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Case Studies

Ease Trauma Case Studies

CASE STUDIES

 

Study 1: HYPNOSIS TO TREAT GASTROINTESTINAL BLEEDING – HYPNOTIC CONTROL OF UPPER GASTROINTESTINAL HEMORRHAGE: A CASE REPORT

Results: After treatment with hypnosis, the patient (who was suffering from upper gastrointestinal tract bleeding) was discharged from the hospital without the need for surgical intervention.

Notes: This paper presents the successful treatment with hypnosis of a patient with upper gastrointestinal tract bleeding. After treatment, the patient was discharged from the hospital without the need for surgical intervention.

Reference: American Journal of Clinical Hypnosis, Volume 27, Issue 1, 1984. By: Emil G. Bishay M.D.a, Grant Stevensa and Chingmuh Lee, UCLA School of Med.  http://www.tandfonline.com/doi/abs/10.1080/00029157.1984.10402584?journalCode=ujhy20

Study 2: HYPNOSIS HELPS HEMOPHILIACS AVOID TRANSFUSIONS, DECREASES RISK OF OTHER HEALTH PROBLEMS, AND INCREASES QUALITY OF LIFE. THE USE OF HYPNOSIS WITH HEMOPHILIA

Results: The hemophiliacs using hypnosis realized a reduction in the need for transfusions, which results in a decrease in the development of inhibitors, less potential exposure to dangers such as the AIDS virus and a lower incidence of liver and kidney damage. A decrease in the frequency and severity of bleeding episodes results in less morbidity and better coping in the face of HIV infection. Self-hypnosis has provided many bleeders with increased feelings of control and confidence and improved the quality of their lives.

Notes: The Colorado Health Sciences Center’s program to treat hemophiliacs using hypnosis is described.

Reference: Psychiatr Med. 1992;10(4):89-98. By: W. LaBaw, University of Colorado Health Sciences Center, Denver.  http://www.ncbi.nlm.nih.gov/pubmed/1289965

Study 3: HYPNOSIS FOR HEMOPHILIA DENTAL CARE TO DECREASE BLEEDING – THE USE OF HYPNOSIS IN HEMOPHILIA DENTAL CARE

Results: This paper discusses how hypnosis can decrease bleeding during dental care and lower the anxiety of hemophiliacs about dental procedures.

Notes: The author describes the experiences of a dental clinic that uses hypnosis for hemophiliacs undergoing dental surgical procedures.

Reference: Ann N Y Acad Sci,1975 , 240;263-6, Volume 240. By: Oscar N. Lucas, University of Oregon Dental School.  http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1975.tb53358.x/abstract

Study 4: HYPNOSIS IN PAIN MANAGEMENT – ACUTE PAIN
The most researched form of acute (short-term) pain in the context of hypnosis is that associated with burn patients. The use of hypnosis is important at the outset as well as throughout the healing process. For burn patients, the use of hypnotic induction as close as possible to the time of injury is essential as it helps to limit the amount of inflammatory reaction to the injury. Furthermore, the minds of the patients are focused upon entry into the emergency room which makes hypnosis easy to induce. According to earlier studies, signs of inflammation are affected by the attitude of the patient toward the injury (Chapman et al., 1959). Therefore, the perception of heat at the burn site leads to increased inflammation and the perception of coolness leads to decreased inflammation.

Applied before the initiation of the natural response, hypnotic suggestions of cooling and anesthesia limit and prevent inflammation. Burn patients who accept the suggestions that the wounded area is ³cool² and ³comfortable² are easier to treat, more optimistic, and heal faster (Ewin, 1978). As burn patients go through the healing process, the pain of caring for the wound is reported to be more severe than the pain of sustaining the wound. In order to prevent infection, patients must undergo daily debridement, which involves scraping necrotic tissue off the wound and applying antiseptic. The procedure causes excruciating pain. Since the frequency of wound care prohibits regular use of general anesthesia, the use of hypnoanalgesia is highly applicable (Patterson et al., 1996).

In a study done by Patterson et al. (1992), 30 burn patients undergoing debridement were randomly assigned to three groups: hypnosis, attention/pseudohypnosis (placebo), and no intervention (control). The hypnosis condition included suggestions for relaxation, analgesia, amnesia, and comfort when touched on the shoulder. The placebo condition involved pseudohypnosis (closing your eyes, counting to 20, imagining yourself in a relaxing place), the touch on the shoulder, and instructions to distinguish between sensations of healing and signals of harm. The control condition provided no other procedures to alleviate pain. The results showed that only the group which underwent true hypnosis reported a significant reduction in pain. The true hypnosis group reported a 46% decrease in pain from the baseline, the placebo group reported a 16% decrease, and the control group reported a 14% decrease. Even though the placebo group believed that they underwent hypnosis, those assigned to that group did not report much less pain than those assigned to the control group. Therefore, the results discount the effects of expectancy and reveal that pain reduction due to hypnoanalgesia goes beyond relaxation.

References: Hoi Ning Ngai ’00. Chapman, L. F., Goodell H., & Wolff, H. G. (1959). Augmentation of the inflammatory reaction by activity of the central nervous system. AMA Archives of Neurology, 1,557-72. Ewin, D. M. (1978). Clinical use of hypnosis for attenuation of burn depth. Hypnosis at its Bicentennial-Selected Papers from the Seventh International Congress of Hypnosis and Psychosomatic Medicine.New York: Plenum Press. Patterson, D. R., Everett, J. J., Burns, G. L., & Marvin, J. A. (1992). Hypnosis for the treatment of burn pain. Journal of Consulting and Clinical Psychology, 60,713-7. Patterson, D. R., Goldberg, M. L., & Ehde, D. M. (1996). Hypnosis in the treatment of patients with severe burns. American Journal of Clinical Hypnosis, 38,200-12.

 
Study 5: HYPNOSIS FOR PAIN MANAGEMENT WITH CANCER SURVIVORS. Seattle, Washington 98109

Purpose: This randomized pilot clinical trial studies hypnotherapy in treating chronic pain in cancer survivors. Hypnotherapy is a state of concentration and focused attention which can provide more control over the experience of acute and chronic pain and its impact and may provide comfort, maximize function, and improve quality of life in cancer survivors.

Study summary: PRIMARY OBJECTIVES: I. To test the feasibility (recruitment, attrition, adherence, logistical issues) of delivering the hypnosis (hypnotherapy) intervention to cancer survivors with chronic pain. II. To evaluate the acceptability of the hypnosis intervention among cancer survivors with chronic pain. III. To explore preliminary efficacy (estimate effect size) of hypnosis in relieving pain and improving associated anxiety and functional performance at 4 weeks and 8 weeks compared to a wait-list control. OUTLINE: Participants are randomized to 1 of 2 groups. IMMEDIATE INTERVENTION GROUP: Participants undergo hypnotherapy session over 20-30 minutes using a standardized script for pain reduction that contains post-hypnotic suggestions for permanence of hypnotherapy benefits. The hypnotherapy session is recorded and the participant listens to the recording daily for 4 weeks. WAIT-LIST CONTROL GROUP: At week 5, participants undergo hypnotherapy session over 20-30 minutes using a standardized script for pain reduction that contains post-hypnotic suggestions for permanence of hypnotherapy benefits. The hypnotherapy session is recorded and the participant listens to the recording daily for 4 weeks.

Criteria: Inclusion Criteria: – Self-report of moderate or higher pain on average during the last week (> 3 on a 0-10 pain intensity numeric scale) – Completed active cancer treatment other than maintenance therapy >= 3 months ago – Functional fluency in English – Mentally and physically able to participate and complete surveys over the phone Exclusion Criteria: – Chronic pain is not cancer-related

Reference:  Principal Investigator, Kathleen Shannon Dorcy. Fred Hutch/University of Washington Cancer Consortium

Study 6: A RANDOMIZED CLINICAL TRIAL OF A BRIEF HYPNOSIS INTERVENTION TO CONTROL SIDE EFFECTS IN BREAST SURGERY PATIENTS

Abstract

Background: Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective.

Methods: We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0–100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review.

Results: Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 μg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time.

Conclusions: Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.

Reference: JNCI: Journal of the National Cancer Institute, Volume 99, Issue 17, 5 September 2007, Pages 1304–1312

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