The use of hypnosis in emergency medicine

Study protocol: hypnosis versus standard care for shoulder dislocation reduction in the emergency department - a multicentre, randomised, controlled study protocol

INTRODUCTION

Anterior shoulder dislocation is a common reason for consultation at the emergency department (ED). Hypnosis could be a safe and effective alternative therapy for pain relief during shoulder dislocation reduction but nowadays, evidence is not sufficient. The main objective of this study is to show that reduction under hypnosis is associated with a decrease in the use of analgesic compared with usual care.

METHODS AND ANALYSIS

We will conduct an interventional, controlled, multicentre, randomised study. A total of 44 patients with shoulder dislocation will be randomised in two groups: the hypnosis group (N=22) and the usual care group (N=22). The primary endpoint will be the comparison of morphine equivalent analgesic consumption during a shoulder dislocation reduction manoeuvre. Secondary endpoints will include haemodynamic parameters monitoring, patient and practitioner satisfaction using a Likert scale, use of coanalgesic or sedative drugs, number of reduction attempts and time spent at ED. Adverse events will be recorded. Statistical analysis will include parametric tests, multivariate linear regression and descriptive statistics.

ETHICS AND DISSEMINATION

This study has received ethics approval from the Comité de Protection des Personnes of Sud-Est IV on 03/11/2021 (ANSM informed on 19 November 2021). The results will be published in scientific articles and communicated in national and international conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrial.gov: NCT04992598; National Clinical trial no ID RCB : 2021-A01382-39.

Post-traumatic stress in the medical setting

This article addresses the prevalence of posttraumatic stress arising from serious illness and injury. Its purpose is to underscore the importance of assessment and treatment of this population. The article reviews literature about patient stress responses to intensive care experiences and hospitalization. Above all, serious illness and injury hamper the individual's ability to maintain their ongoing lifestyle and interpersonal relationships; the experience raises the specter of vulnerability and mortality and can obstruct the experience of a familiar "self". Issues to be assessed and areas to be addressed therapeutically using hypnosis are suggested.

Introducing Clinical Hypnosis to Dentists: Special Challenges and Strategies

Dentistry is a natural match for clinical hypnosis. The special characteristics and requirements of dental diagnostic and treatment processes offer daily opportunities for dentists and patients to replace anxiety, pain, and uncontrolled challenges with confidence, comfort, and fully controlled solutions. The ways in which hypnosis can be used in dentistry are reviewed. However, dentists have not as a profession readily accepted, studied, nor utilized hypnosis for their clinical practices. The reasons for this poor linkage are catalogued and explained to both dentist and nondentist readers. Strategies and suggestions are made for introducing clinical hypnosis to dentists so that they might more readily and fully integrate useful hypnotic techniques into their dental practices.

Pain and placebo in pediatrics: a comprehensive review of laboratory and clinical findings

Pain modulation by placebo mechanisms is one of the most robust and best-studied phenomena, yet almost all research investigating the mechanisms and implications of the placebo analgesia are based on adult research. After highlighting crucial aspects that need to be considered in studying pain modulation in children, this comprehensive review examines studies related to pain modulation with an emphasis on factors such as age, neural development and pain measures. We critically discuss psychological mechanisms underlying placebo effects, including (1) verbally induced expectations, (2) conditioning and learning mechanisms, and (3) child-parent-physician interactions. Taken together, research suggests that placebo mechanisms can affect therapeutic outcomes and potentially be exploited clinically to improve clinical outcomes in pediatric population. Recommendations for further investigating the mechanistic bases and harnessing placebo effects for supportive therapeutic applications are given.

An hypnotic suggestion: review of hypnosis for clinical emergency care

BACKGROUND

Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings.

OBJECTIVE

This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas.

DISCUSSION

A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems.

CONCLUSIONS

Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings.

Comment on Zimmerman's use of the river metaphor in irritable bowel syndrome treatment

The river approach has been used effectively in the treatment of irritable bowel syndrome within the U.K. National Health Service (Gonsalkorale, Houghton, & Whorwell, 2002; Whorwell, 2006) and in single case studies (Galovski & Blanchard, 2002; Zimmerman, 2003; Kraft & Kraft, 2007). Zimmerman (2003) pointed out that this metaphor was extremely powerful in that it linked the altered motility of the digestive system to an emotional disturbance: by encouraging his patient to imagine a smooth flowing river, he helped her to come to terms with her emotional conflict and, in turn, to experience normal gut activity. The author reviews this approach to treatment and offers an alternative which utilizes process suggestions, accessing questions and truisms while providing clients with the space to imagine their own tailor-made scene.

The impact of watching cartoons for distraction during painful procedures in the emergency department

OBJECTIVE

The purpose of this study was to determine whether the viewing of cartoons in the acute care setting reduces the perception of pain by pediatric patients.

METHODS

A convenience prospective study of pediatric patients in pain was performed at a community teaching level I pediatric and adult emergency department, with 44,000 patient visits per year. The inclusion criteria for entry into the study were any child who presented to the emergency department in acute pain from any cause. The younger children were randomized to watch a Barney cartoon in Spanish or English, and the older children were randomized to view a Tarzan cartoon in Spanish or English. The younger children were assessed 5 minutes before the procedure, during the procedure, and 5 minutes after the procedure using Poker Chip Tool and Faces Scale. The older children were assessed at the same time interval using self-reporting and a visual analog scale. The study was internal review board approved. A difference of 20% or greater was considered a significant difference. The data were analyzed using a general linear model-repeated measures a priori level of significance of P < 0.05.

RESULTS

There was a significant difference within subject effects: F(1)= 9.268, significant at 0.03, with observed power at 0.85 or 85%, with the α set at 0.05 or less. A comparison of the groups revealed that there were no differences in the causes of pain (F(1) = 0.301, P = 0.585), pain duration (F(1) = 0.062, P = 0.084), or type of anesthesia, if used (F(1) = 0.064, P = 0.804) between groups. This lack of difference was upheld for age (F(1) = 3.0407, P = 0.068), race (F(1) = 0.537, P = 0.466), and sex (F(1) = 0.002, P = 0.964).

CONCLUSIONS

The finding that cartoon viewing was effective does illustrate 1 more pain relief tool for use in the ED when pediatric patients present. It is useful because of the fact that it does not interfere with assessment of patients' presenting or underlying problems. The need for more ways in which to address pediatric pain persists.

Practitioner review: clinical applications of pediatric hypnosis

BACKGROUND

Over the past quarter century, hypnosis has been employed in a broad range of pediatric clinical settings; however, its efficacy and feasibility as a treatment approach for children and adolescents remain in question.

METHOD

Published studies on the role of clinical hypnosis in the management of specific pediatric medical and psychological conditions were identified and reviewed.

RESULTS

Pediatric clinical hypnosis has been employed in diverse medical settings to treat primary conditions (e.g., enuresis), as well as to address factors related to management of the condition (e.g., skills training for asthma) or its treatment (e.g., burn dressing changes). Despite great breadth to the possible applications of pediatric hypnosis and many reported successes, much of the present research comprises case histories and small, uncontrolled group studies.

CONCLUSION

To date, research in pediatrics views clinical hypnosis as a promising tool with the potential to help manage a variety of conditions. However, additional research, particularly utilizing randomized, controlled methodologies and adequate sample sizes, is required.

Hypnosis in contemporary medicine

Hypnosis became popular as a treatment for medical conditions in the late 1700s when effective pharmaceutical and surgical treatment options were limited. To determine whether hypnosis has a role in contemporary medicine, relevant trials and a few case reports are reviewed. Despite substantial variation in techniques among the numerous reports, patients treated with hypnosis experienced substantial benefits for many different medical conditions. An expanded role for hypnosis and a larger study of techniques appear to be indicated.

Perioperativer Einsatz von medizinischer Hypnose

BACKGROUND

Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient.

PATIENTS AND METHODS

During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis.

RESULTS

Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable.

CONCLUSION

Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.

Reflections on hypnotizability and its impact on successful surgical hypnosis: a sole anesthetic for septoplasty

While hypnosis has been a significant medical tool through the ages, its use has been, at best, capricious. After the development and widespread use of ether, hypnosis has been mostly relegated to the role of an adjunct to chemical anesthesia. The present paper describes a case where hypnosis was used as the sole anesthetic for a septoplasty. The chronology of the surgery, hypnotic suggestion and strategies used as well as the clinician's responses are described. The paper highlights relevant clinical issues such as the hypnotic capacity of the patient, associated hypnotic phenomena, enhancing trance, and maximizing the hypnotic capacity by "meeting them where they are."

Paranormal phenomena in the medical literature sufficient smoke to warrant a search for fire

Paranormal phenomena - events that cannot be explained by existing science - are regularly reported in medicine. Surveys have shown that a majority of the population of the United States and Great Britain hold at least one paranormal belief. Information was retrieved by MEDLINE searches using keywords 'paranormal' and 'psychic', and from the author's own collection. Reports are predominantly by physicians, and from peer-reviewed, MEDLINE-indexed literature. This is a representative sample, as there is no database for paranormal medical phenomena. Presented and discussed are: a case of systemic lupus erythematosis ameliorated by witchcraft; an analysis of studies on distant healing; acupuncture, as a bridge between what is now accepted but recently would have been deemed paranormal; a carefully-done study of a psychic; auditory hallucinations informing a patient, correctly, that she had a brain tumor; two nearly-identical lay press reports of self-predicted death; lycanthropy (the delusion of being an animal); the development of Carl Jung's collective unconscious; hypnosis - still questioned despite documented therapeutic benefit, and a well-researched report of a person speaking a foreign language, apparently unlearned (xenoglossy) while hypnotized; and multiple examples of children who spout the details of the life of an unknown, deceased person. The inability of existing paradigms to explain these observations does not negate them; rather, it elucidates a need for more research.