Christina Liossi

Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations.

A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.

Clinical Hypnosis in the Alleviation of Procedure-Related Pain in Pediatric Oncology Patients

This prospective controlled trial investigated the efficacy of a manual-based clinical hypnosis intervention in alleviating pain in 80 pediatric cancer patients (6–16 years of age) undergoing regular lumbar punctures. Patients were randomly assigned to 1 of 4 groups: direct hypnosis with standard medical treatment, indirect hypnosis with standard medical treatment, attention control with standard medical treatment, and standard medical treatment alone. Patients in the hypnosis groups reported less pain and anxiety and were rated as demonstrating less behavioral distress than those in the control groups. Direct and indirect suggestions were equally effective, and the level of hypnotizability was significantly associated with treatment benefit in the hypnosis groups. Therapeutic benefit degraded when patients were switched to self-hypnosis. The study indicates that hypnosis is effective in preparing pediatric oncology patients for lumbar puncture, but the presence of the therapist may be critical.

Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.

A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6-16 years). The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability. Patients were randomized to 1 of 3 groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention. Results confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure. The level of hypnotizability was significantly associated with the magnitude of treatment benefit, and this benefit was maintained when patients used hypnosis independently.

A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients.

ABSTRACT Venepuncture for blood sampling can be a distressing experience for a considerable number of children. A prospective controlled trial was conducted to compare the efficacy of a local anaesthetic (EMLA) with a combination of EMLA with self‐hypnosis in the relief of venepuncture‐induced pain and anxiety in 45 paediatric cancer outpatients (age 6–16 years). A secondary aim of the trial was to test whether the intervention will have a beneficial effect on parents’ anxiety levels during their child’s procedure. Patients were randomized to one of three groups: local anaesthetic, local anaesthetic plus hypnosis, and local anaesthetic plus attention. Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety, and less procedure‐related pain and anxiety, and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups. Parents whose children were randomized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child’s procedure than parents whose children had been randomized to the other two conditions. The therapeutic benefit of the brief hypnotic intervention was maintained in the follow‐up. The present findings are particularly important in that this study was a randomized, controlled trial conducted in a naturalistic medical setting. In this context, convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self‐hypnosis, an intervention that can be easily taught to children, is noninvasive and poses minimal risk to young patients and their parents.

The impact of head injury neurobehavioural sequelae on personal relationships: Preliminary findings

Background: Existing evidence suggests that neurobehavioural disability is a frequent legacy of serious head trauma and has a major impact on the psychological well-being of relatives and friends of people with brain injuries. Objective: To explore which neurobehavioural legacies of serious head trauma have the greatest impact on personal relationships and increase the risk of relationship breakdown. Method: Forty-eight partners of people who had suffered serious head trauma were asked to complete a 12-item measure to rate how different neurobehavioural characteristics had adversely affected their relationship with the brain injured person. Twenty-three couples who had divorced or separated from their injured partner in the years following injury comprised the ‘separated’ group, 25 still in the relationship at the time data were collected comprised the ‘together’ group. Results: Even though many neurobehavioural characteristics of brain injury were reported by partners of both the separated and the together group as placing a strain on the relationship only mood swings accounted for a significant between groups difference [t(40.13) = 3.33, p = 0.002]. The magnitude of the difference in the means was large (η2 = 0.19). Conclusions: Unpredictable patterns of behaviour, as perceived by partners of brain injured individuals, impose the greatest burden on personal relationships and may contribute to relationship breakdown.

Living with chronic low back pain: a metasynthesis of qualitative research:

Objectives The purpose of this qualitative metasynthesis is to articulate the knowledge gained from a review of qualitative studies of patients’ experiences of chronic low back pain. Methods Meta-ethnographic methodology guided the review of 33 articles representing 28 studies published in English in peer-reviewed journals between 2000 and 2012. A systematic comparison of the main themes from each study was conducted and ‘synthesised’ to create superordinate themes. Results Three overarching interrelated themes were identified: the impact of chronic low back pain on self; relationships with significant others that incorporated two streams – health professionals and the organisation of care and relationships with family and friends; coping with chronic low back pain. Coping strategies were predominantly physical therapies, medication and avoidance behaviours with very few successful strategies reported. Professional and family support, self-efficacy, motivation, work conditions and exercise opportunities influenced pain experiences. Review authors’ recommendations included psychological therapies, education, the facilitation of self-management strategies and support groups. Discussion The review substantiates chronic low back pain as complex, dynamic and multidimensional, underpinned by experiences of persistent distressing pain, loss, and lowered self-worth, stigma, depression, premature aging, fear of the future. Future research should address the paucity of longitudinal studies, loss and issues of ethnicity, gender, ageing.

Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer.

A single institution, prospective, randomized trial was performed in terminal cancer patients to compare tropisetron (TRO), metoclopramide (MET), and chlorpromazine (CHL) in the management of nausea and emesis. Patients had far advanced cancer, were far removed from chemotherapy or radiotherapy, and their nausea and emesis was not due to bowel obstruction, drug intake, or cranial, electrolytic, or metabolic causes. The effects of antiemetic treatments were evaluated from Days 1‐15.

Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis.

The hypothalamic-pituitary-adrenal (HPA) axis is a psychoneuroendocrine regulator of the stress response and immune system, and dysfunctions have been associated with outcomes in several physical health conditions. Its end product, cortisol, is relevant to fatigue due to its role in energy metabolism. The systematic review examined the relationship between different markers of unstimulated salivary cortisol activity in everyday life in chronic fatigue syndrome (CFS) and fatigue assessed in other clinical and general populations. Search terms for the review related to salivary cortisol assessments, everyday life contexts, and fatigue. All eligible studies (n=19) were reviewed narratively in terms of associations between fatigue and assessed cortisol markers, including the cortisol awakening response (CAR), circadian profile (CP) output, and diurnal cortisol slope (DCS). Subset meta-analyses were conducted of case-control CFS studies examining group differences in three cortisol outcomes: CAR output; CAR increase; and CP output. Meta-analyses revealed an attenuation of the CAR increase within CFS compared to controls (d=-.34) but no statistically significant differences between groups for other markers. In the narrative review, total cortisol output (CAR or CP) was rarely associated with fatigue in any population; CAR increase and DCS were most relevant. Outcomes reflecting within-day change in cortisol levels (CAR increase; DCS) may be the most relevant to fatigue experience, and future research in this area should report at least one such marker. Results should be considered with caution due to heterogeneity in one meta-analysis and the small number of studies.

Attentional bias toward pictorial representations of pain in individuals with chronic headache.

ObjectivesThis study investigated attentional biases for pictorial headache-related stimuli in individuals with chronic headache and healthy controls. MethodsAttentional bias was assessed using a visual probe task that presented headache-related images and neutral images at 2 exposure duration conditions, 500 and 1250 ms. ResultsThe results indicated that individuals with chronic daily headache showed a significantly greater overall attentional bias across presentation times toward headache-related stimuli compared with the controls, which indicates a bias in both initial orienting and maintained attention to pain cues in this group. DiscussionIt is concluded that both hypervigilance and sustained processing are critical factors for the maintenance of chronic pain.

Time-course of attentional bias for pain-related cues in chronic daily headache sufferers

This study investigated attentional biases for linguistic pain‐related stimuli in individuals suffering from chronic headaches and healthy controls. Attentional bias was assessed using a visual probe (also reported as dot probe in previous investigations) task which presented pain‐related (sensory and affective) and neutral words at two exposure duration conditions, 500 and 1250ms. The results indicated that individuals suffering from chronic headaches showed a significantly greater attentional bias at 1250ms compared to the controls, which indicates a bias in maintained attention to pain cues in this group. No significant differences between groups were found in attentional bias scores at the shorter stimulus duration of 500ms, which instead correlated significantly with trait anxiety. Results are discussed in relation to research into pain‐related and anxiety‐related biases in initial orienting and maintained attention.