1
|
Rosenbloom BN, Slepian PM, Azam MA, Aternali A, Birnie KA, Curtis K, Thaker S, Ladak S, Waisman A, Clarke H, Katz J, Weinrib AZ. A Randomized Controlled Trial of Clinical Hypnosis as an Opioid-Sparing Adjunct Treatment for Pain Relief in Adults Undergoing Major Oncologic Surgery. J Pain Res 2024; 17:45-59. [PMID: 38196969 PMCID: PMC10775151 DOI: 10.2147/jpr.s424639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
Clinical hypnosis is an effective strategy for managing acute pain in the surgical setting. However, the opioid sparing effects of clinical hypnosis are not as well understood. This pre-registered (NCT03730350) randomized, controlled trial (RCT) examined the impact of clinical hypnosis, pre- and post-surgery, on opioid consumption during hospitalization as well as on measures of pain intensity, pain interference, depressed mood, anxiety, sleep, and pain catastrophizing. Participants (M = 57.6 years; SD = 10.9) awaiting oncologic surgery were randomized to treatment-as-usual (n = 47) or hypnosis (n = 45). Intent-to-treat analyses were conducted using linear mixed effects modeling. A significant Group × Time interaction, F(6, 323.34) = 3.32, p = 0.003, indicated an opioid sparing effect of clinical hypnosis during the acute postoperative period. Hypnosis also protected against increases in pain catastrophizing at one-week after surgery, F (1, 75.26) = 4.04, p = 0.048. A perioperative clinical hypnosis intervention had a sparing effect on opioid consumption in-hospital after major oncologic surgery. These findings extend the efficacy of clinical hypnosis as an adjunct tool for perioperative pain management.
Collapse
Affiliation(s)
- Brittany N Rosenbloom
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada
| | - P Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammed Abid Azam
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kathryn Curtis
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sonal Thaker
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Salima Ladak
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Aliza Z Weinrib
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| |
Collapse
|
2
|
Malloggi E, Santarcangelo EL. Physiological Correlates of Hypnotizability: Hypnotic Behaviour and Prognostic Role in Medicine. Brain Sci 2023; 13:1632. [PMID: 38137080 PMCID: PMC10742099 DOI: 10.3390/brainsci13121632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Studies in the field of experimental hypnosis highlighted the role of hypnotizability in the physiological variability of the general population. It is associated, in fact, with a few differences which are observable in the ordinary state of consciousness and in the absence of suggestions. The aim of the present scoping review is summarizing them and indicate their relevance to the neural mechanisms of hypnosis and to the prognosis and treatment of a few medical conditions. Individuals with high, medium and low hypnotizability scores display different cerebral functional differences-i.e., functional equivalence between imagery and perception/action, excitability of the motor cortex, interoceptive accuracy-possibly related to brain structural and functional characteristics, and different control of blood supply at peripheral and cerebral level, likely due to different availability of endothelial nitric oxide. These differences are reviewed to support the idea of their participation in hypnotic behaviour and to indicate their prognostic and therapeutic usefulness in a few medical conditions.
Collapse
Affiliation(s)
- Eleonora Malloggi
- Department Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56127 Pisa, Italy;
- Department of Physics, University of Trento, 38122 Trento, Italy
| | - Enrica L. Santarcangelo
- Department Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56127 Pisa, Italy;
| |
Collapse
|
3
|
Cortade DL, Markovits J, Spiegel D, Wang SX. Point-of-Care Testing of Enzyme Polymorphisms for Predicting Hypnotizability and Postoperative Pain. J Mol Diagn 2023; 25:197-210. [PMID: 36702396 DOI: 10.1016/j.jmoldx.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/16/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Hypnotizability is a stable trait that moderates the benefit of hypnosis for treating pain, but limited availability of hypnotizability testing deters widespread use of hypnosis. Inexpensive genotyping of four single-nucleotide polymorphisms in the catechol-o-methyltransferase (COMT) gene was performed using giant magnetoresistive biosensors to determine if hypnotizable individuals can be identified for targeted hypnosis referrals. For individuals with the proposed optimal COMT diplotypes, 89.5% score highly on the Hypnotic Induction Profile (odds ratio, 6.12; 95% CI, 1.26-28.75), which identified 40.5% of the treatable population. Mean hypnotizability scores of the optimal group were significantly higher than the total population (P = 0.015; effect size = 0.60), an effect that was present in women (P = 0.0015; effect size = 0.83), but not in men (P = 0.28). In an exploratory cohort, optimal individuals also reported significantly higher postoperative pain scores (P = 0.00030; effect size = 1.93), indicating a greater need for treatment.
Collapse
Affiliation(s)
- Dana L Cortade
- Materials Science and Engineering, School of Engineering, Stanford University, Stanford, California.
| | - Jessie Markovits
- Department of Internal Medicine, School of Medicine, Stanford University, Stanford, California
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California
| | - Shan X Wang
- Materials Science and Engineering, School of Engineering, Stanford University, Stanford, California; Electrical Engineering, School of Engineering, Stanford University, Stanford, California
| |
Collapse
|
4
|
Császár N, Scholkmann F, Bókkon I. Implications on hypnotherapy: Neuroplasticity, epigenetics and pain. Neurosci Biobehav Rev 2021; 131:755-764. [PMID: 34619172 DOI: 10.1016/j.neubiorev.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/07/2021] [Accepted: 10/01/2021] [Indexed: 01/11/2023]
Abstract
We provide a brief review about the significance of hypnosis with respect to applications and physiological processes in hypnotherapy. Our review concludes that hypnosis is a promising method to manage acute and chronic pain. In addition, we discuss indications pointing toward the view that hypnosis can induce changes in neuroplasticity possibly involving epigenetic mechanisms.
Collapse
Affiliation(s)
- N Császár
- National University of Public Services, Budapest, Hungary; Psychosomatic Outpatient Clinics, Budapest, Hungary.
| | - F Scholkmann
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Switzerland.
| | - I Bókkon
- Psychosomatic Outpatient Clinics, Budapest, Hungary; Vision Research Institute, Neuroscience and Consciousness Research Department, Lowell, MA, USA.
| |
Collapse
|
5
|
Santarcangelo EL, Carli G, Sebastiani L. An evolutionary approach to hypnotizability. THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2021; 63:294-301. [PMID: 33999772 DOI: 10.1080/00029157.2020.1860893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We propose here an evolutionary interpretation of the presence of highly hypnotizable persons (highs) among the general population. Current experimental evidence suggests the presence of stronger functional equivalence between imagery and perception, non-opioid cognitive control of pain, favorable cardiovascular asset, and greater interoceptive sensitivity in highs. We hypothesize that these characteristics were greatly relevant to our ancestors' survival, and that they may have facilitated the natural selection of individuals who are now named "highs" due to one of their side effects - the proneness to accept suggestions - as part of the reported physiological features. Unfortunately, our theoretical hypothesis cannot be currently experimentally proven. We believe, however, that looking at hypnotizability in a naturalistic, evolutionary perspective may emphasize the importance of its physiological correlates in daily life and in the prediction of the outcome of medical treatments.
Collapse
|
6
|
Daniel AM, Rushing BG, Tapia Menchaca KY. Variation of the human mu-opioid receptor (OPRM1) gene predicts vulnerability to frustration. Sci Rep 2020; 10:21840. [PMID: 33318511 PMCID: PMC7736895 DOI: 10.1038/s41598-020-78783-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/19/2020] [Indexed: 11/09/2022] Open
Abstract
Understanding the emotional reaction to loss, or frustration, is a critical problem for the field of mental health. Animal models of loss have pointed to the opioid system as a nexus of frustration, physical pain, and substance abuse. However, few attempts have been made to connect the results of animal models of loss to human behavior. Allelic differences in the human mu opioid receptor gene, notably the A118G single nucleotide polymorphism, have been linked to individual differences in pain sensitivity, depressive symptoms, and reward processing. The present study explored the relationship between A118G and behavior in two frustrating tasks in humans. Results showed that carriers of the mutant G-allele were slower to recover behavior following a reward downshift and abandoned a frustrating task earlier than those without the mutation. Additionally, G-carriers were more sensitive to physical pain. These results highlight the overlap between frustration and pain, and suggest that genetic variation in opioid tone may contribute to individual differences in vulnerability and resilience following emotional disturbances.
Collapse
Affiliation(s)
- Alan M Daniel
- Department of Science and Math, Texas A&M University-San Antonio, One University Way, San Antonio, TX, 78224, USA.
| | - Brenda G Rushing
- Department of Science and Math, Texas A&M University-San Antonio, One University Way, San Antonio, TX, 78224, USA
| | - Karla Y Tapia Menchaca
- Department of Science and Math, Texas A&M University-San Antonio, One University Way, San Antonio, TX, 78224, USA
| |
Collapse
|
7
|
Abstract
This paper is the forty-first consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2018 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (2), the roles of these opioid peptides and receptors in pain and analgesia in animals (3) and humans (4), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (5), opioid peptide and receptor involvement in tolerance and dependence (6), stress and social status (7), learning and memory (8), eating and drinking (9), drug abuse and alcohol (10), sexual activity and hormones, pregnancy, development and endocrinology (11), mental illness and mood (12), seizures and neurologic disorders (13), electrical-related activity and neurophysiology (14), general activity and locomotion (15), gastrointestinal, renal and hepatic functions (16), cardiovascular responses (17), respiration and thermoregulation (18), and immunological responses (19).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
| |
Collapse
|
8
|
Presciuttini S, Carli G, Santarcangelo EL. HYPNOTIZABILITY-RELATED FAAH C385A POLYMORPHISM: POSSIBLE ENDOCANNABINOID CONTRIBUTION TO SUGGESTION-INDUCED ANALGESIA. Int J Clin Exp Hypn 2020; 68:29-37. [PMID: 31914367 DOI: 10.1080/00207144.2020.1682254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fatty acid amide hydrolase (FAAH) degrades the endogenous endocannabinoid (eCB) anandamide and might be involved in the response to suggestions of analgesia in subjects with high hypnotizability scores (highs). Since the A allele of the FAAH C385A polymorphism (rs324420) is associated with lower FAAH activity, it was studied in 21 highs, 66 low hypnotizable individuals (lows), and 172 individuals not selected for hypnotizability (controls) representing the general population. No significant difference was observed among groups, but the A allele frequency showed a significant trend to increase from lows to controls and from controls to highs. Since eCB small differences can be amplified by eCB interactions with other neurotransmitters, a contribution of the FAAH polymorphism to the highs' analgesia should not be excluded.
Collapse
Affiliation(s)
- Silvano Presciuttini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giancarlo Carli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Enrica L Santarcangelo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| |
Collapse
|
9
|
Colloca L, Wang Y, Martinez PE, Christy Chang YP, Ryan KA, Hodgkinson C, Goldman D, Dorsey SG. OPRM1 rs1799971, COMT rs4680, and FAAH rs324420 genes interact with placebo procedures to induce hypoalgesia. Pain 2019; 160:1824-1834. [PMID: 31335650 PMCID: PMC6668362 DOI: 10.1097/j.pain.0000000000001578] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Genetics studies on the placebo hypoalgesic effect highlight a promising link between single nucleotide polymorphisms (SNPs) in the dopamine, opioid, and endocannabinoid genes and placebo hypoalgesia. However, epistasis and replication studies are missing. In this study, we expanded on previous findings related to the 3 SNPs in the opioid receptor mu subunit (OPRM1 rs1799971), catechol-O-methyltransferase (COMT rs4680), and fatty acid amide hydrolase (FAAH rs324420) genes associated with placebo hypoalgesia and tested the effect of a 3-way interaction on placebo hypoalgesia. Using 2 well-established placebo procedures (verbal suggestion and learning paradigm), we induced significant placebo hypoalgesic effects in 160 healthy participants. We found that individuals with OPRM1 AA combined with FAAH Pro/Pro and those carrying COMT met/met together with FAAH Pro/Pro showed significant placebo effects. Participants with COMT met/val alleles showed significant placebo effects independently of OPRM1 and FAAH allele combinations. Finally, the model that included the placebo procedure and genotypes predicted placebo responsiveness with a higher accuracy (area under the curve, AUC = 0.773) as compared to the SNPs alone indicating that genetic variants can only partially explain the placebo responder status. Our results suggest that the endogenous mu-opioid system with a larger activation in response to pain in the met/val allele carriers as well as the synergism between endogenous mu-opioid system and cannabinoids might play the most relevant role in driving hypoalgesic responses. Future epistasis studies with larger sample sizes will help us to fully understand the complexity of placebo effects and explain the mechanisms that underlie placebo responsiveness.
Collapse
Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | | | | | | | - Colin Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Susan G. Dorsey
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| |
Collapse
|
10
|
Visuospatial imagery in healthy individuals with different hypnotizability levels. Neurosci Lett 2019; 690:158-161. [PMID: 30342994 DOI: 10.1016/j.neulet.2018.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 12/31/2022]
Abstract
Hypnotizability is a psychophysiological trait associated with morpho-functional brain differences. Since also cerebellar peculiarities have been reported in individuals with different hypnotizability levels and the cerebellar function is relevant to spatial imagery, the present study was aimed at investigating possible hypnotizability-related differences in the ability of spatial imagery. Highly (highs, N = 31), low (lows, N = 17) and medium (mediums, N = 16) hypnotizable participants (classified by Stanford Hypnotic Susceptibility Scale, form A) of both genders were submitted to a test of mental rotation, which requires the integrity of both executive and cerebellar structures. In order to disentangle the role of the cerebellum from that of executive circuits as much as possible, visuospatial and verbal working memory tests, which mainly reflect executive processes, were also performed. Healthy highs exhibited higher scores of mental rotation ability compared to mediums in the absence of significant differences in visual-spatial and verbal working memory. Lows reported intermediate scores not significantly different from both highs' and mediums'. Different cognitive strategies were observed in the three groups as the correlations between mental rotation, visuospatial and verbal working memory were different in highs, mediums and lows. In conclusion, present findings represent the first report of hypnotizability-related differences in a mental rotation task, which is relevant to several cognitive functions.
Collapse
|
11
|
Santarcangelo EL, Consoli S. Complex Role of Hypnotizability in the Cognitive Control of Pain. Front Psychol 2018; 9:2272. [PMID: 30515125 PMCID: PMC6256013 DOI: 10.3389/fpsyg.2018.02272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Enrica L. Santarcangelo
- Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa, Pisa, Italy
| | | |
Collapse
|