillofacial procedures under clinical hypnosis]. / Therapiezufriedenheit mund-, kiefer- und gesichtschirurgischer Patienten nach Operationen unter Klinischer Hypnose.

The Department of Maxillofacial Surgery of the University Hospital Schleswig-Holstein/Campus Lübeck offers intraoperative hypnosis since 2002. Besides clinical evaluation by controlled studies, patients attitudes should be included in the judgement on such adjuvant procedure not established in general.70 patients of the department treated under combined local anaesthesia/hypnosis rated their individual postoperative patient satisfaction by standardised questionnaires. A control group of equal size and demographic/surgical features consisted of patients that were treated without hypnosis in the same interval. Results of the inquiry indicate that intraoperative hypnosis increases significantly postoperative satisfaction of oral and maxillofacial patients. Satisfaction is attributed decisively on the adjuvant procedure.

Hypnosis and surgery: past, present, and future.

Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. Yet little progress has been made to fully comprehend or appreciate its potential compared to the pharmacologic advances in anesthesiology. Recently, hypnosis has aroused interest, as hypnosis seems to complement and possibly enhance conscious sedation. Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.

Can the cerebral state monitor replace the bispectral index in monitoring hypnotic effect during propofol/remifentanil anaesthesia?

BACKGROUND: In 2004, the cerebral state monitor, CSM, was launched as a low-cost alternative to the bispectral index, BIS, for monitoring depth of sleep during anaesthesia. We tested whether the two monitors would reflect hypnosis equally during propofol/remifentanil anaesthesia. METHODS: During laparoscopy or breast/surface surgery, 55 non-paralyzed patients were monitored simultaneously with the BIS and the CSM. Trend curves for the indexes [BIS and cerebral state index (CSI)] were compared for congruence. The difference between the two indexes for the entire course was quantified, and the ability of the two monitors to separate awake from asleep during induction was described. RESULTS: In the majority of the patients, 87%, there was a good fit between the indexes. There were major deviations in seven patients, in whom CSI indicated that the patients were awake during parts of the course despite clinical sleep, correctly identified with the BIS. Both indexes separated awake from asleep during induction in the individual patient, but the overlap in values between patients was more pronounced for CSI. CONCLUSION: CSM and BIS show some important differences in measuring hypnotic state during clinical propofol/remifentanil anaesthesia.

Antenatal self-hypnosis for labour and childbirth: a pilot study.

UNLABELLED: In our institution we have used antenatal training in self-hypnosis for over three years as a tool to provide relaxation, anxiolysis and analgesia for women in labour. To assess the effects of hypnotherapy, we prospectively collected data related to the use of hypnosis in preparation for childbirth, and compared the birth outcomes of women experiencing antenatal hypnosis with parity and gestational age matched controls. METHODS: Prospective data about women taught self-hypnosis in preparation for childbirth were collected between August 2002 and August 2004. Birth outcome data of women using hypnosis were compared with routinely collected retrospective data from parity and gestational age matched women delivering after 37 weeks gestation during 2003. RESULTS: Seventy-seven antenatal women consecutively taught self-hypnosis in preparation for childbirth were compared with 3,249 parity and gestational age matched controls. Of the women taught antenatal self-hypnosis, nulliparous parturients used fewer epidurals: 36% (18/50) compared with 53% (765/1436) of controls (RR 0.68 [95%CI 0.47-0.98]); and required less augmentation: 18% (9/50) vs 36% (523/1436) (RR 0.48 [95%CI 0.27-0.90]). CONCLUSIONS: Our clinical findings are consistent with recent meta-analyses showing beneficial outcomes associated with the use of hypnosis in childbirth. Adequately powered, randomized trials are required to further elucidate the effects of hypnosis preparation for childbirth.

Eficacia y aplicación de la hipnosis clínica / No disponible

La hipnosis es una técnica potente para la mejora de la calidad de vida de una gran variedad de pacientes. Sin embargo, es frecuente que tanto pacientes como terapeutas tengan creencias erróneas que dificultan que la hipnosis clínica se utilice más. El presente trabajo disipa estas creencias erróneas, destaca la eficacia clínica de la hipnosis y la investigación de vanguardia, y argumenta en favor de un uso más extendido de esta técnica terapéutica adjunta (AU)

Hypnosis is a powerful technique for improving quality of life for a wide variety of patients. Unfortunately, misconceptions about hypnosis are too often held by patients and therapists alike, possibly preventing greater use of clinical hypnosis. The present paper dispels these misconceptions, highlights clinical effectiveness of hypnosis and cutting edge research, and argues for more widespread use of this adjunctive therapeutic technique (AU)

Aprendizaje en hipnosis profunda: potenciación de capacidades mentales?

En esta investigación los autores se propusieron enfrentar la solución de las dificultades académicas individuales de los estudiantes en la asignatura de Histología, empleando la hipnosis durante parte de su estudio individual, y luego comparar los resultados anteriores en la disciplina con los obtenidos en el examen aplicado después de la intervención. En el período de evaluaciones finales del primer semestre del curso 1997, siete estudiantes en riesgo académico fueron sometidos a inducción hipnótica, para que estudiaran la materia en dos sesiones de hipnosis muy profunda, durante las cuales se les dieron sugerencias de seguridad, concentración máxima, reforzamiento de capacidades intelectuales, aumento de la afectividad positiva hacia el estudio, potenciación de las capacidades de memoria, análisis, síntesis, resumen y generalización. El proceso transcurrió con sordera selectiva y visión selectiva. Los resultados en el examen final fueron comparados mediante la prueba de los signos, con los resultados anteriores obtenidos en la asignatura, comprobándose un aumento significativo del rendimiento(AU)

El recurso de la Hipnosis Ericksoniana en anestesiología / Ericksonian hypnosis as an anesthetic alternative

El propósito de este capítulo es revisar la utilidad que tiene la aplicación de las diferentes técnicas de Hipnosis Ericksoniana en Anestesiología y transmitir nuestra experiencia en la práctica de ellas en nuestro Hospital. El método y las técnicas hipnóticas nos revelan que nuestros problemas tienen antecedentes en nuestra historia personal (debido a experiencias dolorosas del pasado desarrollamos defensas mentales para protegernos del dolor emocional). El paciente encuentra en sí mismo recursos internos para superar sus dificultades presentes de la comunicación verbal y transverbal para que la Hipnosis se haga posible. La complejidad de un cuadro doloroso requiere ser atacado desde los niveles psicológico, cognoscitivo, afectivo y simbólico, y la Hipnosis es un recurso que encaja muy bien dentro de este punto de vista

Hypnosis: practical applications and theoretical considerations in normal labour.

OBJECTIVE: To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women. DESIGN: A semi-prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy. SUBJECTS: One hundred twenty-six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included. SETTING: Aberdare District Maternity Unit, Mid Glamorgan, Wales. INTERVENTION: Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy. OUTCOME MEASURES: Analgesic requirements, duration of first and second stages of labour. RESULTS: The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group (P < 0.0001); the mean lengths of the second stage were 37 min and 50 min, respectively (P < 0.001). In the parous women the corresponding values were 5.3 h and 6.2 h (P < 0.01); and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P < 0.001) in both hypnotised groups compared with their controls. CONCLUSION: In addition to demonstrating the benefits of hypnotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.