Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients

Feasibility of a Self-Administered Hypnosis Intervention for Improving Sleep in College Students

Approximately two out of three college students report experiencing suboptimal sleep quality. The aim of this study was to examine the feasibility of a self-administered hypnosis intervention to improve sleep in college students. Twenty-two college students who self-reported poor sleep quality were enrolled in a 4-week study comprising 1 baseline week and a 3-week self-administered hypnosis intervention. Sleep onset latency and sleep efficiency as measured by wrist actigraphy were significantly improved. The mean average nightly sleep duration during the baseline week was 398.88 minutes (SD = 56.44), which increased to a mean of 413.88 minutes (SD = 57.80) during the 3rd week of intervention. However, the results show that there was no statistically significant difference between weeks on objective nightly sleep duration, 95% CI [-11.13, 41.13], t(15) = 1.224, p = .240. Also, results showed that there was no significant difference between weeks on self-reported nightly sleep duration, F(3, 57) = 2.155, p = .103. Twenty participants (91%) completed the study intervention and adherence to daily self-hypnosis practice with an audio recording was high. Zero study-related adverse events were reported, and participants perceived the intervention as easy to use and helpful for improving sleep. These results provide evidence for the feasibility and safety of a self-administered hypnosis intervention to improve sleep in college students. A larger randomized clinical trial is warranted to determine efficacy.

Hypnosis as an alternative to general anaesthesia for paediatric superficial surgery: a randomised controlled trial

BACKGROUND

Reducing perioperative anxiety and controlling pain in children are essential to optimise recovery and outcomes for both children and their parents. By acting on sensory and affective modulation of anxiety and pain, hypnosis is widely used in medical care, especially in anaesthesia. This randomised controlled clinical trial was designed to compare general anaesthesia and intraoperative hypnosis support for perioperative management of children undergoing superficial surgery.

METHODS

Children aged 7-16 yr scheduled for day-case superficial surgery were included and randomly assigned to one of the following two groups: general anaesthesia group or hypnosis group. The primary outcome was length of hospital stay. Child and parent anxiety, child pain, and the occurrence of postoperative negative behavioural changes were also evaluated.

RESULTS

Sixty children of mean age 10.3 (standard deviation: 2.6) yr were enrolled in the study. Hypnosis was successful in all but one case. The median (25th-75th percentile) length of hospital stay was shorter in the hypnosis group (120 [95-145] vs 240.5 [218-275] min; P<0.001). The general anaesthesia group was associated with a greater incidence of high levels of preoperative anxiety in children (30 vs 11%; P=0.001) and parents (55 vs 30%; P=0.05). Pain scores did not differ between groups. No negative postoperative behavioural changes were reported.

CONCLUSIONS

In children aged 7-16 yr, hypnosis appears to be feasible and accepted. The quality of the perioperative experience and the rapid recovery support the use of hypnosis as an effective and safe alternative to general anaesthesia for paediatric superficial surgery.

CLINICAL TRIAL REGISTRATION

NCT02505880.

Applications of Hypnosis as an Adjuvant in Oncological Settings: A Systematic Review

Previous research has shown promising results in using hypnosis to treat various symptoms and side effects of medical treatments. The objective was to identify studies that use hypnosis as an adjuvant to evidence-based treatments to evaluate its benefits in patients with cancer. The search identified 873 articles published between 2000 and February 2021, of which 22 were selected using the principles of the PRISMA. Apart from 1 study, all studies showed that interventions improved the measured variables compared to a control group. Most studies showed that hypnosis has positive effects on reducing anxiety, pain, nausea, fatigue, drug use, and length of hospital stays. Hypnosis also improves depressive symptoms, insomnia, hot flashes, well-being, and quality of life, and helps increase adherence to treatment. When used by qualified professionals as an adjuvant to well-established treatments, hypnosis improves symptoms caused by oncological interventions and the disease itself. In addition, hypnosis has no side effects.

Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline

PURPOSE

The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer.

METHODS

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 227 relevant studies to inform the evidence base for this guideline.

RECOMMENDATIONS

Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.

Hypnosis and cognitive behavioral therapy with online sessions to reduce fatigue in patients undergoing chemotherapy for a metastatic colorectal cancer: Rational and study protocol for a feasibility study

Background

In metastatic colorectal cancer (CRCm), fatigue is pervasive, reduces quality of life, and is negatively associated with survival. Its course is explained in part by psychosocial variables such as emotional distress, coping strategies, or perceived control. Thus, to reduce fatigue, psychosocial interventions appear to be relevant. In some cancers, Cognitive Behavioral Therapies (CBT) reduce fatigue. Hypnosis is also used as a complementary therapy to reduce the side effects of cancer. While CBT requires specific training often reserved for psychologists, hypnosis has the advantage of being increasingly practiced by caregivers and is therefore less expensive (Montgomery et al., 2007). On the other hand, CBT and hypnosis remain understudied in the CRC, do not focus on the symptom of fatigue and in Europe such programs have never been evaluated.

Objectives

Implementing an intervention in a healthcare setting is complex (e.g., economic and practical aspects) and recruiting participants can be challenging. The primary objective will therefore be to study the feasibility of two standardized interventions (hypnosis and CBT) that aim to reduce fatigue in patients with CRCm treated in a French cancer center.

Methods and design

A prospective, single-center, randomized interventional feasibility study, using mixed methods (both quantitative and qualitative). A total of 60 patients will be allocated to each intervention group [Hypnosis (n = 30) and CBT (n = 30)]. Participants will be randomized into two parallel groups (ratio 1:1). Both programs will consist of 6 weekly sessions focusing on the CRF management over a period of 6 weeks. Trained therapists will conduct the program combining 3 face-to-face sessions and 3 online sessions. The feasibility and experience of interventions will be evaluated by the outcome variables, including the adhesion rate, the reasons for acceptability, relevance or non-adherence, the satisfaction, the fatigue evolution (with ecological momentary assessments), and the quality of life. All questionnaires will be self-assessment using an online application from the cancer center.

Discussion

Results will highlight the barriers/facilitators to the implementation of the program and the relevance of the program to the patients, and will be used to generate hypotheses for a randomized control trial.

Clinical trial registration

ClinicalTrials.gov Identifier: NCT04999306; https://clinicaltrials.gov/ct2/show/NCT04999306.

Clinical Hypnosis in Medical Care: A Mixed-Method Feasibility Study

Background

Preoperative hypnosis has shown promising effects in controlling side effects from breast cancer surgery, but the feasibility and effects are largely unknown outside the US.

Methods

A mixed-methods approach was applied involving a large-scale population survey and a small-scale pilot study. The survey assessed attitudes toward hypnosis in a representative sample from the general population (n = 1049), while the pilot study involved interviews with 5 women who received hypnosis prior to mastectomy/lumpectomy.

Results

In the survey, 8% reported to have previous experience with hypnosis, and 67% reported willingness to accept hypnosis in a medical setting. Increasing age was associated with more skepticism, while previous experience was associated with less skepticism. In the pilot study, 4 themes were identified: (1) caretaking, (2) experiences related to hypnosis, (3) thoughts and feelings related to diagnosis, and (4) surgery. All participants reported positive experiences related to hypnosis, and none described unpleasant side effects or postoperative pain (pain intensity > 3) after surgery.

Conclusions

The results indicate that the general public is positive toward clinical hypnosis as a supplement to medical treatment and that preoperative hypnosis is feasible in Norwegian breast cancer patients.

Trial Registration

ClinicalTrials.gov Identifier: NCT04300283.

Pilot randomized controlled trial of a hypnosis intervention for women with bladder pain syndrome

AIMS

To evaluate the feasibility and acceptability of a randomized controlled trial of a hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in women.

METHODS

We conducted a parallel arm, non-blinded, pilot randomized controlled trial of standardized hypnosis sessions including a hypnosis web tool versus usual care in adult women with BPS/IC. Pilot study outcomes included feasibility domains: process, resources and management, safety, and acceptability. Clinical outcomes of lower urinary tract symptoms and quality of life were measured using validated questionnaires at baseline and at the end of the 4-week intervention.

RESULTS

We randomized 29 out of 30 (96.7%) eligible women. In the hypnosis group, 12 of 15 (80.0%) subjects completed the 4-week intervention and follow up, and 13 of 14 (92.9%) in the usual care group. In the hypnosis group, adherence to the standardized sessions was 80% and participants used the web-based tool for an average of 5.6 ± 2.7 times per week. Scores for emotional distress, relaxation, pain severity and expected bladder symptoms significantly improved during the first two of three planned hypnosis sessions (all p < 0.05). Improvement in quality of life scores was greater in the hypnosis group than the usual care group (-2.6 ± 2.3 vs. -0.9 ± 1.1, p = 0.04). There were no significant between-group differences in urinary symptoms or bladder pain. No adverse events were reported.

CONCLUSIONS

A hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis is feasible, acceptable, safe, and may improve quality of life.

Hypnosis Sedation Reduces the Duration of Different Side Effects of Cancer Treatments in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

Simple Summary

Reducing side effects of cancer treatments is a major challenge for clinicians involved in the management of breast cancer patients. Among patients receiving neoadjuvant chemotherapy followed by surgery, radiotherapy and endocrine therapy, prolonged side effects frequently mentioned are: polyneuropathy, musculoskeletal pain, postoperative pain and cancer-related fatigue. Conventional drugs have proven to be ineffective in treating theses effects, except for postoperative pain. This is the reason why we prospectively tested the impact of hypnosis sedation used as anesthetic technique for breast cancer surgery on the different side effects of cancer treatment. Despite the limitations of this small non-randomized cohort, preliminary results are very encouraging.

Abstract

Background: Reducing side effects of cancer treatments is a major challenge for clinicians involved in the management of breast cancer patients. Methods: We analyzed data from 63 patients (32 in the general anesthesia group and 31 in the hypnosis sedation group) who were included in 1 prospective non-randomized trial evaluating hypnosis sedation in breast cancer treatment. The patients were followed every 3 months for 2 years. All patients received neoadjuvant chemotherapy with 4 cycles of epirubicin and cyclophosphamide followed by taxanes. Thereafter, patients underwent surgery while on general anesthesia or while on hypnosis sedation. Radiotherapy was administered according to institutional guidelines. Endocrine therapy was prescribed if tumors expressed hormone receptors. Prevalence, intensity and duration of polyneuropathy, musculoskeletal pain, postoperative pain and cancer-related fatigue were assessed at each medical visit. Results: Symptoms duration was statistically reduced for polyneuropathy (p < 0.05), musculoskeletal pain (p < 0.05) postoperative pain and cancer-related fatigue (p < 0.05) in the hypnosis group. Conclusion: Despite the limitations of this study (lack of randomization and small size) we conclude that hypnosis sedation may exert a role on different side effects of breast cancer treatment in patients receiving neoadjuvant chemotherapy, mainly by reducing their duration.

Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis

This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen's guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials-the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.

Impact of Perioperative Hypnosedation on Postmastectomy Chronic Pain: Preliminary Results

Objectives: The main aim of this prospective nonrandomized study was to evaluate if mastectomy performed with perioperative hypnosedation led to a lower incidence of chronic pain compared with mastectomy under general anesthesia. Methods: Forty-two breast cancer patients who underwent mastectomy either under GA (GA group, n = 21) or HYP (HYP group, n = 21) associated with local and/or regional anesthesia were included. The type of adjuvant therapy as well as the number of reconstructive surgical procedures were well balanced between the 2 groups. The average age of the patients and the type of axillary surgery were also equivalent. Incidence of postmastectomy chronic pain, lymphedema, and shoulder range of motion (ROM) were evaluated after a mean 4-year follow-up. Results: The study shows a statistically significant lower incidence of postmastectomy chronic pain in HYP group (1/21, 1 patient out of 21 experiencing pain) compared with GA group (9/21) with 9 patients out of 21 experiencing pain (P = .008). ROM for shoulder was also less frequently affected in the hypnosedation group, as only 1 patient had decreased ROM, instead of 7 in the other group (P = .04). Conclusions: Our study is the first to hint at the potential benefits of hypnosedation on postmastectomy chronic pain. Despite the limitations of this study (nonrandomized, small sample), preliminary results merit further study of hypnosedation.

Hypnotherapy in management of delivery pain: a review

Hypnosis in obstetrics is available for more than one hundred years, but the development of inhalational anesthetic and chemotherapy agents and anesthesia drugs pending the 19th century induced the decrement of its application. However, experimental assessment of this type of intervention on labor and delivery in not high yet. For this reason, evaluation of hypnotic techniques in preparing childbirth should be carried out. One of the main unified mind-body healing practices, which has a great remedial potential in different applications of health care like labor and delivery. Assessment of effectiveness of this procedure in various administered trials is not easy, due to methodologic challenges, like normalizing trial conditions and picking up sufficient sizes of sample. Applying techniques of hypnosis for childbirth within hospital settings makes women to easily overcome barriers associated with institutional policies or caregiver resistance. Potential analgesic and anxiolytic clinical hypnosis effects for childbirth deserve more clinical trials. In this regard, nurses who manage women pending labor and delivery could easily enhance their skills and related understandings for contributing to techniques of hypnotherapy.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.

The Evolution of Hypnosis in the Profession of Nursing: We've Come a Long Way, Baby, and Still Have a Long Way to Go

Registered nurses (RNs) are the largest, most diverse, and most respected of all healthcare professions in the United States, numbering over 3.5 million (Gallup poll, 2017). Nurses have evolved from being the handmaidens of physicians and bedpan handlers to highly trained and educated clinicians who have assumed an important, integral, and indispensable role in the healthcare system. The capabilities of nurses to expand the excellent care they can provide has historically been thwarted by others in the healthcare field, including in the area of hypnosis. This article begins with a historical perspective on the education, training, and ever-expanding profession of nursing. The multiplicity of settings where nurses have the opportunity to incorporate clinical hypnosis into the care of their patients is discussed.

Positive effects of acupressure bands combined with relaxation music/instructions on patients most at risk for chemotherapy-induced nausea

PURPOSE

Research by our group has shown that acupressure bands are efficacious in reducing chemotherapy-induced nausea (CIN) for breast cancer patients who expect nausea, and that their effectiveness in controlling CIN can largely be accounted for by patients' expectations of efficacy, i.e., a placebo effect. The present research examined if the effectiveness of acupressure bands could be enhanced by boosting patients' expectation of the bands' efficacy.

METHODS

Two hundred forty-two chemotherapy-naïve patients with breast cancer who expected nausea were randomized. Arms 1 and 2 received acupressure bands, plus a relaxation MP3 and written handout that were either expectancy-enhancing (arm 1) or expectancy-neutral (arm 2). Arm 3 was the control without bands or MP3 and received standard care. All participants received guideline-specified antiemetics.

RESULTS

Peak CIN for arms 1, 2, and 3 on a 1-7 scale was 3.52, 3.55, and 3.87, respectively (p = 0.46). Because no differences were observed between arms 1 and 2 (primary analysis), we combined these two arms (intervention) and compared them to controls for the following analyses. A significant interaction was found between intervention/control and receiving doxorubicin-based chemotherapy (yes/no) and pre-treatment anxiety (high/low). Intervention patients receiving doxorubicin had lower peak CIN than controls (3.62 vs. 4.38; p = 0.02). Similarly, intervention patients with high pre-treatment anxiety had a lower peak CIN than controls (3.62 vs. 4.62; p = 0.01).

CONCLUSIONS

In breast cancer patients undergoing chemotherapy and having high CIN expectation, acupressure bands combined with a relaxation recording were effective in reducing CIN for patients who received doxorubicin or had high anxiety.

Clinical Hypnosis and Music In Breast Biopsy:A Randomized Clinical Trial

A randomized clinical study was conducted to evaluate the effects on anxiety, depression, stress and optimism levels of an audio-recorded clinical hypnosis intervention and a music session and compare them with a control group in women scheduled for breast biopsy. We analyzed the data of 170 patients with an average age of 47 years, who were randomly assigned to each of the groups. The psychosocial variables were measured in three moments: baseline, which corresponds to the period before the intervention with hypnosis, music or waiting in the room before biopsy; a second measurement after the interventions and a third measurement after the breast biopsy procedure was finished. The results showed a statistically significant reduction in the stress (p < .001, η²p = .06); pain, (p < .01, η²p = .04); anxiety, (p < .001, ƞ²p = .07) and depression, (p < .001, ƞ²p = .05) in hypnosis and music groups compared with the control group. Before biopsy, hypnosis decrease significantly pain and depression levels compared with music, but after biopsy there were no differences between both groups. It is recommended to use audio-recorded hypnosis and music interventions to reduce physical and emotional discomfort during the biopsy procedure and to improve the quality of life of patients with suspected breast cancer.

A Meta-Analysis of Hypnotic Interventions for Depression Symptoms: High Hopes for Hypnosis?

This meta-analysis quantifies the effectiveness of hypnosis for treating the symptoms of depression. To be included in the meta-analysis, studies were required to use a between-subjects or mixed-model design in which a hypnotic intervention for depression was compared with a control condition in reducing depression symptoms. Of 197 records screened, 10 studies incorporating 13 trials of hypnosis met the inclusion criteria. The mean weighted effect size for 13 trials of hypnosis at the end of active treatment was 0.71 (p ≤ .001), indicating the average participant receiving hypnosis showed more improvement than about 76% of control participants. The mean weighted effect size for four trials of hypnosis at the longest follow-up was 0.52 (p ≤ .01), indicating the average participant treated with hypnosis showed more improvement than about 51% of control participants. These effect sizes are comparable to those associated with well-known psychological interventions for depression (e.g., Beck's cognitive therapy, interpersonal therapy) and suggest hypnosis is a very effective way of alleviating the symptoms of depression. Clinicians may wish to give serious consideration to hypnosis as a treatment option when working with clients and patients who are depressed.

Hypnosis as adjunct therapy to conscious sedation for venous access device implantation in breast cancer: A pilot study

BACKGROUND

Recent reviews support that hypnosis has great potential for reducing pain and anxiety during mini-invasive surgery. Here, we assessed the feasibility of hypnotic induction session as adjunct therapy in conscious sedation for venous access device implantation. Primary outcomes were safety and patient satisfaction.

METHODS

Thirty consecutive women with breast cancer were proposed adjunct of hypnosis before implantation under conscious sedation (midazolam: 0.5 mg ± bolus of Ketamin: 5 mg on demand) indicated for chemotherapy. Self-hypnosis was programmed and guided by one of two trained anesthesiologists. Implantation was performed by one of two experimented surgeons. It consisted of blind subclavian implantation of Braun ST 305 devices using a percutaneous technique adapted from Selinger's procedure. Clinical data were prospectively collected and retrospectively analyzed. A comprehensive custom-made questionnaire recorded patient satisfaction.

RESULTS

In all, 30/30 patients consented to the procedure. The median age was 54 years (range: 35-77 years). The primary procedure was successful in 29/30. One case was converted into internal jugular vein access after a first attempt. Median length time of the implantation procedure in the operative room was 20 min (range: 10-60 min). Median length time in the recovery room preceding home discharge was 65 min (range: 15-185 min). None of the patients suffered complications. The satisfaction rate was ≥90%, 27/30 patients would get hypnosis in case of reimplantation if necessary and 27/30 would recommend this procedure to others.

CONCLUSION

Hypnosis under conscious sedation appears feasible and safe for port implantation under conscious sedation in cancer patients. Further studies would determine the exact value of hypnosis effectiveness.

Hypnotherapy to Reduce Hot Flashes: Examination of Response Expectancies as a Mediator of Outcomes

The mechanism of action responsible for hypnotherapy's effect in reducing hot flashes is not yet known. The purpose of this study was to examine the role of response expectancies as a potential mediator. Hypnotizability was also tested as an effect moderator. Data were collected from a sample of 172 postmenopausal women, who had been randomized to receive either a 5-week hypnosis intervention or structured attention counseling. Measures of response expectancies were analyzed to determine if the relationship between group assignment and hot flashes frequency was mediated by expectancies for treatment efficacy. A series of simple mediation and conditional process analyses did not support mediation of the relationship between treatment condition and hot flash frequency through response expectancy. The effect of hypnotherapy in reducing hot flashes does not appear to be due to placebo effects as determined by response expectancies. Implications for clinical practice and future research are discussed.

Future-Focused Therapeutic Strategies for Integrative Health

For many years, the therapy field was dominated by a focus on the past. In this context, many clinicians were trained to use hypnosis as a tool to explore the past, and there is a rich literature documenting the use of hypnosis as a tool to induce age regression and the uncovering of traumatic memories. This article presents a therapeutic paradigm that focuses on the future. Hypnosis is used to induce creativity, flexibility, and openness to the future. In the context of health care, hypnosis is used to explore the best possible treatment outcome, which may be pharmacological, surgical, or a combination of both as well as other nonsurgical interventions. This article elaborates on the effective use of a therapeutic hypnosis strategy and technique focused on the future.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.

Does expecting more pain make it more intense? Factors associated with the first week pain trajectories after breast cancer surgery

We studied postoperative pain trajectories and associated factors. Expectation of severe postoperative pain was associated with higher intensity of experimental and postoperative pain.

The aim of this study was to identify clinical risk factors for unfavorable pain trajectories after breast cancer surgery, to better understand the association between pain expectation, psychological distress, and acute postoperative pain. This prospective study included 563 women treated for breast cancer. Psychological data included questionnaires for depressive symptoms and anxiety. Experimental pain tests for heat and cold were performed before surgery. The amount of oxycodone needed for satisfactory pain relief after surgery was recorded. Pain intensity in the area of operation before surgery and during the first postoperative week and expected intensity of postoperative pain were recorded using the Numerical Rating Scale (NRS 0-10). Pain trajectories were formed to describe both initial intensity (the intercept) and the direction of the pain path (the slope). Factors associated with higher initial pain intensity (the intercept) were the amount of oxycodone needed for adequate analgesia, psychological distress, type of axillary surgery, preoperative pain in the area of the operation, and expectation of postoperative pain. The higher the pain initially was, the faster it resolved over the week. Expectation of severe postoperative pain was associated with higher scores of both experimental and clinical pain intensity and psychological factors. The results confirm that acute pain after breast cancer surgery is a multidimensional phenomenon. Psychological distress, pain expectation, and the patients' report of preoperative pain in the area to be operated should be recognized before surgery. Patients having axillary clearance need more efficient analgesic approaches.

Expectations predict chronic pain treatment outcomes

Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.

Use of a Numeric Visual Analog Anxiety Scale Among Patients Undergoing Colorectal Surgery

The aim of this study was to evaluate the utility of a Numeric Visual Analog Anxiety Scale (NVAAS) as a potentially accurate and efficient way to determine presurgery anxiety among patients undergoing colorectal surgery. A secondary aim was to determine the relationship between NVAAS ratings of anxiety and postsurgery pain. Thirty-six patients scheduled for colorectal surgery were asked to rate their state anxiety on the NVAAS and to complete the State-Trait Anxiety Inventory (STAI). The NVAAS correlated significantly with STAI-state anxiety (0.64,p < .0001). The NVAAS measure of presurgery anxiety also correlated significantly with STAI-trait anxiety (0.46,p < .005) and postsurgery Visual Analog Scale pain ratings (0.35,p <.038). The NVAAS appears to be a valid and sensitive measure of anxiety among patients undergoing colorectal surgery. The NVAAS also has the advantage of being convenient and easy to use at bedside, increasing its clinical utility in medical nursing care.

Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia

BACKGROUND

In a review and meta-analysis conducted in 1993, psychological preparation was found to be beneficial for a range of outcome variables including pain, behavioural recovery, length of stay and negative affect. Since this review, more detailed bibliographic searching has become possible, additional studies testing psychological preparation for surgery have been completed and hospital procedures have changed. The present review examines whether psychological preparation (procedural information, sensory information, cognitive intervention, relaxation, hypnosis and emotion-focused intervention) has impact on the outcomes of postoperative pain, behavioural recovery, length of stay and negative affect.

OBJECTIVES

To review the effects of psychological preparation on postoperative outcomes in adults undergoing elective surgery under general anaesthetic.

SEARCH METHODS

We searched the Cochrane Register of Controlled Trials (CENTRAL 2014, Issue 5), MEDLINE (OVID SP) (1950 to May 2014), EMBASE (OVID SP) (1982 to May 2014), PsycINFO (OVID SP) (1982 to May 2014), CINAHL (EBESCOhost) (1980 to May 2014), Dissertation Abstracts (to May 2014) and Web of Science (1946 to May 2014). We searched reference lists of relevant studies and contacted authors to identify unpublished studies. We reran the searches in July 2015 and placed the 38 studies of interest in the `awaiting classification' section of this review.

SELECTION CRITERIA

We included randomized controlled trials of adult participants (aged 16 or older) undergoing elective surgery under general anaesthesia. We excluded studies focusing on patient groups with clinically diagnosed psychological morbidity. We did not limit the search by language or publication status. We included studies testing a preoperative psychological intervention that included at least one of these seven techniques: procedural information; sensory information; behavioural instruction; cognitive intervention; relaxation techniques; hypnosis; emotion-focused intervention. We included studies that examined any one of our postoperative outcome measures (pain, behavioural recovery, length of stay, negative affect) within one month post-surgery.

DATA COLLECTION AND ANALYSIS

One author checked titles and abstracts to exclude obviously irrelevant studies. We obtained full reports of apparently relevant studies; two authors fully screened these. Two authors independently extracted data and resolved discrepancies by discussion.Where possible we used random-effects meta-analyses to combine the results from individual studies. For length of stay we pooled mean differences. For pain and negative affect we used a standardized effect size (the standardized mean difference (SMD), or Hedges' g) to combine data from different outcome measures. If data were not available in a form suitable for meta-analysis we performed a narrative review.

MAIN RESULTS

Searches identified 5116 unique papers; we retrieved 827 for full screening. In this review, we included 105 studies from 115 papers, in which 10,302 participants were randomized. Mainly as a result of updating the search in July 2015, 38 papers are awaiting classification. Sixty-one of the 105 studies measured the outcome pain, 14 behavioural recovery, 58 length of stay and 49 negative affect. Participants underwent a wide range of surgical procedures, and a range of psychological components were used in interventions, frequently in combination. In the 105 studies, appropriate data were provided for the meta-analysis of 38 studies measuring the outcome postoperative pain (2713 participants), 36 for length of stay (3313 participants) and 31 for negative affect (2496 participants). We narratively reviewed the remaining studies (including the 14 studies with 1441 participants addressing behavioural recovery). When pooling the results for all types of intervention there was low quality evidence that psychological preparation techniques were associated with lower postoperative pain (SMD -0.20, 95% confidence interval (CI) -0.35 to -0.06), length of stay (mean difference -0.52 days, 95% CI -0.82 to -0.22) and negative affect (SMD -0.35, 95% CI -0.54 to -0.16) compared with controls. Results tended to be similar for all categories of intervention, although there was no evidence that behavioural instruction reduced the outcome pain. However, caution must be exercised when interpreting the results because of heterogeneity in the types of surgery, interventions and outcomes. Narratively reviewed evidence for the outcome behavioural recovery provided very low quality evidence that psychological preparation, in particular behavioural instruction, may have potential to improve behavioural recovery outcomes, but no clear conclusions could be reached.Generally, the evidence suffered from poor reporting, meaning that few studies could be classified as having low risk of bias. Overall,we rated the quality of evidence for each outcome as 'low' because of the high level of heterogeneity in meta-analysed studies and the unclear risk of bias. In addition, for the outcome behavioural recovery, too few studies used robust measures and reported suitable data for meta-analysis, so we rated the quality of evidence as `very low'.

AUTHORS' CONCLUSIONS

The evidence suggested that psychological preparation may be beneficial for the outcomes postoperative pain, behavioural recovery, negative affect and length of stay, and is unlikely to be harmful. However, at present, the strength of evidence is insufficient to reach firm conclusions on the role of psychological preparation for surgery. Further analyses are needed to explore the heterogeneity in the data, to identify more specifically when intervention techniques are of benefit. As the current evidence quality is low or very low, there is a need for well-conducted and clearly reported research.

Hypnosis for Acute Procedural Pain: A Critical Review

Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

Clinical Study: Change in Outlook Towards Birth After a Midwife Led Antenatal Education Programme Versus Hypnoreflexogenous Self-Hypnosis Training for Childbirth

Aim: To compare the change of maternal outlook towards birth due to a midwife led antenatal education programme versus hypnoreflexogenous self-hypnosis training for childbirth. Method: Before beginning of the classes and after the last class maternal perception on birth was evaluated using Osgood semantic differential questionnaire. The Gießen personality score was evaluated once. Results: 213 patients were enrolled in this study. 155 were in the midwife led education programme and 58 in the self-hypnosis training programme. There was no statistically significant difference between the two groups in regard of participants' characteristics, Gießen personality score and initial Osgood semantic differential scores. After the midwife led course childbirth was emotionally more negatively scored (displeasure, tarnishing, dimension evaluation [p < 0.05]), whereas after the hypnosis course childbirth was emotionally more positively evaluated (pleasure, harmony, dimension evaluation [p < 0.01] and brightness [p < 0.05]). Summary: In this study hypnoreflexogenous self-hypnosis training resulted in a positive maternal outlook towards childbirth, in comparison to the midwife led course. Further prospective randomised studies are required to test these initial results.

Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer

BACKGROUND

The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies.

METHODS

Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system.

RESULTS

The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).

CONCLUSIONS

Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.

Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam

BACKGROUND

Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE.

DESIGN AND SETTINGS

A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey.

METHODS

A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented.

RESULTS

Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P < .05 and P < .001, respectively).

CONCLUSION

Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

Mechanisms of hypnosis: toward the development of a biopsychosocial model

Evidence supports the efficacy of hypnotic treatments, but there remain many unresolved questions regarding how hypnosis produces its beneficial effects. Most theoretical models focus more or less on biological, psychological, and social factors. This scoping review summarizes the empirical findings regarding the associations between specific factors in each of these domains and response to hypnosis. The findings indicate that (a) no single factor appears primary, (b) different factors may contribute more or less to outcomes in different subsets of individuals or for different conditions, and (c) comprehensive models of hypnosis that incorporate factors from all 3 domains may ultimately prove to be more useful than more restrictive models that focus on just 1 or a very few factors.

Hypnosis in breast cancer care: a systematic review of randomized controlled trials

INTRODUCTION

Many breast cancer patients and survivors experience pain and emotional stress related to their disease, its diagnostic procedures, or treatment. Hypnosis has long been used for the treatment of such symptoms. The aim of this review was to systematically assess the effectiveness of hypnosis in women with breast cancer, breast cancer survivors, and in women undergoing diagnostic breast biopsy.

METHODS

PubMed, Scopus, the Cochrane Library, PsycINFO, and CAMBASE were screened through February 2014 for randomized controlled trials (RCTs) of hypnosis in women with breast cancer or undergoing diagnostic breast biopsy. RCTs on postmenopausal women without a history of breast cancer were also eligible. Primary outcomes were pain, distress, fatigue, nausea/vomiting, and hot flashes. Safety was defined as secondary outcome measure. Risk of bias was assessed by 2 reviewers independently using the Cochrane Risk of Bias Tool.

RESULTS

Thirteen RCTs with 1357 patients were included. In women undergoing diagnostic breast biopsy (3 RCTs), hypnosis positively influenced pain and distress; 1 RCT on breast cancer surgery found effects of hypnosis on pain, distress, fatigue, and nausea. For women undergoing radiotherapy (3 RCTs), hypnosis combined with cognitive-behavioral therapy improved distress and fatigue. In 3 RCTs on women with and without a history of breast cancer experiencing hot flashes, hypnosis improved hot flashes and distress. Three RCTs on women with metastatic breast cancer found effects on pain and distress.

CONCLUSIONS

This systematic review found sparse but promising evidence for the effectiveness of hypnosis in breast cancer care. While more research is needed to underpin these results, hypnosis can be considered as an ancillary intervention in the management of breast cancer-related symptoms.

Pre-biopsy psychological factors predict patient biopsy experience

BACKGROUND

Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort).

PURPOSE

The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes.

METHODS

Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure).

RESULTS

The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort.

CONCLUSIONS

Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.

The experience of pain and anxiety in rectal cancer patients during high-dose-rate brachytherapy

BACKGROUND

Pain and anxiety have been reported as primary concerns for patients with head-and-neck, gynecologic, and prostate cancers undergoing high dose rate (hdr) brachytherapy. However, almost no research has been published on the degree to which these symptoms are experienced by rectal cancer patients undergoing hdr brachytherapy. We conducted a pilot study examining the experiences of rectal cancer patients during hdr brachytherapy, specifically the intensity and trajectory of their anxiety and pain.

METHODS

Rectal cancer patients (n = 25) who received hdr brachytherapy treatment at a hospital in Montreal, Quebec, completed verbal analog scales for pain and anxiety at 4 time points over 4 treatment days.

RESULTS

On all 4 days, a subset of patients reported moderate-to-severe anxiety before applicator insertion. Pain increased significantly from the time patients were lying on the table to immediately after insertion of the applicator (p < 0.001). Insertion of the applicator appears to be the most painful part of the procedure, and although anxiety declined to below baseline after applicator removal, pain remained somewhat elevated. Some patients required conscious sedation; however, reports of moderate-to-severe pain were more frequent from patients who received pain medications than from patients who did not receive such medication (p < 0.05).

CONCLUSIONS

Most patients with rectal cancer tolerated hdr rectal brachytherapy well, although the procedure is stressful and painful for some. Insertion of the applicator was found to be the point of maximal pain, and medication was not always completely successful at alleviating the pain, suggesting that additional psychosocial interventions might be needed, with particular emphasis on the time of applicator insertion.

Disseminating hypnosis to health care settings: Applying the RE-AIM framework

Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM).

REACH

In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems.

EFFICACY

There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome.

ADOPTION

Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do.

IMPLEMENTATION

Hypnosis is a brief intervention capable of being administered effectively by healthcare providers.

MAINTENANCE

Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination.

Hypnosis before diagnostic or therapeutic medical procedures: a systematic review

The aim of this systematic review was to estimate the efficiency of hypnosis prior to medical procedures. Different databases were analyzed to identify randomized controlled trials (RCTs) comparing hypnosis to control interventions. All RCTs had to report pain or anxiety. Eighteen RCTs with a total of 968 patients were included; study size was from 20 to 200 patients (14 RCTs ≤ 60 patients). Fourteen RCTs included 830 adults and 4 RCTs included 138 children. Twelve of 18 RCTs had major quality limitations related to unclear allocation concealments, provider's experience in hypnosis, patient's adherence to hypnotic procedures, and intention-to-treat design. This systematic review observed major methodological limitations in RCTs on hypnosis prior to medical procedures.

Hypnosis for treatment of HIV neuropathic pain: a preliminary report

OBJECTIVE

Painful HIV distal sensory polyneuropathy (HIV-DSP) is the most common nervous system disorder in HIV patients. The symptoms adversely affect patients' quality of life and often diminish their capacity for independent self-care. No interventions have been shown to be consistently effective in treating the disorder. The purpose of the present study was to determine whether hypnosis could be a useful intervention in the management of painful HIV-DSP.

METHOD

Participants were 36 volunteers with HIV-DSP who received three weekly training sessions in self-hypnosis. Participants were followed for pain and its sequelae for 7 weeks prior to the intervention, and for 7 weeks postintervention. Participants remained on the same standard-of-care pain regimen for the entire 17 weeks of the protocol. The primary outcome measure was the Short Form McGill Pain Questionnaire cale (SFMPQ) total pain score. Other outcome measures assessed changes in affective state and quality of life.

RESULTS

Mean SFMPQ total pain scores were reduced from 17.8 to 13.2 (F[1, 35] = 16.06, P < 0.001). The reductions were stable throughout the 7-week postintervention period. At exit, 26 out of 36 (72%) had improved pain scores. Of the 26 who improved, mean pain reduction was 44%. Improvement was found irrespective of whether or not participants were taking pain medications. There was also evidence for positive changes in measures of affect and quality of life.

CONCLUSION

Brief hypnosis interventions have promise as a useful and well-tolerated tool for managing painful HIV-DSP meriting further investigation.

Hypnosis for cancer care: over 200 years young

Answer questions and earn CME/CNE Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are: 1) to describe hypnosis and its components and to dispel misconceptions; 2) to provide an overview of hypnosis as a cancer prevention and control technique (covering its use in weight management, smoking cessation, as an adjunct to diagnostic and treatment procedures, survivorship, and metastatic disease); and 3) to discuss future research directions. Overall, the literature supports the benefits of hypnosis for improving quality of life during the course of cancer and its treatment. However, a great deal more work needs to be done to explore the use of hypnosis in survivorship, to understand the mediators and moderators of hypnosis interventions, and to develop effective dissemination strategies.

Anxiety reduction using hypnotic induction and self-guided imagery for relaxation during dermatologic procedures

Many patients experience some degree of anxiety during dermatologic procedures. A prospective, randomized-control trial of hypnotic induction followed by self-guided imagery was conducted with patients in 3 groups: live induction, recorded induction, or control. By 20 minutes into the procedure, there was significantly reduced anxiety reported in the live-induction group compared with the control, whereas reported anxiety in the recorded-induction group was similar to that of the control group. All 13 in the live induction, 11 of the 13 in the recorded induction, and none of the 13 in the control group imagined scenes. The findings of this study suggest that live hypnotic induction followed by self-guided imagery can help to reduce anxiety experienced by many patients during dermatologic procedures.

Response expectancy versus response hope in predicting birth-related emotional distress and pain

Response expectancies and response hopes have been shown to be two distinct constructs with important implications for nonvolitional outcomes. More specifically, studies show that response expectancies: (1) are sufficient to cause nonvolitional outcomes, (2) are not mediated by other psychological variables, and (3) are self-confirming while seemingly automatic. A new programmatic research line has differentiated between people's response expectancies and their response hopes regarding nonvolitional outcomes and showed that even if response hope and response expectancy are separate constructs, they are not unrelated. These concepts have not yet been studied in pregnant women. Moreover, determining the causal factors that best explain the variance of emotional distress and pain in pregnancy is of great importance. Thus, the aim of this study was to investigate the interrelations between response expectancy and response hope in pregnant women with respect to (1) emotional distress prior to giving birth and (2) pain during giving birth. Additionally, self-reported labor hours were analyzed as a secondary outcome. Results show that response expectancy for pain directly predicts pain, and that the discrepancy between response hopes and response expectancies is a strong predictor of investigated outcomes. Thus, our results support the idea that preventive psychological interventions for pregnant women should emphasize adjusting response expectancies and response hopes regarding the pain and emotional distress associated with giving birth. We believe that the results have both theoretical and practical implications and the topic deserves further investigation.

Meta-analysis of psychosocial interventions to reduce pain in patients with cancer

PURPOSE

Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010.

METHODS

Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures.

RESULTS

Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04).

CONCLUSION

Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.