HYPNOTHERAPY and FAMILY MEDICINE How HYPNOTHERAPY CAN COMPLEMENT CLINICAL WORK in FAMILY MEDICINE By: Sherry M

HYPNOTHERAPY AND FAMILY MEDICINE How HYPNOTHERAPY CAN COMPLEMENT CLINICAL WORK IN FAMILY MEDICINE by: Sherry M. Hood and Fred Janke Sherry M Hood MH, C. CHt is the Dr. Janke completed his medical education at founder, curriculum developer and HEAD the University of Calgary in 1982 and has been instructor for The Pacific Institute of practicing in Sylvan Lake, Alberta as A family Advanced Hypnotherapy where she teaches physician since 1984. both full time and part time hypnotherapy courses. In August 2009 He became involved with the University of Alberta as site director in Red Sherry was appointed Clinical Lecturer in the Department of Family Deerfor A new rural stream family medicine program in the year 2000. Medicine, University of Alberta. Her hypnotherapy course became Since then HE has become increasingly involved with teaching family A medical elective for post graduate residents from The University of medicine at the post-graduate level. He became the "Rural Program Alberta in December 2010. A pilot study through The University of Director" for the Department of Family Medicine in 2008 and more Alberta was conducted using Sherry's smoking cessation recently; in October 2011, took on A broader position as "Director of Rural intervention. A two year study using her same smoking cessation and Regional Health "for the Faculty of Medicine. Although HE isfull time intervention isplanned for thefuture. faculty his clinical work remains in Sylvan Lake. In April 2012, Dr. Fred Janke and Sherry Hood were given the during this presentation: 1) the use of hypnotherapy in opportunity to present at A national conference for rural surgery; 2) hypnotherapy as an adjunct to pain management; physicians held at Whistles; British Columbia, Canada. This 3) addressing psychiatric conditions; and 4) addressing was unique because the topic of hypnosis and hypnotherapy is focused areas of therapy such as smoking cessation. rarely seen on the program of conferences for medical The use of hypnosis in surgical management was reviewed professionals. It was all opportunity to present how in detail. Although hypnosis has been used in surgery for hypnotherapy could complement clinical care. almost 200 hundred years, there has been only minimal interest and research until quite recently. By comparison The objectives of the presentation were as follows: To there have been many more pharmacological advances in understand the basic premises behind hypnosis/ anesthesia and analgesia. Contemporary clinical hypnotherapy; investigations have shown that the combination of analgesia To be able to outline a variety of clinical conditions for and hypnosis is superior to conventional pharmacologic which there is good evidence supporting the use of anesthesia.' Hypnosis can enhance conscious sedation. All of hypnotherapy; these techniques are used regularly for surgical cases at the To understand criteria with which to identify reputable University Hospital at Liege, Belgium.Y Cost analyses show hypnotherapists; that adjunct hypnotherapy used with conscious sedation To understand ways of accessing hypnotherapy in smaller reduces overall costs." In fact, using hypnotherapy even for communities via referral, telephone and Skype. outpatient interventional radiology procedures can reduce As noted the first objective was to present a basic costs by half. 9 Perioperative hypnotherapy can significantly understanding of what hypnosis is and what it is not. reduce costs by decreasing postoperative stays, particularly Following a very simplistic introduction into the basics of amongst children." There are reduced post-surgical costs hypnosis, some of the more recent research on hypnosis and related to less nausea and emesis as well as less analgesia brain physiology was provided. Brain imaging studies using required when hypnotherapy is used peri-operatively.., At either Positron Emission Tomography (pET) or Magnetic Liege, in a high quality prospective study, Faymonville Resonance Imaging (MRI) have shown where in the brain, demonstrated that patients who experienced hypnotherapy neuronal activity may be taking place during hypnotic states for surgery had significantly lower pain scores, required less or, alternatively, may be blocked or inactivated. Imaging opioids and experienced less postoperative nausea. 12 studies show that the brain is affected by hypnosis in the same There is a BBC documentary available on hypnosis and location in which the actual experience might take place. For surgery." A small clip of this documentary was used in the example, kinesthetic suggestion would take place in the area of presentation showing dental surgery taking place in Glasgow, the brain related to the same kinesthetic input. The actual Scotland. Dr. Mike Gow and Dr. Avid Faquir used the location may vary depending on the actual hypnotic technique of anesthetic glove to provide local anesthesia in a experience taking place. The importance of this work is patient undergoing oral surgery for a dental implant drilling twofold: I) Brain activity related to hypnotherapy is in quite a directly into the maxilla." For individuals who have never different location than where imagination takes place and so is seen hypnotherapy used in a clinical situation, this video clip something much more profound than simple imagination; 2) It had a profound influence. provides evidence of real changes in the brain related to Hypnotherapy has also shown its usefulness in treating h . 1-4 ypnosrs. burn patients. Arandomized control trial (the highest form of Four main areas of clinical hypnotherapy were covered evidence) compared hypnotherapy with other stress 8 Continues on page 9 ... HYPNOTHERAPY, Continues from page 8 ... decrease the amount of augmentation oflabour through the use reduction strategies as an adjunct to regular analgesia when of oxytocin (a hormone that is used to stimulate uterine changing bum dressings. Visual analogue scores for anxiety contractions). Of note: there is a reduction of C-section rates. and pain control were significantly improved using Hypnotherapy also improves post-pactum recovery including hypnotherapy." reductions in breast pain, nausea, headache and possibly Hypnotherapy interventions have been shown to reduces the incidence of post-pactum depression.f:" Of consistently decrease pain associated with a variety of chronic particular importance is that hypnosis may be instrumental in pain conditions such as cancer pain, chronic low back pain, halting pre-term labour. One small pilot study done in Halifax, fibromyalgia, temporomandibular pain and mixed chronic Nova Scotia, showed a 55 percent success rate in prolonging pain conditions. Studies have compared hypnotherapy with pregnancy." no treatment, medication or other non-hypnotic interventions Hypnotherapy can be useful throughout maternity care, not such as physical therapy and have found hypnotherapy to be just in labour and delivery. It is useful to help control back pain compIementary. 1617. and abdominal discomfort and can help with pre-labour Another recurrent pain condition is headache; studies anxiety. Especially useful, hypnotherapy can help control the investigating hypnotherapy are generally quite dated which nausea and vomiting of pregnancy. The severe form of this, makes them less useful. The criteria for headache diagnosis hyperemesis gravidarurn, often requires hospitalization for have become much more stringent and one type of headache fluid and electrolyte imbalances and may require many may respond quite differently to hypnotherapy than another medications to control. Hypnotherapy has shown some type of headache. The rigor of some of these older studies is encouraging results in this area but more rigorous studies are also inferior. There is one excellent study published in 1987 needed." involving children with classic juvenile migraine. Subjects Anxieties and phobias respond well to hypnotherapy. For were used as their own controls going through three phases of example, David Kraft presents quite a complete literature the study: placebo/propranolol/self-hypnosis. With self- review on the subject of hypnotherapy and agoraphobia and hypnosis the mean number of migraines per child dropped by social phobia." More contemporary studies in the area of 60 percent, and in general there was a reduction in the severity insomnia, generalized anxiety and obsessive compulsive of migraine headaches. IX disorders would be very useful. Small often-flawed studies The use of hypnotherapy in the condition of irritable bowel show a trend that hypnotherapy can be a useful adjunct to syndrome is perhaps one of the most studied uses of cognitive behavioural therapy, however we need randomized hypnotherapy. One review showed that there is a median control trials (RCTs) confirming this. response rate of 86 percent with a decrease in overall There have been RCTs investigating the use of symptoms of 50 percent. In addition there is an improvement hypnotherapy in depression. One recent meta-analysis (2009) in overall function. 19 The therapeutic gains obtained through combining these RCTs showed a significant positive effect. 2M hypnotherapy are generally well maintained as shown by a Because of the lack of high quality studies, the evidence study that followed patients for a year after treatment. 20 In fact, regarding the use of hypnotherapy in smoking cessation the group of patients who had received hypnotherapy seemed remains controversial. As suggested in our last article, to continue improvement over time post-intervention

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