Article

Adjunctive Self-hypnotic Relaxation for Outpatient Medical Procedures: A Prospective Randomized Trial with Women Undergoing Large Core Breast Biopsy

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Abstract

Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients' self-ratings at 1 min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women's anxiety increased significantly in the standard group (logit slope=0.18, p<0.001), did not change in the empathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, p<0.001). Pain increased significantly in all three groups (logit slopes: standard care=0.53, empathy=0.37, hypnosis=0.34; all p<0.001) though less steeply with hypnosis and empathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/161 dollars for standard care, 43 min/163 dollars for empathy, and 39 min/152 dollars for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.

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... The number of participants in the samples ranged from 44 to 240. In the adult samples, the ages ranged from 18 to 88 years old; 11 had a diagnosis of breast cancer (Amraoui et al., 2018;Butler et al., 2009;Elkins et al., 2011Elkins et al., , 2008Lang et al., 2006;Merckaert et al., 2017;Montgomery et al., 2007Montgomery et al., , 2014Montgomery et al., , 2009Montgomery, Sucala, Dillon et al., 2017;Schnur et al., 2009), and the remaining eight had other types of cancer (Ebell, 2008;Grégoire et al., 2020;Lang et al., 2008;Liossi & White, 2001;Mendoza, Capafons, Gralow et al., 2017;Snow et al., 2012;Stalpers et al., 2005;Thuma et al., 2016). Three studies included children, who were aged between 6 and 16 years with a diagnosis of leukemia or non-Hodgkin's lymphoma (Liossi & Hatira, 2003;Liossi et al., 2006Liossi et al., , 2009. ...
... In 10 studies, hypnosis was applied as an adjuvant to pharmacological treatments, which were mainly analgesics (Amraoui et al., 2018;Ebell, 2008;Liossi & Hatira, 2003;Liossi & White, 2001;Liossi et al., 2006Liossi et al., , 2009Montgomery et al., 2007;Snow et al., 2012;Stalpers Thuma et al., 2016), and in the other nine, hypnosis sessions were combined with various psychological treatments, including emotional support treatment (Butler et al., 2009;Grégoire et al., 2020;Lang et al., 2006Lang et al., , 2008 and cognitive behavioral treatment (Mendoza, Capafons, Gralow et al., 2017;Merckaert et al., 2017;Montgomery et al., 2014Montgomery et al., , 2009Montgomery, Sucala, Dillon et al., 2017;Schnur et al., 2009). Two studies used hypnosis with no other adjuvant treatment for hot flashes (Elkins et al., 2011(Elkins et al., , 2008. ...
... The quality of the studies was assessed using the EPHPP tool (Thomas et al., 2004; Table 2). For overall quality, 13 of the studies were rated "strong" (Amraoui et al., 2018;Elkins et al., 2011Elkins et al., , 2008Grégoire et al., 2020;Lang et al., 2006;Liossi & Hatira, 2003;Liossi et al., 2006Liossi et al., , 2009Montgomery et al., 2007Montgomery et al., , 2014Montgomery et al., , 2009Schnur et al., 2009;Snow et al., 2012), six were rated "moderate" (Butler et al., 2009;Lang et al., 2008;Liossi & White, 2001;Mendoza, Capafons, Gralow et al., 2017;Stalpers et al., 2005;Thuma et al., 2016), and 3 were rated "weak" (Ebell, 2008;Merckaert et al., 2017;Montgomery, Sucala, Dillon et al., 2017). ...
Article
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 anxi-ety, 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.
... This process can have a protective effect on pain, called hypnoanalgesia. It also reduces anxiety during therapeutic or diagnostic medical procedures [20][21][22][23][24][25]. A 2004 study of coronary angioplasty alone also compared hypnosis to drug sedation without significant results [26]. ...
... These values are higher than the norms reported for patients in medical stress situations such as patients hospitalized for various organic diseases, or undergoing medical examinations or surgery [30]. However, our results are in agreement with those of Lang et al., for patients hospitalized for a biopsy under hypnosis with suspicion of breast cancer or to perform a transesophageal ultrasound examination [21,31]. The anxiety state score before the intervention, with alternative medicine, is on average comparable to that observed in our study [11,[14][15][16][17]. ...
... It may also be due to the choice of the evaluation method. Indeed, if hypnosis is effective against anxiety, its statistical proof seems to be provided by an evaluation throughout the intervention and not in the moments preceding it [21,23,32,33]. The patients were subjected to the Spielberger's inventory on their arrival in the coronary angiography room, therefore before initiating a process of self-hypnosis. ...
Article
Full-text available
Background Coronary angiography is the gold standard for the diagnosis of coronary artery disease. This intervention is nevertheless a source of anxiety for the patient both by its discomfort and by the consequences linked to the discovery of potential diseases. Objectives The aim of this study was to determine the effectiveness of hypnosis in reducing anxiety in patients undergoing coronary angiography. Methods One hundred sixty-nine patients with planned coronary angiography and no history of coronary angiography were randomized to a hypnosis or control group. Patients in the hypnosis group underwent a hypnosis session with self-hypnosis posthypnotic suggestions, while those in the control group had a conversational interview with the hypnotherapist. The primary endpoint was pre-exam anxiety level assessed by the Spielberger State-Trait Anxiety Inventory (STAI-Y A). Results Performing a hypnosis session did not result in a significant decrease in anxiety before the intervention. Age, high trait anxiety, high state anxiety the day before, and belief that hypnosis works in general were associated with increased anxiety before the procedure. No adverse events were reported after hypnosis. There was no statistically significant difference between the 2 groups for the occurrence of complications of the intervention. Conclusion In this study, performing a hypnosis session before coronary angiography did not reduce the state of anxiety measured just before the intervention. In all cases, the hypnotic experience appears to be positive for the patient, encouraging further research efforts. Trial registration The research protocol has been registered on the ClinicalTrials.gov registry (NCT02818101; 29/06/2016) and with the ANSM (IDRCB 2016-A00205-46; 02/02/2016).
... Literature review. Five studies have evaluated the use of hypnosis during procedures, [87][88][89][90][91] including three with methodologic weaknesses and two well-designed studies with an attention control as well as a standard-of-care arm. 88,91 The two most rigorous trials with more than 200 randomly assigned participants each evaluated hypnosis for large core breast biopsies 91 and tumor embolization or radiofrequency ablation. ...
... Five studies have evaluated the use of hypnosis during procedures, [87][88][89][90][91] including three with methodologic weaknesses and two well-designed studies with an attention control as well as a standard-of-care arm. 88,91 The two most rigorous trials with more than 200 randomly assigned participants each evaluated hypnosis for large core breast biopsies 91 and tumor embolization or radiofrequency ablation. 88 Both studies demonstrated significantly lower pain ratings compared with control arms with a median reduction of $ 2 (0-10 point scale) reported during the procedure. ...
... Five studies have evaluated the use of hypnosis during procedures, [87][88][89][90][91] including three with methodologic weaknesses and two well-designed studies with an attention control as well as a standard-of-care arm. 88,91 The two most rigorous trials with more than 200 randomly assigned participants each evaluated hypnosis for large core breast biopsies 91 and tumor embolization or radiofrequency ablation. 88 Both studies demonstrated significantly lower pain ratings compared with control arms with a median reduction of $ 2 (0-10 point scale) reported during the procedure. ...
Article
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.
... This study initially retrieved 502 articles and finally included 8 studies (10)(11)(12)(13)(14)(15)(16)(17). The selection flow chart is shown in Figure 1. ...
... There was a large selection bias. Allocation concealment was not described in 4 studies (10,11,12,17), which may introduce significant bias. All studies described the blinding method, and only one study (15) did not describe the dropout cases, which may lead to incomplete data. ...
... Seven studies (10,(12)(13)(14)(15)(16)(17) reported the effect of hypnosis before general anesthesia on postoperative pain after breast cancer surgery, with statistical heterogeneity between the studies (I 2 =93%, P<0.00001). Hypnosis before general anesthesia reduced the postoperative pain of patients undergoing breast cancer surgery (MD =−1.25, 95% CI: −1.64, −0.86, P<0.00001) performed by random effects model, as shown in Figure 4. ...
Article
Background: Preoperative anxiety is a common phenomenon in breast cancer, causing pain and tension, which is not conducive to the effective surgical treatment and postoperative recovery. It is believed that hypnosis can change the patient's perception of pain, thereby improving the patient's ability to control pain. However, the results of studies for this topic were controversy. In order to explore the effect of hypnosis in breast cancer surgery we included randomized controlled trials (RCTs) and conducted a meta analysis. Methods: PubMed, Web of Science, Wiley online library, Elsevier, and Clinicaltrials.gov databases were searched by computer with the keywords "hypnosis/hypnotherapy" and "breast cancer" and "oncologic surgery/surgery/biopsy". After screening, the meta-analysis was performed using RevMan 5.4 software, and the evidence was rated using GRADE profiler 3.6 software. Results: A total of 1,242 patients were included in 8 studies, including 630 patients who received preoperative hypnosis and 612 patients who did not receive hypnosis. Meta-analysis showed that hypnosis before general anesthesia reduced the degree of preoperative anxiety (MD =-2.79, 95% CI: -3.93, -1.65, P<0.00001) and postoperative pain (MD =-1.25, 95% CI: -1.64, -0.86, P<0.00001) in patients undergoing breast cancer surgery, but had no effect on the operation time (MD =-6.30, 95% CI: -15.38, 2.78, P=0.17) and the incidence of postoperative nausea and vomiting (OR =0.68, 95% CI: 0.22, 2.07, P=0.49). Discussion: The application of hypnosis before general anesthesia for breast cancer surgery can reduce the degree of anxiety of patients, also reducing postoperative pain.
... After a full survey, 33 articles had to be excluded: six are systematic reviews, 10 with incomplete results, six are not CCTs, in four studies the study population was pediatric, in three articles the intervention hypnosis is not cited and three studies did not treat the same variables sought. The eleven CCTs with a total of 1182 patients were included in this systematic review: Ten published randomized controlled trials (RCTs) (44,(46)(47)(48)(49)(50)(51)(53)(54)(55)(56), and one nonrandomized CCT (52) were found. ...
... The characteristics of the included studies concerning the samples, the type of interventions and the type of control conditions, the results of measurements, and information on the quality of the study are presented in Tables 1 and 2. The eleven CCTs with a total of 1182 participants included in this systematic review were conducted: in the United States (46)(47)(48)(49)51,55,56), Italy (52), in France (54); in Taiwan (50); in India (53). ...
... The participants were cancer patients, the majority of whom were women (n ¼ 968); five studies had predominantly women as the target population (46,47,50,54,55). In most studies, age ranged from 20 to 80 years, in seven studies the mean ages were between 48 and 58 years (46)(47)(48)(49)(50)(51)53), two studies not reported the age of the participants (55,56). ...
Article
Full-text available
Background Pain is a common symptom in cancer patients. Hypnosis is considered one of the most recognized non-pharmacological techniques in pain management. In oncology, this technique can be used as a complementary treatment to reduce the level of pain and anxiety. The objective of this study is to systematically review and evaluate controlled clinical trials (CCT) examining the effect of hypnosis on the intensity of pain, and anxiety in cancer patients. Methods A systematic review was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA). The Cochrane systematic review database, the abstract databases, Scopus, PubMed, google scholar and Cochrane Library have been systematically reviewed from 2005 to 2018. Results Eleven CCT with a total of 1182 participants met the inclusion criteria and were included in this review. The participants were mainly women (n = 968). Their average age alternates between 48 and 58 years. Perceived pain was measured primarily by visual analog scale (VAS)/Numerical Pain Rating Scale (NPRS), which showed that anxiety was measured by Hospital Anxiety and Depression scale (HADS). Hypnosis-related anxiety and pain decreased significantly with respect to usual treatment. Conclusions Evidence suggests promising results of hypnosis on the management of pain, and anxiety levels in the vast majority of cancer patients. Therefore, because of the exploratory design and high risk of bias, the effectiveness of hypnosis or hypnotherapy in reducing pain and anxiety levels remains unclear. There is a need for more rigorous randomized controlled trials.
... Hypnosis-derived communication (HC) has emerged as a promising approach to promote pain relief and patient well-being during cancer treatments such as radiation therapy and cancer surgery [12,13]. HC is a simple form of conversation which integrates the language patterns of clinical hypnosis such as verbal repetition, suggestion, and metaphor. ...
... A large body of evidence supports the feasibility and the soothing properties of HC during various medical procedures [12,13,16]. Research in a specific cancer population has also supported the use of HC for persistent symptoms management after cancer treatments [17][18][19]. ...
... These barriers include not only limited resources, but also time constraints since nurses can rarely focus on one patient for a sustained period of time. To address such gaps, a brief HC intervention was adapted and translated from a previously published protocol [13], with the objective that the typical oncology nurse would be able to successfully integrate HC into his/her practice surrounding chemotherapy treatments. ...
Article
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Purpose This pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology. Methods The trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale. Results Forty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses ( N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion. Conclusions Our results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology. Trial registration Clinical Trial Identifier: NCT04173195, first posted on November 19, 2019
... Prior randomized clinical trials in procedure and imaging settings showed that reading a short self-hypnotic relaxation script upfront favorably shaped the patients' pain and overall experience (Lang et al., , 2006(Lang et al., , 2008. Throughout these and subsequent trials focusing on staff education in advanced communication, it was possible to validate specific verbal content and suggestions in terms of pain and anxiety reduction (Ajam et al., 2017;Norbash et al., 2016). ...
... Content of the test app derived from segments of self-hypnotic relaxation scripts that had been used successfully in prior clinical trials (Lang et al., , 2006(Lang et al., , 2008. When spoken live by staff immediately preceding invasive medical procedures, use of these scripts was associated with significant reductions in pain and anxiety. ...
... The majority of text derived from the study-script used in the prior clinical trials (reprinted in Lang et al., 2006) and a book we used for training of medical teams (Lang & Laser, 2009). The app starts with a general explanation about self-hypnotic relaxation and how an eye-roll with counting from 1 to 3 is used for entry into a relaxed state and how patients can return to their natural state of awareness by counting backward from 3 to 1. Then follows an eye-roll induction, an invitation to float, to breathe in strength and letting go of what to let go of, and to choose a preferred place, to associate all senses with it, and to use it as an anchor of comfort and safety. ...
Article
Despite an explosion of mobile app offerings for management of pain and anxiety, the evidence for effectiveness is scarce. Placebo-controlled trials are the most desirable but designing inactive placebo apps can be challenging. For a prospective randomized clinical trial with 72 patients in a craniofacial pain center, we created an app with self-hypnotic relaxation (SHR) for use with iOS and Android systems. A placebo background audio (BA) app was built with the same look and functionality. Both iOS and Android SHR apps alone and in comparison to the BA group significantly reduced pain and anxiety during the waiting-room time. The Android BA app significantly reduced anxiety but not pain. The iOS BA app affected neither pain nor anxiety, functioning as an ideal placebo. Usage analysis revealed that different default approaches of the iOS and Android devices accounted for the difference in results.
... When patients are going through minimally invasive procedures under a light conscious sedation, they often experience severe pain and anxiety (Alaeddini et al., 2007;Aryana et al., 2008;Flory, Salazar, & Lang, 2007;Lang et al., 2000Lang et al., , 2006Lang et al., , 2008. A minimally invasive procedure can be defined as a procedure that is less invasive than open surgery and used for the same purpose and requires the penetration of tissue (Horne, Vatmanidis, & Careri, 1994;Wickham, 1987). ...
... Invasive procedures in which hypnotic analgesia has been used together with usual pain medication with greater effectiveness compared to conventional care or usual pain medication include large core breast biopsy, percutaneous tumour treatment, radiological, percutaneous vascular, cardiovascular and renal procedures. (Flory et al., 2007;Lang et al., 2000Lang et al., , 2006Lang et al., , 2008 Besides ameliorating pain, the consumption of pain medication (Fentanyl and Midazolam) was in some studies reduced. In addition, the procedure lengths and the number of adverse events were decreased in several studies (Lang et al., 2000(Lang et al., , 2006(Lang et al., , 2008. ...
... (Flory et al., 2007;Lang et al., 2000Lang et al., , 2006Lang et al., , 2008 Besides ameliorating pain, the consumption of pain medication (Fentanyl and Midazolam) was in some studies reduced. In addition, the procedure lengths and the number of adverse events were decreased in several studies (Lang et al., 2000(Lang et al., , 2006(Lang et al., , 2008. ...
Article
Introduction: Patients undergoing minimally invasive procedures under a light conscious sedation perceive pain and anxiety. Hypnosis used together with analgesics has been investigated in numerous studies. Aims and methods: This systematic review aimed to assess the effectiveness of hypnotic analgesia in management of pain, anxiety, analgesic consumption, procedure length and adverse events in adults undergoing minimally invasive procedures. Clinical controlled trials in which hypnosis was used together with pharmacological analgesia compared to pharmacological analgesia alone during invasive procedures were included. Seven databases were searched. The methodological quality of the studies was assessed by two reviewers using a standardized instrument for critical appraisal from Joanna Briggs Institute, "Meta-Analysis of statistics assessment and review Instrument". Meta-analyses using the review manager version 5.3 software were conducted on procedure length and adverse events. Results for pain, anxiety and analgesics were synthesized in narrative summaries. Conduction of the review adheres to the PRISMA checklist. Results: Ten studies comprising 1365 participants were included. A reduction in the consumption of pain medication was found between 21% and 86% without aggravating pain intensity and anxiety. In few studies significant reduction in pain intensity and anxiety was found. Meta-analysis including seven studies revealed a small beneficial effect on reducing procedure length. A meta-analysis on adverse events showed no significant reduction. Statistical heterogeneity was found among the studies included. Conclusion: For patients undergoing invasive procedures hypnotic analgesia was effective in reducing consumption of analgesics. Only a slight effect was however found on experienced anxiety and pain intensity. It did not prolong the procedure and was safe to provide. Relevance to clinical practice: Hypnosis is recommended as pain-management for adults during invasive procedures. A reduced consumption of pain medication potentially has a major impact on monitoring and observation of patients following the procedure, thus improving patient safety and reducing resource consumption.
... Moreover, there are many definitions of hypnosis and related terms in the literature (Elkins, Barabasz, Council, & Spiegel, 2015). Hypnosis is an interactive method utilized by a hypnotist for inducing sensations, perceptions, comprehension, and voluntary motor activity in an individual and for facilitating attention diversion from disturbing stimuli in patients and help them feel better (Lang et al., 2006;Montgomery, David, Winkel, Silverstein, & Bovbjerg, 2002). Complementary treatments can also be employed for effective pain relief without any side-effects in surgical patients (Kekecs, Nagy, & Varga, 2014;Montenegro, Alves, Zaninotto, Falcão, & Batista de Amorim, 2017;Sahmeddini, Farbood, & Ghafaripuor, 2010;Wobst, 2007). ...
... Postoperative pain, anxiety, stress, nausea, and hospital stay duration have been investigated in surgical interventions (Abdeshahi et al., 2013;Lang et al., 2006;Montgomery et al., 2002Montgomery et al., , 2010Vanhaudenhuyse et al., 2014). The meta-analysis conducted by Montgomery et al. (2002) revealed that 89% of the studies reported better outcomes for hypnotized surgery patients than for controls. ...
... (Sener et al., 2008;Szychta & Antoszewski, 2010). Here, we used diclofenac for subjects in both the HG and CG; our findings with regard to the requirement for postoperative opioid analgesic were found to be similar and in agreement with the results of the cited studies, i.e., the additional analgesic requirements in the HG and CG were 36.4% and 45.5%, respectively (Abdeshahi et al., 2013;Kekecs et al., 2014;Lang et al., 2006;Montgomery et al., 2010;Stoebl et al., 2009). ...
Article
This prospective, randomized study investigated the effects of preoperative hypnosis on hemorrhage and pain in open septorhinoplasty (SRP). Twenty-two patients undergoing SRP under general anesthesia were included and equally divided into two groups. Patients in the hypnosis group (HG) received a total of three sessions of hypnotic induction. The first two sessions occurred 3 days and 1 day prior to surgery, respectively, and the last session was in the hospital the day of surgery. The other 11 patients constituted the control group (CG). Compared with the CG, the HG’s intraoperative use of total remifentanil and the visual analog scale scores at the 2nd and 3rd postoperative hours were significantly lower (p < .05). Hypnosis did not affect the quality of the surgical field. However, preoperative use of hypnosis decreased intraoperative remifentanil requirements and postoperative pain.
... 17 The use of self-hypnotic relaxation scripts prior to interventional radiological procedures under conscious sedation resulted in a reduction of anxiety, pain, drug use, procedure time and complications in adult patients. [18][19][20] This study aimed to investigate whether a script, adapted for pediatric use, read prior to percutaneous cardiac interventions under general anesthesia had similar benefits. Since there is debate about the use of audible positive suggestions of healing during anesthesia, we also assessed whether a script read prior to extubation would further improve recovery. ...
... The interventions consisted of 1) the reading of a self-hypnotic relaxation pre-procedure script ("PP-Script") adapted for children from language found to be effective in adults in reducing anxiety, pain and complications of invasive-image guided procedures. [18][19][20] This script was read in the pre-catheterization work-up area, by one of three nurses, trained in procedural hypnotic language (Comfort Talk ® , Brookline, MA). It contained relaxing and hypnotic language with suggestions for ego strengthening and coping; 2) The second intervention was the reading of a pre-extubation script ("PX-Script") containing suggestions for healing and recovery with acknowledgement of the patient's contribution during the procedure. ...
Article
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Purpose: To assess the impact on children of self-hypnotic relaxation scripts read by trained staff prior to the induction of anesthesia and/or extubation on the periprocedural experience. Patients and methods: A total of 160 children aged 7-18 years undergoing a cardiac catheterization intervention under general anesthesia were randomized into 4 groups: (1) a pre-procedure (PP-script) read prior to entering the procedural room, (2) a script read prior to extubation (PX-Script), (3) both PP- and PX-Scripts read and (4) no script read. Anxiety and pain were rated on self-reported 0-10 scales. The modified Yale Preoperative Anxiety Scale was used for preoperative anxiety. The effect of script reading was associated with outcomes by linear regression for continuous variables, and logistic regression for binary variables in two-sided tests at a significance level of 0.05. Results are given in odds ratios (OR) and 95% confidence intervals (CI). Results: Data were available for 158 patients. Reading the PP-Script prior to anesthesia was associated with a significant reduction in the use of intraoperative sedatives from 30% to 14% (OR 0.40; CI 0.18-0.88; p = 0.02) by the anesthesiologists, who were blinded to group attribution until extubation. This was despite the children not self-reporting significantly lower levels of anxiety or pain. The PX-Script did not change outcomes. Among groups, there was no significant difference in room time, postoperative recovery time and pain. Conclusion: Reading a PP-Script for guidance in self-hypnotic relaxation can result in less need for intravenous sedation in the judgment of the anesthesiologist, independent of the children's self-reported anxiety and pain. This raises interesting questions about subconscious patient-physician interactions affecting pain management. Clinicaltrialsgov identifier: NCT02347748.
... Chemotherapy is notorious for causing general fatigue, pain and other systemic symptoms that are difficult to treat with classic pharmacotherapy (Miaskowski et al., 2017). As a result, many professional and scientific organizations recommend using complementary, non-pharmacological approaches, in addition to pharmacotherapy, to support patients and optimize the management of persistent symptoms during and after chemotherapy ( Of the various complementary approaches that can be used by nurses in an outpatient setting, conversational hypnosis (CH) has in recent years proven to be effective in improving anxiety management during radiation therapy and cancer surgery (Lang et al., 1997;Lang et al., 2006). CH has also been found to be useful in reducing chemotherapy-induced fatigue and discomfort (Arbour et al., 2021), as well as pain resulting from invasive forms of care (intravenous drips, injections) in pediatric oncology (Aramideh et al., 2020). ...
... CH has also been found to be useful in reducing chemotherapy-induced fatigue and discomfort (Arbour et al., 2021), as well as pain resulting from invasive forms of care (intravenous drips, injections) in pediatric oncology (Aramideh et al., 2020). From a technical standpoint, CH is a simple and direct form of conversation that is shaped by the language-related principles of clinical hypnosis (Lang et al., 2008), where the clinician uses a lulling tone of voice, repetition and metaphor to redirect a patient's attention away from the source of stress and toward soothing mental imagery (Lang et al., 2006). To date, studies on the use of CH in oncology have focused primarily on physicians specializing in hypnotherapy. ...
Article
Introduction: Conversational hypnosis (CH) is known to optimize the management of symptoms resulting from antineoplastic treatment. However, the perception of nurses who have been called upon to integrate this practice into their care has yet to be documented. Goal: Describe how nurses perceive the integration of CH into chemotherapy-related care. Methods: Individual interviews and an iterative analysis were conducted with six nurses who had previous experience in CH in an outpatient oncology clinic. Findings: Six themes emerged: 1) the outpatient oncology clinic, a saturated care setting; 2) the key elements supporting the integration of CH into care; 3) an added value for patients; 4) a positive and rewarding experience for nurses; 5) collateral benefits; and 6) CH, an approach that warrants consideration amid the pandemic. Conclusion: These findings shed light on nurses’ unique point of view regarding the challenges and benefits of integrating CH into oncology care. Keywords: cancer, outpatient chemotherapy, conversational hypnosis, nursing
... To avoid medications or to at least reduce their dose and hence the risks, several alternative strategies have been proposed and investigated to reduce patients' fear during MR imaging [16][17][18]. Hypnosis and relaxation techniques have been found to reduce patients' anxiety and the need for medication during medical procedures [19][20][21][22]. Hypnosis may be considered as a modified state of consciousness that emphasizes attention, concentration, and the letting go of thoughts and is characterized by mental relaxation, altered perception of the environment, and disengagement of the discursive and critical analytical reasoning [23]. ...
... Previous investigations show a positive effect of hypnosis on other medical procedures especially in terms of the need for medical sedation [19,[27][28][29]. Hypnosis can reduce the amount of medications needed or even completely replace benzodiazepines [22,[30][31][32]. Particularly, patients with comorbidities precluding sedating drug therapy or children might benefit from hypnosis [33,34]. ...
Article
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Objectives To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging. Methods In this prospective observational 2-group study, 55 patients (69% female, mean age 53.6 ± 13.9) used self-hypnosis directly before imaging. Claustrophobia included premature termination, sedation, and coping actions. The claustrophobia questionnaire (CLQ) was completed before self-hypnosis and after MR imaging. Results were compared to a control cohort of 89 patients examined on the same open MR scanner using logistic regression for multivariate analysis. Furthermore, patients were asked about their preferences for future imaging. Results There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14; p = .001). Self-hypnosis patients also needed less sedation (2% vs 16%; 1/55 vs 14/89; odds ratio .1; p = .008) and non-sedation coping actions (13% vs 28%; 7/55 vs 25/89; odds ratio .3; p = .02). Self-hypnosis did not influence the CLQ results measured before and after MR imaging ( p = .79). Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49; p = .002). In the subgroup below the CLQ cut-off of 0.33, there were no significant differences (0% vs 9%, 0/6 vs 1/11; p = 1.0). Most patients (67%; 35/52) preferred self-hypnosis for future MR examinations. Conclusions Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions. Key Points • Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner. • Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia. • Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations.
... Approximately 1.6 million breast biopsies are performed in the USA annually (Silverstein 2009), approximately 70% of which are large-core stereotactic breast biopsies (SBB), an outpatient procedure involving local anesthesia (Gutwein et al. 2011). This procedure is laden with anxiety for most patients due to the uncertain nature of cancer status as well as the foreign, uncomfortable equipment (Lang et al. 2006). High pre-procedural anxiety levels have been related to increased procedural pain (Miller et al. 2014), longer procedure duration (Schupp et al. 2005), and more appointment cancelations and incomplete procedures . ...
... VAS anxiety scores were skewed with relatively few reports in the highest response categories. To correct for this, we collapsed rating categories of 8, 9, and 10, creating a 0-8 VAS rating scale (Lang et al. 2006). This affected < 7% of the anxiety data. ...
Article
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Objectives This study examined trait mindfulness, spiritual well-being, and distress tolerance as moderators of the effect of a brief mindfulness intervention on anxiety reported during stereotactic breast biopsy (SBB).Methods This is a secondary analysis of an RCT examining guided meditation (GM; n = 30), focused breathing (FB; n = 30), or standard care (SC; n = 16) on anxiety for women undergoing SBB. Women in GM and FB were guided through their respective interventions for 10 min before and during biopsy. Anxiety (0–10 visual analogue scale), trait mindfulness (FFMQ), spiritual well-being (FACIT-SP), and discomfort intolerance (DI) were assessed at baseline, and anxiety was assessed every 4 min during SBB. Multilevel modeling examined moderator-by-group-by-time interactions. Significant 3-way interactions were decomposed using a median split.ResultsFFMQ observing, FFMQ describing, FACIT-SP meaning/peace, and DI moderated the group-by-time effects on anxiety during biopsy (p’s < 0.03). For those high in FFMQ describing, FACIT-SP-Meaning/Peace, or DI, GM was associated with a steeper reduction in anxiety compared to FB and SC (p’s < 0.05). For those low in FFMQ describing, FFMQ observing, and FACIT-SP-Meaning/Peace, both GM and FB were associated with a steeper reduction in anxiety compared to SC (p’s < 0.05).Conclusions Individuals high in mindful describing, high in the meaning/peace aspect of spiritual well-being, and high in distress intolerance may benefit most from GM. Individuals low in attentional aspects of mindfulness (i.e., describing and observing) and low in the meaning/peace aspect of spiritual well-being may benefit from either a GM or FB intervention.Trial Registration ClinicalTrial.org (NCT03023215)
... Other factors include high costs (non-reimbursable expenses) and unavailability of treatment 5 . The results of this study corroborate with research that has reported the beneficial effects of clinical hypnosis on pain in cancer patients 4,[21][22][23][24][25][26][27] . ...
Article
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ORIGINAL The effect of clinical hypnosis and self-hypnosis on pain intensity in moroccan cancer patients: a pilot study El efecto de la hipnosis clínica y la autohipnosis sobre la intensidad del dolor en pacientes marroquíes con cáncer: Un estudio piloto Abstract Background: Pain is a common symptoms in cancer patients. Objectives: This pilot study evaluated the feasibility, acceptability, and potential efficacy of a 4-week hypnosis intervention in cancer patients with pain. Methods: The study was conducted at the Regional Oncology Centre in Agadir, Morocco. The favourable opinion of the Ethics Committee was registered under No.06/19. The study population consisted of 20 patients. Each patient received four hypnosis sessions. Assessments with the Visual Analogue Scale (VAS) for pain and evaluation of opiate and analgesic use were carried out at the beginning and after 2-4 weeks of hypnosis treatment. Results: The mean age of the subjects was 43.25 years (±14.05). For the VAS score at baseline: (35%) had severe pain, (30%) very severe pain and (35%) intolerable pain with an average VAS of 6, 8 and 9 respectively. The mean VAS value decreased from baseline to 3.71 (±0.48), 6.00 (±0.5) and 6.86 (±0.69) respectively at two weeks of follow-up, and 2.43 (±0.5 3), 4.67 (±0.51), 5.14 (±1.07) respectively at four weeks of follow-up (P<0.001). The results showed a significant decrease in the doses of analgesic drugs consumed by the patients in the study after 2 to 4 weeks of hypnosis treatment compared to baseline (P<0.001). Conclusion: Our results suggest that Clinical hypnosis is feasible and beneficial for pain control in cancer diseases.
... For the relaxation video we chose to use a self-hypnotic intervention; it's length of 9 min was comparable to the information video. Hypnosis has been proven to be an effective instrument in a broad variety of medical contexts such as reducing pain, anxiety, and procedural times (Lang et al., 2000(Lang et al., , 2006(Lang et al., , 2008Revenstorf & Peter, 2015;Tefikow et al., 2013). Thereby, hypnosis through a live hypnotist seems to be as effective as taped interventions (Tefikow et al., 2013). ...
Article
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MRI-related anxiety is present in 30% of patients and may evoke motion artifacts/failed scans, which impair clinical efficiency. It is unclear how patient anxiety can be countered most effectively. Habitual preferences for coping with stressful situations by focusing or distracting one’s attention thereof (coping style) may play a key role in this context. This study aimed to compare the effectiveness of two patient-preparation videos with informational vs. relaxational content and to determine whether the fit between content and coping style affects effectivity. The sample consisted of 142 patients ( M = 48.31 ± 15.81 years). Key outcomes were anxiety, and cortisol as a physiological stress marker. When not considering coping style, neither intervention improved the patients’ reaction; only patient preparation that matched the patients’ coping style was associated with an earlier reduction of anxiety. This suggests that considering individual preferences for patient preparation may be more effective than a one-size-fits-all approach.
... Clinical research with at least 20 different surgical populations has indicated that hypnosis can reduce the need for medication, reduce post-surgical symptoms, and enhance recovery [32]. Furthermore, meta-analyses [33], narrative reviews [34,35], and randomized clinical studies [36][37][38][39] all support the potential clinical utility of hypnosis with surgical patients. A rigorous trial from the US demonstrated particularly promising results [40]. ...
Article
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Background Breast cancer is the most common cancer type among women worldwide with over a million new cases each year. More than 40% of these women will struggle with chronic pain and fatigue after surgery, regardless of surgical procedure. These consequences are detrimental and result in distress and disability, including work disability. Few attempts have been made to prevent chronic pain and fatigue after surgery by applying a psychological approach, despite psychological risk factors being crucial in the development of both chronic pain and fatigue. In this study, we aim to develop and test an easily implementable strategy of preventing chronic pain and fatigue after breast cancer surgery. The intervention strategy involves a pre-operative hypnosis session and a web-based post-operative Acceptance and Commitment Therapy (ACT). The hypnosis has previously been found effective in alleviating acute post-operative pain and fatigue in breast cancer patients, while ACT is well suited to cancer populations as it offers a model of healthy adaptation to difficult circumstances. Together they form an intervention strategy with both a preventive and a rehabilitative focus. Methods/Design This randomized controlled trial aims to estimate the effects of the pre- and post- operative interventions compared to attentional control and treatment as usual (TAU) and will also include a qualitative process evaluation. Participants will be randomized to receive either a pre-operative brief hypnosis session and a post-operative web-based psychological intervention (iACT) or a pre-operative one-session mindfulness through an audio file and post-operative TAU. Self-reported questionnaire data and biomarker data will be assessed pre-surgery, post-surgery and 3 and 12 months after surgery. In addition, we will assess registry data on sick leave and prescriptions until 2-year follow-up. In the qualitative process evaluation, data will be collected from participants from both study arms (through interviews and a diary) and two different analyses performed (socio-narrative and Grounded Theory) with the objective to describe the development of chronic post-surgical pain and fatigue and the potential influence of the interventions on these processes. The study is set-up to demonstrate a minimum difference in pain of 1 point on NRS (0–10) and 3 points on FACIT-F (0–52) between the groups at 3-months follow-up by including 200 breast cancer patients in total. Discussion This trial will be the first study to estimate the effect of a combined pre-operative hypnosis with a post-operative iACT to prevent pain and fatigue after breast cancer surgery. The results from our study might i) help the large group of women affected by chronic pain and fatigue after breast cancer surgery, ii) shed light on the mechanisms involved in chronic pain and fatigue development, and iii) serve as a model for other surgical procedures. Trial registration Clinicaltrials.gov, registration number NCT04518085 . Registered on January 29 th , 2020. https://clinicaltrials.gov/ct2/show/NCT04518085 .
... Clinical research with at least 20 different surgical populations has indicated that hypnosis can reduce the need for medication, reduce post-surgical symptoms, and enhance recovery (32). Furthermore, meta-analyses (33), narrative reviews (34,35), and randomized clinical studies (36)(37)(38)(39) all support the potential clinical utility of hypnosis with surgical patients. A rigorous trial from the US demonstrated particularly promising results (40). ...
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Full-text available
Background Breast cancer is the most common cancer type among women worldwide with over a million new cases each year. More than 40% of these women will struggle with chronic pain and fatigue after surgery, regardless of surgical procedure. These consequences are detrimental and result in distress and disability, including work disability. Few attempts have been made to prevent chronic pain and fatigue after surgery by applying a psychological approach, despite psychological risk factors being crucial in the development of both chronic pain and fatigue. In this study, we aim to develop and test an easily implementable strategy of preventing chronic pain and fatigue after breast cancer surgery. The intervention strategy involves a pre-operative hypnosis session and a web-based post-operative Acceptance and Commitment Therapy (ACT). The hypnosis has previously been found effective in alleviating acute post-operative pain and fatigue in breast cancer patients, while ACT is well suited to cancer populations as it offers a model of healthy adaptation to difficult circumstances. Together they form an intervention strategy with both a preventive and a rehabilitative focus. Methods/design This randomized controlled trial aims to estimate the effects of the pre- and post-operative interventions compared to attentional control and treatment as usual (TAU) and will also include a qualitative process evaluation. Participants will be randomized to receive either a pre-operative brief hypnosis session and a post-operative web-based psychological intervention (iACT) or a pre-operative one-session mindfulness through an audio file and post-operative TAU. Self-reported questionnaire data and biomarker data will be assessed pre-surgery, post-surgery and 3 and 12 months after surgery. In addition, we will assess registry data on sick leave and prescriptions until 2-year follow-up. In the qualitative process evaluation, data will be collected from participants from both study arms (through interviews and a diary) and two different analyses performed (socio-narrative and Grounded Theory) with the objective to describe the development of chronic post-surgical pain and fatigue and the potential influence of the interventions on these processes. The study is set-up to demonstrate a minimum difference in pain of 1 point on NRS (0-10) and 3 points on FACIT-F (0-52) between the groups at 3-months follow-up by including 200 breast cancer patients in total. Discussion This trial will be the first study to estimate the effect of a combined pre-operative hypnosis with a post-operative iACT to prevent pain and fatigue after breast cancer surgery. The results from our study might i) help the large group of women affected by chronic pain and fatigue after breast cancer surgery, ii) shed light on the mechanisms involved in chronic pain and fatigue development, and iii) serve as a model for other surgical procedures. Trial registration Clinicaltrials.gov, registration number NCT04518085 . Registered on January 29 th , 2020.
... Het bleek dat hypnose het mogelijk maakt om peroperatief minder sedativa/analgetica toe te dienen. (Faymonville , et al., 1999) (Mackey, 2009) (Montgomery, David, Winkel, Silverstein, & Bovbjerg, 2002) (Lang, et al., 2000) (Lang, et al., 2006) (Lang, et al., 2008) (Hoge Gezondheidsraad, 2020. De twee prospectieve, gerandomiseerde studies (Faymonville, et al., 1997) (Defechereux, et al., 2000) tonen aan dat medische hypnose een effectieve anesthesietechniek is dat zorgt voor een pijn-en angst reductie tijdens en na een operatie, minder vermoeidheid postoperatief en een sneller hervatten van (professionele) activiteit. ...
Thesis
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De inhoud van deze scriptie behandelt het onderwerp ‘medische hypnose’ in de verpleegkundige praktijk, meer bepaald het gebruik van Virtual Reality (VR) in de perioperatieve fase. De onderzoeksvraag binnen deze scriptie is: ‘Kan Virtual Reality toegepast worden bij zorgontvangers tijdens een medische ingreep ter reductie van perioperatieve stress en angst?’. De studie wordt uitgevoerd in kader van het behalen van het diploma bachelor in de verpleegkunde binnen Hogeschool VIVES, academiejaar 2021-2022. Vanuit wetenschappelijke literatuur zal de term ‘medische hypnose’ worden gedefinieerd, in het bijzonder wordt stilgestaan bij het gebruik van Virtual Reality als hulpmiddel voor medische hypnose in de gezondheidszorg. De literatuurstudie beschrijft het werkingsmechanisme van VR en welke invloed dit heeft op lichamelijke-, psychische- en cognitieve functies. De studie richt zich op het gebruik van VR tijdens medische en/of chirurgische ingrepen. Aanvullend wordt een prospectieve studie uitgevoerd, waarbij VR werd toegepast bij zorgontvangers die een medische ingreep ondergingen, VR werd telkens gebruikt in de peroperatieve fase. Een postoperatieve vragenlijst peilt naar ervaringen en gevoelens na de hypnosesessie. De resultaten worden in de scriptie besproken en verwerkt. Er worden kritische terugkoppelingen gemaakt met de literatuur en de praktijk. De studie toont aan dat VR voordelen biedt aan de beleving van een zorgontvanger die een operatie ondergaat, de pijnscore (NRS) wordt verlaagd en de patiënttevredenheid neemt toe. Om de zorgontvanger een kwalitatieve begeleiding te bieden is het van belang dat de verpleegkundige kennis heeft omtrent het gebruik van VR. Preoperatieve informatie is noodzakelijk voor elke zorgontvanger die in aanmerking komt voor VR tijdens zijn/haar ingreep. VR is veilig en kan peroperatief geïmplementeerd worden binnen de chirurgische praktijk, als aanvulling op locoregionale anesthesie.
... Finally, the hypnotic induction intervention was effective with significant differences in anxiety levels (subjetive and objetive) and psysical data (HR and BP). Hypnosis has been used in other medical invasive procedures and cancer patients to reduce anxiety and pain [24][25][26]36,[41][42][43][44][45]. In PET/CT scan this technique has not been used and can be new, however, our data showed how a hypnotic induction intervention has been effective in all studied variables. ...
... 18,19 A randomized-controlled trial using mindfulness in postsurgical spine patients demonstrated less pain, more pain acceptance, higher quality of life (QOL), better sleep quality, and lower frequency of use and potency of analgesics for pain. 20 Mindfulness has also been shown to improve surgical outcomes and pain postoperatively following breast surgery, 21 and to decrease intrapartum pain 22 and pain during core needle breast biopsy. 23,24 Given the success seen with mindfulness meditation in acute and procedural pain, we developed a web-based guided mindfulness meditation tool for adjunctive postoperative pain management. ...
Article
Background: Mindfulness meditation has been shown to alleviate pain and may be an appealing adjunctive pain management option. Objective: To compare measures of pain, mindfulness, and opioid usage, and collect evaluative feedback among patients undergoing septorhinoplasty with and without guided meditation. Methods: Patients undergoing septorhinoplasty were randomized to online-guided meditation postoperative days 0-3 versus standard care; all received the same pain medications. Primary outcome measures included pain intensity, opioid consumption, mindfulness scores, and evaluative feedback. Results: Twenty-one patients received guided meditation and 24 received standard care. No significant difference in opioid consumption or pain scores was seen with the exception of higher opioid use in patients with intranasal splints in the standard care group. Twenty out of 21 patients provided evaluative feedback; all recommended mindfulness meditation to friends undergoing nasal surgery, 90% reported it was beneficial, 85% believed it eased pain/discomfort, and 80% believed it aided with sleep. Conclusion: Although no objective difference was found in opioid consumption or pain scores, most patients reported that guided mindfulness meditation was beneficial to their recovery following septorhinoplasty.
... -In reduction of pain for gastrointestinal disorders such as ulcers, irritable colon, colitis, crohn's disease (9); -In reduction for pain for dermatological disorders like eczema, herpes, neurodermatitis, itchiness, psoriasis, warts (10); -In reduction of acute and chronic pain back aches, oncological pain, head aches and migraines, arthritis, rheumatism (11)(12)(13)(14)(15); -In reduction of nausea and vomiting as symptoms caused by chemotherapy (16)(17)(18)(19)(20); -In stabilizing hematic flow (21,22); -In handling anxiety in cases of acute respiratory events connected to allergies, in particular asthma (23); -In reduction of hypertension and in invasive vascular procedures (24,25); -In reduction of pain connected to the replacement of medication on second degree burns and above (26,28); -In surgery as an analgesic, especially in cases of allergic or hypersensitive patients or in cases of awake surgery (5,18,29,30); -During childbirth as to reduce nausea caused by pregnancy (gestational hypermisis) (31); -As an alternative to pharmaceutical anesthesia in dental contexts (32)(33)(34); -In reduction of anxiety and pain connected to invasive procedures in ambulatory regimes (29)(30)(31)(32)(33)(34)(35)(36)(37)(38); -In reduction of anxiety, through the blocking of the sympathetic reactions caused by stress (16; 39-41); ...
Article
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Background Much evidence shows that hypnotic communication can have a pain-relieving effect and reduce complications such as anxiety, insomnia and depression. Whenever this technique was applied, the use of pharmaceuticals was reduced, there were less side effects, shorter hospitalization timesframes and lower treatment costs. Aim of the study Evaluate the knowledge and perceptions of nurses about hypnotic communication and the causes for which this technique is not frequently used. A secondary objective pointed to measuring the effectiveness of an educational event on hypnosis. Method The evaluation was done by administering an anonymous and voluntary survey, in a pre-test and post-test modality to nurses subscribed to a formative event on hypnotic communication organized by the Nursing Order, Province of Ravenna. Results 78 nurses participated in the study. The analysis of the pre-test results show a gap of knowledge regarding hypnotic communication. The main causes were found regarding the lack of use for hypnotic communication: stereotypes and prejudices related to this technique and insufficient university education. Conclusions The implementation of this technique, effective and efficient under various aspects, requires a preliminary creation of culture regarding this theme, capable of surpassing the stereotypes and resistances brought by a lack of theoretical elements.
... For invasive procedures (such as large-core breast biopsy or percutaneous tumour treatment), the use of hypnosis has been shown to reduce the use of painkillers [46,47]. Two factors could account for this difference between labour/childbirth and invasive procedures. ...
Article
Background and purpose: Hypnosis in labour and childbirth is a complex intervention. Both qualitative and quantitative assessment methods have been used, but have targeted different outcomes. We followed a synergistic approach and a reconciliation strategy to further understand and evaluate this intervention. Methods A mixed-method analysis of quantitative and qualitative evidence was conducted. The assessment of efficacy was based on a recent Cochrane review (9 trials, 2954 women randomised). Four qualitative studies and 4 case studies were included. Results The outcomes addressed by the qualitative studies (mostly concerning maternal experiences) and in the quantitative studies (mostly concerning analgesic use) overlapped slightly. Discrepancies across results from the two study types suggested that response shift issues could occur. Conclusion Patient-centred instruments exploring response shift issues would be of great value. Hypnosis can be presented as a technique enabling patients to have a positive birth experience.
... Pain intensity, 15 pain unpleasantness, 15 pain medication desire, 24 and anxiety 41,70,71 were measured with individual items rated on a numeric rating scale (0-10), a widely used and validated approach to measuring clinical pain and related symptomology. 21 Patient-Reported Outcomes Measurement Information System-Physical Function scores were obtained through a medical record review. ...
Article
While knee and hip replacements are intended to relieve pain and improve function, up to 44% of knee replacement patients and 27% of hip replacement patients report persistent postoperative joint pain. Improving surgical pain management is essential. We conducted a single-site, three-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (CBE) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes - pain intensity, pain unpleasantness, pain medication desire, and anxiety - were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test. TJA patients were randomized to preoperative MM, HS, or CBE (n=285). MM and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. MM also decreased preoperative pain medication desire relative to CBE and increased postoperative physical functioning at 6-week follow-up relative to HS and CBE. Moderation analysis revealed surgery type did not differentially impact the three interventions. Thus, a single session of a simple, scripted MM intervention may be able to immediately decrease TJA patients' preoperative clinical symptomology and improve postoperative physical function. As such, embedding brief MM interventions in surgical care pathways has the potential to improve surgical outcomes for the millions of patients receiving TJA each year.
... Adverse affective states can arise from anticipatory anxiety in patients awaiting medical treatment that can negatively influence patients' experience of illness and treatment itself [46,[59][60][61][62][63] and may compromise patients on a physiological level by causing hemodynamic instability, procedural complications [64] coronary constriction, elevated levels of blood pressure and heart rate [65]. Importantly, preprocedural anxiety level is also a predictor of the experience of pain and anxiety during procedures themselves [63,66] and patients with these emotional issues also tend to have longer procedural times and request more medication [63]. ...
Article
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There are a myriad of sensory elements that contribute to the hospital sensory experience.Environmental Music Therapy is a human-centered, trauma informed strategy that encompasses a process using the metaphoric and associative properties of live music that seeks to modulate patients’ and staff’s perception of the hospital milieu as hostile. While there have been a few studies that have measured EMT’s actual impact quantifiably [1-5], this is the first article to outline the steps and provide orientation, theoretical grounding, and training guidelines for its actual implementation. It is hoped that EMT can be instituted in hospital ICUs as a viable, accessible practice for music therapists whereby its institution will address the sound environment, and perhaps most particularly in those ICUs that are extremely noisy or eerily quiet. Keywords: Environmental Music Therapy, soundscape, soundtrack, ICU, milieu perception
... They showed that shorter room times reduces costs effectively because of equipment amortization and personnel cost based on local salaries. 24,25 However, a potential drawback of hypnotherapy is the cost and availability of a skilled hypnotherapist. Further studies are needed to evaluate cost-effectiveness of adjunct hypnotherapy in rigid cystoscopy patients. ...
Article
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Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs,better visual performance and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Methods and methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: HypnosisGroup (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, 2)Standart Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using Visual Analog Scale(VAS) for pain, State-TraitAnxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI ,hemodynamic parameters and recovery duration were statistically similar between the two groups.The procedure duration was shorter in GroupH(p=0,018). The postprocedural STAI and VAS scores of patients in GroupH were significantly lower than those of Group SC (p=0,006;p=0,02,respectively). Heart rate and mean arterial pressure after positioning of the patient (p=0,000; p=0,004, respectively) and insertion of the cystoscope (p=0,000; p=0,000) were statistically lower in GroupH; whereas baseline,postprocedural and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p=0,000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain, anxiety; provides more stable hemodynamic conditions, shortens procedure duration and thus appears attractive for pain and anxiety management.
... Pain intensity, 15 pain unpleasantness, 15 pain medication desire, 24 and anxiety 41,70,71 were measured with individual items rated on a numeric rating scale (0-10), a widely used and validated approach to measuring clinical pain and related symptomology. 21 Patient-Reported Outcomes Measurement Information System-Physical Function scores were obtained through a medical record review. ...
Preprint
Background: More than 80% of surgical patients report inadequate pain management, which is associated with prolonged recovery and functional impairment.Methods: A single-site, three-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. A nonrandomized usual care group of patients was also collected. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (CB) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes - pain intensity, pain unpleasantness, pain medication desire, and anxiety - were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test.Results: TJA patients (N=727) were randomized to preoperative MM, HS, or CB (n=285) or received usual care (n=443). MM and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. MM also decreased preoperative pain medication desire relative to CB and increased postoperative physical functioning at 6-week follow-up relative to HS, CB, and usual care. Moderation analysis revealed MM increased physical function regardless of surgery type.Conclusion: In one of the largest studies of mind-body interventions ever conducted, a single 15-minute, preoperative mindfulness intervention immediately decreased pain, pain medication desire, and anxiety while also increasing physical function at the 6-week follow-up assessment. Level of Evidence: Level 1.
... This is important because advanced radiation therapy procedures, such as DIBH, increasingly require physically and mentally demanding participation from patients that further elevate their stress and anxiety levels. CBT approaches that have been well validated in radiologic and interventional procedures, such MRI, breast biopsies, and surgical procedures, [108][109][110]118 can be adaptable to the specific needs of advanced radiation therapy, particularly if combined with coaching and training. ...
Preprint
Full-text available
The delivery of radiation therapy shares many of the challenges encountered in imaging procedures. As in imaging, such as MRI, organ motion must be reduced to a minimum, often for lengthy time periods, to effectively target the tumor during imaging-guided therapy while reducing radiation dose to nearby normal tissues. For patients, radiation therapy is frequently a stress- and anxiety-provoking medical procedure, evoking fear from negative perceptions about irradiation, confinement from immobilization devices, claustrophobia, unease with equipment, physical discomfort, and overall cancer fear. Such stress can be a profound challenge for cancer patients' emotional coping and tolerance to treatment, and particularly interferes with advanced radiation therapy procedures where active, complex and repetitive high-level cooperation is often required from the patient.In breast cancer, the most common cancer in women worldwide, radiation therapy is an indispensable component of treatment to improve tumor control and outcome in both breast-conserving therapy for early-stage disease and in advanced-stage patients. High technological complexity and high patient cooperation is required to mitigate the known cardiac toxicity and mortality from breast cancer radiation by reducing the unintended radiation dose to the heart from left breast or left chest wall irradiation. To address this, radiation treatment in daily deep inspiration breath hold (DIBH), to create greater distance between the treatment target and the heart, is increasingly practiced. While holding the promise to decrease cardiac toxicity, DIBH procedures often augment patients' baseline stress and anxiety reaction toward radiation treatment. Patients are often overwhelmed by the physical and mental demands of daily DIBH, including the nonintuitive timed and sustained coordination of abdominal thoracic muscles for prolonged breath holding.While technologies, such as DIBH, have advanced to millimeter-precision in treatment delivery and motion tracking, the "human factor" of patients' ability to cooperate and perform has been addressed much less. Both are needed to optimally deliver advanced radiation therapy with minimized normal tissue effects, while alleviating physical and cognitive distress during this challenging phase of breast cancer therapy.This article discusses physical training and psychotherapeutic integrative health approaches, applied to radiation oncology, to leverage and augment the gains enabled by advanced technology-based high-precision radiation treatment in breast cancer. Such combinations of advanced technologies with training and cognitive integrative health interventions hold the promise to provide simple feasible and low-cost means to improve patient experience, emotional outcomes and quality of life, while optimizing patient performance for advanced imaging-guided treatment procedures - paving the way to improve cardiac outcomes in breast cancer survivors.
... Hypnosis has been shown to facilitate habit change, including health-risk habits, with smoking cessation and smoking relapse prevention [17][18][19][20]. Hypnosis has been shown to prepare patients effectively for surgical procedures and other medical interventions, to a degree producing costsavings in overall care [21,22]. Hypnosis also moderates the adverse effects of medical procedures such as radiation therapy for cancer patients [23]. ...
... These patients commonly experience clinically significant anxiety and physiologic stress responses equivalent to that of receiving a cancer diagnosis (12,13). Interventions to improve patient experiences have addressed the benefits of better communication, pain control, and reducing anxiety (3,(14)(15)(16)(17)(18). ...
Article
Objective Spiritual care is an important part of healthcare, especially when patients face a possible diagnosis of a life-threatening disease. This study examined the extent to which women undergoing core-needle breast biopsy desired spiritual support and the degree to which women received the support they desired. Methods Participants (N = 79) were women age 21 and older, who completed an ultrasound- or stereotactic-guided core-needle breast biopsy. Participants completed measures of spiritual needs and spiritual care. Medical and sociodemographic information were also collected. Independent sample t-tests and chi-square tests of examined differences based on demographic, medical, and biopsy-related variables. Results Forty-eight participants (48/79; 60.8%) desired some degree of spiritual care during their breast biopsy, and 33 participants (33/78; 42.3%) wanted their healthcare team to address their spiritual needs. African American women were significantly more likely to desire some type of spiritual support compared to women who were not African American. Among the 79 participants, 16 (20.3%) reported a discrepancy between desired and received spiritual support. A significant association between discrepancies and biopsy results was found, χ 2(1) = 4.19, P = .04, such that 2 (7.4%) of 27 participants with results requiring surgery reported discrepancies, while 14 (26.9%) of 52 participants with a benign result reported discrepancies. Conclusion Most women undergoing core-needle breast biopsy desired some degree of spiritual care. Although most reported that their spiritual needs were addressed, a subset of women received less care than desired. Our results suggest that healthcare providers should be aware of patients’ desires for spiritual support, particularly among those with benign results.
... Bollmann et al found that postinterventional pain correlates with longer procedural times and larger intraoperative narcotic requirements. [42][43][44][45] There is a lack of evidence whether maximum or average pain values are more important for patient satisfaction. ...
Article
Background: There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated. Methods: A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0-10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection. Results: In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)-maxNRS, peri: 3 (0-10) versus peri-post: 4 (0-9) (ns), and meanNRS, peri: 1.4 (0-7) versus peri-post: 2.0 (0-6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain. Conclusion: Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.
Article
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.
Article
Purpose To determine whether video-based informational or relaxational preparation reduces the number of unexpected patient-related events and scan duration more efficiently, and to assess how patients evaluate the interventions. Methods We randomized 142 adult patients (mean age: 48 ± 16 years) to three groups. The control group (n = 48, 33.8%) received standard care. The intervention groups watched an informational (n = 50, 35.2%) or relaxational (n = 44, 31.0%) video while awaiting their MRI examination. We recorded scan duration, number of motion artifacts/sequence repetitions, and patient-related incidents (e.g., interruptions, premature termination). Subjective evaluation of the interventions was provided by the patients after MRI completion. Results Mean scan duration for the control, relaxation, and information group was 39.38±16.62 minutes, 32.59±11.67 minutes, and 34.54 ± 11.91 minutes. Compared to the control group, scan duration was significantly shorter in the relaxation, but not in the information group (relaxation vs. control: p = .019; information vs. control: p = .082). The information and relaxation group did not differ significantly (p = .704). In 35 (24.6%) patients, one or more sequences were repeated; incidents occurred in six (4.2%) patients. Neither the frequency of repeated sequences nor incidents differed between the groups (all p > .239). Patients evaluated both videos very positively; the information video received even better evaluations (all p < .027). Conclusion Additional preparation, especially information, is perceived very positively by patients and at least relaxational preparation may have a positive impact on clinical operations.
Article
Background : Virtual reality hypnosis is a combination of visual immersion in a virtual reality environment and clinical hypnosis. It can be used in addition to conventional techniques, for sedation and pain management during wound care. Patients undergoing painful and long-lasting procedures under regional anesthesia could also benefit, from this technique alleviating the need for sedative-hypnotic medication. Case presentation : Two patients with relative contra- indications for general anesthesia underwent lengthy orthopedic surgery of the upper limbs under regional anesthesia with additional virtual reality hypnosis. Written informed consent was obtained from both patients before surgery. A 69-year-old man, with a previous medical history of severe symptomatic aortic valve stenosis (ѳ 0.69cm2, max/mean gradient of 91/58mmHg) sustained a proximal humerus fracture-dislocation and was scheduled to undergo shoulder hemi-arthroplasty. Anesthesia was provided with ultrasound-guided continuous interscalene block at the C5-C6 level (11mL levobupivacaine 0.5%) combined with a single-shot superficial cervical plexus block (6mL levobupivacaine 0.5%). The second case was a 56-year-old man suffering from rheumatoid arthritis with severe restrictive lung function due to interstitial lung disease and bilateral bronchiectasis. He received a unilateral elbow prosthesis. Continuous infra-clavicular brachial plexus block, per- formed under ultrasound guidance was provided (20 mL mepivacaine 1.5%). Both patients required prolonged immobilization on the operating table. We used virtual reality hypnosis to induce sedation and improve comfort without using medication. This was provided by headphones and head-mounted goggles, showing computer generated images of underwater scenes (Aqua module, Oncomfort ™). Both surgeries were uneventful during which time cardiorespiratory stability was maintained. Patients were comfortable during and satisfied after surgery. No sedative drugs were given before nor during the procedures. Conclusion : Non-pharmacological sedation can be achieved with virtual reality hypnosis. When com- bined with regional anesthesia, this technique provides satisfactory sedation when pharmacological methods may be hazardous.
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Background Surgery is a cornerstone of breast cancer management. Prior to surgery, a wire marker is placed at the site of the tumor, to enable the surgeon to accurately localize the lesion during later surgery. This procedure can generate considerable anxiety for many patients. We investigated the value of conversational hypnosis (CH) in reducing anxiety in patients undergoing preoperative wire placement under radiographic control. Methods Randomized, multicentre study in 7 centers in France. Inclusion criteria were patients aged >18 years with an Eastern Cooperative Oncology Group performance status ≤2, scheduled to undergo preoperative wire placement in one or several breast lesions. Patients were randomized in a 1:1 ratio, stratified by center to undergo preoperative wire placement with or without the use of CH by a radiological technician trained in the CH technique. The primary endpoint was the percentage of patients with an anxiety score ≥ 6 on a visual analog scale ranging from 0 (absence of anxiety) to 10 (maximal anxiety). Secondary endpoints were pain score, perceived duration reported by the patient, technician satisfaction with their relationship with the patient, and ease of marker insertion reported by the radiologist. Semi-structured interviews were performed with patients to assess their perception of the marker placement procedure. Results The trial was prematurely interrupted for futility after a planned interim analysis after accrual of 167 patients, i.e., half the planned sample size. Prior to marker placement, 29.3% ( n = 24) of patients in the control group had an anxiety score ≥ 6, versus 42.3% ( n = 33) in the CH group ( p = 0.08). After marker placement, the change of anxiety score was not significantly different between groups (11.0% ( n = 9) versus 14.3% ( n = 11), p = 0.615). There was no significant difference in any of the secondary endpoints. In the interviews, patients from both groups frequently spoke of a feeling of trust. Conclusion This study failed to show a benefit of conversational hypnosis on anxiety in patients undergoing marker placement prior to surgery for breast cancer. The fact that some caregivers had learned this personalized therapeutic communication technique may have had a positive impact on the whole caregiving team. Trial registration The study was registered with ClinicalTrials.gov (NCT02867644).
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The following research focused on psycho-social determinants of health perception from the perspective of patient self-analysis underlying aspects of diagnostics and therapy directly linked to the patient's personal experience, for Quality Improvement Purposes. In particular, the study analyzed the importance of factors such as environment, personal belief and perspective on life, as a way to relate the patient's viewpoint within the specific structure of therapeutic groups led by the University of Vermont Medical Center (UVMMC, former Fletcher Allen Health Care) Inpatient Psychiatry Activities Therapists on the units Shepardson 3 and 6. Methods: The research is comprised of two parts: Part 1 has been represented by the Focus Group Questionnaire (FGQ), as previously approved by UVMMC Quality Council Meeting, and administered verbally (through printed handouts) on both units by UVMMC Activities therapists. Part 2, the Health Perception Survey, has been presented as printed attachment to the FGQ and followed the same structure, rules, and requirements of the FGQ. The data collected have been part of a retrospective cohort study in the case of the FGQ and have been implemented by the HPS, an empirical research questionnaire conducted over a period of six months, as approved by the Institutional Review Boards (IRBs). Patients have been able to choose to participate in the therapeutic focus group and not allow their responses to be used for research. Furthermore, patients have been able to decide to only answer the questions in the FGQ and not take part in the HPS. In the case of patients changing their mind after the focus group interview has been completed and wishing to withdraw from the study, the information collected has been used as part of the research study because the information was recorded with no identifiers, and with no link to patients' name.
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This textbook is written as a comprehensive overview of acute pain management. It is designed to guide clinicians through an impressive array of different options available to them and to patients. There has been a flurry of interest in the extent to which acute pain can become chronic pain, and how we might reduce the incidence of such chronicity. This overview covers a wide range of treatments for pain management, including the anatomy of pain pathways, the pathophysiology of severe pain, pain assessment, therapeutic guidelines, analgesic options, organization of pain services, and the role of anesthesiologists, surgeons, pharmacists, and nurses in providing optimal care. It also discusses the use of patient-controlled analgesia and how this may or may not be effective and useful.
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Hypnosis interventions have too often failed to disseminate, in part because of the relatively few high-quality, randomized clinical trials. The Task Force proposes efficacy guidelines, which are intended to improve the quality of clinical hypnosis research and thereby increase dissemination of beneficial hypnosis interventions. However, the Task Force, in muddying the focus on efficacy with opinions about moderation and mediation, proposes guidelines that are likely to: (1) weaken efficacy findings; (2) increase participant mistrust; (3) make efficacy trials more cumbersome; and, (4) treat hypnosis as though it were something other than a time-honored form of talk therapy. While applauding the Task Force's intentions, the current recommendations could be changed to better accomplish their goal of increasing hypnosis dissemination and implementation.
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L'auto-ipnosi è una generalizzazione dell'etero-ipnosi, di cui rappresenta la necessaria integrazione. Benché largamente applicata in ambito clinico, poco si sa della sua fenomenologia, della relazione con l'etero-ipnosi e la mindfulness, dei suoi meccanismi neurofisiologici e neuropsicologici, della sua efficacia clinica e del suo profilo di sicurezza. La letteratura in merito è sorprendentemente scarna e aneddotica. L'auto-ipnosi costituisce un'importante risorsa interiore auto-regolatoria e terapeutica, qualitativamente differente dall'etero-ipnosi, ma verosimilmente di non diversa efficacia clinica in numerosi ambiti di applicazione (e.g. controllo del dolore, dell'ansia, dei disturbi della condotta alimentare, ecc.). I correlati neurofisiologici e neuropsicologici dell'auto-ipnosi restano virtualmente sconosciuti per la mancanza di studi dedicati e di confronto con l'etero-ipnosi. Si discute ancora se l'esperienza auto-ipnotica possa essere autogena o indotta dalla suggestione etero-ipnotica, mentre sembra accertata una correlazione positiva tra ipnotizzabilità e profondità della trance auto-indotta. Anche il profilo di sicurezza rimane largamente impregiudicato, perché la stragrande maggioranza degli studi clinici omette la prevalenza e la tipologia di eventi avversi e/o effetti collaterali dipendenti dalla pratica ipnotica in generale. Assiomaticamente, si tende a considerare l'auto-ipnosi come una pratica altamente sicura e priva di effetti collaterali. In conclusione, all'importanza clinica dell'auto-ipnosi corrisponde paradossalmente una sostanziale mancanza di studi clinico-sperimentali. L'auto-ipnosi è dunque una Terra Incognita che aspetta urgentemente di essere esplorata.
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Veel kinderen ervaren ‘procedureel leed’: angst, pijn en verzet tijdens medische verrichtingen. Dat heeft grote invloed op hun vertrouwen, en dat van hun ouders, in de medische zorg. Verschillende technieken om patiënten zo goed mogelijk te begeleiden zijn verenigd in een multimodale aanpak, de zogeheten ‘procedurele comfortzorg’. Dit artikel gaat in op verschillende aspecten van deze aanpak.
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Interest and use of hypnosis to improve physical and psychological well-being in oncology Cancer and its treatments have several consequences: pain, fatigue, sleep disturbances, nausea, vomiting, hot flashes, and emotional distress. These symptoms negatively affect patients’ quality of life and can persist for years after treatment completion. Despite the difficulty to improve them with pharmacological approaches, hypnosis has often been ignored in oncology settings. Hypnosis can be defined as a particular state of consciousness during which focalized attention and concentration processes allows the person to be absorbed in their inner world, associated with a suspension of the awareness of the environment. During this procedure, a therapist will suggest to the patient some changes in their sensations, perceptions, thoughts or behaviors. Studies have shown the efficacy of hypnosis to decrease treatment and procedure-related painin oncology. Hypnosis is also useful to deal with cancer-related fatigue. Interventions combining hypnosis and cognitive-behavioral therapy or self-care techniques have shown positive effects on fatigue. Hypnosis also helps to improve procedure-related emotional distress and psychological well-being, as well as some physical symptoms such as nausea and hot flashes. Neuroimaging studies highlighted specific neural mechanisms of hypnotic state, allowing to better understand behavioral modifications reported by patients, after hypnosis.
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Nonpharmacological complementary and integrative medical therapies comprise those acceptable healthcare approaches outside of our conventional medicine. According to the National Center for Complementary and Integrative Health at National Institute of Health, more than 30% of adults and 12% of children use nonconventional medical therapies. Many complementary and integrative medical therapies can be used in pediatric sedation which include guided imagery, acupuncture-related techniques, music therapy, hypnotherapy, and sucrose sucking in infants. These remedies are generally underutilized and can be successfully integrated in conjunction with available conventional medical treatments for pediatric sedation.
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Hypnotizability assessment can inform hypnotic interventions, and studies on brief hypnotic inductions suggest that it may also confer therapeutic benefits. However, hypnotizability is rarely assessed in clinical practice due to limitations of current measures. The Elkins Hypnotizability Scale (EHS) improved upon such limitations and has been shown to be a very reliable and valid hypnotizability measure. This is the first study to examine the feasibility of the EHS as a therapeutic measure. Fifty-five participants were administered the EHS and randomized to two weeks of self-hypnosis with or without a recording. Results indicated that relaxation increased immediately after EHS administration, and relaxation and psychological distress improved after two weeks of self-hypnosis with the EHS induction. These results suggest that the EHS may be considered as a therapeutic measure and an avenue to introduce self-hypnosis in clinical practice with or without audio recordings.
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Positive patient care and healthcare facility outcomes are associated with using various psychological interventions during magnetic resonance imaging and interventional radiology procedures. Interventions such as hypnosis, relaxation, guided imagery, and empathic communication can improve anxiety, pain, and hemodynamic stability during procedures, as well as improve claustrophobia and anxiety during magnetic resonance imaging. Little is understood as to the potential underlying mechanisms of how these interventions operate and contribute to positive outcomes. Thus, this article seeks to address that question by integrating autonomic nervous system functioning, neuropsychological concepts, and common factors theory of psychotherapy as potential underlying mechanisms. Opportunities for future directions in the field are also included.
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Periprocedural anxiety is a major cause of morbidity, particularly for interventional radiology procedures that often depend on conscious sedation. Management of anxiety and pain during image-guided procedures has traditionally relied on pharmacologic agents such as benzodiazepines and opioids. Although generally safe, use of these medications risks adverse events, and newer noninvasive, nonpharmacologic techniques have evolved to address patient needs. In this review, we explore the roles of hypnosis, structured empathic attention, anodyne imagery, music, video glasses, and mobile applications in reducing procedural anxiety and pain with the goal of improving patient satisfaction, operational efficiency, and clinical outcomes.
Chapter
Patient-centered care is one of the core values of the Society of Breast Imaging and calls for provider collaboration with patients and families in shared decision-making processes to optimize care and patient satisfaction. As patients undergo imaging-guided breast biopsy procedures, understanding the patients’ experiences is critical for enabling radiologists to provide the most effective, patient-centered approach. This chapter describes factors such as effective radiologist-patient communication, reducing wait times, psychosocial support for anxiety, and procedural techniques and interventions for pain control to enhance patients’ experiences as they navigate the breast biopsy process.
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In the present work, we posit that a clearer outline of the interaction between hypnotic suggestion and attention would help establishing the precise point in the perceptual timeline at which hypnosis effects intervene, how exactly do they modulate cognitive control, and to what extent is hypnotic responding dependent on attentional resources. In order to tend to these experimental questions, we developed three research projects: (1) the normative data on our French translation for the Harvard Group Scale of Hypnotic Susceptibility, (2) an evaluation of the effects of posthypnotic suggestion on visuospatial attention, and (3) an evaluation on the capability of hypnotic suggestion to modulate the automatic attention allocation granted by the anger-saliency effect. The results from our first study allowed us to reliably score the hypnotic susceptibility of over 500 participants for the studies that ensued. Results from our second study indicated that for highly susceptible participants, posthypnotic suggestion successfully disrupted the early attentional mechanisms necessary for the fostering of priming, as well as late subjective visual awareness judgments. Our third study revealed that, through hypnotic suggestion, highly susceptible participants were able to deflect automatic attention allocation towards targets’ task-irrelevant angry features through strategic decoupling of cognitive control, but only when attentional resources were not coopted by competing processes. Pooled together, our findings support the ideas that hypnosis enacts its effects through cognitive control, that these can disrupt both early and late attentional mechanisms in distinct manners, and that the availability of attentional resources determines the range of action of hypnotic induction and suggestion
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Knowledge management (KM) is the name given to the set of systematic and disciplined actions that an organisation can take to obtain the greatest value from the knowledge available to it. Knowledge management has received increasing attention from 1990. For a few years, it was the next big thing after business process reengineering and total quality management. This paper describes and compares concepts of KM and TQM. At the end, it concludes that KM and TQM are complementary and to be successful, it is necessary to take an integrated approach to management.
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The long term effect of mammographic service screening is not well established. We aimed to assess the long-term effect of mammographic screening on death from breast cancer, taking into account potential biases from self-selection, changes in breast cancer incidence, and classification of cause of death. We compared deaths from breast cancer diagnosed in the 20 years before screening was introduced (1958-77) with those from breast cancer diagnosed in the 20 years after the introduction of screening (1978-97) in two Swedish counties, in 210000 women aged 20-69 years. We also compared deaths from all cancers and from all causes in patients diagnosed with breast cancer in the 20 years before and after screening was introduced. In the analysis, data were stratified into age-groups invited for screening (40-69 years) and not invited (20-39 years), and by whether or not the women had actually received screening. We also analysed mortality for the 40-49-year age-group separately. The unadjusted risk of death from breast cancer dropped significantly in the second screening period compared with the first in women aged 40-69 years (relative risk [RR] 0.77 [95% CI 0.7-0.85]; p<0.0001). No such decline was seen in 20-39 year olds. After adjustment for age, self-selection bias, and changes in breast-cancer incidence in the 40-69 years age-group, breast-cancer mortality was reduced in women who were screened (0.56; 0.49-0.64 p<0.0001), in those who were not screened (0.84 [0.71-0.99]; p=0.03), and in screened and unscreened women combined (0.59 [0.53-0.66]; p<0.0001). After adjustment for age, self-selection bias, and changes in incidence in the 40-49-year age-group, deaths from breast cancer fell significantly in those who were screened (0.52 [0.4-0.67]; p<0.0001); and in all women, screened and unscreened combined (0.55 [0.44-0.7] p<0.0001) but not in unscreened women (p=0.2). In both 40-69-year and 40-49-year age-groups, reductions in deaths from all cancers and from all-causes in women with breast cancer were consistent with these results. Taking account of potential biases, changes in clinical practice and changes in the incidence of breast cancer, mammography screening is contributing to substantial reductions in breast cancer mortality in these two Swedish counties.
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This paper demonstrates that the introduction of large-core needle biopsy (LCNB) replacing needle-localised breast biopsy (NLBB) for nonpalpable (screen-detected) breast lesions could result in substantial cost savings at the expense of a possible slight increase in breast cancer mortality. The cost-effectiveness of LCNB and NLBB was estimated using a microsimulation model. The sensitivity of LCNB (0.97) and resource use and costs of LCNB and NLBB were derived from a multicentre consecutive cohort study among 973 women who consented in getting LCNB and NLBB, if LCNB was negative. Sensitivity analyses were performed. Replacing NLBB with LCNB would result in approximately six more breast cancer deaths per year (in a target population of 2.1 million women), or in 1000 extra life-years lost from breast cancer (effect over 100 years). The total costs of management of breast cancer (3% discounted) are estimated at pound 4676 million with NLBB; introducing LCNB would save pound 13 million. The incremental cost-effectiveness ratio of continued NLBB vs LCNB would be pound 12 482 per additional life-year gained (3% discounted); incremental costs range from pound -21 687 (low threshold for breast biopsy) to pound 74 378 (high sensitivity of LCNB).
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The effects of tailored versus scripted hypnotic inductions were tested with the intention of shedding light on age regression phenomena. From an initial pool of 31 volunteers, 10 males and 10 females who scored 3 or better on the Stanford Hypnotic Clinical Scale, participated in this study. Participants were assigned to either scripted or tailored hypnotic induction conditions for regression to age 5. The age specific developmental task was to indicate for each of 10 abstract figure pairs, which of each pair "was upside down". Both groups showed significant focal point dependency. However, the tailored induction group showed significantly greater focal point dependency characteristic of 5-year-old children, in contrast to the scripted induction group. It appears that tailored hypnotic inductions may provide a better avenue for the ego to regulate its own degree of regression. The better match to personality style takes advantage of the naturally occurring ego-syntonic capacities of the participant, thereby facilitating greater hypnotic responsiveness.
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Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients’ selfreported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients’ pain and method of the administration. We conducted metaanalyses of published controlled studies (n 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. (Anesth Analg 2002;94:1639 –45)
Article
Context An increasing number of nonpalpable abnormalities requiring breast biopsy are being identified due to the widespread use of screening mammography. Large-core needle biopsy (LCNB) has become an alternative to surgical excision.Objective To determine whether LCNB is a safe and accurate technique to evaluate nonpalpable abnormalities found on breast imaging studies.Design and Setting Case series at an institutional referral center from August 1, 1991, to December 31, 1997.Patients A total of 1643 women with 1 or more suspicious breast abnormalities received LCNBs (n=1836 lesions).Intervention The LCNB of the breast uses a 14- or 11-gauge needle with stereotactic localization or ultrasound guidance.Main Outcome Measure Utility and potential limitations of LCNB compared with the criterion standard, surgical excision after wire localization.Results Of the 1836 breast lesions sampled, 444 (24%) were found to be malignant. A total of 412 (22%) were found to be malignant on the initial LCNB and 202 repeat biopsies yielded 32 additional malignancies. Complications were infrequent: 1 patient experienced a superficial infection and 1 developed a pneumothorax after LCNB.Conclusion Image-guided LCNB is a reliable diagnostic alternative to surgical excision of suspicious nonpalpable breast abnormalities.
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Fidelity of treatment in outcome research refers to confirmation that the manipulation of the independent variable occurred as planned. Verification of fidelity is needed to ensure that fair, powerful, and valid comparisons of replicable treatments can be made. The central purpose of this article is the evaluation of outcome studies from 1980 to 1988 to determine the extent to which investigators are attending adequately to the issue of treatment fidelity. The evaluation covered 359 treatment outcome studies from major journals in four domains: clinical psychology, behavior therapy, psychiatry, and marital and family therapy. The studies were evaluated with respect to: (a) the training of treatment implementors, (b) the procedures used to promote fidelity, (c) the aspects of treatment verified, (d) the methods for assessing fidelity, and (e) the utilization of fidelity assessment in the interpretation of results. Although there were significant increases over the decade in the percentage of studies that checked adherence to treatment and used supervision to promote fidelity, the majority (55%) of the studies essentially ignored the issue of treatment fidelity. Furthermore, only one out of eight studies in the most recent period (1986–1988) combined the use of treatment manuals, supervision of treatment agents, and checking of adherence to protocol. Finally, attention given to the aforementioned aspects of fidelity did not differ significantly across journal domains. The overall implication of the review of existing practices is that investigators, reviewers, and journal editors need to give even greater consideration to the issues associated with fidelity. Specific recommendations for improving the promotion and verification of treatment fidelity in outcome studies were offered.
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Conventional pain management with drugs has limitations and potentially serious side effects. Use of structured empathic attention and self-hypnosis can effectively reduce patients' pain perception and anxiety during interventional procedures, with the effect becoming more pronounced the longer a procedure lasts. Both nonpharmacologic interventions result in use of less sedatives and narcotics during procedures and fewer episodes of respiratory depression. However, in a prospective randomized study, only patients who had self-hypnosis had also fewer incidents of hemodynamic instability. Applied correctly and according to a written set of instructions, nonpharmacologic analgesia intervention can shorten total room time significantly, resulting in savings of precious resources. The techniques presented have been structured so that they are relatively immune to interruptions and can be applied safely in the procedure suite. Techniques include establishing of rapport by adapting verbal and nonverbal communication patterns to the patients' preferred mode, use of positive suggestions, avoidance of negatively loaded suggestions, and rapid induction of hypnosis where patients concentrate on a sensation of floating in a safe and comfortable place. With this approach, average, nonselected patients can easily engage in an imagery process regardless of their hypnotic potential.
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Rationale and Objectives The authors' purpose was to develop an electronic teaching module in nonpharmacologic analgesia and anxiolysis for use in the radiology department.
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Because of difficulties encountered with patient compliance using the standard visual analogue scale, a new nonvisual analogue scale has been devised for pain measurement. The new scale was found to give values for pain that correlated well with values given using the visual scale and was found to be more easily understood. The scale was considered to be simpler and more reliable than the visual scale heretofore in use. (C) Lippincott-Raven Publishers.
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Rapid assessment of patient anxiety is necessary to insure quality care. A number of self-report measures provide valid and reliable measures of anxiety. These measures can be timeconsuming to complete, however, and may be burdensome to medical patients who are in pain or acute anxiety states. Many medical procedures are performed in conditions in which written measures are cumbersome (e.g. patient in supine position), and scoring and interpretation of written measures in a busy clinical setting may be difficult for medical personnel. The present study provides validity data for a verbally administered (0–10) anxiety rating. One hundred and ninety-eight adult interventional radiology patients completed standard measures assessing state anxiety, trait Negative and Positive Affect, and the dimensions of the five-factor model of personality. Verbal anxiety rating was highly correlated with Spielberger’s State Anxiety Inventory, showed moderate correlations to the related constructs of neuroticism and trait Negative Affect, and was largely unrelated to theoretically distinct constructs. Verbal anxiety ratings made prior to the invasive procedure also predicted pain and anxiety during the procedure. The verbal anxiety rating also demonstrated sensitivity to changes in anxiety that occurred as a result of changes in situation. Findings support the convergent and discriminant validity of verbal anxiety ratings.
Article
The effect of analgesics on pathological pain in a double-blind, complete cross-over design was assessed by means of two rating scales, a verbal rating scale (VRS) and visual analogue scale (VAS). The VRS is widely used, but has several disadvantages as compared to the VAS. The results obtained by means of the VRS showed higher F-ratios (analysis of variance and Kruskall-Wallis H-test) than those obtained by means of the VAS. The VRS, which transfers a continuous feeling into a digital system, seems to augment artificially the measurement of effects produced by analgesics, and the VAS seems to assess more closely what a patient actually experiences with respect to change in pain intensities. The correlation between the two scales was highly significant (r = 0.81, P less than 0.001). The calculated regression line (y=-29.6 + 0.55-x) was not similar to the line of identity and showed much lower values for the VAS, supporting our interpretation. The distribution of the variances of the values obtained by means of both scales was not homogenous. This indicates that the homogeneity of the distribution of variances should always be checked and a Kruskall-Wallis H-test used, if they are inhomogenously distributed.
Article
This article represents the French translation of the Schedule for Affective Disorders and Schizophrenia (SADS), developed by researchers at the New York State Psychiatric Institute and Columbia University (New York) to permit the selection of homogeneous samples of patients presenting with a defined psychiatric illness. The SADS was developed in the mid-1970s in an effort to provide research investigators with a clinical procedure which would reduce information variance in both diagnostic and descriptive evaluations of subjects. It provides: 1. A detailed description of the features of the current episode of illness when they were at their most severe; 2. A similar description of the major features during the week prior to the evaluation; 3. A detailed description of past psychopathology and functioning relevant to the evaluation of prognosis and overall severity of disturbance; and 4. A series of questions and criteria which enable one to make diagnoses using the Research Diagnostic Criteria. These criteria currently represent the most widely used nosologic system for clinical research in psychiatry, allowing for comparison of results and facilitation of replication by different research teams.
Article
The question of how to analyze unbalanced or incomplete repeated-measures data is a common problem facing analysts. We address this problem through maximum likelihood analysis using a general linear model for expected responses and arbitrary structural models for the within-subject covariances. Models that can be fit include standard univariate and multivariate models with incomplete data, random-effects models, and models with time-series and factor-analytic error structures. We describe Newton-Raphson and Fisher scoring algorithms for computing maximum likelihood estimates, and generalized EM algorithms for computing restricted and unrestricted maximum likelihood estimates. An example fitting several models to a set of growth data is included.
Article
Models for the analysis of longitudinal data must recognize the relationship between serial observations on the same unit. Multivariate models with general covariance structure are often difficult to apply to highly unbalanced data, whereas two-stage random-effects models can be used easily. In two-stage models, the probability distributions for the response vectors of different individuals belong to a single family, but some random-effects parameters vary across individuals, with a distribution specified at the second stage. A general family of models is discussed, which includes both growth models and repeated-measures models as special cases. A unified approach to fitting these models, based on a combination of empirical Bayes and maximum likelihood estimation of model parameters and using the EM algorithm, is discussed. Two examples are taken from a current epidemiological study of the health effects of air pollution.
Article
In a prospective randomized study, 103 women had stereotactic biopsies performed either in the prone (n = 51) or sitting (n = 52) position. Questionnaires were administered before and after biopsy, to measure anxiety, pain and subjective experience in all patients. Vasovagal reactions were scored from 0 to 2 according to severity. There was no significant difference between biopsies performed in the sitting or the prone position with regard to overall tolerance. Significantly more patients biopsied in the prone position (15 of 51, 29 per cent) than in the sitting position (seven of 52, 13 per cent) would prefer premedication before a repeat biopsy (P = 0.04). Of the total patient group, three women fainted, one in the prone position and two others in the sitting position. Breast biopsies performed in the prone or sitting position are equally well tolerated. Somatic reactions such as fainting are not a major problem during breast biopsy; however, attention should be focused on patient care, including information given before the procedure.
Article
The ability to quantify pain intensity is essential when caring for individuals in pain in order to monitor patient progress and analgesic effectiveness. Three scales are commonly employed: the simple descriptor scale (SDS), the visual analog scale (VAS), and the numeric (pain intensity) rating scale (NRS). Patients with English as a second language may not be able to complete the SDS without translation, and visually, cognitively, or physically impaired patients may have difficulty using the VAS. The NRS has been found to be a simple and valid alternative in some disease states; however, the validity of this scale administered verbally, without visual cues, to oncology patients has not yet been established. The present study examined validity of a verbally administered 0-10 NRS using convergence methods. The correlation between the VAS and the NRS was strong and statistically significant (r = 0.847, p < 0.001), supporting the validity of the verbally administered NRS. Although all subjects were able to complete the NRS and SDS without apparent difficulty, 11 subjects (20%) were unable to complete the VAS. The mean opioid intake was significantly higher for the group that was unable to complete the VAS (mean 170.8 mg, median 120.0 mg, SD = 135.8) compared to the group that had no difficulty with the scale (mean 65.6 mg, 33.0 mg, SD = 99.7) (Mann-Whitney test, p = 0.0065). The verbally administered 0-10 NRS provides a useful alternative to the VAS, particularly as more contact with patients is established via telephone and patients within the hospital are more acutely ill.
Article
The purpose was to evaluate the effects on patients' pain perception of educating interventional radiology personnel in nonpharmacologic analgesia. Ninety-six patients undergoing lower-extremity arteriography or percutaneous nephrostomy were asked to rate the pain they experienced during the procedure on a scale of 0 to 5 (0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe pain, 4 = very severe pain, 5 = worst pain possible). Patients were studied at two baseline sessions (baseline 1, December 1993 to August 1994, n = 15; and baseline 2, September 1995 to January 1996, n = 11) and after the staff underwent one of two training sessions (posttraining 1, January 1995 to July 1995, n = 34; posttraining 2, January 1996 to April 1996, n = 36). Training targeted nurses and technologists and included rapport skills, correct use of language and suggestions, distraction, relaxation training, and self-hypnosis. Data were evaluated with analysis of variance for repeated measures. The mean pain scores reported after training were lower (1.48) and matched an "acceptable" pain score of 1.52 more closely than those reported under baseline conditions (2.54, P = .001). There was a tendency toward reduced use of intravenously administered agents for conscious sedation after training. There were no statistically significant differences in the pain scores between patients who underwent arteriography and patients who underwent nephrostomy overall (1.76 and 1.78, respectively), at baseline (2.58 and 2.43, respectively), and after staff training (1.49 and 1.42, respectively). Interventional radiology personnel trained in nonpharmacologic analgesia methods can help reduce patients' pain perception during interventional procedures.
Article
Women awaiting needle-guided breast biopsy procedures may experience high anxiety levels. A randomized, double-blind, placebo-controlled study was designed to evaluate the ability of midazolam and diazepam (in a lipid emulsion [Dizac]) to improve patient comfort during needle localization and breast biopsy procedures. Ninety women received two consecutive doses of a study medication, one before the mammographic needle localization and a second before entering the operating room. Patients were assigned randomly to receive saline, 2.0 ml intravenously, at the two time points; midazolam, 1.0 mg intravenously and 2.0 mg intravenously; or diazepam emulsion, 2.0 mg intravenously and 5.0 mg intravenously, respectively. Patients assessed their anxiety levels before the needle localization, before entering the operating room, and on arrival in the operating room. Patients completed a questionnaire evaluating their perioperative experience at the time of discharge. Patient satisfaction during needle localization was significantly improved in both benzodiazepine treatment groups (vs. saline). The incidence of moderate-to-severe discomfort during needle localization was lower in the midazolam (20%) and diazepam emulsion (6%) groups compared with the saline group (70%) (P<0.05). The preoperative visual analogue scale anxiety scores were similar in all three groups. In the operating room, however, anxiety scores were 55% and 68% lower after midazolam (21+/-19) and diazepam emulsion (15+/-14) compared with saline (46+/-28). Finally, there was no difference in the time to achieve home-readiness or actual discharge time among the three groups. Premedication with midazolam or diazepam emulsion improved patients' comfort during needle localization procedures and significantly reduced intraoperative anxiety levels before breast biopsy procedures without prolonging discharge times. Use of diazepam emulsion may be an effective alternative to midazolam in this population.
Article
An increasing number of nonpalpable abnormalities requiring breast biopsy are being identified due to the widespread use of screening mammography. Large-core needle biopsy (LCNB) has become an alternative to surgical excision. To determine whether LCNB is a safe and accurate technique to evaluate nonpalpable abnormalities found on breast imaging studies. Case series at an institutional referral center from August 1, 1991, to December 31, 1997. A total of 1643 women with 1 or more suspicious breast abnormalities received LCNBs (n = 1836 lesions). The LCNB of the breast uses a 14- or 11-gauge needle with stereotactic localization or ultrasound guidance. Utility and potential limitations of LCNB compared with the criterion standard, surgical excision after wire localization. Of the 1836 breast lesions sampled, 444 (24%) were found to be malignant. A total of 412 (22%) were found to be malignant on the initial LCNB and 202 repeat biopsies yielded 32 additional malignancies. Complications were infrequent: 1 patient experienced a superficial infection and 1 developed a pneumothorax after LCNB. Image-guided LCNB is a reliable diagnostic alternative to surgical excision of suspicious nonpalpable breast abnormalities.
Article
Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
Article
The objective of this study was to evaluate and document pain and psychological distress related to imaging-guided core needle biopsy (CNB) of the breast. This prospective study of 52 consecutive patients undergoing CNB of the breast assessed anxiety, pain, acute stress disorder, and activities of daily living both preprocedure and at 24 hours, 5 days, and 30 days postprocedure. Survey instruments included the State-Trait Anxiety Inventory (STAI), a visual analog pain scale, the SF-36 Physical Functioning Scale, and DSM IV criteria for acute stress disorder. Preprocedure the mean scores for self-reported levels of state and trait anxiety were 47.11 (SD = 13.53) and 37.71 (SD = 11.24), respectively. At 24 hours postprocedure, the mean score for self-reported state anxiety was 38.74 (SD = 17.77), a significant reduction from the preprocedure level reported by patients (p < 0.005). Further reductions in state anxiety levels were reported at 5 and 30 days postprocedure. The mean scores for state anxiety fell within the normal range at 30 days postprocedure (mean 32.75, SD = 10.97). However, at 5 days post-CNB, patients with confirmed malignancies reported significantly more anxiety than patients without malignancies (p = 0.002). This difference was not present at 30 days post-CNB (p = 0.17). Patients reported average pain scores of 2.0 (on a scale of 0-10) during the biopsy. This decreased to 1.3 at 24 hours, 0.3 at 5 days, and 0.2 at 30 days. Reported symptoms of acute stress related to the procedure significantly increased over the period between the 5-day interview and the 30-day interview. One (2%) patient reported avoidance of thoughts about CNB 5 days postprocedure and 5 (12%) patients reported this at 30 days postprocedure (p < 0.05). Patients undergoing CNB reported significant levels of state anxiety which were greatest at the time of biopsy. A significant decrease was observed at 24 hours postprocedure, despite the fact that biopsy results were not available to the patients. Self-reported levels of anxiety for the group, regardless of biopsy results, fell within the normal range by 30 days. Further research and interventions are recommended to address the management of anxiety for patients undergoing CNB.
Article
The authors performed this study to investigate the level of patient anxiety immediately preceding breast biopsy and examined potential clinical and demographic correlates of anxiety. The authors evaluated 102 women who were referred to a radiology breast clinic to undergo breast biopsy. The women were assessed with a self-report of demographic and medical items and the State Trait Anxiety Inventory (STAI) immediately before their biopsy. The STAI also was administered at 1 and 5 days after biopsy. The participants' mean state anxiety T score as measured with the State Trait Anxiety Inventory was 71.1 (standard deviation, 7.2). Multiple regression analysis was performed to determine the correlates of state anxiety. The variables that showed the strongest correlation with state anxiety were trait anxiety, being concerned about the results of biopsy, education (less education was associated with more anxiety), age (an older age was associated with more anxiety), and number of relatives with breast cancer. Given the expected overlap (r = 0.55) between state and trait anxiety, a second regression analysis was performed that controlled for trait anxiety. The results of this analysis also identified age, being concerned about the results of the biopsy. and number of relatives with breast cancer as relevant correlates of state anxiety. Overall, the results give some indication of the characteristics of women likely to be most anxious before biopsy. Future research should assess the effectiveness of different strategies for addressing situational anxiety.
Article
Our purpose was to determine whether patients prefer immediate or delayed results of screening mammography and to determine the cost of immediate reporting at our institution. A survey was anonymously and randomly distributed to 129 women who were 35-70 years old during a visit to their primary care physician, asking the women's preference for receiving mammography results by one of two systems: by letter with a return visit for any additional tests; or by speaking at once with the radiologist, with the option of additional tests being performed during the same visit. Patients' willingness to pay for the latter service was also determined. A cost identification model was constructed using commercially available software. We considered the impact on radiologists' and technologists' time and the need for additional equipment and space, and we analyzed the effect on the cost of immediate reporting. One hundred twenty (93%) surveys were completed. Eighty women (67%) preferred immediate reporting, and 62 (78%) of these 80 patients would wait 30-60 min. The additional cost of immediate reporting is $28.22 per patient. Only 11% of patients were willing to pay this additional cost. When new equipment and space were not required, the cost would increase by $4.38. This cost was most influenced by the time required to give patients normal results. Most surveyed patients preferred speaking with a radiologist immediately but were unwilling to pay additional fees. Radiologists, hospital administrators, and health care planners must be aware of the costs of immediate reporting and must factor these costs into any change in hospital or national policy.
Article
Previous research focusing on one-time screening rather than repeat adherence, have largely pointed out that anxiety levels and pain expectation are the most common factors which may act as a barrier to mammography. These studies also show that anxiety pain and depression are very often associated with the experience of mammography. The aim of this study was to evaluate whether a supportive psychological intervention can be effective in reducing these feelings in patients undergoing follow-up mammography The study was performed on 60 women who had already received a diagnosis of breast cancer. In order to detect the variables of depression, anxiety and pain before and after mammography the following questionnaires were administered to the patients: State-Trait Anxiety Inventory (STAI), Self-rating Depression Scale (SDS), Visual Analog Scale (VAS). The results of this study show that our psychological intervention significantly lowered the levels of state anxiety and pain but it had no effect on depression. A psychological approach giving patients both emotional and informational support about the examination, may significantly reduce state anxiety levels and the pain felt during mammography.
Article
Unlabelled: Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients' self-reported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients' pain and method of the administration. We conducted meta-analyses of published controlled studies (n = 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D = 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. Implications: A meta-analytical review of studies using hypnosis with surgical patients was performed to determine the effectiveness of the procedure. The results indicated that patients in hypnosis treatment groups had better clinical outcomes than 89% of patients in control groups. These data strongly support the use of hypnosis with surgical patients.
Article
The authors' purpose was to develop an electronic teaching module in nonpharmacologic analgesia and anxiolysis for use in the radiology department. The teaching document was derived from previous training courses validated by patient outcome. Skills in structured empathic attention and guidance of self-hypnotic relaxation were tested in a previous prospective, randomized study with 241 patients and shown to affect positively patients' perception of pain and anxiety. Patients undergoing hypnosis had the greatest relief and most hemodynamic stability. The skills applied also saved, on average, 17 minutes of procedure time and approximately $340 in sedation cost per case. With these validated behavioral skills, an electronic teaching module was constructed. The mode of teaching reflected the content of teaching, which was achieved through a multimedia format containing text, audio, video, pictures, and animation. Advanced navigation tools put the students in control of their learning experience. Inclusion of experiential components, congruity of language with Ericksonian syntax, and provision of an electronic journal catered to the development of greater biobehavioral awareness. Electronic teaching modules for biobehavioral skill training are feasible and promise to reduce the time need for life interactions with instructors.
Article
To evaluate effectiveness of oral anxiolytic medication versus relaxation technique for anxiety reduction in women undergoing breast core-needle biopsy (CNB). The institutional review board reviewed and approved the study. Informed consent was obtained from 143 consecutive women scheduled for breast CNB. Women were randomized as follows: no anxiety intervention (usual care group), relaxation therapy with an audiotape of classical music and ocean sounds during CNB (relaxation group), and 0.5-mg of alprazolam administered orally 15 minutes before CNB (medication group). Anxiety before, during, and 24 hours after the procedure was assessed with State-Trait Anxiety Inventory and self-reported visual analog scale from 0 (no anxiety) to 10 (worst anxiety). Data analysis was performed with statistical software. Descriptive statistics were computed for all variables. Group differences were determined with analysis of variance. Differences in mean values were assessed with Bonferroni multiple comparison procedure. Categorical demographic differences were assessed with chi(2) statistic. Preprocedural State-Trait Anxiety Inventory scores indicated that women were not inherently anxious: usual care group, score of 44.63; relaxation group, 45.74; and medication group, 49.1. Scores represented significantly elevated anxiety for women in all three groups when compared with the normative value of 35.12 (P < .0001), with no statistically significant differences between the scores of the three groups. Women in medication group reported significant reductions in anxiety (-44%) from levels determined before the procedure to levels determined during the procedure (P = .02) and significant reduction during the procedure when compared with changes in usual care (+15%) and relaxation (-8%) groups (P = .02). Women in all three groups reported significant reduction in anxiety from levels determined before the procedure to levels determined at 24 hours after it (P < .0001). There was no significant difference (P = .95) in 24-hour postprocedural anxiety levels among the three groups. Use of oral anxiolytic medication before breast CNB can significantly reduce anxiety women experience during the procedure.
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