Effectiveness and reliability of hypnosis in stereotaxy: a randomized study.

BACKGROUND: Patients suffering from Parkinson's disease (PD) may experience pain during stereotactic frame (SF) fixation in deep brain stimulation (DBS). We assessed the role of hypnosis during the SF fixation in PD patients undergoing awake bilateral subthalamic nucleus (STN) DBS. METHODS: N = 19 patients were included (N = 13 males, mean age 63 years; N = 10 allocated to the hypnosis and N = 9 allocated to the control groups). Patients were randomly assigned to the interventional (hypnosis and local anesthesia) or non-interventional (local anesthesia only) groups. The primary outcome was the pain perceived (the visual analogue scale (VAS)). Secondary outcomes were stress, anxiety, and depression, as measured by the perceived stress scale (PSS) and hospital anxiety and depression scale (HADS). Procedural distress was measured using the peritraumatic distress inventory (PDI-13). RESULTS: In the hypnosis group, VASmean was 5.6 ± 2.1, versus 6.4 ± 1.2 in the control group (p = 0.31). Intervention and control groups reported similar VASmax scores (7.6 ± 2.1 versus 8.6 ± 1.6 (p = 0.28), respectively). Both groups had similar HADS scores (6.2 ± 4.3 versus 6.7 ± 1.92, p = 0.72 (HADSa) and 6.7 ± 4.2 versus 7.7 ± 3, p = 0.58 (HADSd)), so were the PSS scores (26.1 ± 6.3 versus 25.1 ± 7, p = 0.75). Evolutions of VASmean (R2 = 0.93, 95% CI [0.2245, 1.825], p = 0.03) and PDI-13 scores (R2 = 0.94, 95% CI [1.006, 6.279], p = 0.02) significantly differ over follow-up with patients in the hypnosis groups showing lower scores. CONCLUSION: In this unblinded, randomized study, hypnosis does not influence pain, anxiety, and distress during awake SF fixation but modulates pain memory over time and may prevent the integration of awake painful procedures as a bad experience into the autobiographical memory of patients suffering from PD. A randomized controlled study with more data is necessary to confirm our findings.

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.

[Healing communication: Therapeutic communication in internal medicine]. / La « communication thérapeutique ¼ en médecine interne.

Caregiver-patient communication is a central element of the therapeutic relationship and a powerful placebo. While poorly adapted communication can have harmful effects, adequate communication offers many benefits for the patient and the caregiver. Therapeutic communication (TC), a set of strategies inspired by clinical hypnosis, is easy to learn and apply. In addition to reinforcing an empathetic attitude, TC appears to be effective in various clinical situations, particularly for its effects on pain and anxiety. In order to better understand the interest of CT in internal medicine, we have conducted a literature review on its efficacy during different medical procedures.

La communication soignant-e/soigné-e est un élément central de la relation thérapeutique et un puissant placebo dont il serait dommage de se priver. Mal adaptée, elle peut avoir des effets néfastes, efficace, elle offre de nombreux bénéfices pour les patient-e-s et soignant-e-s. La communication thérapeutique (CT), un ensemble de stratégies inspirées de l'hypnose clinique, est facile à apprendre et à appliquer. En plus de renforcer une attitude empathique, la CT semble efficace dans diverses situations cliniques, notamment pour ses effets sur la douleur et l'anxiété. Dans le but de mieux comprendre l'intérêt de la CT en médecine interne, nous avons effectué une revue de littérature démontrant son utilisation lors de gestes techniques auxquels les patient-e-s sont fréquemment confronté-e-s.

[Hypnotherapy in psycho-oncology : clinical benefits and future prospects]. / Hypnothérapie en psycho-oncologie : bénéfices cliniques et perspectives d'avenir.

After a cancer diagnosis, emotional distress is common. We currently have many conventional treatments such as radiotherapy, surgery, chemotherapy, targeted therapies and immunotherapy to fight cancer. However, these treatments are associated with significant adverse effects, which may themselves be the cause of psychic suffering. Hypnosis has been shown to be effective in relieving some of these symptoms, but its practice is still limited in oncology. This is as much related to ignorance about the discipline as to a lack of large randomized prospective studies. This article provides an overview of hypnotherapy and its benefits in the field of psycho-oncology and discusses the prospects for the future.

Pour lutter contre le cancer, nous disposons à l'heure actuelle de nombreux traitements tels que la chirurgie, la radiothérapie, la chimiothérapie, mais également les thérapies ciblées et l'immunothérapie. La détresse émotionnelle pouvant accompagner le diagnostic peut parfois s'aggraver en raison des effets indésirables des traitements entrepris. Il est démontré que l'hypnose médicale est efficace pour soulager certains des symptômes présentés, pourtant sa pratique en oncologie reste limitée, probablement en raison de la méconnaissance de cet outil et d'un manque de grandes études prospectives randomisées. Cet article se propose de faire un état des lieux de l'hypnothérapie et de ses bénéfices dans le domaine de la psycho-oncologie et identifie les perspectives d'avenir.

Influence of CYP2D6 activity on pre-emptive analgesia by the N-methyl-D-aspartate antagonist dextromethorphan in a randomized controlled trial of acute pain.

BACKGROUND: There is some evidence that dextromethorphan (DM) is effective as a pre-emptive analgesic agent.  DM is mainly metabolized to dextrorphan (DOR) by CYP2D6 whose activity can be inhibited by pharmacologic intervention. OBJECTIVES: To investigate the efficacy of DM as a pre-emptive analgesic agent and describe the population pharmacokinetics in the presence of normal and poor CYP2D6 metabolism in acute post-operative pain. STUDY DESIGN: Double blind, randomized, placebo-controlled trial SETTING: Post-surgical analgesic consumption after knee ligament surgery, a setting of acute pain. METHODS: Forty patients were randomized to a single oral dose of 50 mg quinidine or placebo, administered 12 hours before 50 mg DM. Patients were genotyped for the major CYP2D6 and ABCB1 variants and phenotyped for CYP2D6 using urine DM/DOR metabolic ratios and blood samples for population pharmacokinetic modeling. RESULTS: Quinidine was effective in inhibiting CYP2D6 activity, with 2-fold reduction of DM to DOR biotransformation clearance, prolonged DM half-life, and increased DM systemic availability. Patients in the quinidine group required significantly less often NSAIDs than patients in the placebo group (35.3% vs. 75.0%, P = 0.022). The odds ratio for NSAID consumption in the placebo vs. quinidine group was 5.5 (95% confidence interval (CI) 1.3 - 22.7) at 48 hours after surgery. LIMITATIONS: While this study shows an impact of DM on pre-emptive analgesia and is mechanistically interesting, the findings need to be confirmed in larger trials. CONCLUSION: CYP2D6 inhibition by quinidine influenced the pre-emptive analgesic effectiveness of DM confirming that CYP2D6 phenotypic switch increases the neuromodulatory effect of oral dextromethorphan.

Accuracy of preparation of i.v. medication syringes for anesthesiology.

PURPOSE: The results of a study of the accuracy of i.v. medication preparation by anesthesiologists are presented. METHODS: The accuracy of syringe preparation was assessed by analyzing the contents of 500 unused syringes collected after adult and pediatric surgery procedures. The collected syringes contained various i.v. medication formulations representative of different preparation techniques: atracurium 1, 2.5, and 5 µg/mL and fentanyl 10, 20, 25, and 50 µg/mL, which required serial dilution after withdrawal of the drugs from ampuls; thiopental 5, 25, and 50 mg/mL, prepared by diluting reconstituted powdered drug from vials; and lidocaine 10-mg/mL solution, which was withdrawn directly from the ampul into a syringe. Variances between actual and labeled drug concentrations were determined via a validated ultraviolet-visible light spectro-photometry method. RESULTS: Overall, 29% of the evaluated syringes were found to contain drug concentrations outside the designated range of acceptability (±10% of the targeted concentration); 18% of preparations deviated from the declared dose by ±20%, 8% deviated by ±50%, and 4% deviated by ±100%. In one instance, the actual drug concentration was at variance with the labeled concentration by >100%. In 4% of cases (n = 20), discrepancies exceeded 100%, suggesting not just imprecision but errors in the preparation process, such as incorrect dilution calculations and selection of the wrong medication vial by the syringe preparer. CONCLUSION: Analysis of different i.v. formulations of four medications prepared in syringes by anesthesiologists revealed a high rate of discrepancies between ordered and actual drug concentrations, suggesting a need for increased institutional efforts to prevent errors during the preparation process.