Neurophysiologie de l’hypnose

We here review behavioral, neuroimaging and electrophysiological studies of hypnosis as a state, as well as hypnosis as a tool to modulate brain responses to painful stimulations. Studies have shown that hypnotic processes modify internal (self awareness) as well as external (environmental awareness) brain networks. Brain mechanisms underlying the modulation of pain perception under hypnotic conditions involve cortical as well as subcortical areas including anterior cingulate and prefrontal cortices, basal ganglia and thalami. Combined with local anesthesia and conscious sedation in patients undergoing surgery, hypnosis is associated with improved peri- and postoperative comfort of patients and surgeons. Finally, hypnosis can be considered as a useful analogue for simulating conversion and dissociation symptoms in healthy subjects, permitting better characterization of these challenging disorders by producing clinically similar experiences

Differentiating muscle damage from myocardial injury by meaans of the serum creatinine kinase (CK) isoenzyme MB mass measurement/total CK activity ratio

We immunoenzymometrically measured creatine kinase (CK) isoenzyme MB in extracts of myocardium and in homogenates of five different skeletal muscles. CK-MB concentrations in the former averaged 80.9 micrograms/g wet tissue; in the skeletal muscles it varied widely, being (e.g.) 25-fold greater in diaphragm than in psoas. CK-MB in skeletal muscles ranged from 0.9 to 44 ng/U of total CK; the mean for myocardium was 202 ng/U. In sera from 10 trauma and 36 burn patients without myocardial involvement, maximum ratios for CK-MB mass/total CK activity averaged 7 (SEM 1) ng/U and 18 (SEM 6) ng/U, respectively. Except for an infant (220 ng/U), the highest ratio we found for serum after muscular damage was 38 ng/U. In contrast, the mean maximum ratio determined in 23 cases of acute myocardial infarction exceeded 200 ng/U. Among seven determinations performed 8 to 32 h after onset of symptoms, each infarct patient demonstrated at least one ratio greater than or equal to 110 ng/U. Ratios observed after infarct were unrelated to treatment received during the acute phase. We propose a CK-MB/total CK ratio of 80 ng/U as the cutoff value for differentiating myocardial necrosis from muscular injury

Psychological interventions influence patients' attitudes and beliefs about their chronic pain.

Background: Patients' changing attitudes and beliefs about pain are considered as improvements in the treatment of chronic pain. Multidisciplinary approaches to pain allow modifications of coping strategies of patients, from passive to active. Methods: We investigate how two therapeutic treatments impact patients' attitudes and beliefs regarding pain, as measured with the Survey of Pain Attitudes (SOPA). We allocated 415 patients with chronic pain either to psychoeducation combined with physiotherapy, self-hypnosis combined with self-care learning, or to control groups. Pain intensity, global impression of change, and beliefs and attitudes regarding pain were assessed before and after treatment. Results: Our main results showed a significant effect of psychoeducation/physiotherapy on control, harm, and medical cure SOPA subscales; and a significant effect of self-hypnosis/self-care on control, disability and medical cure subscales. Correlation results showed that pain perception was negatively associated with control, while positively associated with disability, and a belief that hurt signifies harm. Patients' impression of improvement was associated with greater control, lower disability, and lower belief that hurt signifies harm. Conclusions: The present study showed that self-hypnosis/self-care and psychoeducation/physiotherapy were associated with patients' evolution of coping strategies from passive to active, allowing them to reduce pain perception and improve their global impression of treatment effectiveness. Keywords: Chronic pain, Hypnosis, Psychoeducation, Coping, Pain belief

Intérêt et utilisation de l’hypnose pour améliorer le bien-être physique et psychologique en oncologie

Le cancer et ses traitements ont de nombreux effets secondaires : douleurs, fatigue, difficultés de sommeil, nausées, vomissements, bouffées de chaleur, détresse émotionnelle. Ces symptômes impactent négativement la qualité de vie des patients et perdurent souvent pendant des années après les traitements. Malgré la difficulté à traiter ces effets secondaires au moyen d’approches pharmacologiques, l’hypnose a souvent été laissée de côté en oncologie. L’hypnose est définie comme un état de conscience modifié au cours duquel des processus d’attention et de concentration focalisées permettent au sujet une absorption dans son monde intérieur associée à une relative mise en suspens de la conscience de l’environnement. Durant cette procédure, un professionnel suggère au patient des changements dans ses sensations, perceptions, pensées ou comportements. Plusieurs études ont mis en évidence l’efficacité de l’hypnose pour diminuer la douleur provoquée par les traitements et procédures oncologiques. ’hypnose est également utile dans le cadre de la gestion de la fatigue liée au cancer. Des interventions combinant hypnose et thérapie cognitivocomportementale ou auto-bienveillance ont montré des effets positifs à ce niveau. Par ailleurs, l’hypnose permet une amélioration de la détresse émotionnelle liée aux procédures médicales et du bien-être psychologique général, ainsi qu’une diminution de certains symptômes physiques comme les nausées et les bouffées de chaleur. Les techniques de neuro-imagerie mettent en évidence des processus cérébraux spécifiques à l’état d’hypnose. Nous pouvons ainsi mieux comprendre les mécanismes sous-jacents aux modifications comportementales rapportées par les patients qui bénéficient de l’hypnose dans leur prise en charge.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 pain in 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

Hypnose et recherche : que se passe-t-il à Liège ?

Depuis quelques années, il est de plus en plus clair que l’hypnose présente un champ de recherche fondamentale et appliquée important. L’Hôpital Universitaire (CHU) ainsi que l’Université de Liège font partie des centres pionniers s’intéressant à l’étude de l’hypnose en tant qu’objet de recherche. Ces équipes ont pour objectif de comprendre les bases neurophysiologiques de la conscience humaine, les effets de la suggestion et les dimensions biopsychologiques qui en découlent pour pouvoir intégrer cet outil au mieux dans la pratique médicale à Liège

French Survey on Pain Perception and Management in Patients with Locked-In Syndrome.

peer reviewedPatients with locked-in syndrome (LIS) may suffer from pain, which can significantly affect their daily life and well-being. In this study, we aim to investigate the presence and the management of pain in LIS patients. Fifty-one participants completed a survey collecting socio-demographic information and detailed reports regarding pain perception and management (type and frequency of pain, daily impact of pain, treatments). Almost half of the LIS patients reported experiencing pain (49%) that affected their quality of life, sleep and cognition. The majority of these patients reported that they did not communicate their pain to clinical staff. Out of the 25 patients reporting pain, 18 (72%) received treatment (60% pharmacological, 12% non-pharmacological) and described the treatment efficacy as 'moderate'. In addition, 14 (56%) patients were willing to try other non-pharmacological treatments, such as hypnosis or meditation. This study provides a comprehensive characterization of pain perception in LIS patients and highlights the lack of guidelines for pain detection and its management. This is especially pertinent given that pain affects diagnoses, by either inducing fatigue or by using pharmacological treatments that modulate the levels of wakefulness and concentration of such patients

Impact de l’auto-hypnose, la méditation et la transe cognitive auto-induite chez des patients en oncologie : protocole d’étude.

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Hypnose, méditation et transe cognitive auto-induite pour améliorer la qualité de vie des patients oncologiques après le traitement

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