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Effectiveness and Reliability of Hypnosis in Stereotaxy: A Preliminary Case-Series
02 June 2017 (online)
Aims: In certain neurosurgical procedures, the use of a stereotactic frame is required. The mounting of the stereotactic frame on the awake patient’s head by screwing the device into the patient’s skull, is consistently reported as “painful” to “extremely painful” by patients. Since the existence of hypnosis-related phenomena and their influence on the pain signal perception are abundantly reported, the potential of hypnosis in pain modulation during the stereotactic frame fixation should be explored.
Methods: In an ongoing prospective monocentric randomized controlled study, the patients’ cohort is dichotomized into two groups: the first group undergoes hypnosis and local anesthesia (EMLA patch and instillation of rapidocaïn/epinephrin) during the frame fixation, whereas the second group benefits from local anesthesia only. The hypnosis session is performed by a senior, board-certified anesthesiologist. During the procedure, patients report their highest pain using the Visual Analogue Scale.
Results: A preliminary pilot sample of 5 patients undergoing awake deep brain stimulation for Parkinson’s disease (4 males, mean age 55 years, baseline VAS-head 0/10, 1 patient without hypnosis, 4 patients with hypnosis) was analyzed. Of the 4 patients in the hypnosis group, 1 patient did not enter in the hypnotic state and reported VAS 9/10 during the procedure. For the three remaining patients, 2 patients had VAS-head of 0/10 during the fixation and 1 patient reported VAS-head of 3/10. The patient allocated to the control group reported VAS head of 9/10 during the frame disposal.
Conclusions: Hypnosis during stereotactic frame fixation could represent a simple and inexpensive tool to decrease the pain and stress perceived by the patient during the frame disposal. Further data are being collected to confirm this impression.