Hypnosis for pain and anxiety management in cognitively impaired older adults undergoing scheduled lumbar punctures: a randomized controlled pilot study

Abstract

Background Core cerebrospinal fluid (CSF) amyloid and tau biomarker assessment has been recommended to refine the diagnostic accuracy of Alzheimer’s disease. Lumbar punctures (LP) are invasive procedures that might induce anxiety and pain. The use of non-pharmacological techniques must be considered to reduce the patient’s discomfort, in this setting. The objective of this study was to examine the efficacy of hypnosis on anxiety and pain associated with LP. Methods A monocentric interventional randomized-controlled pilot study is conducted in a university geriatric day hospital. Cognitively impaired patients aged over 70 were referred for scheduled LP for the diagnostic purpose (CSF biomarkers). The participants were randomly assigned either to a hypnosis intervention group or usual care. Pain and anxiety were both self-assessed by the patient and hetero-evaluated by the operator. Results We included 50 cognitively impaired elderly outpatients (women 54%, mean age 77.2 ± 5.0, mean Mini-Mental State Examination score 23.2 ± 3.5). Hypnosis was significantly associated with reduced self-assessed (p < 0.05) and hetero-assessed anxiety (p < 0.01). Hetero-evaluated pain was significantly lower in the hypnosis group (p < 0.05). The overall perception of hypnosis was safe, well-accepted, and feasible in all the participants of the intervention group with 68% perceiving the procedure as better or much better than expected. Conclusions This pilot study suggested that hypnosis was feasible and may be used to reduce the symptoms of discomfort due to invasive procedures in older cognitively impaired patients. Our results also confirmed the overall good acceptance of LP in this population, despite the usual negative perception. Trial registration ClinicalTrials.gov NCT04368572. Registered on April 30, 2020.

Pain Management in Cognitively Impaired Older Adults

“…In a small pilot study, [31] hypnosis was positively associated with quality of life in patients with dementia. Hypnosis lowered pain, measured by self-assessment and the operator's judgment, by changing the state of consciousness [32]. Hypnosis was also found to be an effective non-pharmacological pain treatment option for medical procedures (e,g., lumbar punctures) [32] and chronic pain management (e.g., osteoarthristis [33].…”

“…Hypnosis lowered pain, measured by self-assessment and the operator's judgment, by changing the state of consciousness [32]. Hypnosis was also found to be an effective non-pharmacological pain treatment option for medical procedures (e,g., lumbar punctures) [32] and chronic pain management (e.g., osteoarthristis [33]. Hypnosis has been found to have no noteworthy adverse effects, which is a significant advantage for patients who are susceptible to treatment-induced complications, like CIOA patients [32].…”

“…Hypnosis was also found to be an effective non-pharmacological pain treatment option for medical procedures (e,g., lumbar punctures) [32] and chronic pain management (e.g., osteoarthristis [33]. Hypnosis has been found to have no noteworthy adverse effects, which is a significant advantage for patients who are susceptible to treatment-induced complications, like CIOA patients [32]. The limitations of using hypnosis as a non-pharmacological pain treatment modality include the availability of hypnotherapists.…”